Chester Medical School: Recent submissions
Now showing items 21-40 of 246
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Legal Implications for Clinicians in Cybersecurity Incidents: A ReviewCybersecurity incidents in healthcare present significant legal implications for clinicians, necessitating careful consideration of technological advancements and regulatory frameworks. This literature examines the healthcare cybersecurity landscape, emphasizing clinicians’ challenges, and legal responsibilities. It explores the impact of advanced technologies such as artificial intelligence and quantum computing, highlighting the potential benefits and risks, including biases and ethical dilemmas. The review addresses international regulatory differences, offering a comparative analysis of how various countries handle cybersecurity incidents. This analysis provides insights into best practices and identifies areas for improvement. Practical recommendations are provided, tailored to different healthcare settings, including large hospitals and small clinics, to enhance cybersecurity preparedness. Case studies illustrate real-world scenarios, offering practical guidance for clinicians in managing cybersecurity challenges. The review also identifies critical gaps in the literature, particularly concerning artificial intelligence ethics and international regulatory frameworks, suggesting specific areas for future research. These findings underscore the need for robust cybersecurity policies, comprehensive training for healthcare professionals, and a nuanced understanding of the legal landscape. This review informs policymakers, clinicians, and researchers about the evolving nature of cybersecurity challenges in healthcare, addressing key concerns raised by reviewers and contributing to a comprehensive understanding of the field.
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Mediating kinase activity in Ras-mutant cancer: Potential for an individualised approach?It is widely acknowledged that there is a considerable number of oncogenic mutations within the Ras superfamily of small GTPases which are the driving force behind a multitude of cancers. Ras proteins mediate a plethora of kinase pathways, including the MAPK, PI3K, and Ral pathways. Since Ras was considered undruggable until recently, pharmacological targeting of pathways downstream of Ras has been attempted to varying success, though drug resistance has often proven an issue. Nuances between kinase pathway activation in the presence of various Ras mutants are thought to contribute to the resistance, however, the reasoning behind activation of different pathways in different Ras mutational contexts is yet to be fully elucidated. Indeed, such disparities often depend on cancer type and disease progression. However, we are in a revolutionary age of Ras mutant targeted therapy, with direct-targeting KRAS-G12C inhibitors revolutionising the field and achieving FDA-approval in recent years. However, these are only beneficial in a subset of patients. Approximately 90% of Ras-mutant cancers are not KRAS-G12C mutant, and therefore raises the question as to whether other distinct amino acid substitutions within Ras may one day be targetable in a similar manner, and indeed whether better understanding of the downstream pathways these various mutants activate could further improve therapy. Here, we discuss the favouring of kinase pathways across an array of Ras-mutant oncogenic contexts and assess recent advances in pharmacological targeting of various Ras mutants. Ultimately, we will examine the utility of individualised pharmacological approaches to Ras-mediated cancer.
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Mental health and public health: Improving mental health and well-being of communities in the modern world: A pragmatic approach using the Global Mental Health Assessment Tool/PCThe World Health Organization report of 2022 on mental health highlights the slow progress in reducing the treatment gap for people with mental illness worldwide. It emphasizes that everyone should participate in improving the mental health and well-being of the communities. The governments should put their act together and all agencies should work in coordination to address the mental health needs of their population. They should also focus on mental health promotion, early intervention, and prevention of suicide. The Mental Health Action Plan 2013–2030 outlines the importance of leadership and governance for mental health in providing comprehensive, integrated, and responsive mental health and social care services in community-based settings. Stigma, human resource shortages, fragmented service delivery models, and poor commitment of authorities for mental health are some of the factors for the ongoing service gap in mental health. Providing mental health knowledge and assessment skills to frontline workers, supporting frontline workers by mental health specialists using their leadership skills, and fully utilizing mobile and Internet technology in providing education and training as well as providing services could bring down the treatment gap of mental disorders worldwide. The Global Mental Health Assessment Tool for Primary Care and General Health Setting (GMHAT/PC)-based training package has been developed and successfully implemented in training frontline health workers in different parts of the word. The authors propose that this may be a pragmatic way to integrate mental health in public health by skilling frontline workers in assessing mental health along with physical health and by providing holistic care.
