Effect of empagliflozin on liver function in type 2 diabetes: A systematic review and meta-analysis of randomized trials

Many reports are indicating the blood sugar-lowering potential of empagliflozin in type 2 diabetes mellitus and its anti-lipogenesis effects in the liver, as studied in mice models; while few clinical trials have evaluated its effect on liver fat content and liver function. This study aimed to evaluate the effect of empagliflozin on the treatment of non‐alcoholic fatty liver disease in type 2 diabetes mellitus patients. Scopus, Cochran Library, PubMed, and Web of Science databases were searched from 1990 to 2022 with reference checking and citation searching to identify additional studies. The inclusion criteria for studies included were the evaluation of patients with non‐alcoholic fatty liver disease and type 2 diabetes being treated with empagliflozin for 24 weeks. Our interest outcomes were Liver fat, Alanine transaminase (ALT), and Aspartate transaminase (AST). Data analysis random effect size model was used for pooling data to calculate mean differences in RevMan Version 5.3. I2 was used to evaluate heterogeneity. Three clinical trial studies were included with 2344 patients. In pooled ALT mean difference evaluation within 24 weeks of studies, there was a significant difference between subjects receiving empagliflozin versus controls (MD = -6.6 CI95% (-10.27 to -3.73; P = 0.06; I2 = 99%). In the case of AST (MD = -9.06 CI95% (-20.45 to 2.34; P = 0.12; I2 = 98%) and Liver fat (MD = -4.46 CI95% (-10.06 to 0.77; P = 0.09; I2 = 98%), there was not any significant difference between subjects receiving empagliflozin versus controls. While empagliflozin seems to be effective in lowering ALT levels; further studies are needed to confirm its efficacy in lowering liver fat

Sexual self-efficacy and its related factors among married women of reproductive age

Sexual self-efficacy (SSE) has also been cited as an important factor for healthy and satisfying sex. The purpose of this study was to determine SSE and its related factors among married women of reproductive age.The present study is a cross-sectional, descriptive-analytical study. The research samples were 588 married women of reproductive age. A cluster sampling method is used to select participants. Data collection instruments were the socio-demographic form and the Sexual Self-Efficacy Scale-Female Functioning (SSES-F). Data analysis, Friedman, Multiple LinearRegression was performed through SPSS software version 16. The highest and lowest score was related to body acceptance (77.78) and communication (69.66), respectively. The results showed that age (B= 0.471, P<0.001), marital satisfaction (B= 0.11.3, P<0.001), life satisfaction (B= 3.5, P<0.03) and the economic-social welfare satisfaction were related to SSE. We’ve found that Women with a higher Education, Employment, higher income, and Younger husbands had the highest SSE score.The components of age, marital satisfaction, life satisfaction, and economic status affect the SSE of married women of reproductive age. The results of this study can be useful in the design and implementation of sexual health promotion interventions. Keywords: Efficacy; sexual behavior; women

Investigation of the effect of watery and alcoholic extract of Calendula officinalis on the growth of fungal agents isolated from skin infections caused by burns

Discovering new antifungals, is essential to saving modern medicine. Therefore, this study aimed to determine the antifungal effects of extracts of Calendula officinalis on the growth of fungal agents isolated from skin infections caused by burns. In this experimental study, watery and alcoholic extracts of C. officinalis were prepared by the maceration method. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of extracts were evaluated against yeast isolates (Candida albicans, Candida tropicalis, Candida parapsilosis, Candida krusei, Candida glabrata, Trichosporon asahi, Rhodotorula mucilaginosa, and Rhodotorula dirnensis) and filamentous fungi (Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Rhizopus oryzae, Alternaria alternata, Fusarium oxysporum, and Cladosporium cladosporioides). All tested yeast isolates were resistant to the watery extract of C. officinalis, while all (except C. tropicalis) were sensitive to the alcoholic extract. Among filamentous fungi, only Aspergillus spp. were sensitive to the watery extract of C. officinalis. In this study, only A. alternata and C. cladosporioides were resistant to the alcoholic extract of C. officinalis. The results of this study showed that the alcoholic extract of C. officinalis can be a suitable alternative for antifungal drugs in the treatment of burn wound infections caused by fungal agents

El efecto de la educación en el cuidado paliativo por parejas en el manejo del dolor en pacientes con cáncer

The number of cancer patients is on the rise. Palliative care has an important role in improving the quality of life of these patients. Regarding the role of peers, this study aimed to evaluate the effect of peer care education by peers on pain management in cancer patients. In this clinical trial, 64 patients with cancer were selected as available, divided into control and intervention groups. The control group received usual educations and the intervention group received education package with pain management content by interested, educated and qualified peers in terms of education. The research instrument was pain management questionnaires that were filled before and 3 and 6 weeks after the intervention. Data were analyzed by SPSS software at the significant level of 0.05. The findings showed that the two groups were not significantly different in terms of age, sex, type of cancer, type of treatment, family history, occupation and education and were homogenous. The findings showed that pain management (from 11.78 to 22.59) was significantly different in the intervention group before and three and six weeks after the intervention (P <0.001). The effect of intervention of palliative care education by peers has increased the level of pain management among cancer patients. The findings of this study showed that palliative care education by peers affects the level of pain management in cancer patients. Getting help from interested and educated peers in pain management education for cancer patients is recommended.El número de pacientes con cáncer está en aumento. Los cuidados paliativos tienen un papel importante en la mejora de la calidad de vida de estos pacientes. Con respecto al papel de los pares, este estudio tuvo como objetivo evaluar el efecto de la educación de cuidado de pares por parte de los pares en el manejo del dolor en pacientes con cáncer. En este ensayo clínico, 64 pacientes con cáncer fueron seleccionados como disponibles, divididos en grupos de control e intervención. El grupo de control recibió educación habitual y el grupo de intervención recibió un paquete educativo con contenido de manejo del dolor por parte de pares interesados, educados y calificados en términos de educación. El instrumento de investigación consistió en cuestionarios de manejo del dolor que se completaron antes y 3 y 6 semanas después de la intervención. Los datos fueron analizados por el software SPSS en el nivel significativo de 0.05. Los resultados mostraron que los dos grupos no eran significativamente diferentes en términos de edad, sexo, tipo de cáncer, tipo de tratamiento, antecedentes familiares, ocupación y educación, y eran homogéneos. Los resultados mostraron que el manejo del dolor (de 11.78 a 22.59) fue significativamente diferente en el grupo de intervención antes y tres y seis semanas después de la intervención (P <0.001). El efecto de la intervención de educación en cuidados paliativos por parte de los compañeros ha aumentado el nivel de manejo del dolor entre los pacientes con cáncer. Los hallazgos de este estudio mostraron que la educación en cuidados paliativos por parte de los compañeros afecta el nivel de manejo del dolor en pacientes con cáncer. Se recomienda obtener ayuda de colegas interesados ​​y educados en educación sobre el manejo del dolor para pacientes con cáncer

