Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: a systematic review.

OBJECTIVE: Care bundles are a promising approach to reducing postpartum hemorrhage-related morbidity and mortality. We assessed the effectiveness and safety of care bundles for postpartum hemorrhage prevention and/or treatment. DATA SOURCES: We searched MEDLINE, Embase, Cochrane CENTRAL, Maternity and Infant Care Database, and Global Index Medicus (inception to June 9, 2023) and ClinicalTrials.gov and the International Clinical Trials Registry Platform (last 5 years) using a phased search strategy, combining terms for postpartum hemorrhage and care bundles. STUDY ELIGIBILITY CRITERIA: Peer-reviewed studies evaluating postpartum hemorrhage-related care bundles were included. Care bundles were defined as interventions comprising ≥3 components implemented collectively, concurrently, or in rapid succession. Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies (controlled or uncontrolled) were eligible. METHODS: Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). For controlled studies, we reported risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with certainty of evidence determined using GRADE. For uncontrolled studies, we used effect direction tables and summarized results narratively. RESULTS: Twenty-two studies were included for analysis. For prevention-only bundles (2 studies), low-certainty evidence suggests possible benefits in reducing blood loss, duration of hospitalization, and intensive care unit stay, and maternal well-being. For treatment-only bundles (9 studies), high-certainty evidence shows that the E-MOTIVE intervention reduced risks of composite severe morbidity (risk ratio, 0.40; 95% confidence interval, 0.32-0.50) and blood transfusion for bleeding, postpartum hemorrhage, severe postpartum hemorrhage, and mean blood loss. One nonrandomized trial and 7 uncontrolled studies suggest that other postpartum hemorrhage treatment bundles might reduce blood loss and severe postpartum hemorrhage, but this is uncertain. For combined prevention/treatment bundles (11 studies), low-certainty evidence shows that the California Maternal Quality Care Collaborative care bundle may reduce severe maternal morbidity (risk ratio, 0.64; 95% confidence interval, 0.57-0.72). Ten uncontrolled studies variably showed possible benefits, no effects, or harms for other bundle types. Nearly all uncontrolled studies did not use suitable statistical methods for single-group pretest-posttest comparisons and should thus be interpreted with caution. CONCLUSION: The E-MOTIVE intervention improves postpartum hemorrhage-related outcomes among women delivering vaginally, and the California Maternal Quality Care Collaborative bundle may reduce severe maternal morbidity. Other bundle designs warrant further effectiveness research before implementation is contemplated.

Heavy metals in wild and cultured shrimp, supplied feeds, and their habitats: Assessing public health risk.

The contamination and risk assessment of heavy metals (HMs) in highly priced tiger shrimp and its associated ecosystems and farming conditions (hatcheries and commercial grow-out ponds) were scarcely investigated in South Asian countries. In this study, we determined the five HMs (Cu, Zn, Pb, Cd, and Cr) concentrations in PL14 (fourteen days of Post-Larva) of Penaeus monodon, commercial diets, surface water, and sediments from hatcheries, farms, rivers using ICP-MS for two years. The results revealed that surface sediments of rivers and hatcheries had the highest amounts of Cr (65.85 ± 0.82 and 72.50 ± 0.42 mg/kg), Cu (18.82 ± 3.96 and 19.26 ± 4.61 mg/kg), and Zn (63.74 ± 11.14 and 87.42 ± 17.96 mg/kg), whereas commercial farms had the greatest levels of Cd (0.09 ± 0.05 mg/kg). Pb was significantly higher in sediment of hatcheries and farms than in other sites. Except for Zn in surface waters, all metals were found above the recommended limit. In case of supplied feed, all values were in the safe limit excepting Cr (3.39 ± 1.45 to 108.92 ± 3.49 mg/kg). On the other hand, among the metals, only Cr (VI) ranging from 1.75 ± 1.39 mg/kg in P. monodon samples exceeded the suggested international guidelines. The Igeo values of all the metals were Igeo <0, indicating that the study areas were practically unpolluted. PLI values in every station were found to be below 1 which indicates the perfection of the sediment. The Potential Risk Index (PERI) values were less than 150 suggesting low risk of metals in sediments. The public health risk assessment estimated through the calculated daily intake (EDI), target hazard quotient (THQ) and hazard index (HI) has shown that the shrimp was safe for consumers except for Cd and Cr. The THQ for Cd and Cr were higher than the threshold (>1) indicating potential health hazards. The low CR values for Cd, Cr Pb were 3.1 × 10-4, 3.7 × 10-4 and 1.6 × 10-4, respectively indicates no cancer risks upon consuming P. monodon.

