Conectar
by Ismat Tasnim, Md. Asif Iqbal, Ismat Ara Begum, Mohammad Jahangir Alam, Morten Graversgaard, Paresh Kumar Sarma, Kiril Manevski
Food insecurity and agriculture in South Asia, including Bangladesh, pose significant threats to the well-being and livelihoods of its people. Building adaptive capacities and resilient food systems is crucial for sustainable livelihoods. This study employs the Resilience Index Measurement and Analysis II framework to construct a Resilience Capacity Index (RCI) and analyze its relationship with food security using data from the Bangladesh Integrated Household Survey 2018. The study applies Exploratory Factor Analysis and Structural Equation Modeling to examine the impact of key resilience components such as Access to Basic Services, Adaptive Capacity, and Assets on household resilience. The findings reveal that access to basic services, land assets, and farm equipment positively influences households’ resilience capacity. However, the presence of livestock assets has a negative impact, potentially due to market volatility, climate vulnerability, and disease outbreaks. Additionally, adaptive capacity has a positive but insignificant influence on RCI, suggesting that without enhancing economic opportunities, institutional support, and inclusive development strategies, adaptive capacity could not be enough to foster resilience. However, resilient capacity enhances food security metrics such as the Food Consumption Score and Expenditure. These findings underscore the importance of policies that focus on increasing and maintaining access to basic services, promoting sustainable land management practices, and strengthening social safety nets. This study emphasizes the importance of focusing on livestock assets to ensure their sustainability by stabilizing the livestock market, improving veterinary services, and providing subsidies to reduce maintenance costs.Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide, and detecting CAD in stable chest pain patients is challenging but crucial for early intervention. Strain and strain rate (S/SR) imaging offers a non-invasive method to assess myocardial function and detect coronary stenosis before symptoms occur. In this study, we aimed to demonstrate how effectively and accurately resting strain echocardiography can diagnose CAD.
We conducted a prospective diagnostic accuracy study of patients with chest pain who were referred for CT coronary angiography (CCTA).
Single-centre study conducted in the University Hospital of North Norway in Tromsø, Norway between 2016 and 2021.
A total of 510 patients with chest pain were included in the present study.
Echocardiography examination with S/SR imaging was performed.
Echocardiography findings were compared with CCTA and coronary angiography findings. A novel scoring model incorporating S/SR parameters was developed to assess diagnostic accuracy.
In this study, we showed that receiver operating characteristic curve analysis of early diastolic strain rate (SRe), systolic strain rate (SRs) and peak longitudinal strain (PLS) has high sensitivity and specificity with area under the curve (AUC) scores: SRe, 0.91; PLS, 0.81; SRs, 0.71 in identifying patients undergoing coronary artery bypass graft (CABG). However, these parameters showed lower sensitivity and specificity with AUC scores: SRe, 0.580; SRs, 0.539; PLS, 0.552 in detecting patients undergoing percutaneous coronary intervention (PCI).
Our study emphasises the potential of S/SR imaging in detecting CAD, particularly in high-risk CABG patients. However, its diagnostic utility in PCI patients is limited. Our study highlights the need for comprehensive approaches in coronary disease prediction.
Our research aimed to assess the feasibility of digital health in enhancing healthcare access in the semiurban areas of Karachi, Pakistan.
This qualitative descriptive study was employed at three villages in Gadap, Karachi, Pakistan, with varying socioeconomic contexts, using a feasibility framework. Ethical approval was provided by the Ethical Review Committee (ERC) of The Aga Khan University.
Through purposive sampling, demand and supply-side stakeholders (N=152) were invited to participate in the study, including community leaders, activists and members, representatives from non-governmental organisations, public and private sector healthcare providers, and digital healthcare providers and experts. Both inductive and deductive approaches were used for data analysis.
The assessment of feasible demand-side and supply-side factors would be extremely useful in the planning and implementation of a sustainable digital health programme.
