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EXPLORING THE CONTROVERSIAL LINK BETWEEN ARTIFICIAL SWEETENERS AND CANCER RISK: A NARRATIVE REVIEW.
Get PDFAspartame is a widely consumed non-sugar sweetening agent used in more than ninety different countries. It is a methoxycarbonyl of apeptidyl of aspartic acid and phenylalanine. It is many times more saccharine than sugar but has very less calories therefore it is widely used in diet or zero-sugar food products. When metabolized in our body it is broken down into diketopiperazine, aspartyl phenylalanine, and phenylalanine. It is a frequently used and studied synthetic sweetening agent. However, there is a controversy related to its possible carcinogenic effect. Some studies have shown it to have some genotoxic and carcinogenic effects. But others have shown no genotoxic or carcinogenic effects of aspartame when ingested. The possible carcinogenic effect of aspartame is controversial for a long time. As aspartame is widely used in daily use dietary products, finding out whether it is safe for human consumption is extremely important. This literature review/study’s sole objective is to know about aspartame’s possible carcinogenic roles. The search engine used to find articles related to the possible carcinogenic effects of aspartame is PubMed. The keywords used for searching the articles are; aspartame, carcinogenesis, metabolism of aspartame in humans, aspartame as a carcinogen, genotoxicity, genotoxicity induced by aspartame, and artificial sweeteners. The articles are further filtered by the timeline (articles from 2013 – 2023 only). Articles from only the past 10 years are included, which consist of systemic reviews, meta-analyses, research articles, and literature reviews. 27 articles are studied.https://www.jptcp.com/index.php/jptcp/article/view/5715?__cf_chl_tk=egst_VW02apE706nMS0I7cfL4oqiMnH.XTuOfrbnHNU-1717162243-0.0.1.1-398
Mental health workers' perspectives on the implementation of a peer support intervention in five countries: Qualitative findings from the UPSIDES study
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BMJ.OBJECTIVE: The introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers' (MHWs) experiences with peer support comes from high-income countries. Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) is an international multicentre study, which aims at scaling up peer support for people with severe mental illness in Europe, Asia and Africa. This study investigates MHWs experiences with UPSIDES peer support. DESIGN: Six focus groups with MHWs were conducted approximately 18 months after the implementation of the UPSIDES peer support intervention. Transcripts were analysed with a descriptive approach using thematic content analysis. SETTING: Qualitative data were collected in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel) and Pune (India). PARTICIPANTS: 25 MHWs (19 females and 6 males) from UPSIDES study sites in the UPSIDES Trial (ISRCTN26008944) participated. FINDINGS: Five overarching themes were identified in MHWs' discussions: MHWs valued peer support workers (PSWs) for sharing their lived experiences with service users (theme 1), gained trust in peer support over time (theme 2) and provided support to them (theme 3). Participants from lower-resource study sites reported additional benefits, including reduced workload. PSWs extending their roles beyond what MHWs perceived as appropriate was described as a challenge (theme 4). Perceptions about PSWs varied based on previous peer support experience, ranging from considering PSWs as equal team members to viewing them as service users (theme 5). CONCLUSIONS: Considering local context is essential in order to understand MHWs' views on the cooperation with PSWs. Especially in settings with less prior experience of peer support, implementers should make extra effort to promote interaction between MHWs and PSWs. In order to better understand the determinants of successful implementation of peer support in diverse settings, further research should investigate the impact of contextual factors (eg, resource availability and cultural values). TRIAL REGISTRATION NUMBER: ISRCTN26008944.https://bmjopen.bmj.com/content/14/5/e08196
Atrial fibrillation inpatient management patterns and clinical outcomes during the conflict in Syria: An observational cohort study
No full textBackground: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there is no data on AF inpatient management strategies and clinical outcomes in Syria. Objectives: The study aims were to review the inpatient management of patients with AF and assess cardiovascular (CV) mortality in a tertiary cardiology centre in Latakia, Syria. Methods: A single-centre retrospective observational cohort study was conducted at Tishreen's University Hospital, Latakia, Syria, from June 2021 to June 2023. Patients ≥16 years of age presenting and being treated for AF as the primary diagnosis with or without a thromboembolic event were included. Medical records were examined for patients' demographics, laboratory results, treatment plans and inpatient details. Studied outcomes include inpatient all-cause and CV mortality, ischemic and bleeding events, and conversion to sinus rhythm (SR). Results: The study included 596 patients. The median age was 58, and 61% were males. 121 patients (20.3%) were known to have AF. A rhythm control strategy was pursued in 39% of patients. Ischemic and bleeding events occurred in 62 (11%) and 12 (2%), respectively. CV and all-cause mortality occurred in 28 (4.7%) and 31 patients (5%), respectively. The presence of valvular heart disease (VHD) (adjusted odds ratio (aOR) = 9.1, 95% confidence interval (CI): 1.7 to 55.1, p < .001), thyroid disease (aOR: 9.7, 95% CI = 1.2 to 91.6, p < .001) and chronic obstructive pulmonary disease (COPD) (aOR: 82, 95% CI: 12.7 to 71, p < .001) were independent risk factors of increased CV inpatient mortality. Conclusion: Syrian inpatients admitted with AF in Latakia are relatively younger than those in other countries. Active thyroid disease, COPD and VHD were independent risk factors of inpatient CV mortality with AF.https://journals.sagepub.com/doi/full/10.1177/02676591241259140?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.or
