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Exploring the social and emotional impact of COVID-19 on older residents of the Greater Klang Valley, Malaysia: a qualitative study
No full textBackground: The Coronavirus Disease 2019 (COVID-19) pandemic and associated public health measures significantly disrupted the lives of older adults. Few studies have captured the firsthand experiences of this population during such unprecedented times, emphasizing the need for qualitative insights into their lived realities. This study aimed to explore the social and emotional impact of the COVID-19 pandemic on older adults, focusing on personal experience, coping mechanisms, and adaptive responses to changes.Methods: A qualitative research design was employed, utilizing snowball sampling to recruit participants aged 60 years and above. Semi-structured interviews were conducted to collect in-depth narratives about participants' experiences post-pandemic, between May 2023- March 2024. Data were analysed using thematic analysis to identify recurring patterns and meaningful themes.Results: A total of 19 participants (aged 60-81 years, 10 women) were interviewed. Four themes emerged from the study: 1) emotional and psychological symptoms linked to infection control; 2) feeling of loss from restrictions; 3) coping strategies in adversity; 4) information and communication. Participants relied on their resilience and life experiences to navigate fear and uncertainty during the pandemic.Conclusion: The identified themes reflect a collective experience of fear, loss, adaptation and resilience. Support systems and adaptability demonstrated by individuals underscored the capacity to cope with and overcome adversity. A good social security system post-retirement is hard to achieve in low and middle income countries. Future research should utilize fundings to focus on providing targeted support to older adults and other LMICs to develop mitigation strategies to prevent negative psychological, physical and financial effects in major disasters.</p
Impact of community-based participatory research on capacity building: findings from a household and ambient air project
No full textCommunity-Based Participatory Research (CBPR) is increasingly recognised as a promising approach in health research for fostering participation and improving longterm outcomes. However, limited evidence exists on how specific CBPR processes contribute to sustainable impacts. This study employed a multi-method qualitative design to explore how CBPR processes influenced community capacity building (CCB) in addressing household and ambient air pollution (HAAP) in a rural community in Malawi. Guided by Wallerstein et al.’s CBPR model and Israel et al.’s CBPR principles, we gathered community members at baseline, intervention, and endline through Photovoice, talking circles, focus group discussions, and transect walks.Data were analysed using Braun and Clarke’s thematic approach, with outcomes mapped against Liberato et al.’s nine CCB domains. Enhanced CCB was observed across all domains, particularly in communication, leadership, and participatory decision-making. Key CBPR activities, such as intervention ranking and train-thetrainer models, fostered shared ownership, local leadership, and sustained community engagement. These processes reinforced the community’s commitment to action and positioned them as co-leaders in developing culturally relevant and sustainable HAAP interventions.This study contributes conceptual and methodological insights by integrating CBPR model with a practical framework for evaluating CCB as both a process and outcome. It underscores the value of embedding community perspectives in intervention design, not only to address energy and health challenges but to support long-term sustainability. Meaningful community engagement is critical to ensuring that interventions are not only accepted but owned and maintained by communities, to drive more equitable and sustainable health outcomes.</p
Impact of digital health interventions on patient satisfaction in outpatient gastrointestinal endoscopy: a systematic review
