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Epidemiology and Health 2022Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the first systematic review and meta-analysis on its prevalence in humans, animals, and ticks in the Eastern Mediterranean region.
METHODS
Major Iranian and international databases were searched from 2000 to 2021. We extracted the prevalence of Q fever in blood samples from animals and milk samples from animals, ticks, and humans as the main outcome. We reported the prevalence of seropositivity and molecular positivity as point estimates and 95% confidence intervals (CIs).
RESULTS
In this review, 112 papers were identified. The overall seroprevalence of Q fever was 22.4% (95% CI, 19.8 to 25.1). The pooled prevalence of Q fever in ticks was 17.5% (95% CI, -1.3 to 36.4). The prevalence was 25.5% (95% CI, 16.1 to 34.9) in humans. The prevalence of Q fever in animal blood samples from goats, sheep, camels, cattle, cats, dogs, horses, and buffalo were 28.1%, 25.1%, 25.0%, 20.1%, 9.8%, 8.4%, 6.5%, and 6.3%, respectively. Furthermore, the prevalence of Q fever in milk samples of animals was higher in cattle (20.3%) than in sheep (20.0%), goats (16.4%), and camels (3.3%).
CONCLUSIONS
Coxiella burnetii infections are common in humans and in a wide range of animal species, but they are still not recognized in many countries in the Eastern Mediterranean region, thus presenting a significant threat to human and animal health in the region.
Topics: Cattle; Humans; Animals; Sheep; Dogs; Horses; Q Fever; Coxiella burnetii; Prevalence; Seroepidemiologic Studies; Camelus; Iran; Goats
PubMed: 36317399
DOI: 10.4178/epih.e2022097 -
Ophthalmology Oct 2022The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight...
PURPOSE
The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature.
CLINICAL RELEVANCE
Health care disparities continue to plague the nation's well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age).
METHODS
A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms "barriers and facilitators to health care," "access," and "disparities in general and sub-specialty eye care." Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria.
RESULTS
Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH.
CONCLUSIONS
The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.
Topics: Cataract; Ethnicity; Health Personnel; Healthcare Disparities; Humans; Referral and Consultation
PubMed: 36058739
DOI: 10.1016/j.ophtha.2022.07.012 -
International Journal of Colorectal... Aug 2022Haemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard.
PURPOSE
Haemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively novel option. This systematic review and meta-analysis objectively evaluated the efficacy, safety, and tolerability of LHP compared against conventional (Milligan-Morgan) open haemorrhoidectomy (CoH).
METHOD
A comprehensive search of MEDLINE, EMBASE, CENTRAL, and Google Scholar was conducted. Randomised controlled trials (RCTs) and comparative cohort studies (CCSs) which compared LHP against CoH were included, with postoperative pain as the primary outcome. Secondary outcomes included intraoperative characteristics, short- and moderate-term outcome, and complications.
RESULTS
A total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed. LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month. The mean dosage and duration of postoperative analgesia use was similarly lower, with a mean difference of 4.88 mg (morphine) and 2.25 days, respectively. Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21-2.40) at a mean follow-up duration of 8.58 ± 9.55 months. LHP resulted in lower blood loss and was 12.74 min shorter on average. LHP's postoperative recovery time was 9.03 days less with equivalent or decreased risk of most short- and moderate-term complications except anal thrombosis.
CONCLUSION
Our study suggests that LHP is more tolerable than CoH, providing patients with superior postoperative quality of life at equivalent moderate-term efficacy. These findings contribute to improved understanding of LHP and its potential at enhancing the quality of HD care.
Topics: Hemorrhoidectomy; Hemorrhoids; Humans; Lasers; Pain Measurement; Pain, Postoperative
PubMed: 35906356
DOI: 10.1007/s00384-022-04225-4 -
Journal of Addictive Diseases 2023Disparities in the healthcare system are a topic of continuous discussion in public health. Despite decades of conversations with regards to health inequities,...
Disparities in the healthcare system are a topic of continuous discussion in public health. Despite decades of conversations with regards to health inequities, disparities still plague substance use disorder treatment. Opioid use disorder treatment is no exception as disparities has been attributed to the ingrained and deeply flawed mindset of discrimination. Hence, this review highlights the role of policy with regards to discrimination.
