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Immune checkpoint inhibitors and allograft rejection risk: Emerging evidence regarding their use in kidney transplant recipients
No full textThe indications for immune checkpoint inhibitor (ICI) use in cancer treatment continue to expand. This is attributable to their proven anticancer activity in addition to their tolerability and favorable toxicity profile as compared to conventional chemotherapeutic agents. ICIs work by blocking the inhibitory signals between tumor cells and T-cells, thereby enhancing the T-cell cytotoxic activity to inhibit tumor growth. Because of their immune-stimulating effect, ICIs are linked to adverse renal outcomes in both native and transplanted kidneys. The risk of kidney allograft rejection in the setting of ICI use has been reported to be around 40%, leading to an increased risk of graft loss. In this report, we review the literature examining outcomes in kidney transplant recipients receiving ICIs for various oncologic indications
A qualitative study assessing acceptability and appropriateness of a technology-assisted mental health intervention by community frontline workers: mPareshan implementation research in rural Pakistan
No full textBackground: With a shortage of mental health specialists and a significant rural population in Pakistan, leveraging community-based healthcare workers becomes crucial to address mental health needs. Equipping the healthcare workers with digital tools such as mobile applications have the potential to increase access to mental health support in low-resource areas. This study examines the acceptability, appropriateness, barriers, and facilitators to implementing a technology-assisted mental health intervention (mPareshan) delivered by Lady Health Workers (LHWs) in rural Pakistan.Methods: This is a qualitative study embedded within a larger implementation research trial assessing the feasibility of an mHealth intervention aimed at improving anxiety and depression. 8 focus group discussions and 18 in-depth interviews were conducted. Perceptions were sought before and after intervention from stakeholders comprising of policymakers, LHWs, Lady Health Supervisors (LHSs), and community participants. Data underwent thematic analysis using the RE-AIM framework.Results: Six main themes emerged from the data. All participants had realization of rising burden of mental illnesses and identified key determinants for mental ill-health. Delivery of mental health counselling by LHWs through a technology-assisted intervention was deemed acceptable and appropriate. LHWs were considered capable and trustworthy by the community to deliver a home-based mHealth intervention, given their easy accessibility as residents of the same community. The technology demonstrated potential for easy adoption as these frontline health workers were already familiar with smartphone technology. Some barriers identified during implementation roll-out included heavy workload of LHWs and difficulty in internet connectivity. Use of videos for counselling, and supportive supervision by LHSs emerged as key facilitators for implementation.Conclusion: This study highlights that a technology-focused mental health intervention is feasible, acceptable, and appropriate to be implemented by community frontline workers in resource-constrained rural Pakistani settings. The mPareshan intervention can be easily adopted within the LHW-P. Further research should investigate how implementation barriers can be addressed for successful delivery
Intervention to improve children\u27s hygiene in urban squatter settlement schools in Pakistan: An implementation research
No full textBackground: School-based interventions are crucial for promoting healthy behaviors in children and preventing the spread of diseases. This study aimed to enhance hygiene knowledge and practices (K&P) among school children through a school-based intervention.Objective: To improve personal and environmental hygiene K&P amongst primary and middle-grade students in urban squatter settlement schools in Karachi, Pakistan using school-based intervention.Design: Quasi-experimental study conducted in three schools over 2 years.Setting: Urban squatter settlement schools in Karachi, Pakistan, serving primary, and middle-grade students.Participants: A total of 156 students participated in the study, with a majority of 55.77% being girls (n = 87). Pre- and post-intervention assessments were conducted to evaluate the impact of the intervention.Intervention: Behavioral Change Communication (BCC) strategies aimed at improving school children\u27s hygiene K&P.Primary outcome measures: The primary outcome measures included changes in hygiene K&P pre- and post-intervention, specifically focusing on personal hygiene and environmental hygiene.Results: Significant improvements observed post-intervention. Mean knowledge score differences were 20.33 (SD = 5.85) for personal hygiene and 10.08 (SD = 7.72) for environmental hygiene. Practice scores also increased, with mean differences of 2.52 (SD = 1.98) and 2.47 (SD = 2.08) for personal and environmental hygiene, respectively. Statistically significant improvements (P \u3c .05) were noted across most of the hygiene domains.Conclusions: The school-based intervention effectively improved personal and environmental hygiene K&P among primary and middle-grade children in urban squatter settlement schools. Key recommendations include integrating hygiene education into the curriculum, providing enabling environment to children and capacity building of school teachers to teach hygiene education
Challenges and opportunities of universal health coverage in Africa: A scoping review
Full text linkBackground: Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions.
Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature to map out the evidence on UHC adoption, roll out, implementation, challenges, and opportunities in the African countries. Literature searches of the Cochrane database of systematic reviews, PUBMED, EBSCO, Eldis, SCOPUS, CINHAL, TRIP, and Google Scholar were conducted in 2023. Using predefined inclusion criteria, we focused on UHC adoption, rollout, implementation, and challenges and opportunities in African countries. Primary qualitative, quantitative, and mixed-methods evidence was included, as well as original analyses of secondary data. We employed thematic analysis to synthesize the evidence.
Results: We found 9633 documents published between May 2005 and December 2023, of which 167 papers were included for analysis. A significant portion of UHC implementation in Africa has focused on establishing social health protection schemes, while others have focused on strengthening primary healthcare systems, and a few have taken integrated approaches. While progress has been made in some areas, considerable obstacles still exist. Financial constraints and supply-side challenges, such as a shortage of healthcare workers, limited infrastructure, and insufficient medical supplies, remain significant barriers to UHC implementation throughout Africa. Some of the promising solutions include boosting public funding for healthcare systems, strengthening public health systems, ensuring equity and inclusion in access to healthcare services, and strengthening governance and community engagement mechanisms.
Conclusion: Successful UHC implementation in Africa will require a multifaceted approach. This includes strengthening public health systems in addition to the health insurance schemes and exploring innovative financing mechanisms. Additionally, addressing the challenges of the informal sector, inequity in healthcare access, and ensuring political commitment and community engagement will be crucial in achieving sustainable and comprehensive healthcare coverage for all African citizens
Extension for community healthcare outcomes-palliative care in Africa and quality of life, symptoms, patient experience, and caregiver distress among patients with cancer
Full text linkPurpose: In this study, we aimed to evaluate the association between the Extension for Community Healthcare Outcomes-Palliative Care (ECHO-PC; ECHO Model–Based comprehensive educational and telementoring intervention) for health care professionals (HCPs) and change in patient-reported quality-of-life (QOL; Functional Assessment of Cancer Therapy-General [FACT-G]) among patients with advanced cancer. We also examined the association between ECHO-PC and changes in symptom distress (Edmonton Symptom Assessment Scale [ESAS]), patient experience and satisfaction, and caregiver distress scores.
Methods: ECHO-PC Clinic sessions were conducted twice a month for 1 year by an interdisciplinary team of PC clinicians at the MD Anderson Cancer Center, with participation of experts in PC in sub-Saharan Africa, using standardized curriculum on the basis of PC needs in the region. Study participants included palliative HCPs from ECHO participating programs in Kenya, Nigeria, Ghana, and South Africa. HCPs, their patients, and caregivers were assessed at baseline, 3, 6, 9, and 12 months of the study for QOL (FACT-G), ESAS-Symptom Distress Score (prorated) (SDS), patient experience, satisfaction (FAMCARE-P-16-patient), and caregiver distress (FAMCARE-caregiver).
Results: Two hundred seventy patients completed the assessments. Fifty-eight percent was female, the mean age was 56 years, and most common cancer type was breast cancer (24.3%). Multivariate generalized linear mixed model analysis found that ECHO-PC intervention was associated with significant improvement in QOL and symptom distress (FACT-G total score, P = .0433; FACT-G physical well-being, P \u3c .013; FACT-G emotional well-being, P = .0232, and ESAS-SDS, P \u3c .0001). No significant changes were found in patient experience, satisfaction, and caregiver distress scores.