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Co-presence of Epstein-Barr Virus and Human Papillomavirus is associated with a high frequency of p53 gene mutation in cervical cancer diagnosed in southern NigeriaBackground: Evidence shows that the co-existence of Human papillomavirus (HPV) and Epstein-Barr virus (EBV) is associated with aggressive and poorly differentiated cervical squamous cell carcinomas (CSCC) phenotype. Aim: This study aimed to determine the frequency of mutant p53 (mtp53) gene in single and co-existence of HPV and oncogenic EBV latent membrane protein 1 (E-LMP1) among women diagnosed with CSCC in Southern Nigeria. Methods: This retrospective cohort study included 105 cervical cancer tissues, diagnosed between January 2016 and December 2018. The tissue sections were immunohistochemically stained for mtp53, E-LMP1, and HPV proteins and scored accordingly. Descriptive, Chi- square test and Pearson’s correlation were performed, and statistical significance was set at p≤0.05. Result: Among the stained sections, the frequency of HPV, E-LMP1, and E-LMP1/HPV detection was 8.6%, 20.0%, and 42.9%, respectively. The mtp53 detection was higher in ELMP1/HPV co-presence (86.7%) compared with HPV and ELMP1 mono-presence (55.6%, and 14.3%, respectively), and this was statistically significant (p< 0.0001). The prevalence of invasive and non-invasive cases of CSCC were 62.9% and 37.1%, respectively. E-LMP1 and HPV co-presence were significantly higher in invasive cervical cancer (48.5%) compared to non-invasive cervical cancer cases (33.3%) at p= 0.156. The E-LMP1 presence was significantly higher in poorly differentiated CSCC (50.0%) compared to the moderately and well- differentiated CSCC (25.0% and 10.5%, respectively) at p= 0.011. Conclusion: This study revealed a higher frequency of EBV/HPV co- infection in CSCC. It also shown- that a higher frequency of mtp53 in E-LMP1 and HPV co-presence, suggesting that E-LMP1 could be responsible for the high CSCC lethality in West Africa.
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Lifelong dietary protein restriction induces denervation and skeletal muscle atrophy in miceAs a widespread global issue, protein deficiency hinders development and optimal growth in offspring. Maternal low-protein diet influences the development of age-related diseases, including sarcopenia, by altering the epigenome and organ structure through potential increase in oxidative stress. However, the long-term effects of lactational protein restriction or postnatal lifelong protein restriction on the neuromuscular system have yet to be elucidated. Our results demonstrated that feeding a normal protein diet after lactational protein restriction did not have significant impacts on the neuromuscular system in later life. In contrast, a lifelong low-protein diet induced a denervation phenotype and led to demyelination in the sciatic nerve, along with an increase in the number of centralised nuclei and in the gene expression of atrogenes at 18 months of age, indicating an induced skeletal muscle atrophy. These changes were accompanied by an increase in proteasome activity in skeletal muscle, with no significant alterations in oxidative stress or mitochondrial dynamics markers in skeletal muscle later in life. Thus, lifelong protein restriction may induce skeletal muscle atrophy through changes in peripheral nerves and neuromuscular junctions, potentially contributing to the early onset or exaggeration of sarcopenia.
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Active case finding and evaluation of IL-6 production among household contacts of pulmonary tuberculosis patients in a high disease settingBackground: Tuberculosis (TB) is a top infectious disease killer worldwide and remains a huge public health concern. However, most TB case findings are limited to self-referral (passive case finding), when individuals develop symptoms of TB. Only 15% of disease burden in Nigeria are reported. In view of this, it is important to assess the latent and active disease burden amongst HHC of TB patients suffering from pulmonary TB. In addition, it has been suggested that IL-6 levels could be used as a prognostic marker in exposed individuals. IL-6 levels were assessed in this cohort. Methods: A total of 205 subjects participated in this study, comprising 62 pulmonary TB index cases and 143 of their household contacts. Also, 54 apparently healthy subjects were recruited to serve as controls. Active case finding was performed amongst the HHC, using sputum and blood samples; they were tested for active TB. Blood samples were also collected for measuring IL-6 levels. Results: Findings reveal 6.3% previously undiagnosed active TB among the HHC of the TB patients and a significantly higher number of latently infected TB cases compared to the control population (p=0.0078). There were significant differences when comparing HIV co-infected index group to their HIV negative counterparts (P=0.032). Significantly different IL-6 levels were found among the study groups and sub-groups (p<0.0001), with significantly higher levels in TB mono-infection compared to in TB/HIV co-infection (p=0.031).Conclusions: These results demonstrate the importance of active TB case finding for TB control and the possible role of IL-6 as a diagnostic marker in TB control.