No full textObjectives: The integration of digital health technologies in gastrointestinal (GI) endoscopy presents opportunities to enhance patient experience, an important dimension of care quality. This systematic review aims to evaluate the impact of digital health interventions on patient satisfaction and experience in outpatient endoscopy settings.Design: A systematic review and narrative synthesis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the Grading of Recommendations Assessment, Development and Evaluation approach.Data sources: PubMed/Medline, EMBASE, PsycInfo, and Cochrane databases were searched through 9 March 2023.Eligibility criteria: Studies were eligible if they involved adult patients (≥18 years) undergoing outpatient colonoscopy or gastroscopy and in English. Interventions included any form of educational digital health technology aimed at enhancing healthcare delivery. Telehealth studies were not included.Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias, using the Mixed Methods Appraisal Tool. A mixed-method approach was employed for the narrative synthesis, focusing on the primary outcome of patient experience and satisfaction.Results: Nine studies met the inclusion criteria, all assessing patient satisfaction rather than experience. Five studies reported improved satisfaction associated with digital interventions, three showed no significant change, and one lacked statistical analysis. Interventions ranged from smartphone applications to online educational resources, and satisfaction measurement tools varied significantly. Overall, the evidence was characterised by heterogeneity and very low methodological quality.Conclusion: Digital health interventions may have a positive impact on patient satisfaction in GI endoscopy, although evidence quality is very low and outcome measurement is inconsistent. Future research should focus on standardising measures of patient experience and satisfaction, ensuring robust study designs to inform the integration of digital health tools into endoscopy practice.Prospero registration number: CRD42023428609.</p
Gene–environment interaction affects risk of atopic eczema: population and in vitro studies
No full textBackground: Multiple environmental and genetic factors play a role in the pathogenesis of atopic eczema (AE). We aimed to investigate gene-environment interactions (G × E) to improve understanding of the pathophysiology.Methods: We analysed data from 16 European studies to test for interaction between the 24 most significant AE-associated loci identified from genome-wide association studies and 18 early-life environmental factors. We tested for replication using a further 10 studies and in vitro modeling to independently assess findings.Results: The discovery analysis (including 25,339 individuals) showed suggestive evidence for interaction (p IL7R) was nominally significant (ORinteraction = 0.91 [0.83-0.99] p = 0.025), with a risk effect of the T allele observed only in those not exposed to dogs. A similar interaction with rs10214237 was observed for siblings in the discovery analysis (ORinteraction = 0.84 [0.75-0.94] p = 0.003), but replication analysis was under-powered (ORinteraction = 1.09 [0.82-1.46]). rs10214237 homozygous risk genotype is associated with lower IL-7R expression in human keratinocytes, and dog exposure modelled in vitro showed a differential response according to rs10214237 genotype.Conclusion: Interaction analysis and functional assessment provide preliminary evidence that early-life dog exposure may modify the genetic effect of rs10214237 on AE via IL7R, supporting observational epidemiology showing a protective effect for dog ownership. The lack of evidence for other G × E studied here implies only weak effects are likely to occur.</p
Different types of oesophageal reconstructions in the contemporary era: a systematic review and network meta-analysis
No full textIntroduction: Oesophageal reconstruction is a complex operation that continues to present a surgical challenge associated with significant morbidity and its associated sequelae. The conventional gastric conduit remains the gold standard reconstructive technique when available. Alternative conduits for oesophageal replacement become necessary when the stomach is unavailable with common options for conduit creation being the jejunum and the colon. The aim of this systematic review and network meta-analysis was to interrogate outcomes in oesophageal reconstruction with gastric pull-up, colonic interposition and jejunal flap.Methods: A systematic review of three electronic databases (PubMed, EMBASE and SCOPUS) was undertaken. An NMA as per the PRISMA-NMA guidelines. Statistical analysis was carried out using R and Shiny.Results: In a total of 19 studies, 3927 patients were included; 79.5% (3123/3927) of patients underwent gastric pull-up; 13.5% (531/3927) of patients underwent colonic interposition; 7% (273/3927) of patients underwent jejunal flap as their reconstructive method. At NMA, there was no significant difference in anastomotic leak rates, mortality rates, stricture formation, necrosis and length of stay between the three reconstructive techniques. Trend results showed jejunal flap performed better than colonic interposition in length of stay and mortality rates.Conclusion: At present, the gastric conduit is the conventional and first choice for oesophageal reconstruction ab initio after oesophagostomy. Colonic interposition and jejunal free flap represent viable options and are associated with non-inferior short-term surgical outcomes when gastric pull-up is not available or feasible.</p