The Effectiveness of the Anteroom (Vestibule) Area on Hospital Infection Control and Health Staff Safety: A Systematic Review

The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.publishedVersio

Serum tumour necrosis factor alpha in osteopenic and osteoporotic postmenopausal females: A cross-sectional study in Pakistan

Objective: To compare biochemical parameters serum tumour necrosis factor alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D in postmenopausal women.Methods: This cross-sectional study was carried out from June 2015 to July 2016 at Jinnah Medical and Dental College, Karachi, and comprised postmenopausal women. Bone mineral density done by dual energy X-ray absorptiometryscan categorised subjects by World Health Organisation classification into normal (T score \u3e -1) osteopenic (T score between -1 and -2.5) and osteoporotic (T score \u3c -2.5). Biochemical parameters like tumour necrosis alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D were measured by solid phase enzyme amplified sensitivity immunoassay method. SPSS 16 was used to analyse the data.Results: Of the 146 women, 34(23%) were normal, 93(67%) were osteopenic and 19(13%) were osteoporotic. There was significant difference in mean body mass index, serum tumour necrosis factor alpha and calcium in all the three groups (p\u3c0.01). Significant mean difference was observed in serum calcium levels between normal and osteopenic, and between normal and osteoporotic group (p\u3c0.05 each) without any significant mean difference between osteopenic and osteoporotic groups (p\u3e0.05). A significant difference was observed for mean tumour necrosis factor alpha values between normal and osteoporotic groups (p\u3c0.05). Tumour necrosis factor alpha showed negative correlation with bone mineral density in osteopenic and osteoporotic groups (p\u3e0.05).Conclusions: Increased bone turnover in postmenopausal osteopenic women can be predicted by increased serum cytokine

Influencing Factors on Patients’ Length of Stay in an Emergency Department of a Training Hospital

Background & Objectives: Patients’ length of stay in emergency departments is one of the key criterion which has been focused by hospital managers recently. This study aimed to assess the influencing factors on patients’ length of stay in an emergency department of a training hospital affiliated by Alborz Medical University of Medical Sciences. Methods: This was a descriptive-analytical study with a cross-sectional design in 2017. Study population consisted of all inpatients in a six month time period from the beginning of the study year. Through the use of Cochrane sample size calculation formula 555 numbers of samples were selected which their related data were obtained from the review of patients’ medical records. To test study hypotheses data were entered to a SPSS version 20 and analyzed through descriptive statistical analysis method, Pearson correlation test, t-test, and ANOVA. Results: Mean of patients’ length of stay was 11.31 hours. Evidence showed that this mean time was correlated with some of the factors including internal or external medical counseling, the necessity to have a medical laboratory test, a medical imaging test or the time interval between triage and the first physician’s visit. Conclusion: Modifying hospital processes and performance procedures in an emergency department with an aim to improve service quality and effective interactions among different hospital units can play a helpful role in solving existing problems. Key¬words: Length of Stay, Emergency Department, Training Hospital, Inpatients Citation: Bagheri Z, Rafiei S, Mohebbifar R. Influencing Factors on Patients’ Length of Stay in an Emergency Department of a Training Hospital. Journal of Health Based Research 2019; 4(4): 371-81. [In Persian

Study of Population Structure and Genetic Prediction of Buffalo from Different Provinces of Iran using Machine Learning Method

Considering breeding livestock programs to milk production and type traits based on existence two different ecotypes of Iranian’s buffalo, a study carried out to investigate the population structure of Iranian buffalo and validate its classification accuracy according to different ecotypes from Iran (Azerbaijan and North) using data SNP chip 90K by means Support vector Machine (SVM), Random Forest (RF) and Discriminant Analysis Principal Component (DAPC) methods. A total of 258 buffalo were sampled and genotyped. The results of admixture, multidimensional scaling (MDS), and DAPC showed a close relationship between the animals of different provinces. Two ecotypes indicated higher accuracy of 96% that the Area Under Curve (AUC) confirmed the obtained result of the SVM approach while the DAPC and RF approach demonstrated lower accuracy of 88% and 80 %, respectively. SVM method proved high accuracy compared with DAPC and RF methods and assigned animals to their herds with more accuracy. According to these results, buffaloes distributed in two different ecotypes are one breed, and therefore the same breeding program should be used in the future. The water buffalo ecotype of the northern provinces of Iran and Azerbaijan seem to belong to the same population

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions