Journal of Ideas in Health (JIDHealth)
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Hyperferritinemia: the link between COVID-19, inflammation, and patient comorbidities
Get PDFFerritin is a key molecule in iron metabolism, as it stores the iron in a non-toxic form for the cells. Serum ferritin is a parameter that reflects the iron content of the body. However, serum ferritin is also an acute-phase reactant protein, as increased levels of serum ferritin are reported in many diseases associated with inflammation. Hyperferritinemia was also reported in COVID-19 (the coronavirus disease 19) patients, where it is considered an independent prognostic factor for the patients, indicating increased severity of the disease, risk for complications, and death. Certain categories of patients (older, those with comorbidities) have an increased risk of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infectivity and developing more severe forms of COVID-19. Chronic/acute systemic inflammatory states often characterize such preexisting comorbidities. In the current paper, a new pathogenic link is proposed and analyzed: between preexisting hyperferritinemia in the context of patient comorbidities (metabolic, cardiovascular, kidney, inflammatory, autoimmune, cancer) and the risk of SARS-CoV-2 infectivity and of developing more severe forms of infection. Ferritin per se can be a causal agent in COVID-19, as it can generate and aggravate inflammation and contributes to the development of a severe cytokine storm. A severe, uncontrolled inflammatory state occurs, triggered by the high levels of serum ferritin, preexisting comorbidities, and SARS-CoV-2 infection, cause of lethality in many patients. The inflammatory stimuli can further aggravate the infection by activating ADAM-17 (disintegrin and metalloprotease 17), a key enzyme involved in ACE2 (angiotensin-converting enzyme 2) activation and viral infectivity. In this context, iron chelators and antioxidants could become potential lines of treatment in COVID-19
ACE2 enzymatic role in the SARS-CoV-2 activation: a perspective through the evolutionary promiscuity and substrate diversity of enzymes
Get PDFThe SARS-CoV-2 is an RNA B type β-coronavirus that distinguishes itself from previous coronaviruses by its high infectivity and mortality rates. The mechanism of viral entry into the host cell via ACE2 is currently under research. Several proteases have been nominated to activate the virus but identifying the exact enzyme/enzymes is missing. Moreover, recent work suggests that TMPRSS2 cannot be the enzyme to cleave the SARS-CoV-2 spike or that multiple proteases contribute to SARS-CoV-2 activation. The multitude of proteases that have been nominated to activate the virus suggests that the consensual identification of the precise, key enzyme is still missing. In this context, we synthesize the current controversies regarding the putative enzymes involved in SARS-CoV-2 infectivity and analyze whether ACE2 could have unexpected enzymatic roles in this process, besides its acknowledged receptor role. We hypothesize that ACE2 plays an enzymatic role as well in SARS-CoV-2 activation. Understanding the exact roles of ACE2 in COVID-19 is capital for the future design of specific, efficient therapies and deserves dedicated research. Our conviction is therefore not "if", “but” "when" will the researchers start to wonder about what is hidden behind the apparent only role of ACE2 as a receptor for SARS-CoV-2
Computed tomography assessment of the ethmoid roof based on Keros classification in Iraqi patients undergoing functional endoscopic sinus surgery
Get PDFBackground: Among the most popular methods employed to classify the depth of the olfactory fossa is Keros classification. This study aims to assess Keros classification of the ethmoid roof, any possible association between Keros types and gender, and the incidence of asymmetry between right and left sides among Iraqi patients.
Methods: A retrospective cross-sectional study was conducted at Al-Shaheed Gazi Al-Hariri Teaching Hospital, Medical City, Baghdad, Iraq. The archived reports and the CT scans images (nose and paranasal sinuses) of 126 patients who have undergone functional endoscopic sinus surgery between January 2019 and January 2020 were reviewed. Univariate and bivariate statistical analysis was performed using SPSS version 24. The statistically significant was considered at less than 0.05.
Results: More than half of patients were females (54.0%) with a mean age of 31.52 ± 11.38 (SD) years (range: 10-57 years). Among the total patients, the mean depth of olfactory fossa (OF) was 3.58 ± 0.02 mm. Results showed that Keros type I was the most common type (71.0%), followed by type II (27.4%) and type III (1.6%) respectively. The difference in the olfactory fossa depth between the right and left sides was ≥ 1 mm in 16 (12.7%) patients and < 1 mm in 110 (87.3%) patients. Moreover, there was no significant relation between symmetry/asymmetry and gender ( p-value > 0.05).