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Assessment of the demographic burden of epidemics and diseases within the African Sub-Region: A review of recent epidemiological data, responses, and resultant psychosocial risk tendenciesBackground: Over the past few decades, epidemic outbreaks and disease occurrences have become more frequent and widespread in Africa, posing challenges for poor countries in the region and impacting vulnerable populations. Limited resources, inadequate healthcare infrastructure, socioeconomic inequalities, malnutrition, mass gatherings, and lack of proper sanitation and hygiene contribute to Africa’s high burden of epidemics and infectious diseases such as cholera, measles, monkeypox, Ebola viral disease, and COVID-19. This paper reviewed epidemic outbreaks and diseases transmitted through intimate contact in Africa and their impacts on vulnerable populations. Methods: A narrative review approach was adopted to gather and analyze the relevant literature on epidemic outbreaks in African sub-regions. The review encompassed causes, transmission patterns, demographic impact, community susceptibility, preventive measures, and psychosocial risk-taking behaviors. Results: This study emphasizes the importance of addressing the causes of response lapses and the resulting human, material, and economic losses in the region. Effective preventive measures include disease surveillance, early mitigation strategies, contact tracing, personal protective measures, improved political and public health leadership, and socioeconomic equity. However, the review highlights challenges in implementing these measures effectively due to limited resources, delayed detection, and difficulties in scaling up response solutions. Conclusions: There is a need for a comprehensive approach involving health departments, infrastructure development, and addressing socioeconomic factors.
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Phytochemical composition, in silico molecular docking analysis and antibacterial activity of Lawsonia inermis Linn leaves extracts against Extended Spectrum Beta-Lactamases-Producing strains of Klebsiella pneumoniaeKlebsiella pneumoniae is an opportunistic Gram-negative bacterium in the Enterobacteriaceae family associated with a wide range of diseases, such as pneumonia, bloodstream infections, meningitis and urinary tract infections. Infections caused by drug-resistant strains of Klebsiella pneumoniae pose a significant threat to the effectiveness of conventional antibiotics. Hence, this has led to the need to explore alternative antimicrobial therapies, especially natural products derived from plant sources. This study assessed the phytochemical composition and antibacterial properties and performed a molecular docking analysis of Henna leaves (Lawsonia inermis L.) extracts on strains of Klebsiella pneumoniae. Crude ethanol and methanol extracts of L. inermis L. were prepared at different concentrations (25, 50, 75 and 100 mg/mL) and tested on extended spectrum beta-lactamases (ESBLs)-producing strains of Klebsiella pneumoniae. Phytocompounds were identified using gas chromatography–mass spectrometry (GC-MS) and further subjected to virtual ligands screening with DataWarrior (v05.02.01) and a molecular docking analysis using AutoDock4.2 (v4.2.6). The active compounds of L. inermis L. were determined by the docking analysis, including phytochemical, physicochemical, pharmacokinetics and docking score. The GC-MS analysis identified 27 phytoconstituents, including ethyl acetate, sclareol, 2-[1,2-dihydroxyethyl]-9-[β-d-ribofuranosyl] hypoxanthine, α-bisabolol and 2-Isopropyl-5-methylcyclohexyl 3-(1-(4-chlorophenyl)-3-oxobutyl)-coumarin-4-yl carbonate. The 27 compounds were then screened for their physicochemical and pharmacokinetic properties. The results revealed that the methanol extracts at 100 mg/mL showed significantly higher (p < 0.05) zones of inhibition (13.7 ± 1.2 mm), while the ethanol extracts at 50 mg/mL were significantly lower (6.3 ± 0.6 mm) compared to all the other treatments. The docking analysis revealed that out of the 27 compounds identified, only twelve (12) compounds have a drug-likeness activity. The 12 compounds were further subjected to docking analysis to determine the binding energies with the CTX-M protein of Klebsiella pneumoniae. Only one compound [CID_440869; (2-[1,2-dihydroxyethyl]-9-[β-d-ribofuranosyl] hypoxanthine)] had the best binding energy of −9.76 kcal/mol; hence, it can be considered a potentially suitable treatment for infections caused by ESBLs-producing strains of Klebsiella pneumoniae. This study has demonstrated that L. inermis L. extracts have antibacterial effects. Further research could explore the potential antimicrobial applications of L. inermis L. extracts to many bacterial strains.
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Effect of lactational low-protein diet on skeletal muscle during adulthood and ageing in male and female mouse offspringSarcopenia is characterised by the loss of skeletal muscle mass and function, which leads to a high risk of increased morbidity and mortality. Maternal malnutrition has been linked to impaired development of skeletal muscle of the offspring; however, there are limited studies that report the long-term effect of a maternal low-protein diet during lactation on the ageing of skeletal muscles. This study aimed to examine how a maternal low-protein diet (LPD) during lactation affects skeletal muscle ageing in the offspring. Pups born from control mothers were lactated by mothers fed with an LPD. Post-weaning, mice were either maintained on an LPD or switched to a control, normal-protein diet (NPD). In males, an LPD mainly affected the size of the myofibres without a major effect on fibre number and led to reduced grip strength in ageing mice (24 months). Female mice from mothers on an LPD had a lower body and muscle weight at weaning but caught up with control mice at 3 months. During ageing, the muscle weight, myofibre number and survival rate of female pups were significantly affected. These findings highlight the effect of an LPD during lactation on skeletal muscle ageing, the lifespan of offspring and the importance of sexual dimorphism in response to dietary challenges.
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Exploring TSGA10 function: A crosstalk or controlling mechanism in the signaling pathway of carcinogenesis?Cancer-specific antigens have been a significant area of focus in cancer treatment since their discovery in the mid-twentieth century. Cancer germline antigens are a class of antigens specifically overexpressed in germline tissues and cancer cells. Among these, TSGA10 (testis-specific gene antigen 10) is of great interest because of its crucial impact on cancer progression. Early studies explored TSGA10 expression in a variety of cancer types. More recent studies revealed that TSGA10 can suppress tumor progression by blocking cancer cell metabolism, angiogenesis, and metastasis. An open question regarding the TSGA10 is why cancer cells must express a protein that prevents their progression. To answer this question, we conducted a comprehensive review to engage the TSGA10 in the context of the current understanding of “malignant transformation”. This review demonstrated that TSGA10 expression level in cancer cells depends on the cancer stage across malignant transformation. In addition, we evaluated how TSGA10 expression can prevent the “cancer hallmarks”. Given this information, TSGA10 can be of great interest in developing effective targeted anti-cancer therapies.
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Polycystic Ovary Syndrome and the Internet of Things: A Scoping ReviewPolycystic ovary syndrome (PCOS) is a prevalent endocrine disorder impacting women’s health and quality of life. This scoping review explores the use of the Internet of Things (IoT) in PCOS management. Results were grouped into six domains of the IoT: mobile apps, social media, wearables, machine learning, websites, and phone-based. A further domain was created to capture participants’ perspectives on using the IoT in PCOS management. Mobile apps appear to be useful for menstrual cycle tracking, symptom recording, and education. Despite concerns regarding the quality and reliability of social media content, these platforms may play an important role in disseminating PCOS-related information. Wearables facilitate detailed symptom monitoring and improve communication with healthcare providers. Machine learning algorithms show promising results in PCOS diagnosis accuracy, risk prediction, and app development. Although abundant, PCOS-related content on websites may lack quality and cultural considerations. While patients express concerns about online misinformation, they consider online forums valuable for peer connection. Using text messages and phone calls to provide feedback and support to PCOS patients may help them improve lifestyle behaviors and self-management skills. Advancing evidence-based, culturally sensitive, and accessible IoT solutions can enhance their potential to transform PCOS care, address misinformation, and empower women to better manage their symptoms.