Conclusion: Our preliminary study found that the ECHO-PC intervention was significantly associated with improvement in patient outcomes including QOL and symptom distress scores. Further studies are needed
Investing in equitable healthy aging: Why Africa must reform social pension schemes to improve Alzheimer\u27s disease and dementia outcomes
Full text linkThe eligibility criteria for social pension schemes in Africa hinder equitable and healthy aging. In 2019, women in 14 sub-Saharan African countries had an average life expectancy of 67 years but a healthy life expectancy of only 57 years, leaving them 5 years in poor health before receiving a pension at age 62. Men had a similar situation—a life expectancy of 62 years and a healthy life expectancy of 53 years, spending 10 years in poor health before becoming eligible for pensions at age 63. Many men do not receive pensions due to early death. Delays and low pension payouts contribute to a 2.5% increase in the death rate from Alzheimer\u27s disease and dementia
Adenomatoid tumor of the testis: A report of two cases and literature review
Full text linkTesticular adenomatoid tumor is a rare benign condition that can resemble testicular malignancies in its clinical presentation, potentially leading to overtreatment, such as radical orchidectomy. In our two case reports, we aim to better understand the behavior of this disease by examining its clinical presentation, as well as radiological, intraoperative, and pathological findings
Frequency of trigeminal neurovascular contacts identified on 3D-fast imaging employing steady-state acquisition magnetic resonance imaging in asymptomatic adults
No full textBackground: Neurovascular conflict is considered one of the main causes of Trigeminal neuralgia, and 3D fast imaging employing steady-state acquisition magnetic resonance imaging (MRI) is the diagnostic imaging of choice. However, no tool is available to confirm imaging findings as the primary cause of trigeminal neuralgia because neurovascular contact is frequently found in asymptomatic individuals, according to some literature, although very little data is available till now. Therefore, we aim to determine the frequency of trigeminal neurovascular contact, involved nerve segment, culprit vessel, and characteristics of contacts in asymptomatic individuals. Knowledge about this is very crucial so that every patient may not be labeled as having neurovascular conflict as the primary cause and can be saved from unnecessary surgeries.Methods: A retrospective observational study was conducted on 105 MRI brain scans of asymptomatic individuals for trigeminal neurovascular relationships by two expert neuro-radiologists. Percentages calculated for categorical variables and for continuous variables Shapiro-Wilk test were used. The Fisher Exact test is used to assess the association between conflict and other variables. Inter-rater reliability was computed for the outcome and other variables and Cohen\u27s kappa to evaluate the strength of agreement. All calculations were performed using STATA version 17.0.Results: Out of 105 cases, neuro-vascular contact was identified in 64 cases. The most common contacting vessel was the superior cerebellar artery. The most common nerve segment involved was the cisternal segment, followed by the Root entry zone and porous trigeminus. In about 54 cases, the vessel was abutting the nerve, while in eight cases, it was compressing and, in two cases, displacing the nerve. The superior surface of the nerve was commonly involved. The inter-rater reliability between both neuroradiologists showed significant agreement.Conclusion: Neurovascular contact is found in asymptomatic individuals, so just the presence of contact in symptomatic individuals on MRI should not be considered as only the cause of trigeminal neuralgia. It is important to identify nerve thinning and distortion, which are more reliable signs
Incidence, risk factors and outcomes of urinary tract infections among patients undergoing thyroidectomy: Insights from the ACS-NSQIP
No full textIntroduction Urinary tract infections (UTIs) represent a rare postoperative complication following thyroidectomy. Objective This study aimed to assess the clinicodemographic factors associated with the development of UTIs and subsequent outcomes among patients undergoing thyroidectomy. Methods This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to analyze patients who underwent thyroidectomy from 2005 to 2019. Multivariable logistic regression models were used to identify risk factors and associations of UTIs with postoperative morbidity and mortality. Results In a cohort of 180,373 identified thyroidectomy patients, 0.28% contracted a UTI. Significant risk factors associated with UTIs included age \u3e 60 years (adjusted odds ratio [OR] 2.187, 95% confidence interval [CI] 1.618-2.956), female gender (OR 1.767, 95% CI 1.372-2.278), American Society of Anesthesiologists (ASA) Classification 3 to 5 (OR 1.463, 95% CI 1.185-1.805), partially (OR 4.267, 95% CI 2.510-7.253) or totally dependent functional health status (OR 9.658, 95% CI 4.170-22.370), pulmonary disease (OR1.907, 95% CI 1.295-2.808), chronic steroid therapy (OR 1.649, 95% CI 1.076-2.527), inpatient procedure (OR 1.507, 95% CI 1.251-1.814), and operative time \u3e 150 minutes (OR 1.449, 95% CI 1.027-2.044). Additionally, UTIs were independently associated with postoperative complications, including pulmonary, vascular, or cardiac complication; stroke; acute renal failure; infectious complications; sepsis; septic shock; pneumonia; prolonged length of stay; unplanned reoperation; and mortality. Conclusion While UTIs are rare after thyroidectomy, they carry a significant burden on patient outcomes. Preoperative optimization of comorbidities and reducing operative times may help mitigate the risk of UTIs. Optimized care for postoperative UTI patients is also recommended to prevent complications and improve outcomes
Identification of differentially expressed non-coding RNAs in the plasma of women with preterm birth
No full textThis study aimed to identify differentially expressed non-coding RNAs (ncRNAs) associated with preterm birth (PTB) and determine biological pathways being influenced in the context of PTB. We processed cell-free RNA sequencing data and identified seventeen differentially expressed (DE) ncRNAs that could be involved in the onset of PTB. Per the validation via customized RT-qPCR, the recorded variations in expressions of eleven ncRNAs were concordant with the in-silico analyses. The results of this study provide insights into the role of DE ncRNAs and their impact on pregnancy-related biological pathways that could lead to PTB. Further studies are required to elucidate the precise mechanisms by which these DE ncRNAs contribute to adverse pregnancy outcomes (APOs) and their potential as diagnostic biomarkers