Conclusion: Keros type I was the most common type, which carries the lowest risk of inadvertent intracranial injury during endoscopic sinus surgery; besides the relatively low percentage of asymmetry in the depth of the two olfactory fossae among patients, surgeons should always be cautious during surgery to avoid iatrogenic injury concerning the thin lateral lamella of the cribriform plate
Gender differences in the domains of job satisfaction: a questionnaire survey among doctors
Get PDFBackground: The impact of gender differences in the labor market cannot be neglected when studying job satisfaction among doctors. This study aimed to assess the gender differences in a ten-items Warr–Cook–Wall (WCW) job satisfaction scale among Iraqi medical doctors.
Methods: A cross-sectional study was conducted between January and June 2014 in Iraq. The multistage sampling technique was recruited to collect the data from 20 health institutions. A total of 576 doctors returned the self-administered questionnaire (response rate= 87.3%). Student t-test and the Pearson correlation tests were used to analyzing the data.
Results: Female doctors rated the overall job satisfaction index significantly higher than their peer male colleagues (P <0.001). Findings of student t-test showed a significant gender difference; women doctors appeared more satisfied than men in the freedom to choose the method of working, satisfied with their colleagues and fellow workers, amount of responsibility given to them, income, opportunity to use their abilities, hours of work and the amount of variety in the job. In contrast, the Pearson correlation coefficient results indicated a high satisfaction among male doctors than females in terms of recognition for good work (P =0.02) and the physical working condition (P =0.04), respectively.
Conclusion: Analysis of data based on indices rather than the only overall job satisfaction appeared as an efficient method to understand gender differences. The possibility of increasing the representation of women in recognition and awards may raise the level of job satisfaction
Non-invasive thrombectomy: magnetized antibodies in reperfusion of thromboses
Get PDFBackground: Five multi-center randomized controlled trials have shown superior outcomes for mechanical thrombectomy to standard intravenous thrombolysis for acute anterior ischaemic stroke. This idea-paper aims to provoke multi-disciplinary expertise to develop a less invasive and more rapid thrombectomy technology. The hypothesis is that by adapting existing technology to magnetize in vivo blood clots, we should be able to dislodge clots from major vessels magnetically and achieve minimally invasive reperfusion.
Methods: First, magnetized antibodies against specific epitopes in blood clots must be developed (such as the previously used Fibrin Beta-chain specific antibody, 59D8) and an external portable magnetic device with superlens magnetic-field focusing would be used to dislodge and guide the clot proximally to establish reperfusion; subsequently, the clot will be removed. A distal magnet, statically held at the original location of the dislodged clot, would prevent microemboli from occluding distal vessels during dislodgement and removal of the clot.
Conclusion: Developing specific antibodies against in vivo blood clots (immunology) with attached superparamagnetic nanoparticles (nanoscience) and an external portable magnetic device with a focused magnetic flux (applied medical physics) will significantly improve time to revascularization in acute ischaemic stroke, minimize risks of intervention, and thus improve outcomes further
The prevalence and risk of missing outcome data in prenatal vitamin D supplemented gestational diabetes mellitus patients: a systematic review and meta-analysis protocol
Get PDFBackground: Missing outcome data in clinical trials are important determinants of internal validity; however, its burden and risk in gestational diabetes mellitus (GDM) mothers supplemented with vitamin D remain poorly studied. Therefore, a systematic review and meta-analysis protocol is proposed here to study it.
Methods: The English language publications, irrespective of its publication date, will be searched in electronic databases for randomized controlled trials studying the above outcome. The eligible trials will undergo the risk of bias assessment by the Cochrane tool. Data on its trial design, population characteristics, interventions compared, and the outcome will be abstracted. The prevalence and incidence (in risk ratio) of missing outcome data will be estimated meta-analytically. The statistical heterogeneity assessment will include the use of Chi2 and I2 statistics. For the explanation of any substantial heterogeneity, a meta-regression analysis will ensue. The statistical significance will be determined at P <0.05 and 95% CI. All analyses will be done in Stata statistical software. If the quantitative analysis is not possible, narrative reporting will happen.