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Cultural Adaptation and Validation of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-Cog) - Kannada Version for a South Indian populationBackground: At present there a few culturally adapted and validated standardised neuropsychological tests for detection of persons with dementia in low-and middle income countries. Therefore, we conducted an adaptation, validation and feasibility study of the Alzheimer’s disease Assessment Scale – Cognitive Subscale (ADAS-Cog) in Kannada for use among older adults. Methods: two panels set up involving participants, subject experts and other important stakeholders. Several structured qualitative interviews informed the process of cultural adaptations (structure, content and language) the ADAS-Cog-Kannada. For the purpose of validation 120 men and women (58 of them had mild to moderate dementia and 62 of them were age and gender matched controls) were recruited. Concurrent validity was evaluated against the 10/66 Battery of Cognitive Tests in Kannada. Results: The ADAS-Cog-Kannada demonstrated internal consistency and concurrent validity. Sensitivity and Specificity for ADAS-Cog Kannada (score>14) for diagnosis of dementia were 85% and 92% respectively. It was feasible to administer ADAS-Cog in a standardised manner among community dwelling older adults and took an average of 30 minutes to administer. Conclusion: ADAS-Cog was adapted to Kannada and evaluated by employing robust methods resulting in an instrument that we believe is now culturally acceptable. Psychometric properties of ADAS-Cog Kannada were strong and linguistically acceptable. It can be used in clinical setting among Kannada speaking population and the culturally adapted.
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Impact of Different Anti-Hyperglycaemic Treatments on Bone Turnover Markers and Bone Mineral Density in Type 2 Diabetes Mellitus Patients: A Systematic Review and Meta-AnalysisDiabetic bone disease (DBD) is a frequent complication in patients with type 2 diabetes mellitus (T2DM), characterised by altered bone mineral density (BMD) and bone turnover marker (BTMs) levels. The impact of different anti-diabetic medications on the skeleton remains unclear, and studies have reported conflicting results; thus, the need for a comprehensive systematic review is of paramount importance. A systematic search was conducted in PubMed and the Cochrane Library. The primary outcomes assessed were changes in BMD in relation to different anatomical sites and BTMs, including mainly P1NP and CTX as well as OPG, OCN, B-ALP and RANK-L. Risk of bias was evaluated using the JADAD score. The meta-analysis of 19 randomised controlled trials comprising 4914 patients showed that anti-diabetic medications overall increased BMD at the lumbar spine (SMD: 0.93, 95% CI [0.13, 1.73], p = 0.02), femoral neck (SMD: 1.10, 95% CI [0.47, 1.74], p = 0.0007) and in total hip (SMD: 0.33, 95% CI [−0.25, 0.92], p = 0.27) in comparison with placebo, but when compared with metformin, the overall effect favoured metformin over other treatments (SMD: −0.23, 95% CI [−0.39, −0.07], p = 0.004). GLP-1 receptor agonists and insulin analogues seem to improve BMD compared to placebo, while SGLT2 inhibitors and thiazolidinediones (TZDs) showed no significant effect, although studies’ number cannot lead to safe conclusions. For BTMs, TZDs significantly increased P1NP levels compared to placebo. However, no significant differences were observed for CTX, B-ALP, OCN, OPG, and RANK-L between anti-diabetic drugs and metformin or placebo. High heterogeneity and diverse follow-up durations among studies were evident, which obscures the validity of the results. This review highlights the variable effects of anti-diabetic drugs on DBD in T2DM patients, emphasising the need for long-term trials with robust designs to better understand these relationships and inform clinical decisions.