Development of nanozyme based sensors as diagnostic tools in clinic applications: a review.

Since 1970, many artificial enzymes that imitate the activity and structure of natural enzymes have been discovered. Nanozymes are a group of nanomaterials with enzyme-mimetic properties capable of catalyzing natural enzyme processes. Nanozymes have attracted great interest in biomedicine due to their excellent stability, rapid reactivity, and affordable cost. The enzyme-mimetic activities of nanozymes may be modulated by numerous parameters, including the oxidative state of metal ions, pH, hydrogen peroxide (H2O2) level, and glutathione (GSH) concentration, indicating the tremendous potential for biological applications. This article delivers a comprehensive overview of the advances in the knowledge of nanozymes and the creation of unique and multifunctional nanozymes, and their biological applications. In addition, a future perspective of employing the as-designed nanozymes in biomedical and diagnostic applications is provided, and we also discuss the barriers and constraints for their further therapeutic use.

Stool specimen for diagnosis of pulmonary tuberculosis in adults: a systematic review.

OBJECTIVE: To assess the diagnostic accuracy of stool specimens to diagnose pulmonary tuberculosis (PTB) in adults. DESIGN: Systematic review. DATA SOURCES: MEDLINE (Ovid), Embase (Ovid), Web of Science and the Cochrane database were searched from inception to 9 March 2023-10 March 2023 using a comprehensive search strategy; reference lists of selected articles and relevant review articles were manually searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies in English reporting diagnostic performance of stool specimens against respiratory specimens using mycobacterial culture or smear microscopy or Xpert assay to diagnose PTB in adults were eligible for this systematic review. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened the retrieved citations and extracted data. The risk of bias and applicability of results were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Narrative data synthesis was performed. RESULTS: A total of 1658 citations were screened, and 28 full-text articles were assessed. Nine studies met the inclusion criteria. The reported sensitivity and specificity of stool culture varied between 21.4% and 63.9%, and 61.5% and 100%, respectively. In stool smear microscopy, sensitivities and specificities ranged from 12.1% to 53.9%, and from 79.5% to 100%, respectively. The reported sensitivities of PCR assays, including Xpert assays, ranged from 69.7% to 100%, with specificities ranging from 69.8% to 100%. Most of the studies had a low risk of bias and a low applicability concern in all domains. CONCLUSION: This systematic review could not conclude on the diagnostic accuracy of stool specimens for PTB diagnosis in adults. Further studies are required to evaluate the accuracy of stool specimens in adults to enable meta-analyses in updates of this review as well as other systematic reviews. PROSPERO REGISTRATION NUMBER: CRD42021245203.

The ability of non-physician health workers to identify chest indrawing to detect pneumonia in children below five years of age in low- and middle-income countries: A systematic review and meta-analysis.