Results: The reporting of the review will follow the PRISMA guideline. Statistically significant pairwise meta-analysis finding\u27s grading will occur by the GRADE approach.
Conclusion: The proposed review will estimate the prevalence of missing outcome data in vitamin D supplemented GDM mothers in clinical trials and compare its risk with the placebo recipients.
PROSPERO registration ID: CRD42020180634
References
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Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42: S165–72. Available from: http://care.diabetesjournals.org/lookup/doi/10.2337/dc19-S014
Saha S. Compliance and barriers to self-monitoring of blood glucose in patients with gestational diabetes mellitus: A systematic review. Int J Health Sci (Qassim).2019;13:44–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31123440
Akbari M, Mosazadeh M, Lankarani K, Tabrizi R, Samimi M, Karamali M, et al. The effects of vitamin d supplementation on glucose metabolism and lipid profiles in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res.Germany; 2017;49:647–53. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-115225
Saha S, Saha S. A comparison of the risk of cesarean section in gestational diabetes mellitus patients supplemented antenatally with vitamin D containing supplements versus placebo: A systematic review and meta-analysis of double-blinded randomized controlled trials. J Turkish-German Gynecol Assoc. 2020; 21:201–12. https://dx.doi.org/10.4274%2Fjtgga.galenos.2020.2019.0164
Saha SS, Saha SS. The risk of morbidities in newborns of antenatal vitamin D supplemented gestational diabetes mellitus patients. Int J Health Sci (Qassim). Qassim University; 2020; 14:3–17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475207/
Saha S, Saha S. A Comparison of the Changes in Gestational Weight, Body Mass Index, and Serum Vitamin D Level in Gestational Diabetes Mellitus Patients Complemented with Vitamin D in Contrast to Those Who Did Not Receive the Supplement: A Protocol for Systematic Review a. Int J Diabetes Metab. S. Karger AG; 2019; 25:74–9. https://doi.org/10.1159/000505269
Mavridis D, White IR. Dealing with missing outcome data in meta‐ Res Synth Methods.2020;11:2–13. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jrsm.1349
Higgins JPT GS (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Cochrane Collab. 2011 [cited 2020 Aug 27]. Available from: https://training.cochrane.org/handbook/archive/v5.1/
Asemi Z, Hashemi T, Karamali M, Samimi M, Esmaillzadeh A. Effects of vitamin D supplementation on glucose metabolism, lipid concentrations, inflammation, and oxidative stress in gestational diabetes: a double-blind, randomized controlled clinical trial. Am J Clin Nutr.2013;98:1425–32. https://doi.org/10.3945/ajcn.113.072785
Asemi Z, Karamali M, Esmaillzadeh A. Effects of calcium–vitamin D co-supplementation on glycaemic control, inflammation and oxidative stress in gestational diabetes: a randomised placebo-controlled trial. Diabetologia .2014;57:1798–806. https://doi.org/10.1007/s00125-014-3293-x
Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Washington (DC): National Academies Press (US); 2011. Available from: https://books.google.co.in/books?id=VF2aRQJ6IZ4C
Gossman W, Chauhan K, Huecker MR. Vitamin D. StatPearls. 2019. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28722941
Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull. 2018; 126:57–77. https://doi.org/10.1093/bmb/ldy010
Knabl J, Vattai A, Ye Y, Jueckstock J, Hutter S, Kainer F, et al. Role of Placental VDR Expression and Function in Common Late Pregnancy Disorders. I Int J Mol Sci. 2017;18(11):2340. https://doi.org/10.3390/ijms18112340
Yazdchi R, Gargari BP, Asghari-Jafarabadi M, Sahhaf F. Effects of vitamin D supplementation on metabolic indices and hs-CRP levels in gestational diabetes mellitus patients: a randomized, double-blinded, placebo-controlled clinical trial. Nutr Res Pract. 2016; 10:328. Available from: http://synapse.koreamed.org/DOIx.php?id=10.4162/nrp.2016.10.3.328
Jamilian M, Samimi M, Ebrahimi FA, Hashemi T, Taghizadeh M, Razavi M, et al. The effects of vitamin D and omega-3 fatty acid co-supplementation on glycemic control and lipid concentrations in patients with gestational diabetes. J Clin Lipidol. 2017; 11:459–68. https://doi.org/10.1016/j.jacl.2017.01.011
Li Q, Xing B. Vitamin D3-Supplemented Yogurt Drink Improves Insulin Resistance and Lipid Profiles in Women with Gestational Diabetes Mellitus: A Randomized Double Blinded Clinical Trial. Ann Nutr Metab. 2016; 68:285–90. https://doi.org/10.1159/000447433