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Single-stage revision in the management of prosthetic joint infections after total knee arthroplasty - A review of current conceptsProsthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA); and the gold standard surgical approach involves a two-staged, revision TKA (TSR). Owing to the newer, emerging evidence on this subject, there has been gradual shift towards a single-stage revision approach (SSR), with the purported benefits of mitigated patient morbidity, decreased complications and reduced costs. However, there is still substantial lacuna in the evidence regarding the safety and outcome of the two approaches in chronic PJI. This study aimed to comprehensively review of the literature on SSR; and evaluate its role within Revision TKA post PJI. The narrative review involved a comprehensive search of the databases (Embase, Medline and Pubmed), conducted on 20th of January 2024 using specific key words. All the manuscripts discussing the use of SSR for the management of PJI after TKA were considered for the review. Among the screened manuscripts, opinion articles, letters to the editor and non-English manuscripts were excluded. The literature search yielded a total 232 studies. Following a detailed scrutiny of these manuscripts, 26 articles were finally selected. The overall success rate following SSR is reported to range from 73 % to 100 % (and is comparable to TSR). SSR is performed in PJI patients with bacteriologically-proven infection, adequate soft tissue cover, immuno-competent host and excellent tolerance to antibiotics. The main difference between SSR and TSR is that the interval between the 2 stages is only a few minutes instead of 6 weeks. Appropriate topical, intraoperative antibiotic therapy, followed by adequate postoperative systemic antibiotic cover are necessary to ascertain good outcome. Some of the major benefits of SSR over TSR include reduced morbidity, decreased complications (such as arthrofibrosis or anesthesia-associated adverse events), meliorated extremity function, earlier return to activities, mitigated mechanical (prosthesis-associated) complications and enhanced patient satisfaction. SSR is a reliable approach for the management of chronic PJI. Based on our comprehensive review of the literature, it may be concluded that the right selection of patients, extensive debridement, sophisticated reconstruction strategy, identification of the pathogenic organism, initiation of appropriate antibiotic therapy and ensuring adequate follow-up are the key determinants of successful outcome. To achieve this will undoubtedly require an MDT approach to be taken on a case-by-case basis. [Abstract copyright: © 2024 The Authors.]
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Lifelong effects of maternal low protein diet on skeletal muscle development and ageing in male offspringsConference abstract published in a journal
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Metalloelastase-12 is involved in the temporomandibular joint inflammatory response as well as cartilage degradation by aggrecanases in STR/Ort miceTemporomandibular joint dysfunction (TMJD) is characterised by clinical symptoms involving both the masticatory muscles and the temporomandibular joint (TMJ). Disc internal derangement and osteoarthritis (OA) are the most common forms of TMJD. Currently, the molecular process associated with degenerative changes in the TMJ is unclear. Our previous study showed that elastin-digested peptides act on human TMJ synovial cells and lead to upregulation of interleukin-6 (IL-6) and metalloelastase-12 (MMP-12; an elastin-degrading enzyme) in vitro. However, there is limited information regarding the involvement of elastin-degradation by MMP-12 in the processes of inflammatory responses and cartilage degradation in vivo. STR/Ort mice were used as a model of TMJ OA in the present study. Significant articular cartilage degeneration was observed starting at 20 weeks of age in the STR/Ort mice and this progressed gradually until 40 weeks, compared with the age-matched CBA mice. Immunostaining analysis showed that MMP-12 and IL-6 were expressed in the chondrocytes in the superficial zones of the cartilage. Immunostaining also showed that aggrecanases [a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4 and ADAMTS-5] were expressed in the chondrocytes in the superficial zones of the cartilage. These findings suggest that an inflammatory and degradative process was initiated in the TMJ. Harmful mechanical stimuli, particularly pressure, may cause damage to the elastin fibres in the most elastin-rich superficial layer of the articular cartilage. Elastin-digested peptides are then generated as endogenous warning signals and they initiate a pro-inflammatory cascade. This leads to upregulation of pro-inflammatory mediators, such as IL-6 and MMP-12, which further trigger tissue damage resulting in elevated levels of elastin-digested peptides. IL-6 increases expression of the aggrecanases ADAMTS-4 and ADAMTS-5, following cartilage degradation. This leads to the establishment of a positive feedback loop and may result in chronic inflammation and cartilage degradation of the TMJ in vivo.
