The association of hyperglycemia and diabetes mellitus and the risk of chemotherapy-induced neutropenia among cancer patients: A systematic review with meta-analysis

Aim—Conduct a systematic review with meta-analysis to determine the association between incident chemotherapy-induced neutropenia (CIN) and either diabetes mellitus (DM) or hyperglycemia in patients with cancer. Methods—Observational studies in cancer patients of any age receiving chemotherapy and having diabetes or hyperglycemia either during or before chemotherapy induction were included. Studies were retrieved by searching four databases (PubMed, EBSCO, ProQuest, and Cochrane) and cross-referencing. The metric for combining studies was the odds ratio (OR). Results were pooled using a random-effects model, while heterogeneity and inconsistency were assessed using the Q and I 2 statistic, respectively. Potential small-study effects were assessed using the funnel plot. Results—Ten studies met the criteria for inclusion. Overall, the odds of having CIN were 32% higher among cancer patients with either DM or hyperglycemia compared with those without DM or hyperglycemia (OR = 1.32, 95% CI, 1.06–1.64). Statistically significant heterogeneity and inconsistency were found (Q = 33.15, p \u3c 0.05, I 2 = 72.9%). Funnel plot asymmetry reflecting potential small-study effects was observed. Conclusions—Diabetes mellitus and hyperglycemia may be associated with an increased risk for CIN among cancer patients. However, additional well-designed studies are needed before any final and definitive recommendations can be made

Internationalisation of SMEs in least developed countries : a resource-based view

Small and Medium Enterprises (SMEs) have become an integral part of the economy of the modern nation-state and are responsible for job creation and innovation, as well as the growth and development of the wider country. The contributions made by SMEs increasingly impact upon national economies to such an extent that growth and prosperity in the SME sector is now thought to enable economies of Least Developed Countries (LDCs) to grow exponentially. The newly recognised importance of SMEs as a growth factor for LDC economies has moved the focus of researchers towards the impact of the internationalisation of these firms. Both the availability and the optimal utilisation of resources enabling SMEs to grow have subsequently been identified as crucial factors in both their growth and their internationalisation. There is still insufficient knowledge of the internationalisation of SMEs in the least Developed Countries (LDCs) and the existing body of research is thought inadequate to determining whether firm-specific resources can be used to explain whether an SME can be an exporter or non-exporter in such difficult environments. In response to this problematic, an evaluation of the internationalisation of SMEs would be of significant assistance to research into the economic impact that SMEs have on the least developed countries of Sub-Saharan LDCs. One of the factors that will influence the internationalisation of SMEs in LDCs is the availability of resources which has become one of the main focuses of this study. Studies in this area have identified knowledge-based and property-based resources as two categories of resources that determine internationalisation, leading this research towards an investigation of the impact of those two categories of resources on the ability to internationalise of SMEs operating in the least Developed Countries (LDCs). While a review of the research literature found a broad consensus for asserting a weak relationship between resources and innovation, the findings obtained from the data analysis conducted in this study establish a strong positive relationship between the resources of SMEs existing in Sub-Saharan LDCs and their exports. The majority of LDCs identified in this research project are located in the Sub-Saharan region of Africa, entailing that a significant proportion of this study is devoted to a critical evaluation of the impact of resources on the internationalisations of SMEs operating in Sub-Saharan LDCs. The overall aim of the research was therefore to investigate how the availability of resources impacts upon the process of internationalising the SMEs that operate in the Least Developed Countries (LDCs) of the Sub-Saharan region. The principal research objective can be outlined as follows: to analyse the relationship that a firm’s resources have with the level of internationalisation of SMEs in Sub-Saharan LDCs. Two further research questions have addressed the firm-specific resources which have a direct relationship with the internationalisation of SMEs in Sub-Saharan LDCs, and the type of innovation which is thought to have a mediating effect on the relationship between firm-specific resources and the internationalisation of SMEs in Sub-Saharan LDCs. In terms of methodology, this research places a conceptual focus on the Least Developed Countries of Benin, Guinea, Lesotho, Mali and Togo (LDCs), interrogating existing studies of these national economies in order to present a framework for analysis. Based upon the findings from data extracted from the 2016 World Bank Enterprises Survey for LDCs, the study findings establish that resources significantly influence the internationalisation of SMEs. Researchers gathered data from 713 SMEs operating in five LDC nations of Sub-Saharan African region which was analysed using SPSS software to verify the ten hypotheses developed here and so define the conceptual framework of the research. The research results were then generated by conducting Chi-Square and Logistic Regression analysis to compare the dependent, independent and control variables identified in the research. The series of hypotheses presented by this study were drawn from an analysis of their institutions tested through an application of the theory called the Resource-based View (RBV) The hypotheses developed here thus set out to support a conceptual framework best able to serve the findings of the research while working with a positivist research approach which uses quantitative data for explanatory aims. The hypotheses have taken human, financial and technological resources as their independent variables, considering while innovation as a a mediating factor responsible for the internationalisation of SMEs, while SME exports have been taken as the dependent variable for the hypotheses under interrogation. The testing of the ten hypotheses presented in the study found that human, financial and technological resources impact positively upon the likelihood that, as a firm, an SME will internationalise only where the availability of adequate financial resources has tended to have an impact on the innovation taking place in that SME. The research findings also reveal that there is a direct relation between the internationalisation of a SME and the element of innovation, whereas as a factor innovation only mediates the impact of financial resources in aiding in the internationalisation of SMEs. In addition, the study establishes that innovation has a significant positive impact on the exports of SMEs from Sub-Saharan LDCs. The study was hence able to conclude that innovation acts as a mediator for the resources necessary for SMEs operating in the Sub-Saharan LDCs to acquire export-oriented business. In doing so, the study highlights the essence and importance of these relationships and provides an enhanced understanding of the areas upon which SMEs should focus when growing their businesses