Topics: Humans; Opioid-Related Disorders; Health Policy
PubMed: 35757973
DOI: 10.1080/10550887.2022.2091397 -
Archives of Razi Institute Dec 2021Peste des petits ruminants (PPR) or goat plague is considered a leading, highly contagious, and most lethal infectious viral disease of small ruminants affecting the... (Meta-Analysis)
Meta-Analysis Review
Peste des petits ruminants (PPR) or goat plague is considered a leading, highly contagious, and most lethal infectious viral disease of small ruminants affecting the worldwide livestock economy and international animal trade. Although sheep and goats are the primarily affected, the PPR Virus (PPRV) host range has expanded to other livestock (large ruminants) and wildlife animals over the last few decades, resulting in serious concern to the ongoing PPR global eradication program, which is primarily optimized, designed, and targeted towards accessible sheep and goat population. A systematic review and meta-analysis study was conducted to estimate the prevalence and spill-over infection of PPRV in large ruminants (bovine and camel) and wildlife. Published articles from 2001 to October 2021 on the "PPR" were searched in four electronic databases of PubMed, Scopus, Science direct, and Google Scholars. The articles were then selected using inclusion criteria (detection/prevalence of PPRV in bovine, camel, and wildlife population), exclusion criteria (only sheep or goats, lack of prevalence data, experimental trial, test evaluation, and reviews written in other languages or published before 2001), and the prevalence was estimated by random effect meta-analysis model. In the current study, all published articles belonged to Africa and Asia. The overall pooled prevalence of PPR estimates was 24% (95% CI: 15-33), with 30% in Asia (95% CI: 14-49) and 20% in Africa (95% CI: 11-30). The overall estimated pooled prevalence at an Africa-Asia level in bovine and camel was 13% (95% CI: 8-19), and in wildlife, it was 52% (95% CI: 30-74) with significant heterogeneity (I = 97%) in most pooled estimates with a high prevalence in atypical hosts and wildlife across Asia and Africa. Over the last two decades, the host range has increased drastically in the wildlife population, even for prevalent PPR in the unnatural hosts only for a short time, contributing to virus persistence in multi-host systems with an impact on PPR control and eradication program. This observation on the epidemiology of the PPRV in unnatural hosts demands appropriate intervention strategies, particularly at the livestock-wildlife interface.
Topics: Animals; Animals, Wild; Camelus; Cattle; Cattle Diseases; Goat Diseases; Goats; Livestock; Peste-des-Petits-Ruminants; Peste-des-petits-ruminants virus; Prevalence; Sheep; Sheep Diseases
PubMed: 35546985
DOI: 10.22092/ari.2021.356900.1939 -
Vector Borne and Zoonotic Diseases... Apr 2022Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients...
Bubonic plague classically manifests as a painful, swollen superficial lymph node (bubo) that is readily apparent on physical examination. However, patients occasionally present with buboes formed in deep lymph nodes, which are difficult to detect and can lead to delays in diagnosis and treatment. To better characterize this phenomenon, we conducted a review of the published literature to identify reports of occult buboes among patients with plague. Articles were identified from two sources: a systematic review on plague treatment, and a search of the PubMed Central database. Articles were eligible if they described a patient with plague who had (1) no evidence of lymphadenopathy on examination; and (2) at least one bubo discovered during surgery or autopsy. Six patients with occult buboes were identified among 5120 articles screened. The majority were male ( = 4/6) and three were <15 years of age. Fever ( = 6/6), leukocytosis ( = 5/6), and abdominal pain or distention ( = 4/6) were the most common signs and symptoms. Initial diagnoses included other bacterial infections, appendicitis, or acute abdomen. Four patients received at least one antimicrobial effective against ; however, some experienced delayed treatment due to late diagnosis of plague. Occult buboes were discovered in retroperitoneal ( = 2), inguinal/femoral ( = 2), mesenteric ( = 2), axillary ( = 1), and mediastinal ( = 1) regions. Four of the six patients died. Patients with occult buboes experienced delays in the diagnosis of plague and a high fatality rate. Clinicians in plague-endemic areas should consider the presence of occult buboes among patients with compatible symptoms and exposure history.
Topics: Animals; Autopsy; Female; Fever; Male; Plague; Strigiformes; Yersinia pestis
PubMed: 35404104
DOI: 10.1089/vbz.2022.0012 -
Osong Public Health and Research... Feb 2022Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of...
Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of antibiotic resistance. Thus, this systematic review was conducted to alert clinicians to this pathogen's potential antimicrobial resistance. A review of the literature was conducted for experimental reports and systematic reviews on the topics of plague, Y. pestis, and antibiotic resistance. From 1995 to 2021, 7 Y. pestis isolates with 4 antibiotic resistance mechanisms were reported. In Y. pestis 17/95, 16/95, and 2180H, resistance was mediated by transferable plasmids. Each plasmid contained resistance genes encoded within specific transposons. Strain 17/95 presented multiple drug resistance, since plasmid 1202 contained 10 resistance determinants. Strains 16/95 and 2180H showed single antibiotic resistance because both additional plasmids in these strains carried only 1 antimicrobial determinant. Strains 12/87, S19960127, 56/13, and 59/13 exhibited streptomycin resistance due to an rpsl gene mutation, a novel mechanism that was discovered recently. Y. pestis can acquire antibiotic resistance in nature not only via conjugative transfer of antimicrobial-resistant plasmids from other bacteria, but also by gene point mutations. Global surveillance should be strengthened to identify antibiotic-resistant Y. pestis strains by whole-genome sequencing and drug susceptibility testing.
