ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Effectiveness of Alcohol Gel-Based Antiseptics Against Multidrug-Resistant Bacteria: An in vitro Experimental Study
Get PDFBackground: Since the 19th century, asepsis has revolutionized public health, and hand hygiene remains a cornerstone of infection control, particularly in healthcare settings with high exposure to resistant microorganisms. This study aimed to evaluate the antimicrobial efficacy of four commercial alcohol-gel brands (A, B, C, and D) against standard ATCC strains of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis, which are prevalent in clinical environments.
Methods: The disk-diffusion method was employed on Müeller-Hinton agar, using sterile disks impregnated with each gel sample. Following a 24-hour incubation at 35°C, the resulting halo zones were measured.
Results: Significant variability was observed among the brands. Brand C exhibited the highest antimicrobial activity, particularly against P. aeruginosa (11.10 mm), with an overall mean inhibitory activity of 9.8 mm. Brand B demonstrated broad efficacy (mean 9.2 mm), while Brand A showed moderate activity with higher variability (mean 7.9 mm). Brand D demonstrated minimal to no inhibitory activity in the disk-diffusion assay compared to the other tested products (mean 4.3 mm). These differences were statistically significant across all tested bacteria.
Conclusions: These findings indicate that alcohol concentration is not the sole determinant of antimicrobial performance. Formulation factors—such as humectants, polymers, and viscosity—substantially impact efficacy. The composition of an alcohol-based hand sanitizer directly governs its antimicrobial power. The study reinforces the importance of selecting validated products, adhering to hygiene protocols, and conducting microbiological surveillance to prevent healthcare-associated infections
Quality of sepsis management in the Emergency Department at Goulburn Valley Health, Victoria, Australia: A Retrospective Audit
Get PDFBackground: This audit aims to assess the care of sepsis at Goulburn Valley Health by comparing current practice with national benchmarks and the local sepsis protocol. The secondary objectives explore relationships between different clinical factors and sepsis care to provide insights that may guide future studies.
Method: The audit was conducted in the Emergency Department at Goulburn Valley Hospital in Shepparton. It involved a retrospective review of both electronic and paper medical records for patients diagnosed with sepsis. Included participants were patients admitted with sepsis or septic shock between January 1, 2023, and March 31, 2023. Key measurements included adherence to the local sepsis pathway, time from triage to intravenous fluids, time from triage to intravenous antibiotics, and compliance with the electronic Therapeutic Guidelines (eTG) for initial treatment. Additional measurements included time from triage to blood cultures, lactate trends, and adequacy of fluid resuscitation.
Results: The median time from triage to fluid resuscitation was 51 minutes (IQR 32–91.5). The median time from triage to antimicrobial infusion was 68 minutes (IQR 48–117). Overall, 59% of patients received appropriate antimicrobial coverage, while 41% did not.
Conclusion: The median infusion times compared favorably with the national pilot under the definitions used; however, differences in time-zero definitions, selection criteria, and a small sample size limit direct comparison. A notable proportion of patients did not receive appropriate antimicrobial coverage. Based on these findings, improvements in sepsis management are recommended, including implementing a sepsis bundle dashboard and strengthening antimicrobial stewardship efforts
Hyponatremia-Induced Rhabdomyolysis in a Patient with Psychogenic Polydipsia: A Case Report
Get PDFHyponatremia is a common electrolyte abnormality that can lead to various complications, including rhabdomyolysis. Observational studies have identified a correlation between hyponatremia and the occurrence of rhabdomyolysis in hospitalized patients. We report a 45-year-old male with a medical history of hypertension, hyperlipidemia, and a congenital neurological defect featuring an 8 cm right frontal porencephalic cyst communicating with the right lateral ventricle, colpocephaly, congenital left hemiparesis, paranoid schizophrenia, anxiety, and depression. He presented with rhabdomyolysis caused by hyponatremia and aggravated by psychogenic polydipsia. A hyponatremic state caused by psychogenic polydipsia may induce rhabdomyolysis in patients with a genetic predisposition. Hence, monitoring muscle markers in these patients is crucial, with further evidence needed to establish hyponatremia as the primary cause of rhabdomyolysis in the absence of other confounders
Development and Preliminary Evaluation of a Behavioral Lifestyle Assessment Tool: A Methodological Case Study with Graduate-Level Women
Get PDFIntroduction: Obesity in adults remains a pressing public health issue in the United States, closely linked to modifiable behaviors such as diet, physical activity, stress, sleep, and substance use. This study aimed to develop and pilot a brief, multidimensional assessment tool to identify lifestyle risk factors associated with obesity and inform future prevention efforts.Methods: A 30-item Behavioral Lifestyle Risk Assessment (BLRA) survey was developed to measure six domains: physical activity, diet, screen time, sleep, stress, and substance use. The survey was administered online via Microsoft Forms to a purposive sample of six adults. The small sample size was intentionally selected based on cognitive interviewing methodology, which recommends 5–10 participants for early-stage instrument clarity and feasibility testing. Descriptive statistics were used to summarize behavioral patterns and survey usability.Results: All six participants (100% female, aged 18–33) completed the survey without missing data or technical issues. Half reported low physical activity (1–2 days/week), 33% consumed fewer than two servings of fruits and vegetables daily, and another 33% had screen time exceeding eight hours daily. All participants reported moderate to high stress; 83% consumed alcohol, and 17% reported tobacco use. The average survey completion time was 6.8 minutes (SD = 0.6), with positive feedback on clarity and flow.Conclusion: Pilot findings suggest the BLRA is a feasible and user-friendly tool for assessing obesity-related behavioral risks. Broader testing in larger, diverse populations is recommended to validate its public health application
The Impact of Vonoprazan on Tacrolimus Blood Levels in Transplant Recipients: A Systematic Review and Meta-Analysis
Get PDFBackground: Tacrolimus is essential for immunosuppression in transplant recipients but presents risks of toxicity and rejection due to its narrow therapeutic window. Vonoprazan, increasingly replacing proton pump inhibitors (PPIs) in these patients, may alter tacrolimus blood levels, but its impact remains unclear.
