Georgian Medical Journal (GMJ)
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IAP Report Launch 2020: Leadership and Action — Accountability for Action (Independent Accountability Panel, 2020): Reference Summary (Video)
No full textThis reference summary presents key information from the following presentation: https://youtu.be/eFeLZekJGjU. The source is a video titled “IAP Report Launch 2020: Leadership and Action”, produced by the United Nations Secretary-General’s Independent Accountability Panel (IAP) for Every Woman, Every Child and published in 2020. The session focuses on accountability for action in the context of the Sustainable Development Goals (SDGs), emphasizing accountability as a critical mechanism to connect commitments to measurable progress, particularly in the context of COVID-19 and the principle of leaving no one behind. The discussion introduces the IAP’s integrated accountability framework based on four pillars: commit (defining responsibilities and resources), justify (ensuring decisions are evidence-based and rights-aligned), implement (monitoring, review, and remedial action), and progress (achieving continuous, equitable advancement toward health and rights goals). The framework reinforces accountability as a central component of effective global health governance and sustainable development
Why Accountability Matters for Universal Health Coverage and Meeting the SDGs (The Lancet, 2019): Reference Summary (Article)
No full textThis reference summary presents key information from the following article: https://doi.org/10.1016/S0140-6736(19)30434-9. The source is a commentary titled “Why accountability matters for universal health coverage and meeting the SDGs”, authored by Yamin AE and Mason E, on behalf of the United Nations Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP: Nicholas Kojo Alipui, Dame Carol Kidu, Brenda Killen, Elizabeth Mason, Giorgi Pkhakadze, Jovana Ríos Cisnero, Gita Sen, Alicia Ely Yamin, Kul Chandra Gautam, and Joy Phumaphi), and published in The Lancet in 2019. The article emphasizes the critical role of accountability in achieving universal health coverage (UHC) and advancing the Sustainable Development Goals (SDGs), highlighting the need to connect political commitments with measurable outcomes. It underscores the importance of transparent monitoring, independent review, and corrective action to ensure effective implementation and equitable progress. The discussion reinforces accountability as a central pillar of global health governance and a key mechanism to ensure that no one is left behind
NAD⁺ Injections and “NAD Boosters”: Public Health Risks, Adverse Effects, and Regulatory Implications in the Context of Rapid Consumer Adoption
No full textBackground:Nicotinamide adenine dinucleotide (NAD⁺) is an essential endogenous coenzyme central to cellular energy metabolism, redox balance, DNA repair, immune regulation, and stress-response signalling [1–3]. Age-associated alterations in NAD⁺ biology have stimulated scientific interest and preclinical research. In parallel, NAD⁺ injections/infusions and oral “NAD boosters” (primarily nicotinamide riboside [NR] and nicotinamide mononucleotide [NMN]) have rapidly expanded in wellness markets, often promoted for anti-aging, “detoxification,” cognitive enhancement, and disease prevention. Population exposure has increased ahead of outcomes-based clinical evidence and long-term safety evaluation.
Objective:To provide a policy-relevant, evidence-based analysis of the public health implications of NAD⁺ injections and NAD-boosting supplements, focusing on adverse effects, long-term uncertainty, product quality risks, misinformation-driven behavioural harm, and downstream burden on health systems.
Methods:A narrative public health and regulatory review was conducted, integrating peer-reviewed clinical trials and critical reviews of NAD-boosting interventions, mechanistic literature relevant to long-term risk, and regulatory/public health evidence on supplement adulteration, pharmacovigilance limitations, and health misinformation.
Results:Human trials confirm that NAD-boosting interventions are pharmacologically active and can cause adverse effects, while benefits remain largely limited to surrogate biomarkers rather than patient-important outcomes [6–11]. Long-term safety (including cancer and cardiovascular outcomes) is not established. Evidence from supplement oversight demonstrates recurring problems with adulteration and quality failures [14–17] and weak post-market surveillance [18,19]. Misinformation amplifies adoption and may displace evidence-based prevention, contributing to avoidable system-level costs [21,22].
Conclusion:Current consumer diffusion of NAD⁺ injections and NAD-boosting supplements represents a public health risk profile: unproven benefit on meaningful outcomes, documented short-term adverse effects, profound long-term uncertainty, variable product quality, and governance gaps. Precautionary policy, strengthened surveillance, and evidence-led communication are warranted
Angioplasty of Saphenous Vein Grafts After Coronary Artery Bypass Surgery: A Single-Center Retrospective Study with Literature Review
No full textIn many patients undergoing coronary artery bypass graft surgery (CABG), venous saphenous grafts (SVG) are used in addition to arterial grafts. Treatment of degenerated and occluded venous grafts is complex and challenging. Angioplasty on occluded venous bypass grafts involves a high rate of complications (such as massive distal embolization).
Objectives:To review the demographic data, risk factors, outcomes, and complications of SVG use in CABG surgery, and on this basis to build an algorithm for optimal treatment.