Cluster analysis to identify clinical subtypes of Ménière's disease
No full textObjective: To identify distinct clinical subtypes of Ménière's disease by analyzing data acquired from a UK registry of patients who have been diagnosed with Ménière's disease. Study design: Observational study. Methods: Patients with Ménière's disease were identified at secondary/tertiary care clinics. Cluster analysis was performed by grouping participants sharing similar characteristics and risk factors into groups based on a defined measure of similarity. Results: A total of 411 participants were recruited into this study. Two main clusters were identified: participants diagnosed with ear infections (OR = 0.30, p < 0.014, 95% CI: 0.11-0.78) were more likely to be allocated in Cluster 1 (C1). Participants reporting tinnitus in both ears (OR = 11.89, p < 0.001, 95% CI: 4.08-34.64), low pitched tinnitus (OR = 21.09, p < 0.001, 95% CI: 7.47-59.54), and those reporting stress as a trigger for vertigo attacks (OR = 14.94, p < 0.001, 95% CI: 4.54-49.10) were significantly more likely to be in Cluster 2 (C2). Also, participants diagnosed with Benign Paroxysmal Positional Vertigo (OR = 13.14, <0.001, 95% CI: 4.35-39.74), autoimmune disease (OR = 5.97, p < 0.007, 95% CI: 1.62-22.03), depression (OR = 4.72, p < 0.056, 95% CI: 0.96-23.24), migraines (OR = 3.13, p < 0.008, 95% CI: 1.34-7.26), drug allergy (OR = 3.25, p < 0.029, 95% CI: 1.13-9.34), and hay fever (OR = 3.12, p < 0.009, 95% CI: 1.33-7.34) were significantly more likely to be clustered in C2. Conclusions: This study supports the hypothesis that Ménière's disease is a heterogeneous condition with subgroups that may be identifiable by clinical features. Two main clusters were identified with differing putative etiological factors. Level of evidence: 3 Laryngoscope, 134:3286-3292, 2024.https://onlinelibrary.wiley.com/doi/10.1002/lary.3127
Use of early veno-venous extracorporeal membrane oxygenation following lightning strike-induced acute lung injury
No full texthttps://www.jcvaonline.com/article/S1053-0770(24)00271-4/fulltex
Population health management of fuel poverty.
Get PDFFuel poverty is a wider determinant of health1,2 and of legitimate interest of Integrated Care Systems (ICSs). A total of 60 573 deaths have been attributed to cold between 2000–2019 in England and Wales.3 The National Institute for Health and Care Excellence4 recommends a single point of contact should be commissioned to support patents vulnerable to cold including those over 65 years, under 5 years, with mental health conditions, chronic cardiovascular disease, or chronic respiratory disease. Nottinghamshire County Council has co-commissioned the Nottingham Energy Partnership (NEP). NEP supports clients to access support according to their financial and housing circumstances. Opportunistic referral of appropriate patients by healthcare clinicians is challenging. Referrals have been below the service’s capacity. A Population Health Management (PHM) project has been developed by Nottingham and Nottinghamshire Integrated Care Board. Data are used to generate lists of at-risk patients likely to be eligible for support. Iterations have generated referrals matched to specific grant criteria and availability such as a specific number of households not yet connected to gas. Practices from five Primary Care Networks took part in one iteration. Patient-level health data were linked via residential address with Energy Performance Certificate (EPC) where available, and Index of Multiple Deprivation (IMD). Patients at risk of cold-related harm, living in areas associated with IMD deciles 1–2, and resident in homes with EPC ratings E, F, or G were triangulated. Primary care medical centre staff sent SMSs to patients offering NEP referral if they opted in. A total of 154 patients were referred between December 2022 and March 2023. Seventy-nine (51%) were contactable. All 79 received a measure of support. In total, 157 wide-ranging interventions were instigated including two cavity wall insulations, 15 loft insulations, 12 solar power systems, and one heat pump. The initial capital cost of these improvements combined with their 1-year projected savings reaches £144 740. Other interventions included 55 Priority Services Registrations, 8 mobility aids (Homes for Living), 26 water-saving discounts, 15 vouchers, boiler optimisation, hardship funding, and financial advice. This PHM approach is deployed periodically in Nottingham and Nottinghamshire to alleviate health inequality, tackle fuel poverty, and is potentially generalisable. © British Journal of General Practice 2024https://bjgp.org/content/74/744/298.