Preliminary findings of a study on the practice of self-medication of antibiotics among the practicing nurses of a tertiary care hospital

Objectives: Antibiotic resistance is indeed a global concern. It is of significant concern especially in the low-middle income countries because of the ease of accessibility, affordability, and absence of regulations pertaining to the dispensing of non-prescription antibiotics. This study aims to estimate the frequency and factors associated with the self-medication of antibiotics found among the practicing nurses.Methods: We conducted a descriptive cross-sectional study at a tertiary care hospital in Karachi, Pakistan from July 2016 to August 2016.Results: Of the 48 recruited nurses, 60.4% (29/48) were practicing self-medication of antibiotics. There were slightly more male nurses (17/29) than their female counterparts. The most frequently used antibiotic was Amoxicillin/Clavulanic acid, which was reported by 72.4% (21/29) of the nurses. The most prominent factor urging the nurses for practicing self-medication of antibiotics was their perceived knowledge of antibiotics, as was the case with 72.4% (21/29) of the nurses. Fever (79.3%) and sore throat (65.5%) were the two most frequent health problems that prompted the nurses to practice antibiotics self-medication. An earlier experience of the use of antibiotics was reported by 51.7% (15/29) of the nurses. Only 20.7% (6/29) of the nurses completed the entire antibiotic course. The adverse effects of antibiotics were encountered by 41.4% (12/29) of the nurses, which included diarrhoea, nausea, and vomiting.Conclusions: The self-medication of antibiotics is a frequent practice found among the practicing nurses in Karachi. It is a pressing concern and needs considerable attention from the healthcare authorities

Pancreatitis with use of new diabetic medications: a real-world data study using the post-marketing FDA adverse event reporting system (FAERS) database