PubMed: 35255676
DOI: 10.24171/j.phrp.2021.0288 -
Journal of Cardiac Surgery Apr 2022Native mitral valve infective endocarditis (IE) plagues patients and surgeons alike because of its high mortality and recurrence rates as well as poor prognosis. Mitral... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Native mitral valve infective endocarditis (IE) plagues patients and surgeons alike because of its high mortality and recurrence rates as well as poor prognosis. Mitral valve repair (MVP) and mitral valve replacement (MVR) are two main surgical methods. However, the question of which benefits patients more remains controversial. Thus, we conducted a meta-analysis to systematically review the two approaches, focusing on the early survival rate and long-term outcomes.
METHODS
A meta-analysis and systematic review were conducted using studies sourced from the PubMed, Embase, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk ratio (RR) or hazard ratio (HR) values were calculated, and publication bias was tested.
RESULTS
A total of 17 relevant publications with a total population of 3759 patients, with 1180 patients having undergone MVP and 2579 patients having undergone MVR, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR, 0.51; 95% confidence interval [CI], 0.39-0.66; p < .00001), a higher long-term survival rate (HR, 0.69; 95% CI, 0.58-0.81; p < .001; I = 0%), and a lower risk of recurrence (RR, 0.66; 95% CI, 0.40-1.09; p = .10; I = 0%). However, a similar risk of reoperation was observed for both groups (RR, 1.02; 95% CI, 0.36-2.91; p = .96; I = 43%).
CONCLUSION
This meta-analysis suggests that MVP may lead to better outcomes compared to MVR. Among patients with mitral valve IE, MVP can reduce in-hospital mortality, improve long-term survival, and has a lower risk of recurrent endocarditis. As a result, MVP may be suitable as a primary treatment choice and should be considered whenever possible in most IE patients.
Topics: Cardiac Surgical Procedures; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Treatment Outcome
PubMed: 35032059
DOI: 10.1111/jocs.16227 -
The Journal of Hospital Infection May 2022Bone allografts are harvested and transplanted under sterile conditions. However, the risk of bacterial contamination of grafts during these processes is a health... (Meta-Analysis)
Meta-Analysis Review
Bone allografts are harvested and transplanted under sterile conditions. However, the risk of bacterial contamination of grafts during these processes is a health concern. Bioburden testing and bacterial contamination detection are conducted to ensure allograft sterility. The present study aimed to determine the incidence of bacterial contamination in bone allografts based on different classifications. A PROSPERO registration number was received for the study. Systematic searches were conducted in PubMed and EMBASE databases with relevant keywords from January 2000 to March 2021. After choosing related studies according to the PRISMA flow diagram, Stata software was used for data analysis. We considered I˃50% as heterogeneity between studies. The overall incidence of bacterial contamination was 12.6% (95% confidence interval 0.100, 0.152) among 19,805 bone allografts of 17 studies. The bacterial contamination rate among bone allografts was 10.8% before 2010 and 14.7% from January 2010 to March 2021. The contamination frequency in Asia, Europe, and Australia was 11.5%, 14.3% and 5.2%, respectively. Bone contamination rates were higher in cadaver donors (19.9%), retrieval time sampling (13.5%), and swab samples (13.2%) compared with those in living donors (7.5%), implantation time sampling (6.9%), and bone fragments cultures (6.3%). Bacterial contamination was recovered 24.4%, 19.7%, 13.2%, and 21% from tibia, fibula, femoral, and other bones, respectively. Staphylococcus spp. was the predominant isolated bacteria from bones (63.2% of all isolated genera), followed by Propionibacterium spp. (10.6%). In conclusion, the high contamination of bone allografts is a health concern, indicating the need for more health monitoring and improvement of standards.
Topics: Allografts; Bacteria; Bone Transplantation; Humans; Tissue Banks; Transplantation, Homologous
PubMed: 34752801
DOI: 10.1016/j.jhin.2021.10.020 -
Prehospital and Disaster Medicine Dec 2021Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats...
Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats must be comprehensively reviewed to create a preparedness plan to recognize outbreaks, to educate the public, and to offer vaccinations and/or treatment options, if available. A scoping review using PRISMA guidelines was performed to categorize current information on Category A biological agents as well as understand their potential for future threats. The results used 34 articles and found that while botulin neurotoxins were the most lethal, anthrax posed the most likely threat for use as a bioweapon. Most research was conducted on plague, though it is not the most likely threat. Smallpox is the most likely agent to vaccinate against as there is already a working vaccine that has proven effective and the issue at hand is the need for a larger stockpile. Ultimately, preparedness efforts should include vaccinations and continued research and development of them. Category A agents are a serious public health concern; updated and reformed bioterrorism preparedness plans could greatly minimize panic and mortality.
Topics: Anthrax; Bioterrorism; Disease Outbreaks; Humans; Plague; Smallpox
PubMed: 34615562
DOI: 10.1017/S1049023X21001072