Objective: To assess how switching from PPIs to vonoprazan affects tacrolimus through concentration and concentration-to-dose ratio, and to summarize related liver and kidney safety markers in transplant recipients.
Methods: A systematic review was conducted of four Japanese studies (140 kidney or liver transplant recipients) evaluating tacrolimus-based immunosuppression before and after conversion to vonoprazan. The synthesis used exploratory meta-analyses and narrative interpretation, with clinically meaningful changes prespecified, while emphasizing study limitations.
Results: Across studies, a trend toward higher tacrolimus levels was seen after switching to vonoprazan. However, the magnitude and consistency of these changes varied substantially between studies, and most results did not surpass thresholds for clinical concern. Liver and kidney safety signals were generally small and inconsistent. High risk of bias, considerable heterogeneity, and absence of pooled clinical endpoints prevent drawing firm conclusions from quantitative data. Pooled estimates are reported as exploratory only.
Conclusions: There is low-certainty evidence that vonoprazan may increase tacrolimus exposure in transplant recipients, but the clinical significance is unclear due to small, regionally focused studies with major methodological limitations. Therapeutic drug monitoring during and after conversion is prudent, and well-controlled trials in diverse populations are needed before definitive recommendations can be made
Outcome of Kidney Transplant Patients Following Treatment with Checkpoint Inhibitors: A Case Series
Get PDFImmune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enhancing immune surveillance against tumors. However, their use in kidney transplant recipients presents a significant challenge due to the risk of immune-mediated graft rejection. This retrospective case series highlights four kidney transplant recipients treated with ICIs for various malignancies, revealing the complex interplay between oncologic outcomes and transplant function. Two of four patients developed severe acute kidney injury (AKI), leading to dialysis-dependent graft loss despite high-dose corticosteroid therapy. One patient exhibited partial renal recovery following transient dialysis. In contrast, another patient maintained stable graft function despite prolonged ICI therapy. Oncologic outcomes varied, with two patients achieving significant tumor regression, while others experienced disease progression. These cases underscore the need for careful immunosuppressive management and close monitoring when administering ICIs in transplant recipients. The findings emphasize the importance of individualized treatment strategies to optimize both cancer control and graft survival
Amiodarone-Induced Thyrotoxicosis Presenting as Congestive Heart Failure Exacerbation and Thyroid Storm: Role of Plasmapheresis in Management and Prevention of Complications
Get PDFAmiodarone-induced thyrotoxicosis (AIT) is a subtype of thyrotoxicosis caused by the long-term administration of the antiarrhythmic drug amiodarone. It’s classified into type 1 AIT, which is defined as hypersecretion of the thyroid hormone, while type 2 AIT is destructive thyroiditis leading to increased release of thyroid hormone. Each type has its special management and diagnostic features. We report a case of a 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and type 2 diabetes mellitus (DM) who presented with congestive heart failure (CHF) exacerbation and symptoms of an impending thyroid storm. After the diagnosis of type 2 AIT, medical treatment, as well as plasmapheresis, was initiated. In further admissions, the patient returned with ventricular tachycardia and right subclavian deep venous thrombosis due to recurrent catheterization and a hypercoagulable state. The diagnostic workup revealed elevated free T4, suppressed TSH, and initially elevated AST and ALT, which normalized subsequently. Imaging showed decreased thyroid vascularity. This case report highlights the importance of distinguishing between AIT types, tailoring optimal treatment decisions, closely monitoring and following up on such cases, and adhering to treatment to prevent catastrophic complications. Further research is necessary to identify early markers of amiodarone toxicity to prompt early diagnosis and better prognosis
TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research
Get PDFIntroduction: The increasing utilization of real-world data platforms in medical research necessitates a comprehensive understanding of their methodological strengths and limitations. TriNetX has emerged as a significant platform for exploring large healthcare datasets. This review aims to critically evaluate the methodological framework and limitations of TriNetX, assess the impact of electronic health record coding accuracy on data reliability, and analyze the platform\u27s capacity for generating generalizable real-world evidence in clinical research.