Background: Pancreatitis is characterized by inflammation of the pancreas and significantly affects quality of life. Less than 5% of pancreatitis cases are drug-induced, but recent evidence suggests a substantial risk associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The aim of this study was to compare the risk of developing pancreatitis between those using GLP-1 RAs and those using sodium-glucose transport protein 2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors.Methods: This study was done using the FDA Adverse Event Reporting System (FAERS) database from 2019 to 2021. This database contains information from diverse submissions from healthcare providers, patients, and manufacturers. To ensure fairness and accuracy, the risk of pancreatitis associated with other hypoglycemic agents (SGLT2 inhibitors and DPP-4 inhibitors) was also investigated. Traditional and Bayesian statistical analysis methods were used to identify disproportionate statistics and included the reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayes geometric mean (EBGM), and information component (IC). A drug–adverse-event combination that met the criteria of all four indices was deemed a signal.Results: The analysis of 2,313 pancreatitis reports linked to hypoglycemic agents revealed a predominant association with GLP-1 RA (70.2%) compared to DPP-4 inhibitors (15%) and SGLT2 (14.7%). Most of these reports involved female patients (50.4%), and the highest incidence occurred in those over 50 years old (38.4%). Additionally, 17.7% of the reports were associated with serious events. The ROR was significant for the risk of pancreatitis when using DPP-4 (13.2, 95% confidence interval (CI) 11.84-14.70), while the ROR for GLP-1 was 9.65 (95% CI 9.17-10.16). The EBGM was highest with DPP-4 (12.25), followed by GLP-1 (8.64), while IC was highest with DPP-4 inhibitors (3.61). Liraglutide had the greatest association with pancreatitis among the GLP-1 RAs (ROR: 6.83, 95% CI 6.60-7.07).Conclusion: The findings show that pancreatitis has a strong link with DPP-4 inhibitors and GPL1 agonists, which pose a greater risk. Among the GLP-1 agonist medications, liraglutide has been found to have an association with pancreatitis

Melasma and Associated Factors in Arar City, Kingdom of Saudi Arabia (KSA)

Melasma is a common dermatological disorder characterized by irregular brownish patches with unclear etiology and a variety of factors may be associated with its occurrence. Melasma patients suffer significant emotional and psychological problems making assessment of their quality of life is increasingly necessary. Aim of the study: This study was conducted to identify the frequency and factors associated with occurrence of Melasma in in Arar, KSA and its effect on some determinant of quality of life in the affected patients. Subjects and methods: A population based cross sectional study was conducted from January 2016 to January 2017. It included 470 individuals attended five randomly selected primary healthcare centers in Arar city in the Northern Province of Kingdom of Saudi Arabia and were selected by systemic random sampling. Data were collected by means of personal interview with the sampled population using a predesigned questionnaire. Results: Findings revealed that18.7 % of the studied population suffered from Melasma. Age and positive family history were significantly associated with the development of Melasma among the studied patients while gender, skin color, sun exposure and cosmetic use had no significant effect. Most of the studied determinants of quality of life were not affected by suffering from Melasma while lack of self-confidence was significantly associated with the presence of Melasma. Conclusion: less than on fifth (18.7%) of the studied patients suffered from Melasma. Age and positive family history are the most common associations. Melasma had a significant impact on self-confidence of the affected patients.Keywords: Melasma, risk factor, quality of life

Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol

INTRODUCTION: The purpose of this pilot study is to assess the feasibility, acceptability, and safety of a new feeding protocol designed to enhance the delivery of enteral nutrition (EN). METHODS: In a prospective before and after study, we evaluated a new protocol compared to our standard feeding protocol. Innovative elements of the new protocol included setting daily volume based goals instead of hourly rate targets, initiating motility agents and protein supplements on Day 1, liberalizing the gastric residual volume threshold, and the option to use trophic feeds. Bedside nurses filled out questionnaires to assess the acceptability of the new approach and we assessed patients' nutritional and clinical outcomes. RESULTS: We enrolled 20 mechanically ventilated patients who stayed in the Intensive Care Unit for more than three days in the before group and 30 such patients in the after group. On a scale where 1 = totally unacceptable and 10 = totally acceptable, 30 nurses rated the new protocol as 7.1 (range 1 to 10) and no incidents compromising patient safety were observed. In the before group, on average, patients received 58.8% of their energy and 61.2% of their protein requirements by EN compared to 67.9% and 73.6% in the after group (P = 0.33 and 0.13). When the subgroup of patients prescribed to receive full volume feeds in the after group were evaluated (n = 18), they received 83.2% and 89.4% of their energy and protein requirements by EN respectively (P = 0.02 for energy and 0.002 for protein compared to the before group). The rates of vomiting, regurgitation, aspiration, and pneumonia were similar between the two groups. CONCLUSIONS: This new feeding protocol seems to be safe and acceptable to critical care nurses. The adoption of this protocol may be associated with enhanced delivery of EN but further trials are warranted to evaluate its effect on nutritional and clinical endpoints. TRIAL REGISTRATION: ClinicalTrials.gov NCT0110234