Digital health is an acceptable and practically feasible option and is a potential solution to enhance healthcare access and equity, particularly in semiurban and rural remote areas, where healthcare access is limited. Digital healthcare should not replace inperson healthcare but should instead be offered in combination with it, preferably through a ‘Hub & Spoke Model’ facility. Few challenges exist in implementing digital health, including privacy, ethical issues, lack of evidence-based standards, inadequate training of healthcare providers, technological barriers and access to digital health services by vulnerable populations, such as the elderly, women, individuals who are illiterate and those of low-income class.
Our study concludes that digital healthcare is a dire need and is a potential solution to enhance healthcare access and equity, as it is acceptable and practically feasible. A mix of inperson and digital health consultation should be offered through a hub and spoke model. Few challenges to implementing digital health exist and should be addressed by tailoring digital health through co-creation and engaging all stakeholders.
Sympathetic crashing acute pulmonary oedema (SCAPE) is a menacing medical emergency and a severe form of acute heart failure that requires urgent intervention. Nitroglycerin (NTG) is commonly used in SCAPE management, but the optimal dosing remains uncertain. This meta-analysis compared the efficacy and safety of high-dose vs low-dose NTG in SCAPE patients, assessing mechanical ventilation need, symptom resolution, hospital stay and major adverse cardiovascular events (MACE).
Systematic review and meta-analysis conducted per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, registered in Prospective Register of Systematic Reviews (CRD42024527486).
A comprehensive search in PubMed, Europe PMC and ScienceDirect up to November 2024. Reference lists of included studies were also reviewed.
Randomised controlled trials (RCTs) and observational studies comparing high-dose NTG (≥100 mcg/min) with low-dose NTG (
Two authors independently screened the titles and abstracts of identified studies for eligibility. Full texts of potentially relevant articles were then reviewed. Any discordance or disagreements were resolved through discussion, with final decisions made by consensus. Risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analysis was performed using STATA 17.0 and Review Manager 5.4. The Mantel–Haenszel method was applied for dichotomous outcomes, and the inverse variance approach for continuous outcomes. Heterogeneity was assessed via I-squared (I)2, with a random-effects model applied when needed.
Four studies (one RCT, three observational) with 185 SCAPE patients met inclusion criteria. High-dose NTG reduced mechanical ventilation need (RR=0.31, 95% CI: 0.10 to 0.96; p=0.04, I2=0%, high certainty) and increased symptom resolution within 6 hours (RR=3.88, 95% CI: 1.95 to 7.71; p2=27%, moderate certainty). Hospital stay was shorter (MD=–47.49 hours, 95% CI: –93.76 to –1.21; p=0.04, I2=78%, low certainty). No significant difference was found in MACE risk (RR=0.41, 95% CI: 0.06 to 2.68; p=0.35, I2=72%, very low certainty). Hypotension incidence was 0% in both groups.
High-dose NTG improved clinical outcomes in SCAPE, reducing mechanical ventilation need, symptom duration and hospital stay without increased adverse events. These findings suggest high-dose NTG as a promising treatment strategy. Further large-scale studies are needed to optimise dosing protocols.
Proper positioning in trauma care is essential to prevent associated complications by stabilising haemodynamics, preserving the spine, securing the airway and protecting skin integrity. Motor vehicle crashes are the leading cause of traumatic brain injury (TBI) in Pakistan, necessitating rigorous safety measures and high-quality care due to their severe impact and high mortality rates. Resource-limited settings face significant challenges in providing adequate neurosurgical services. Moreover, there is a notable gap in the existing literature regarding effective care of patients with TBI. This study aims to address a gap in neurosurgical nursing research by exploring how nurses’ interactions and behaviors during positioning interventions contribute to the cultural understanding of nursing care strategies and how the specific cultural context of the neurosurgical ward shapes and informs these interactions.