Karamali M, Bahramimoghadam S, Sharifzadeh F, Asemi Z. Magnesium–zinc–calcium–vitamin D co-supplementation improves glycemic control and markers of cardiometabolic risk in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Appl Physiol Nutr Metab. 2018; 43:565–70. Available from: http://www.nrcresearchpress.com/doi/10.1139/apnm-2017-0521
Hosseinzadeh-Shamsi-Anar M, Mozaffari-Khosravi H, Salami M-A, Hadinedoushan H, Mozayan MR. The efficacy and safety of a high dose of vitamin d in mothers with gestational diabetes mellitus: a randomized controlled clinical trial. Iran J Med Sci. 2012; 37:159–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23115447
Saha S. Impact of missingness on clinical trials on the effectiveness of antenatal vitamin D supplementation in gestational diabetes mellitus patients. J Ideas Heal. 2020; 3:138–9. https://doi.org/10.47108/jidhealth.Vol3.Iss1.47
Saha S, Saha S. The variation in participant attrition between prenatal vitamin D supplemented and not supplemented gestational diabetes mellitus patients: a systematic review and meta-analysis of randomized controlled trials. PROSPERO. 2020. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180634
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Gender differences in the factors influencing the choice of future career among the final stage Turkish medical students
Get PDFBackground: Turkey has a marked increase in the proportion of female medical students and graduates doctors compared to males. However, females are still underrepresented in some disciplines and grouped in other branches of medicine. It is essential to regularly assess the medical students\u27 trends toward the specialty and avoid the shortage and maldistribution in some critical specialties. This study aims to investigate the gender differences in Turkish medical students’ specialty preferences and influencing factors.
Methods: A descriptive cross-sectional study carried out among final year students at the Bezmialem Vakif University (BVU), Faculty of Medicine in Istanbul, Turkey. Data collected from March to April 2018 using a pre-tested self-administered questionnaire included socio-demographic characteristics of the population, first choices for specialization, and the factors influencing those choices. An independent sample t-test performed to test the gender differences in different influencing factors. Data were analyzed using SPSS version 16.
Results: A total of seventy (70) students (response rate of 69.5 %) included in the data analysis. The mean age of total respondents was 24.9 ± 0.96 (ranged 23-27), and the male to female ratio of students was approximately 1:1.4. Out of nineteen (19) factors, statistically significant gender differences noted in the mean scores of six factors. Male students were more influenced by family expectations (2.76 ± 0.87, p=0.008), geographical consideration (2.97 ± 0.91, p=0.053), and high income expectations (2.90 ± 0.90, p=0.024) compared to female students. However, female students were more influenced by personal interests (3.61 ± 0.49, p=0.041), personality characteristics (3.59 ± 0.55, p=0.010) and malpractice (2.73 ± 1.03, p=0.015) compared to male students.
Conclusion: There is a significant difference between the sexes in terms of priorities; family, income, and geographical distribution significantly impacted on men, while women were more concerned with lifestyle, well-being and avoiding responsibility
The psychological impact of COVID-19 and the subsequent social isolation on the general population of Karnataka, India
Get PDFBackground: The COVID-19 pandemic has various unfavorable effects on individuals and the community. This study aims to assess the psychological impact of the COVID-19 epidemic and the subsequent social isolation on the general population of Karnataka, India.
Methods: A web-based cross-sectional survey was conducted in Karnataka from 8 to 14 April 2020 using the snowball technique. The psychological impact was assessed with the help of the nine-item Patient Health Questionnaire-9 (PHQ-9) and seven-item General Anxiety Disorder-7 (GAD-7) questionnaires. IBM SPSS Statistics Subscription version 16.0 was recruited to analyze the data. Descriptive (Mean + Standard Deviation) and bivariate (Pearson chi-square and ANOVA tests) analysis used to present data with the significance level set at less than 0.05.