Background: Non-physician health workers play a vital role in diagnosing and treating pneumonia in children in low- and middle-income countries (LMICs). Chest indrawing is a key indicator for pneumonia diagnosis, signifying the severity of the disease. We conducted this systematic review to summarize the evidence on non-physician health workers' ability to identify chest indrawing to detect pneumonia in children below five years of age in LMICs. Methods: We comprehensively searched four electronic databases, including MEDLINE, Embase, Web of Science, and Scopus, and reference lists from the identified studies, from January 1, 1990, to January 20, 2022, with no language restrictions. Studies evaluating the performance of non-physician health workers in identifying chest indrawing compared to a reference standard were included. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the methodological quality of the selected studies and conducted a meta-analysis following a bivariate random effects model to estimate the pooled sensitivity and specificity. Results: We identified nine studies covering 4468 children that reported the accuracy of a non-physician health worker in identifying chest indrawing. Most studies were conducted in the 1990s, based at health facility settings, with children aged 2-59 months, and with pediatricians/physicians as the reference standard. Using the QUADAS-2, we evaluated most studies as having a low risk of bias and a low concern regarding applicability in all domains. The median sensitivity, specificity, positive predictive value, and negative predictive value were 44%, 97%, 55%, and 95%, respectively. We selected five studies for the meta-analysis. The pooled sensitivity was 46% (95% confidence interval (CI) = 37-56), and the pooled specificity was 95% (95% CI = 91-97). Conclusions: We found the ability of non-physician health workers in LMICs in identifying chest indrawing pneumonia is relatively poor. Appropriate measures, such as targeted identification and training, supportive supervision, regular performance assessment, and feedback for those who have a poor ability to recognize chest indrawing, should be taken to improve the diagnosis of pneumonia in children. New studies are needed to assess the new generation of health workers. Registration: PROSPERO (CRD42022306954).

Participatory approaches in primary health care related implementation research in low-and middle-income countries: A narrative review.

Objectives: Primary Health Care (PHC) oriented health systems are crucial to accelerate the achievement of Universal Health Coverage. Previous studies have suggested the importance of participatory approaches to improve PHC. This review aimed to identify the available published implementation research in PHC considering participatory approaches in Low and Middle-Income Countries (LMICs). Study design: A narrative review was conducted following the standard guidelines. Methods: Three electronic databases were searched where keywords were combined using Boolean operators. Studies were included considering the pre-specified inclusion and exclusion criteria through two-phase screening. The quality of the included studies was assessed using the Joanna Briggs Institution's critical appraisal tools. Data were presented using a narrative synthesis approach. Results: A total of 13 articles were included that focused on community-based approaches in PHC service, maternal and newborn care, family planning, tuberculosis, and mental health. Three studies focused on mental health and demonstrated the efficacy of community support groups, peer volunteers, and community-based mental education in promoting mental health services. Two studies described community participation to ensure patient safety and risk reduction. Other studies explored the effectiveness of community-based, directly observed treatment for tuberculosis; community health worker-based maternal and child health care; and a community-based package for family planning. Eleven studies were conducted in Africa and the rest were in South Asia. Conclusion: This review reveals the gap in implementation research incorporating participatory approaches in the field of PHC. Limited studies have been conducted which indicate the need and scope of implementation research with participatory approaches in the PHC field. Prospero registration: CRD42020150749.

Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review.

Background: Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis. Methods: In this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians' acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed. Results: A total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia. Conclusions: This systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.

Inequalities in women's utilization of postnatal care services in Bangladesh from 2004 to 2017.

Postnatal care (PNC) is an essential component of maternity care. Appropriate and timely care immediately after childbirth can save lives and help to prevent or treat comorbidities resulting from pregnancy and childbirth. Despite its importance, PNC coverage is still low in Bangladesh. The aim of this study was to analyse the trends, inequalities, and factors associated with PNC for mothers in Bangladesh. Data from the last five Bangladesh Demographic and Health Surveys (BDHS) were used. Descriptive statistics were used to report PNC outcome rates and trends across six inequality indicators. Modified Poisson regression analyses were used to identify factors associated with PNC use in the most recent BDHS. A total of 21,240 women were included for the analysis. The rate of PNC by 'medically trained provider' within 2 days of birth increased between 2004 and 2017, from 16 to 52%. There were wide inequalities across socio-demographic factors. The regression analyses found women giving birth at home, women from the poorest wealth quintile and women receiving no antenatal care (ANC) were least likely to receive PNC. The findings emphasize the need to improve public health programs supporting women who have the least access to PNC. The identified inequalities can inform policy formulation to ensure more equitable provision of PNC to women in Bangladesh.

Stool specimen for diagnosis of pulmonary tuberculosis in adults: protocol for a systematic review and meta-analysis.

