Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies.

STUDY OBJECTIVE: Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS: Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION: Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.

Wild mushrooms showed analgesic and cytotoxic properties along with phytoconstituent's binding affinity to COX-1, COX-2 and cytochrome P450 2C9.

This study was designed to evaluate the cytotoxic and analgesic potential of methanol extracts of five wild mushrooms available in the University of Chittagong, Bangladesh. The acetic acid-induced writhing method was used for the analgesic activity, while cytotoxicity was tested using brine shrimp lethality bioassay. In silico molecular docking and ADME/T study have been employed by using Schrodinger v11.1, BIOVIA Discovery Studio 2020 and online tool (AdmeSAR) respectively. The methanol extracts of Daldinia concentrica, Trametes lactinea, Fomitopsis cajanderi and Daedaleopsis confragosa exhibited a significant (p < 0.001) decrease in the number of writhing when compared to the control group. Except for Lentinus squarrosulus at 200 mg/kg body weight, the remaining mushroom extracts showed equal to or above 50 % inhibition of writhing. Daldinia concentrica showed the lowest LC50 values with 0.63 µg/mL, while Daedaleopsis confragosa showed the highest LC50 values of 2.33 µg/mL, indicating decisive cytotoxic action all mushrooms extracts. Considering the secondary metabolites, daldinan A and fomlactone A were found the most promising myco-compounds in analgesic and cytotoxic molecular docking studies. Besides, all the selected metabolites meet the rule of Lipinski's drug-likeliness. These results concluded that each mushroom extracts except Lentinus squarrosulus possess a potential analgesic. All the mushroom extracts embrace a promising cytotoxic activity that may guide the progress of a new drug.

Leea macrophylla root extract upregulates the mRNA expression for antioxidative enzymes and repairs the necrosis of pancreatic ß-cell and kidney tissues in fructose-fed Type 2 diabetic rats.

This research investigated the functional food effect of Leea macrophylla (Roxb.) ex Hornem root extract on pancreatic necrosis in Streptozotocin-induced type-2 diabetes. Prior to animal intervention, Leea macrophylla root extract (LMR) was subjected to GC-MS analysis. Across a three-week intervention of fructose-fed albino model with LMR50, LMR100 and LMR200, the fluid & food intake, body weight changes, weekly blood glucose concentrations and oral glucose tolerance (OGT) were recorded. The animals were sacrificed after intervention and serum was analyzed for insulin, ALT, AST, LDH, CK-MB, creatinine, uric acid and lipid profile and liver section was used for glycogen estimation. Changes of pancreas and kidney architecture were evaluated by histopathology. Relative mRNA for superoxide dismutase 1 (SOD1), glutathione peroxidase (GPx) and catalase (CAT) were quantitated using assay kits. Results showed that fluid and food intake, weekly blood glucose level, ALT, AST, LDH, CK-MB level were significantly (p < 0.05) decreased in LMR50 group. Conversely, the glucose tolerance ability, liver glycogen level, serum insulin, organ weight and pancreatic morphology were improved significantly in this group. Diameter of islet of Langerhans (µm), area occupied by ß-cell/ islet of Langerhans (µm2) and number of ß-cells/islet of Langerhans were amazingly improved to the NC animals. Expressions of mRNA for SOD1 and CAT from liver tissue have been found to be increased multifold while GPx was remained unchanged. The data suggests that L. macrophylla root extract could be very potential as functional food to modulate pancreatic action.