The prognostic implications of comorbidities in septic arthritis
No full textSeptic arthritis (SA) is an orthopedic emergency characterized by joint inflammation secondary to infectious etiologies, most commonly Staphylococcus aureus. The prompt recognition of SA is crucial due to its significant morbidity and mortality. Fever, along with a swollen, painful joint and limited range of motion, are typical manifestations; however, presentations can vary. The incidence of SA in adult populations is rising, accompanied by unfavorable mortality rates. This trend is further exacerbated by comorbid conditions that substantially influence outcomes. Among the literature, diabetes mellitus (DM), rheumatoid arthritis (RA), and chronic kidney disease (CKD) have emerged as key prognostic factors in SA. DM exacerbates the severity of SA through impairment of polymorphonuclear function, ultimately leading to increased susceptibility to infection and a higher risk of acquiring infection from atypical pathogens. CKD causes uremia-induced immune dysfunction leading to an immunocompromised state as well as repeated vascular access increasing infection susceptibility, leading to increased mortality. Patients with RA harbor an elevated risk of SA, attributed to immune dysregulation, immunosuppressive therapy, and diagnostic challenges. Additionally, these comorbidities can complicate the surgical management of SA and increase the likelihood of treatment failure. Therefore, given the rising burden of comorbid conditions worldwide and their impact on SA prognosis, healthcare professionals should remain vigilant when managing these factors. A holistic, multidisciplinary approach to management is vital to ensure that SA patients with these certain comorbid conditions experience fewer complications and improved survival. This mini-review aims to highlight the key comorbid conditions that impact the prognosis of SA patients.</p
The effect of sarcopenia on postoperative complications in autologous breast reconstruction – a systematic review and meta-analysis
No full textPurpose: Sarcopenia refers to a loss of muscle mass combined with an associated loss of muscle function and has been demonstrated to predict post operative complications across a range of surgical procedures. The effect of sarcopenia on patient outcomes following autologous breast reconstruction (ABR) remains unknown. This systematic review and meta-analysis aims to assess the impact of sarcopenia on complications following ABR.Methods: A systematic review of electronic databases was performed in conjunction with PRISMA guidelines. Studies reporting on postoperative complications in sarcopenic versus non-sarcopenic patients undergoing autologous breast reconstruction were included. Sarcopenia was identified in all included studies by objectively measuring psoas muscle index (PMI) or skeletal muscle index (SMI) on computed tomography (CT) scan.Results: Six studies were included in this meta-analysis, which reported outcomes of 1315 patients undergoing ABR following mastectomy (407:908, Sarcopenic: Non-Sarcopenic). Sarcopenic patients had an increased risk of haematoma formation (OR= 1.84, 95% CI=1.06-3.18, p=0.03), but this was not associated with an increased risk of return to theatre due to haematoma (OR=1.11, 95% CI=0.36-3.38, p=0.86). There was no significant difference in risk of total flap loss, recipient site infection, recipient site seroma formation, donor site complications, risk of re-operation or wound dehiscence between sarcopenic and non-sarcopenic patients following ABR.Conclusion: This study reports a higher haematoma risk in sarcopenic patients undergoing autologous breast reconstruction. Prospective studies reporting on BMI, PMI/SMI, radiographic muscle attenuation, and patient-reported return to function are required to comprehensively evaluate the potential impact of sarcopenia on post-mastectomy autologous breast reconstruction.</p
Pharmaceutical contamination, water quality assessment and ecotoxicological evaluation of the surface waters of the Sangão River, Santa Catarina, Brazil