INTRODUCTION: Tuberculosis (TB) continues to be a significant health burden, most commonly affecting the lungs and referred to as pulmonary TB (PTB). Diagnostic techniques of PTB primarily rely on expectorated sputum samples. However, the diagnostic yields are often hindered due to insufficient volume and quality of the sputum specimens. Moreover, some individuals are unable to provide sputum samples due to scanty sputum production or difficulty in coughing up and require an invasive procedure to obtain a respiratory sample, such as bronchoscopic or gastric aspiration. Thus, challenges in the acquisition of respiratory specimens warrant an alternate specimen. Therefore, this systematic review aims to evaluate the diagnostic accuracy of a stool specimen for the diagnosis of PTB in adults. METHODS AND ANALYSIS: We will search MEDLINE (Ovid), Embase (Ovid), Web of Science and Cochrane database from inception to April 2021 using a comprehensive search strategy. Two reviewers will independently perform screening, data extraction and quality assessment. The risk of bias assessment and applicability of results of eligible studies will be performed using the Quality of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects models will be performed to calculate pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio and diagnostic odds ratio along with 95% CI of stool specimen for each reported diagnostic method against any of the reference standard test (ie, mycobacterial culture or smear microscopy or Xpert assay using respiratory specimens). Heterogeneity between studies will be assessed by I2 statistics and Q statistic of the χ2 test. ETHICS AND DISSEMINATION: The results will be disseminated through publishing in a peer-reviewed medical journal and public presentations in relevant national and international conferences. As this is a systematic review of publicly available data, ethics approval is not required. PROSPERO REGISTRATION NUMBER: CRD42021245203.

Nanoremediation technologies for sustainable remediation of contaminated environments: Recent advances and challenges.

A major and growing concern within society is the lack of innovative and effective solutions to mitigate the challenge of environmental pollution. Uncontrolled release of pollutants into the environment as a result of urbanisation and industrialisation is a staggering problem of global concern. Although, the eco-toxicity of nanotechnology is still an issue of debate, however, nanoremediation is a promising emerging technology to tackle environmental contamination, especially dealing with recalcitrant contaminants. Nanoremediation represents an innovative approach for safe and sustainable remediation of persistent organic compounds such as pesticides, chlorinated solvents, brominated or halogenated chemicals, perfluoroalkyl and polyfluoroalkyl substances (PFAS), and heavy metals. This comprehensive review article provides a critical outlook on the recent advances and future perspectives of nanoremediation technologies such as photocatalysis, nano-sensing etc., applied for environmental decontamination. Moreover, sustainability assessment of nanoremediation technologies was taken into consideration for tackling legacy contamination with special focus on health and environmental impacts. The review further outlines the ecological implications of nanotechnology and provides consensus recommendations on the use of nanotechnology for a better present and sustainable future.

Ag2S-Sensitized NiO-ZnO Heterostructures with Enhanced Visible Light Photocatalytic Activity and Acetone Sensing Property.

Visible light-driven Ag2S-grafted NiO-ZnO ternary nanocomposites are synthesized using a facile and cost-effective homogeneous precipitation method. The structural, morphological, and optical properties were extensively studied, confirming the formation of ternary nanocomposites. The surface area of the synthesized nanocomposites was calculated by electrochemical double-layer capacitance (C dl). Ternary Ag2S/NiO-ZnO nanocomposites showed excellent visible light photocatalytic property which increases further with the concentration of Ag2S. The maximum photocatalytic activity was shown by 8% Ag2S/NiO-ZnO with a RhB degradation efficiency of 95%. Hydroxyl and superoxide radicals were found to be dominant species for photodegradation of RhB, confirmed by scavenging experiments. It is noteworthy that the recycling experiments demonstrated high stability and recyclable nature of the photocatalyst. Moreover, the electrochemical results indicated that the prepared nanocomposite exhibits remarkable activity toward detection of acetone. The fabricated nanocomposite sensor showed high sensitivity (4.0764 µA mmol L-1 cm-2) and a lower detection limit (0.06 mmol L-1) for the detection of acetone. The enhanced photocatalytic and the sensing property of Ag2S/NiO-ZnO can be attributed to the synergistic effects of strong visible light absorption, excellent charge separation, and remarkable surface properties.