European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 1: Cardiovascular Surgery
No full texthttps://journals.lww.com/ejanaesthesiology/fulltext/2024/08000/european_guidelines_on_peri_operative_venous.4.asp
Ethnicity and outcomes for patients with gastrointestinal disorders attending an emergency department serving a multi-ethnic population
No full textBackground: Ethnic inequalities in acute health acute care are not well researched. We examined how attendee ethnicity influenced outcomes of emergency care in unselected patients presenting with a gastrointestinal (GI) disorder. Methods: A descriptive, retrospective cohort analysis of anonymised patient level data for University Hospitals of Leicester emergency department attendees, from 1 January 2018 to 31 December 2021, receiving a diagnosis of a GI disorder was performed. The primary exposure of interest was self-reported ethnicity, and the two outcomes studied were admission to hospital and whether patients underwent clinical investigations. Confounding variables including sex and age, deprivation index and illness acuity were adjusted for in the analysis. Chi-squared and Kruskal-Wallis tests were used to examine ethnic differences across outcome measures and covariates. Multivariable logistic regression was used to examine associations between ethnicity and outcome measures. Results: Of 34,337 individuals, median age 43 years, identified as attending the ED with a GI disorder, 68.6% were White. Minority ethnic patients were significantly younger than White patients. Multiple emergency department attendance rates were similar for all ethnicities (overall 18.3%). White patients had the highest median number of investigations (6, IQR 3-7), whereas those from mixed ethnic groups had the lowest (2, IQR 0-6). After adjustment for age, sex, year of attendance, index of multiple deprivation and illness acuity, all ethnic minority groups remained significantly less likely to be investigated for their presenting illness compared to White patients (Asian: aOR 0.80, 95% CI 0.74-0.87; Black: 0.67, 95% CI 0.58-0.79; mixed: 0.71, 95% CI 0.59-0.86; other: 0.79, 95% CI 0.67-0.93; p < 0.0001 for all). Similarly, after adjustment, minority ethnic attendees were also significantly less likely to be admitted to hospital (Asian: aOR 0.63, 95% CI 0.60-0.67; Black: 0.60, 95% CI 0.54-0.68; mixed: 0.60, 95% CI 0.51-0.71; other: 0.61, 95% CI 0.54-0.69; p < 0.0001 for all). Conclusions: Significant differences in usage patterns and disparities in acute care outcomes for patients of different ethnicities with GI disorders were observed in this study. These differences persisted after adjustment both for confounders and for measures of deprivation and illness acuity and indicate that minority ethnic individuals are less likely to be investigated or admitted to hospital than White patients.https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03490-
Rebuilding the self through valued action and group connections after acquired brain injury: Participant perspectives of the VaLiANT group intervention
No full textEffective interventions that facilitate adjustment following acquired brain injury (ABI) are needed to improve long-term outcomes and meaningful reengagement in life. VaLiANT is an 8-week group intervention that combines cognitive rehabilitation with Acceptance and Commitment therapy to improve valued living, wellbeing, and adjustment. This study explored participant experiences of VaLiANT to optimize its ongoing development. This included characterization of individually meaningful treatment outcomes, mechanisms of action, and intervention acceptability. Qualitative interviews and quantitative ratings were collected from 39 ABI survivors (M(age )= 52, SD = 15; 54% stroke) following their participation in VaLiANT. Participants reported diverse outcomes which resulted in three themes being generated following reflexive thematic analysis. "A fuller toolkit for life with brain injury" indicated increased strategy usage and better daily functioning; "The value of connection and belonging" captured the importance of social experiences in shaping recovery; and "Finding the me I can be" represented cognitive, behavioural, and emotional aspects of identity reconstruction post-ABI. The content and delivery of the intervention were rated highly but participants desired greater follow-up and tailoring of the intervention. Overall, VaLiANT appears to facilitate adjustment through several mechanisms, but greater intervention individualization and dosage may be required to enhance the treatment impact.https://www.tandfonline.com/doi/full/10.1080/09602011.2024.235999
Urgency adjusted outcomes of emergency abdominal surgery for inflammatory bowel disease
Get PDFINTRODUCTION: Patients undergoing emergency abdominal surgery for inflammatory bowel disease (IBD) are a complex cohort who are relatively poorly represented in published literature. This is partly due to the lack of consensus of the definition of the term emergency in IBD surgery. There is ongoing and recent work defining clinical urgency for unplanned surgical procedures and categorizing the high-risk surgical patient. This paper aims to report the difference in patient metrics and risks as recorded by the National Emergency Laparotomy Audit (NELA). METHODS: Complete patient data, including histology, were available in the NELA database between 2013 and 2016. Urgency categories recorded by NELA are 18 h. Patient characteristics, physiology, biochemistry, and outcomes are reported according to these urgency categories with regression analysis used to compare differences between them. RESULTS: Mortality in Crohn's disease (CD) ranged from 1.4% in the >18 h urgency to 14.6% in the most urgent. In ulcerative colitis (UC), this range was from 3.1% to 14.8%. In both CD and UC, there were significant trends in hemodynamic instability, serum white cell count, serum electrolytes and creatinine, and outcome measures length of stay and unplanned return to theater. CONCLUSIONS: Patients having emergency surgery for IBD are not a single cohort when considering physiology, blood biochemistry, or most importantly, outcomes. Risk counseling and management should reflect this. Hemodynamic changes are subtle and may be missed in this cohort