Methods:A retrospective study of patients who underwent angioplasty of saphenous vein grafts (SVGs) between 2005 and 2015 in a tertiary care hospital. Patients were divided into two groups: 2005–2009 (group A) and 2010–2015 (group B), and the comparison was performed according to demographic data, risk factors, time from CABG, as well as angiographic features.
Results:Among the 238 patients, 226 (95%) were male, with a mean age of 68±22 years.74.4% suffered from hypertension, 56.3% from diabetes mellitus, 17.2% from chronic kidney disease, and 99% had a history of previous myocardial infarction.62% of patients were admitted due to ACS.
Distal protection devices were used in only 31 (22%) patients.Intervention was performed mainly on the right and circumflex coronary arteries.
A lower amount of contrast was used in group B (186 vs 137 mL, p=0.0018).There was more frequent use of covered stents in group B (18.8% vs 2.1%, p=0.003), as well as increased use of protection devices (36.4% vs 9.5%, p=0.0002).
Conclusions:The progression of technologies, mainly the use of protection devices, lowered the rate of complications during intervention on SVGs. This was also reflected in the reduced amount of contrast material used and lower incidence of kidney injury. Over the years, there has been a tendency to treat more severely ill patients with longer time since surgery (“older” grafts).
Keywords: coronary artery bypass grafting; saphenous vein graft; angioplasty; complications; distal embolization; protection devices; stents; acute coronary syndrom
Independent Accountability for Women, Children, and Adolescents Under Threat — IAP Commentary (The Lancet, 2020): Reference Summary (Article)
No full textThis reference summary presents key information from the following article: https://doi.org/10.1016/S0140-6736(20)32484-3. The source is a commentary titled “Independent accountability for women, children, and adolescents under threat”, authored by Phumaphi J, Mason E, Barroso C, Gautam KC, Horton R, on behalf of the United Nations Secretary-General’s Independent Accountability Panel (IAP) for Every Woman, Every Child, Every Adolescent (Nicholas Kojo Alipui, Jovana Ríos Cisnero, Carol Kidu, Brenda Killen, Giorgi Pkhakadze, Gita Sen, Alicia Ely Yamin), and published in The Lancet in 2020. The article highlights the central role of independent accountability in advancing global commitments to women’s, children’s, and adolescents’ health, and warns that progress was already lagging prior to COVID-19 and has since been further undermined. It raises concern about the potential discontinuation of the IAP without a transition plan, emphasizing that such a gap would weaken global accountability mechanisms. The authors call for the establishment of a strengthened independent accountability structure aligned with the Sustainable Development Goals (SDGs), supported by robust data systems, political commitment, and inclusive, rights-based approaches. The discussion reinforces accountability as a critical mechanism to connect commitments to measurable progress and ensure that no one is left behind
Staged Hybrid Coronary Revascularization in an Octogenarian with NSTEMI and High Surgical Risk: A CARE-Compliant Case Report
No full textBackground:Management of multivessel coronary artery disease (CAD) in elderly patients presenting with non-ST elevation myocardial infarction (NSTEMI) remains complex, particularly in the presence of multiple comorbidities and elevated operative risk. Contemporary guidelines recommend individualized, Heart Team–based decision-making when selecting revascularization strategies [3–5]. Hybrid coronary revascularization (HCR), combining minimally invasive surgical bypass with percutaneous coronary intervention (PCI), has emerged as a promising approach to achieve complete revascularization while minimizing procedural risk [9,10].
Case Presentation:
An 87-year-old man presented with NSTEMI and a history of diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease. Risk stratification demonstrated high operative risk (STS score 6.6%, EuroSCORE II 8.6%). Coronary angiography revealed critical two-vessel disease, including a severe lesion in the left anterior descending artery (LAD) involving the diagonal branch and a significant stenosis of the mid-right coronary artery (RCA). Following multidisciplinary Heart Team evaluation, a staged hybrid revascularization strategy was selected. The initial stage consisted of minimally invasive direct coronary artery bypass (MIDCAB) using a left internal mammary artery (LIMA) graft to the LAD and diagonal branch via left thoracotomy on a beating heart. Two days later, PCI with drug-eluting stent implantation was successfully performed in the right coronary artery.
Results:Both procedures were completed without complications. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Early outcomes demonstrated successful complete revascularization and rapid clinical recovery.
Discussion:Hybrid coronary revascularization offers a tailored strategy for high-risk elderly patients by combining the long-term durability of LIMA-to-LAD grafting with the minimally invasive nature of PCI [9–14]. In frail populations, this approach may reduce perioperative risk while maintaining the benefits of complete revascularization [18–21]. Increasing evidence supports the prognostic importance of complete revascularization in elderly patients with acute coronary syndromes [22–25].
Conclusion:Staged hybrid coronary revascularization represents a safe and effective strategy for achieving complete revascularization in carefully selected high-risk elderly NSTEMI patients. A multidisciplinary Heart Team approach enables individualized decision-making and may improve short-term clinical outcomes.