Methods: We conducted a comprehensive review examining TriNetX\u27s data architecture, quality metrics, and research applications, focusing on data integrity, platform architecture, and the external validity of research findings.
Results: The analysis reveals significant methodological considerations. TriNetX\u27s reliance on retrospective data introduces biases such as selection bias and confounding variables. The coding accuracy of electronic health records, which have not been independently validated, is a critical determinant of data reliability. The demographic representation is limited, affecting the generalizability of results.
Discussion: Despite its extensive use, TriNetX\u27s effective utilization requires careful consideration of its inherent limitations. The platform\u27s data, predominantly from insured populations in academic and acute care settings, may not fully represent broader demographic groups. Addressing these methodological constraints is crucial for enhancing the reliability and applicability of research findings derived from TriNetX.
Conclusions: TriNetX is a valuable resource for healthcare research. However, its limitations must be acknowledged, and future research should focus on standardizing data collection and enhancing data validation processes to mitigate platform-specific biases and improve the quality and applicability of the findings
Investigating the Impact of Primary Education on Birth Control Practices in Bangladesh: A Primary Study
Get PDFIntroduction: Bangladesh faces significant challenges due to overpopulation, impacting essential resources such as healthcare, employment, and education. This study investigates the role of primary education in influencing contraceptive adoption and examines the socio-economic and educational factors affecting birth control practices in Bangladesh.
Methods: A cross-sectional study was conducted in four districts (Sylhet, Habiganj, Sunamganj, and Moulvibazar). These areas were selected to provide a diverse representation of both urban and rural populations. A stratified random sampling technique was used to select 160 service recipients. A validated questionnaire was administered face-to-face by trained data collectors. Statistical methods included Chi-square tests, logistic regression modeling, and sensitivity analysis to control for confounding variables.
Results: Higher education levels were significantly associated with increased contraceptive use (OR = 2.31, 95% CI: 1.58-3.47, p < 0.01). Multivariate analysis confirmed that income, religion, and geographic location were significant predictors of contraceptive adoption. Specifically, 41% of service recipients had secondary education, and 56% earned between 4000-5000 Taka per month.
Discussion: This study underscores the importance of primary education in contraceptive adoption and identifies key socio-economic determinants affecting family planning choices. Despite methodological limitations, such as sample size constraints, the findings suggest a need for targeted interventions to enhance educational access and contraceptive awareness, particularly among lower-income groups.
Conclusion: Expanding primary education is a critical strategy for population control in Bangladesh. This study provides valuable insights for policymakers and public health professionals, emphasizing the necessity of data-driven interventions and expanded educational programs to enhance birth control awareness and adoption
Safety and Efficacy of Na Alginate and Mesna in Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis
Get PDFBackground: Sodium hyaluronate, commonly used in ESD, has drawbacks such as high cost and potential tumorigenesis. Sodium alginate (Na alginate) and Mesna offer promising alternative solutions with their viscoelastic and mucolytic properties. In this review we aimed to evaluate the safety and efficacy of Na alginate and Mesna solutions in ESD.
Methods: A systematic search was conducted across multiple databases. Inclusion criteria were randomized controlled trials and observational studies assessing Na alginate and Mesna in ESD. Primary outcome included en-bloc resection rates. Secondary outcomes included adverse events such as perforation and delayed bleeding, and procedural time.
Results: Eight studies involving 255 patients were included in this analysis. Overall en-bloc resection rate for sodium alginate was 97% [95% CI (93%-99%); I2:0%]. En-bloc resection subgroup analysis revealed 97% [95% CI (93%-99%); I2:0%] for 0.6% sodium alginate and 95% [95% CI (70%-99%); I2: 0%] for 0.4% sodium alginate. Moreover, En-bloc resection rate for Mesna was 98% [95%CI: 92%-100%); I2: 0%]. Delayed bleeding rates for sodium alginate were 5% [95% CI (1%-20%); I2: 65.2%]; however, after subgroup analysis delayed bleeding was 2% [95% CI (1%-6%); I2: 0%] for 0.6% sodium alginate and 22% [95% CI (8%-49%); I2:0%] for 0.4% sodium alginate. Perforation rate for 0.6% sodium alginate was 1% [95% CI (0%-5%); I2: 0%].
Conclusion: Na alginate (0.6%) and Mesna are effective and safe alternatives to sodium hyaluronate for submucosal injection in ESD. These solutions offer potential cost-effective and safer options for clinical practice, with Na alginate (0.6%) showing particularly low adverse event rates