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Non-invasive Scores and Serum Biomarkers for Fatty Liver in the Era of Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD): A Comprehensive Review From NAFLD to MAFLD and MASLDThe prevalence of non-alcoholic fatty liver disease (NAFLD) is rapidly increasing worldwide, making it the leading cause of liver related morbidity and mortality. Currently, liver biopsy is the gold standard for assessing individuals with steatohepatitis and fibrosis. However, its invasiveness, sampling variability, and impracticality for large-scale screening has driven the search for non-invasive methods for early diagnosis and staging. In this review, we comprehensively summarise the evidence on the diagnostic performance and limitations of existing non-invasive serum biomarkers and scores in the diagnosis and evaluation of steatosis, steatohepatitis, and fibrosis. Several non-invasive serum biomarkers and scores have been developed over the last decade, although none has successfully been able to replace liver biopsy. The introduction of new NAFLD terminology, namely metabolic dysfunction-associated fatty liver disease (MAFLD) and more recently metabolic dysfunction-associated steatotic liver disease (MASLD), has initiated a debate on the interchangeability of these terminologies. Indeed, there is a need for more research on the variability of the performance of non-invasive serum biomarkers and scores across the diagnostic entities of NAFLD, MAFLD and MASLD. There remains a significant need for finding valid and reliable non-invasive methods for early diagnosis and assessment of steatohepatitis and fibrosis to facilitate prompt risk stratification and management to prevent disease progression and complications. Further exploration of the landscape of MASLD under the newly defined disease subtypes is warranted, with the need for more robust evidence to support the use of commonly used serum scores against the new MASLD criteria and validation of previously developed scores. [Abstract copyright: © 2024. The Author(s).]
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Cardiovascular risk and physical activity in Syrians living in England compared with the population of North West England: a cross-sectional studyObjective: This study aims to assess the 10-year cardiovascular risk and physical activity among Syrians residing in England and compare them with the North West England population. Design: Cross-sectional study. Setting: Bilingual online questionnaire distributed through social media platforms from 21 June to 23 July 2023. Participants: Syrian individuals in England (aged 25–69, migrated post-2010) and residents of North West England within the same age bracket. All participants had no history of cardiovascular disease (CVD). Primary and secondary outcome measures: Primary outcome measures included differences in QRISK3 score, 10-year relative risk (RR), metabolic equivalent of task (MET) and self-reported physical activity between the two groups. Secondary outcome measures included subgroup analyses based on sex and age. Results: Of the 273 eligible participants (137 in the Syrian group and 136 in the Northwest England group), the QRISK3 score was twofold higher in the Syrian group (2.20, 5.50) than in the North West England group (1.20, 3.15) (p=0.042). The 10-year RR was approximately three times higher in the Syrian group (p<0.001), while MET was about twice as high in the Northwest England group (p<0.001). Conclusions: Despite relocating to England, Syrians face substantially elevated cardiovascular risks attributed to an unhealthy lifestyle, including smoking, reduced physical activity, increased body mass index and diabetes, coupled with a strong family history of CVD in first-degree relatives under the age of 60. The study underscores the need for early assessment, risk factor identification and tailored interventions for this population. Raising awareness, particularly in the context of smoking, and promoting physical activity are crucial for mitigating cardiovascular risks. The findings emphasise the importance of culturally sensitive interventions to address the unique health challenges of Syrians in the UK.
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Barriers and incentives influencing the use of partograph in Nigeria: A comprehensive reviewThis comprehensive review examines the barriers and incentives influencing the use of partographs in maternal healthcare within Nigeria. Maternal mortality remains a critical concern in the country, making it imperative to evaluate the factors that shape the adoption of essential tools like the partograph. The literature review underscores the global significance of partograph utilization, emphasizing its role in improving maternal outcomes. A particular focus is placed on existing studies and findings relevant to Nigeria, providing a nuanced understanding of the challenges and opportunities faced by healthcare providers. The article delves into the barriers hindering the widespread adoption of partographs in Nigeria, including issues related to training, resource availability, and cultural considerations. Additionally, it explores the incentives that can positively influence healthcare practitioners and facilities to integrate partographs into their maternal care protocols. Government policies and initiatives in Nigeria related to maternal healthcare and partograph use are also analyzed, shedding light on the broader contextual factors impacting implementation. Through examining case studies, the review presents real-world examples that illustrate successful and challenging instances of partograph implementation. The article concludes with actionable recommendations to overcome identified barriers and enhance incentives for effectively integrating partographs into maternal healthcare practices in Nigeria. This study contributes valuable insights to the ongoing discourse on improving maternal healthcare, emphasizing the need for tailored strategies in the Nigerian context.