Keywords: hybrid coronary revascularization; NSTEMI; elderly; MIDCAB; percutaneous coronary intervention; Heart Team; complete revascularizatio
Challenging Questions of Accountability — PMNCH Webinar 2018: Reference Summary (Video)
No full textThis reference summary presents key information from the following presentation: https://youtu.be/Swr1Y55KRuU. The source is a webinar titled “Challenging Questions of Accountability”, produced by the Partnership for Maternal, Newborn & Child Health (PMNCH) and published on 20 November 2018, serving as a preparatory discussion for the PMNCH Partners’ Forum on global and national health accountability. The event focuses on accountability as a core mechanism for ensuring that health commitments are translated into measurable outcomes, emphasizing the monitoring, review, and remedy framework. The discussion highlights perspectives from governance, data systems, social accountability, health financing, and humanitarian contexts, reinforcing the importance of coordinated, evidence-informed, and rights-based approaches to strengthening health systems and improving equity
Why the SDGs’ Defining Decade Must Focus on Accountability for Those Left Behind (Devex, 2020): Reference Summary (Article)
No full textThis reference summary presents key information from the following article: https://www.devex.com/news/opinion-why-the-sdgs-defining-decade-must-focus-on-accountability-for-those-left-behind-98171. The source is an opinion article titled “Why the SDGs’ defining decade must focus on accountability for those left behind”, authored by Phumaphi J, Mason E, and Yamin AE, and published by Devex in 2020. The article emphasizes that progress toward the Sustainable Development Goals (SDGs) was already lagging prior to the COVID-19 pandemic and has since been further undermined, highlighting accountability as a central mechanism to ensure that commitments translate into measurable outcomes, particularly for vulnerable populations. The discussion aligns with the principles advanced by the United Nations Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP: Nicholas Kojo Alipui, Dame Carol Kidu, Brenda Killen, Elizabeth Mason, Giorgi Pkhakadze, Jovana Ríos Cisnero, Gita Sen, Alicia Ely Yamin, Kul Chandra Gautam, and Joy Phumaphi), emphasizing the need to strengthen data systems, institutionalize monitoring and independent review, and promote inclusive, rights-based accountability. The article reinforces that sustained accountability is essential to ensure that no one is left behind
Private Sector: Who Is Accountable for Women’s, Children’s and Adolescents’ Health (IAP Report, 2018): Reference Summary (Article)
No full textThis reference summary presents key information from the Independent Accountability Panel (IAP) 2018 report titled “Private Sector: Who Is Accountable for Women’s, Children’s and Adolescents’ Health.” The report critically examines the expanding role of the private sector in global health within the context of the Sustainable Development Goals (SDGs), emphasizing that while private actors contribute significantly to service delivery, innovation, and financing, their accountability remains insufficiently defined and weakly enforced. The analysis highlights persistent inequities in access to health services, medicines, and nutrition, and underscores that market-driven approaches alone cannot ensure equitable health outcomes. It introduces the IAP accountability framework—monitor, review, act, and remedy—and applies it to private sector engagement, identifying major gaps in regulation, transparency, data systems, and independent oversight. The report further explores key sectors including health service delivery, the pharmaceutical industry, and the food industry, demonstrating how unregulated practices can exacerbate inequalities, increase out-of-pocket expenditures, and contribute to rising non-communicable diseases. It calls for strengthened government stewardship, binding regulatory frameworks, improved data and monitoring systems, and global accountability mechanisms to align private sector activities with the right to health. The analysis reflects the work of the United Nations Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP: Alicia Ely Yamin, Carmen Barroso, Kul Chandra Gautam, Brenda Killen, Pali Lehohla, Winfred Lichuma, Elizabeth Mason, Giorgi Pkhakadze, and Dakshitha Wickremarathne), reinforcing that achieving universal health coverage and SDG targets requires robust, independent, and enforceable accountability across both public and private sectors
Stronger Regulation of the Private Sector Needed to Ensure Accountability for Women’s, Children’s and Adolescents’ Health: Reference Summary (Webpage)
No full textThis reference summary presents key information from a report by the Independent Accountability Panel (IAP) examining the role of the private sector in global health accountability for women, children, and adolescents. The report highlights that while private sector actors play an increasingly significant role in health service delivery, financing, and innovation, their accountability remains insufficiently defined and weakly enforced. Despite notable global progress in maternal and child health, major inequities persist across and within countries, with vulnerable populations disproportionately affected. The report identifies critical gaps in regulation, transparency, and independent oversight, emphasizing that profit-driven models can conflict with the realization of health as a fundamental human right. It calls for stronger government stewardship, enforceable regulatory frameworks, improved data systems, and inclusive accountability mechanisms. The analysis reflects the work of the United Nations Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP: Alicia Ely Yamin, Carmen Barroso, Kul Chandra Gautam, Brenda Killen, Pali Lehohla, Winfred Lichuma, Elizabeth Mason, Giorgi Pkhakadze, and Dakshitha Wickremarathne), reinforcing that achieving equitable health outcomes under the Sustainable Development Goals requires robust, independent, and system-wide accountability across both public and private sectors