Results: This study included 1537 participants from 26 cities in Karnataka. About two-thirds of the respondents were undergraduate students (951, 61.9%), females (768, 50.0%), and 40.1% stayed about 15-20 days in social isolation. The prevalence of depression was 47.0%, and anxiety was 41.5%, respectively, among the surveyed sample. After the analysis, the age group 21-30 year old (P < 0.001), females P < 0.001), urban residents (P = 0.021), and the students (P p < 0.001) were significant for depression. However, only the age group 31-40 years was found to be more susceptible to anxiety.
Conclusion: As important as addressing the psychological effects, knowing people at risk of developing mental illnesses will contribute effectively to providing appropriate psychological rehabilitation programs at the right time.
References
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Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. https://doi.org/10.3390/ijerph17051729.
World Health Organization, WHO Director-General\u27s opening remarks at the media briefing on COVID-19 - 11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [Accessed on 13 April 2020]
Coronavirus in India: Latest Map and Case Count. Available from: https://www.covid19india.org/ [Accessed 13 April 2020].
Arakal RA. First COVID-19 case in Karnataka: Techie who returned to Bengaluru from US tests positive, (9 March2020). Available from: https://indianexpress.com/article/cities/bangalore/coronavirus-karnataka-first-case-covid-19-bengaluru-6307223/ [Accessed on 13 April 2020]
India Today on 24 March 2020. Modi announces lockdown Updates: No panic buying please. Stay indoors, tweets PM. Available from: https://www.indiatoday.in/india/story/pm-modi-address-the-nation-at-8-pm-today-speech-covid-19-coronavirus-live-updates-1659215-2020-03-24 [Accessed on 13 April 2020]
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Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr. 2020; 51:102083. https://doi.org/10.1016/j.ajp.2020.102083.
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Ali Jadoo SA. COVID -19 pandemic is a worldwide typical Biopsychosocial crisis. Journal of Ideas in Health2020;3(2):152-4. https://doi.org/10.47108/jidhealth.Vol3.Iss2.58
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A juxtaposition of safety outcomes between various doses of sodium-glucose co-transporter inhibitors, in insulin-treated type-1 diabetes mellitus patients: a protocol for systematic review and meta-analysis of randomized controlled trials
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Background: Several clinical trials have tested the safety profile of sodium-glucose co-transport inhibitors’ (SGLTis) in adult type 1 diabetes mellitus (T1DM) patients. However, no systematic review has yet compared its variation between large and low dose SGLTis. Henceforth, a review protocol is proposed here to review it.
Methods: Different electronic databases will be searched for randomized-controlled trials (published in the English language) studying the above objective, irrespective of their publication date. After selecting the eligible trials, their data on the study design, population characteristics, compared interventions, and outcomes of interest will be extracted. Then, utilizing the Cochrane tool, each trial\u27s risk of selection bias, detection bias, performance bias, attrition bias, reporting bias, and other bias will be judged. Next, depending on clinical heterogeneity among the trials, a random-effect or fixed-effect model meta-analysis will be used to compare the respective outcomes. Via the Chi2 and I2 statistics, the statistical inconsistency among the trials will be estimated. When this is substantial, subgroup analysis will follow. Publication bias will be evaluated by funnel plots and Egger’s test. A sensitivity analysis will be done to check different assumptions. If a quantitative juxtaposition is not possible, a narrative reporting will ensue.
Conclusion: The proposed study will perform a dose-wise juxtaposition of the safety profile of SGLTis in insulin-treated T1DM patients.
Registration: Prospective Register of Systematic Reviews (PROSPERO) (Registration no. CRD42019146578)
 
COVID -19 pandemic is a worldwide typical biopsychosocial crisis
Get PDFSince December 2019, the world has been stunned by the speed of the spread of the COVID-19. All the possibilities were likely, except that people would hide in their homes for fear of contracting the disease, as it was very unlikely. The lockdown was imposed severely, and people panicked, and their interest has limited to providing food and caring for health and family. The effect of isolation and the prevention of social interaction was apparent in the individuals\u27 psychological behavior. Unfortunately, the incidence of depression, anxiety, and domestic violence increased, which negatively impact family stability in the short and medium-term. The pathological, psychological, and social impact of COVID-19 imposes a framework for dealing with the pandemic based on the biopsychosocial model