Transfer of a human gene variant associated with exceptional longevity improves cardiac function in obese type 2 diabetic mice through induction of the SDF-1/CXCR4 signalling pathway

Aims: Homozygosity for a four-missense single-nucleotide polymorphism haplotype of the human BPIFB4 gene is enriched in long-living individuals. Delivery of this longevity-associated variant (LAV) improved revascularisation and reduced endothelial dysfunction and atherosclerosis in mice through a mechanism involving the stromal cell-derived factor-1 (SDF-1). Here, we investigated if delivery of the LAV-BPIFB4 gene may attenuate the progression of diabetic cardiomyopathy. Methods and results: Compared with age-matched lean controls, diabetic db/db mice showed altered echocardiographic indices of diastolic and systolic function and histological evidence of microvascular rarefaction, lipid accumulation, and fibrosis in the myocardium. All these alterations, as well as endothelial dysfunction, were prevented by systemic LAV-BPIFB4 gene therapy using an adeno-associated viral vector serotype 9 (AAV9). In contrast, AAV9 wild-type-BPIFB4 exerted no benefit. Interestingly, LAV-BPIFB4-treated mice showed increased SDF-1 levels in peripheral blood and myocardium and up-regulation of the cardiac myosin heavy chain isoform alpha, a contractile protein that was reduced in diabetic hearts. SDF-1 up-regulation was instrumental to LAV-BPIFB4-induced benefit as both haemodynamic and structural improvements were inhibited by an orally active antagonist of the SDF-1 CXCR4 receptor. Conclusions: In mice with type-2 diabetes, LAV-BPIFB4 gene therapy promotes an advantageous remodelling of the heart, allowing it to better withstand diabetes-induced stress. These results support the viability of transferring healthy characteristics of longevity to attenuate diabetic cardiac disease

Overview of the Parents’ Knowledge, Attitude and Practice of Children Vaccinations: A Systematic Review

Background: It is the parents' responsibility to vaccinate their children. As a result, parents' attitudes, knowledge, and beliefs about vaccination are critical because they influence their activities toward timely and full immunization.  Objectives: This systematic review comprehensively investigated the recently published literature on parents’ knowledge regarding children’s vaccination.  Methods: PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar were systematically searched to include the relevant literature. Rayyan QRCI was used throughout this systematic approach. Results & interpretation: This review included twenty-four studies with a total of 13082 parents, and 70.9% were mothers. Knowledge level about children’s vaccination among parents was significantly related to their fathers' age, education level, women's employment status, and family type. Younger mothers were found to have a higher level of expertise. Good knowledge levels and positive attitudes towards the seasonal influenza vaccine were reported. Good knowledge with caution was reported among parents regarding COVID-19 vaccination. The knowledge about HPV infection and vaccination: All of them reported low vaccination rates and willingness to vaccinate their children. The findings of our study highlight the significance of parental understanding of vaccinations and immunization. Health officials should make additional efforts to promote the benefits of vaccination while emphasizing the risks of non- or late pediatric immunization

The Impact of Psychosocial Factors of Physical Health Outcomes: A Review of the Biopsychosocial Model in Family Medicine

Discontent with the biological model of illness—which is still the predominant healthcare model—led to the development of the biopsychosocial model, which was described in Engel's seminal Science paper forty years ago. It is the foundation of the International Classification of Functioning (WHO ICF) developed by the World Health Organization Clinical outcomes for functional disorders and chronic diseases treated in family medicine may be improved by the biopsychosocial approach. Since clinical performance metrics and standards are biomedically focused, family medicine doctors have no financial incentive to implement the biopsychosocial paradigm in their practices. Implementing the biopsychosocial approach in family medicine may be hampered by workload and incompetence