Zinc oxide-decorated polypyrrole/chitosan bionanocomposites with enhanced photocatalytic, antibacterial and anticancer performance.

A bio-nanocomposite matrix of polypyrrole grafted ZnO/chitosan (Ppy/C/Z) was synthesized via the in situ polymerization of pyrrole with different weight fractions of ZnO. Incorporation of ZnO nanoparticles with polypyrrole enhances the photocatalytic, antibacterial as well as cytotoxic properties of the resultant composite. Characterizations of the synthesized product were performed by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and thermal analysis (TGA and DTA). Surface morphology and particle size were determined by SEM and TEM. The elemental composition of the material was studied by EDX coupled with SEM. Electrochemical surface area was calculated from electrochemical double layer capacitance (EDLC) measurements using cyclic voltammetry. The photocatalytic activity of the composite material was tested by monitoring the degradation of reactive orange-16 (RO-16), Coomassie Brilliant Blue R-250 (CBB-R-250) and Methylene Blue (MB) dyes and the composite was found to be an effective catalyst in the presence of a UV light source. Various scavengers were used to detect the reactive species involved in the photocatalytic process. Furthermore, the stability of the photocatalyst was assessed by recycling experiments. Moreover, the Ppy/C/Z bio-nanocomposite shows potential application with anti-bacterial and anti-cancer activity against Gram-positive and Gram-negative bacterial pathogens and human cancer cell lines (HeLa and MCF-7). The experimental data confirm that the bio-nanocomposite of Ppy/C/Z showed excellent anti-bacterial and anti-cancer activity as compared to a pristine polypyrrole and chitosan formulation (Ppy/C). The apoptosis data with varying concentrations of Ppy/C/Z reveal the remarkable activity against these cancer cell lines.

Immobilization of peroxidase on polypyrrole-cellulose-graphene oxide nanocomposite via non-covalent interactions for the degradation of Reactive Blue 4 dye.

In the present study novel polypyrrole-cellulose-graphene oxide nanocomposite (PCeGONC) was employed for the immobilization of ginger peroxidase (GP) via simple adsorption mechanism. Immobilization of enzyme on the obtained support resulted in enhancement of the enzyme activity. The recovery of activity was 128% of the initial activity. Consequently, in 3 h stirred batch treatment, PCeGONC bound GP exhibited higher decolorization efficiency (99%) for Reactive Blue 4 (RB 4) dye as compared to free GP (88%). The immobilized GP exhibited higher operational stability and retained approximately 72% of its initial activity even after ten sequential cycles of dye decolorization in batch process. The kinetic characterization of PCeGONC bound GP revealed slightly lower Km and 3.3 times higher Vmax compared to free GP. Degraded products were identified on the basis of GC-MS analysis and degradation pathway was proposed accordingly which confirms enzymatic breakdown of RB 4 into low molecular weight compounds. Genotoxic assessment of GP treated RB 4 revealed significant reduction of its genotoxic potential. In-silico analysis identified that binding site of PCeGONC on enzyme is distinct and lies far away from the active site of the enzyme. Furthermore, it also revealed higher affinity of 1-hydroxybenzotriazole (a redox mediator) and RB 4 for PCeGONC bound enzyme as compared to the free enzyme. This is in consensus with the observed decrease in Km of the immobilized GP.

A critical review on the prospect of polyaniline-grafted biodegradable nanocomposite.

Among the various electrically conducting polymers, polyaniline (PANI) has gained attentions due to its unique properties and doping chemistry. A number of electrically conducting biodegradable polymers has been synthesized by incorporating a biodegradable content of cellulose, chitin, chitosan, etc. in the matrix of PANI. The hybrid materials are also employed as photocatalysts, antibacterial agents, sensors, fuel cells and as materials in biomedical applications. Furthermore, these biodegradable and biocompatible conducting polymers are employed in tissue engineering, dental implants and targeted drug delivery. This review presents state of the art of PANI based biodegradable polymers along with their synthesis routes and unique applications in diverse fields. In future, the synthesis of PANI-grafted biodegradable nanocomposite material is expected to open innovative ways for their outstanding applications.