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Fulltext Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis

You S, Saxena A, Wang X, Tan W, Han Q, Cao Y, et al.

Stroke Vasc Neurol, 2018 Mar;3(1):22-27.
PMID: 29600004 DOI: 10.1136/svn-2017-000106

The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0-1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I2=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I2=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I2=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.
Fulltext Optimization of FFF Process Parameters by Naked Mole-Rat Algorithms with Enhanced Exploration and Exploitation Capabilities

Chohan JS, Mittal N, Kumar R, Singh S, Sharma S, Dwivedi SP, et al.

Polymers (Basel), 2021 May 23;13(11).
PMID: 34070964 DOI: 10.3390/polym13111702

Fused filament fabrication (FFF) has numerous process parameters that influence the mechanical strength of parts. Hence, many optimization studies are performed using conventional tools and algorithms. Although studies have also been performed using advanced algorithms, limited research has been reported in which variants of the naked mole-rat algorithm (NMRA) are implemented for solving the optimization issues of manufacturing processes. This study was performed to scrutinize optimum parameters and their levels to attain maximum impact strength, flexural strength and tensile strength based on five different FFF process parameters. The algorithm yielded better results than other studies and successfully achieved a maximum response, which may be helpful to enhance the mechanical strength of FFF parts. The study opens a plethora of research prospects for implementing NMRA in manufacturing. Moreover, the findings may help identify critical parametric levels for the fabrication of customized products at the commercial level and help to attain the objectives of Industry 4.0.
Assessment of Dimensional Stability, Biodegradability, and Fracture Energy of Bio-Composites Reinforced with Novel Pine Cone

Jha K, Tyagi YK, Kumar R, Sharma S, Huzaifah MRM, Li C, et al.

Polymers (Basel), 2021 Sep 24;13(19).
PMID: 34641075 DOI: 10.3390/polym13193260

In this investigation, biodegradable composites were fabricated with polycaprolactone (PCL) matrix reinforced with pine cone powder (15%, 30%, and 45% by weight) and compatibilized with graphite powder (0%, 5%, 10%, and 15% by weight) in polycaprolactone matrix by compression molding technique. The samples were prepared as per ASTM standard and tested for dimensional stability, biodegradability, and fracture energy with scanning electron micrographs. Water-absorption and thickness-swelling were performed to examine the dimensional stability and tests were performed at 23 °C and 50% humidity. Results revealed that the composites with 15 wt % of pine cone powder (PCP) have shown higher dimensional stability as compared to other composites. Bio-composites containing 15-45 wt % of PCP with low graphite content have shown higher disintegration rate than neat PCL. Fracture energy for crack initiation in bio-composites was increased by 68% with 30% PCP. Scanning electron microscopy (SEM) of the composites have shown evenly-distributed PCP particles throughout PCL-matrix at significantly high-degrees or quantities of reinforcing.
Identifying Challenges and Potential Solutions for Sustainable Kidney Nutrition Care Delivery in Selected Asian Countries

Karupaiah T, Mat Daud ZA, Khosla P, Khor BH, Sahathevan S, Kaur D, et al.

J Ren Nutr, 2023 Nov;33(6S):S73-S79.
PMID: 37597574 DOI: 10.1053/j.jrn.2023.08.003

BACKGROUND: Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries.
OBJECTIVE: This paper narrates ground experiences gained through the Palm Tocotrienols in Chronic Hemodialysis (PaTCH) project on kidney nutrition care scenarios and some Asian low-to-middle-income countries namely Bangladesh, India, and Malaysia.
METHOD: Core PaTCH investigators from 3 universities (USA and Malaysia) were supported by their postgraduate students (n = 17) with capacity skills in kidney nutrition care methodology and processes. This core team, in turn, built capacity for partnering hospitals as countries differed in their ability to deliver dietitian-related activities for dialysis patients.
RESULTS: We performed a structural component analyses of PaTCH affiliated and nonaffiliated (Myanmar and Indonesia) countries to identify challenges to kidney nutrition care. Deficits in patient-centered care, empowerment processes and moderating factors to nutrition care optimization characterized country comparisons. Underscoring these factors were some countries lacked trained dietitians whilst for others generalist dietitians or nonclinical nutritionists were providing patient care. Resolution of some challenges in low-to-middle-income countries through coalition networking to facilitate interprofessional collaboration and task sharing is described.
CONCLUSIONS: We perceive interprofessional collaboration is the way forward to fill gaps in essential dietitian services and regional-based institutional coalitions will facilitate culture-sensitive capacity in building skills. For the long-term an advanced renal nutrition course such as the Global Renal Internet Course for Dietitians is vital to facilitate sustainable kidney nutrition care.
Fulltext ISPD Catheter-related Infection Recommendations: 2023 Update

Chow KM, Li PK, Cho Y, Abu-Alfa A, Bavanandan S, Brown EA, et al.

Perit Dial Int, 2023 May;43(3):201-219.
PMID: 37232412 DOI: 10.1177/08968608231172740

Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.
Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism

Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, et al.

J Ren Nutr, 2018 11;28(6):380-392.
PMID: 30348259 DOI: 10.1053/j.jrn.2018.08.006

OBJECTIVE: To better define the prevalence of protein-energy wasting (PEW) in kidney disease is poorly defined.
METHODS: We performed a meta-analysis of PEW prevalence from contemporary studies including more than 50 subjects with kidney disease, published during 2000-2014 and reporting on PEW prevalence by subjective global assessment or malnutrition-inflammation score. Data were reviewed throughout different strata: (1) acute kidney injury (AKI), (2) pediatric chronic kidney disease (CKD), (3) nondialyzed CKD 3-5, (4) maintenance dialysis, and (5) subjects undergoing kidney transplantation (Tx). Sample size, period of publication, reporting quality, methods, dialysis technique, country, geographical region, and gross national income were a priori considered factors influencing between-study variability.
RESULTS: Two studies including 189 AKI patients reported a PEW prevalence of 60% and 82%. Five studies including 1776 patients with CKD stages 3-5 reported PEW prevalence ranging from 11% to 54%. Finally, 90 studies from 34 countries including 16,434 patients on maintenance dialysis were identified. The 25th-75th percentiles range in PEW prevalence among dialysis studies was 28-54%. Large variation in PEW prevalence across studies remained even when accounting for moderators. Mixed-effects meta-regression identified geographical region as the only significant moderator explaining 23% of the observed data heterogeneity. Finally, two studies including 1067 Tx patients reported a PEW prevalence of 28% and 52%, and no studies recruiting pediatric CKD patients were identified.
CONCLUSION: By providing evidence-based ranges of PEW prevalence, we conclude that PEW is a common phenomenon across the spectrum of AKI and CKD. This, together with the well-documented impact of PEW on patient outcomes, justifies the need for increased medical attention.
Advocacy at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery

Zheleva B, Verstappen A, Overman DM, Ahmad F, Ali SKM, Al Halees ZY, et al.

Cardiol Young, 2023 Aug;33(8):1277-1287.
PMID: 37615116 DOI: 10.1017/S1047951123002688

The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.