No full textThe waters of the carboniferous basin located in the South of the Brazilian State of Santa Catarina, which are comprised of the hydrographic basins of the Urussanga, Tubarão and Araranguá Rivers (HBA), are an important hydrological resource. Due to the importance of the Sangão River, we evaluated the quality of its surface waters through detection of pharmaceutical contaminants and evaluation of physicochemical parameters. Six contaminants were detected in analyzed samples, including caffeine in all samples. Notable parameters included pH (observed range between 3-7.5), dissolved oxygen (1.08-9.52 mg mL-1), total iron (2.05-56.7 mg L-1), conductivity (2.10-1755 µS cm-1), biochemical oxygen demand (2.5-7.5 mg mL-1), phosphorus (0.02-0.29 mg L-1) and thermotolerant coliforms (values > 9.4 × 103 colony-forming unit (CFU) per 100 mL). We determined the water quality index (WQI) of the samples and performed an acute ecotoxicological study using zebrafish embryos. The results of the WQI revealed that although the source (N1) was classified as regular, samples collected upstream (RS2) and downstream (RS3) of the wastewater treatment plant (WWTP) were considered bad. In the ecotoxicological analysis, all embryos tested in groups RS2 and RS3 were not viable 24 h post-fertilization, although those collected at source survived the experiment. Collectively, our results inform the conclusion that the surface water quality of the Sangão River is impacted from its source onwards, and that remedial strategies are warranted.</p
Drug repurposing by virtual screening: identification of new already approved rock inhibitors as promising drugs to target neurodegeneration
No full textROCK kinases are key players in neurodegenerative diseases such as Alzheimer’s disease (AD), making them attractive therapeutic targets. In this study, we developed a pharmacophoric map of ROCK inhibitors and highlighted the key affinity sites in ROCK1/2 through molecular modeling. Virtual screening led to the identification of six approved drugs as ROCK inhibitors: ruxolitinib (36), baricitinib (37), ponatinib (38), tivozanib (39), nialamide (40), and tucatinib (41). Ruxolitinib (36) (hROCK1 IC50 = 0.025 μM; hROCK2 IC50 = 0.007 μM) and baricitinib (37) (hROCK1 IC50 = 0.019 μM; hROCK2 IC50 = 0.011 μM) showed the highest potency, while tivozanib (39) displayed 15-fold selectivity for ROCK2 over ROCK1. Molecular dynamics revealed that ruxolitinib (36) forms stable bidentate hydrogen bonds with the ROCK hinge region and has selectivity across the AGC kinase family. Biological assays confirmed ruxolitinib’s (36) safety in neuronal and glial cells and its ability to reduce C3 immunolabeling, a glial inflammation marker, in LPS-treated astrocytes. These findings not only highlight ruxolitinib (36) as a promising candidate for AD but also provide a structural basis for designing novel dual JAK-ROCK inhibitors and pave the way for further in vitro and in vivo studies. Moreover, the validated pharmacophoric map for ROCK inhibition highlights the identification of an affinity pocket that can be useful for the design of new ROCK inhibitors.</p
Exploring the impact of chronic urticaria profile as a key predictor of alexithymia: a cross-sectional study
No full textIntroduction: The relationship between chronic urticaria (CU) and alexithymia, a cognitive-affective impairment characterized by difficulty in identifying and expressing emotions, is complex and underexplored. This study aimed to identify predictors of alexithymia in CU patients by focusing on the impact of coexisting mental illnesses and antihistamine use.Methods: An online survey was distributed to specialized allergy and dermatology centers from 2021 to 2022. The survey included the TAS-20, UAS-7, UCT, CU-Q2oL, and demographic information. Participants were 18-80 years old, diagnosed with CU, and had no prior diagnosis of alexithymia. The final analysis included a total of 332 respondents from various countries. Regression models were used to investigate the relationship between clinical and demographic factors of patients with CU as key predictors of alexithymia.Results: Among CU patients, the main predictors of having alexithymia were: presenting mental (OR = 2.406, p p p p p Conclusions: Alexithymia is closely linked to clinical and demographic variables among patients with CU. These findings suggest that comprehensive management of CU should include psychological assessment and support, especially for patients with alexithymia and those using fg-AH. Reducing the reliance on fg-AH and addressing mental health issues may improve outcomes for these patients.</p