The current study will use a focused ethnography design. Patients with TBI, along with nurses and doctors, will be purposively selected from the neurosurgical wards of two tertiary care hospitals in Islamabad, Pakistan, based on set eligibility criteria. Data will be collected through participant observation, semistructured interviews and analysis of documents and artefacts to ensure diversity and trustworthiness. Braun and Clarke’s Reflexive Thematic Analysis approach will be used for data analysis.
This study has been approved by the institutional review boards (IRBs) of Shifa Tameer-e-Millat University (IRB# 125–24) and the Pakistan Institute of Medical Sciences (No. f.1.1/215/ERB/SZABMU/1298). Potential ethical concerns will be addressed by protecting the rights of participants including avoiding harm, ensuring privacy and confidentiality and obtaining informed consent. In line with ethnography guidelines, this study adopted the process-informed consent to ensure informed and autonomous involvement. The study results will be shared with key stakeholders and published in scientific journals and presented at conferences.
A growing body of evidence points to a role for herpesviruses in the development of Alzheimer’s disease (AD) and a reduced risk of AD among patients receiving antiherpetic medications. We investigated the association between herpes simplex virus type 1 (HSV-1) and AD using real-world data (RWD) from USA.
In a matched case–control study, patients with AD aged ≥50 years diagnosed between 2006 and 2021 were identified from the IQVIA PharMetrics Plus claims database. Controls were matched in a 1:1 ratio with subjects with AD on age, sex, region, database entry year and healthcare visit numbers.
The study included 344 628 AD case–control pairs. History of HSV-1 diagnosis was present in 1507 (0.44%) patients with AD compared with 823 (0.24%) controls. HSV-1 diagnosis was found to be associated with AD (adjusted OR 1.80; 95% CI 1.65 to 1.96). Patients with HSV-1 who used antiherpetics were less likely to develop AD compared with those who did not use antiherpetics (adjusted HR 0.83, 95% CI 0.74 to 0.92).
Findings from this large RWD study implicate HSV-1 in the development of AD and highlight antiherpetic therapies as potentially protective for AD and related dementia.
Effective management of type 2 diabetes mellitus (T2DM) consists of lifestyle modification and therapy optimisation. While glycaemic monitoring can be used as a tool to guide these changes, this can be challenging with self-monitoring of blood glucose (SMBG). The FreeStyle Libre 3 (FSL3) is a real-time continuous glucose monitoring (CGM) system designed to replace SMBG. The evidence for the benefit of CGM in people with T2DM on non-intensive insulin regimens is limited. This study aims primarily to assess the glycaemic impact of FSL3 in people with suboptimally controlled T2DM treated with basal-only insulin regimens plus sodium-glucose cotransporter-2 (SGLT-2) inhibitor and/or glucagon-like peptide (GLP)-1 agonist.
This is an open-label, multicentre, parallel design, randomised (2:1) controlled trial. Recruitment has been offered across 24 clinical centres in the UK and nationally through self-referral. Adults with T2DM treated with basal-only insulin regimens plus SGLT-2 inhibitor and/or GLP-1 agonist and with screening HbA1c from ≥59 mmol/mol to ≤97 mmol/mol are included. Eligible participants will be randomised to either FSL3 (intervention) for 32 weeks or continuation of SMBG (control). The study is split into two phases, each of 16 weeks duration: phase 1 consisting of self-management with basal-insulin self-titration and phase 2 where additional therapies may be initiated. Control group participants may subsequently enter an optional extension phase to receive FSL3. The primary endpoint is the difference between treatment groups in mean change from baseline in HbA1c at 16 weeks. Secondary outcomes include HbA1c at 32 weeks, CGM-based metrics, therapy changes, physical activity levels and psychosocial measures. An economic evaluation for costs and patient outcomes will be undertaken.
The study was approved by the Health Research Authority, Health and Care Research Wales and the West Midlands-Edgbaston Research Ethics Committee (reference: 23/WM/0092). Study results will be disseminated in peer-reviewed journals.
Identifier assigned by the sponsor: ADC-UK-PMS-22057.
Revision D. Dated, 13 December 2024.
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