Noble element coatings on endotracheal tubes for ventilator-associated pneumonia prevention: A systematic review and meta-analysis of randomized controlled trials in emergency care settings.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the second most prevalent nosocomial infection in emergency care settings. An emerging strategy to reduce this risk involves coating endotracheal tubes (ETTs) with noble elements, leveraging the antimicrobial properties of elements such as silver, gold, and palladium. This systematic review and meta-analysis aimed to evaluate the effectiveness of noble element coatings on ETTs in reducing VAP incidence rates, mortality, duration of mechanical ventilation, and length of stay in the intensive care unit (ICU). METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted across 5 databases up to 2024. The quality of the randomized controlled trials was assessed using the updated Cochrane Risk of Bias (RoB) 2 tool. A random-effects meta-analysis was performed using RevMan 5.4 Comprehensive Meta-Analysis software. Statistical heterogeneity among the studies was evaluated using the Higgins I2 value, with P < .05 indicating statistical significance. RESULTS: Seven randomized controlled trials from 5 countries were identified. Four studies had some concerns regarding bias, 2 had a high RoB, and 1 had a low RoB. Noble metal-coated ETTs resulted in a lower incidence of VAP compared to noncoated ETTs (relative risk, 0.76 [95% confidence interval [CI], 0.60-0.96]). However, there was no significant difference in mortality rates (relative risk, 1.06 [95% CI, 0.93-1.20]), duration of mechanical ventilation (mean difference, -0.10 [95% CI, -1.62 to 1.41]), and ICU stay (mean difference, 0.07 [95% CI, -1.98 to 2.12]). CONCLUSION: Noble metal-coated ETTs effectively reduce the incidence of VAP but do not significantly impact mortality rates, the duration of mechanical ventilation, or ICU stay. Therefore, these coated ETTs should be integrated into a holistic care plan addressing all aspects of patient management in emergency care settings.

Human exposure to bisphenol A through dietary sources and development of diabetes mellitus: a cross-sectional study in Pakistani population.

Bisphenol A (BPA) is considered as xenoestrogen, a crucial component utilized for the manufacturing of plastic products. It has a potential to disrupt the endocrine system and induces endocrine-related metabolic disorders. We aimed to investigate the exposure of BPA in Pakistani population and its association with sociodemographic features, dietary habits, and risk factors of diabetes mellitus (DM). This cross-sectional study was conducted on 400 participants among which 61.75% participants were diabetic and 38.25% were non-diabetic. We developed a structured questionnaire, gathered sociodemographic data, and collected their urine and blood samples for the estimation of BPA and various biomarkers as risk factors of DM, respectively. Pearson correlation coefficient was determined for urinary BPA levels and DM risk factors. Urinary BPA values were adjusted for confounders. Sociodemographic data shown that urinary BPA level was significantly higher (p < 0.05) in obese people (BMI > 27) living in semi-urban and industrial areas. BPA was detectable in 75% of study participants. Urinary BPA level was found to be higher in diabetic participants compared with that of non-diabetics. A significant correlation is observed between BPA exposure and DM risk factors. We found that urinary BPA level was correlated with elevated levels of HbA1c (r = 0.6028), HOMA-IR (r = 0.5356), CRP (r = 0.6946), BUN (r = 0.6077), AST (r = 0.5151), FFA (r = 0.5759), TGs (r = 0.5608), and MDA (r = 0.6908). Hence, our study adds to the growing body of evidence supporting the role of BPA exposure as a risk factor for DM and may be associated with higher glycemic index, increased pro-inflammatory and oxidative stress biomarkers, dyslipidemia, and impaired functioning of the liver and kidney. Heating food in plastic containers and consumption of packed food items are the main sources of BPA exposure which are positively associated with DM.

Chronic exposure of bisphenol A impairs carbohydrate and lipid metabolism by altering corresponding enzymatic and metabolic pathways.

Bisphenol-A (BPA), a widespread endocrine-disrupting chemical, has been recognized as a risk factor for metabolic disorders. BPA is considered to be involved in the impairment of carbohydrate and lipid metabolism but the underlying mechanisms still need to be elucidated. Present study was aimed to investigate the impact of BPA exposure on enzymatic and metabolic pathways that are responsible to regulate the carbohydrate and lipid metabolism. Experimental rats were exposed to different doses of BPA (50, 500, 2500 and 5000 µg/kg/day orally) dissolved in 1.5% dimethyl sulfoxide for a period of 3 months. Serum level of key metabolic enzymes (α-amylase, α-glucosidase, hexokinase, glucose-6-phosphatase and HMG-CoA-reductase) was measured by ELISA method. BPA-exposure suppressed the mRNA expression of gene encoding insulin resulting in poor insulin production. While hexokinase, acetyl-CoA carboxylase and squalene epoxide were up-regulated upon BPA exposure that justified the increased lipid profile. Moreover, BPA exposure showed considerably decreased glucose uptake through insulin signaling via Akt/GLUT4 pathways. There was a significant (p < 0.001) reduction in tissue level of glucose transporters. BPA significantly (p < 0.001) decreased the serum levels of oxidative stress biomarkers (GSH, CAT, and SOD). Serum levels of leptin, TNF-α, and IL-6 were rapidly increased upon exposure to BPA (p < 0.001). It was clearly evident from this study that BPA disturbed the carbohydrate and lipid metabolism after chronic exposure. It also accelerated the inflammatory processes by increasing the oxidative stress which ultimately lead towards the insulin resistance and impaired carbohydrate and lipid metabolism.