Proton pump inhibitors do not increase the risk of dementia: a systematic review and meta-analysis of prospective studies

Published studies have reported variable results on the association between duration of proton pump inhibitor (PPI) use and the risk of dementia. An extensive literature search was performed in PubMed, Embase, Google Scholar, and Cochrane for studies examining the risk of cognitive decline and dementia among PPI users versus non-PPI users in prospective studies. Retrospective database linkage studies, case reports, case series, editorials, uncontrolled cohort studies, cross-sectional studies, and review articles were excluded. Primary outcome was pooled hazard rate (HR) of any dementia among PPI users compared with non-PPI users. Secondary outcomes were pooled HR of Alzheimer's dementia (AD) and risk with long-term PPI follow-up (more than 5 years) studies. Meta-analysis outcomes, heterogeneity (I2), and meta-regression (for the effect of covariates) were derived by statistical software R and Open meta-analyst. A total of six studies (one RCT and five prospective) with 308249 subjects, average age of 75.8 ± 5.2 years, and follow-up of 5 (range 1.5-11) years were included in the analysis. Pooled HR of any dementia was 1.16 (n = 6, 95% confidence interval (CI) = 0.86-1.47). Results remained unchanged when only studies with long-term PPI use (more than 5 years) were analyzed (n = 4, pooled HR 1.10, 95% CI 0.66-1.53). Finally, the pooled HR for AD was 1.06 (n = 3, 95% CI 0.70-1.41). There was substantial heterogeneity among inclusion studies (I2 = 93%). Meta-regression did not demonstrate a significant role of age at study start (P = 0.1) or duration of PPI use (P = 0.62) to incident dementia. The results of this systematic review and meta-analysis do not show a significant relationship between PPI use and dementia in prospective studies with at least a 5-year follow-up.

Silver/(sub-10 nm)hafnium-oxide-based resistive switching devices on silicon: characteristics and switching mechanism

This study investigates the resistive switching (RS) behavior of Ag/HfO₂(3 nm-thick)/SiO _x (interfacial-layer)/Si devices. The findings are drawn from a systematic electrical and material characterization of the fabricated devices. Based on the current-time (I-t) and current-voltage (I-V) measurements, it is inferred that both metal and oxygen ion migration play a significant role in the switching events, leading to bipolar and unipolar switching modes depending on the biasing scheme. The results demonstrate two competing switching mechanisms taking place when the biasing voltage is increased beyond the RESET voltage in the bipolar mode. The devices are also shown to exhibit self-rectifying characteristics when the bias is applied to the Ag electrode. The proposed method of investigating the total charge passed through the device within the time to SET, during the I-t characterization, is particularly useful for identifying the current transport models governing the high-resistance state. The results reported in this manuscript provide useful insights into the control of RS behavior in this scientifically and technologically important material system. Developing a thorough understanding of the fundamental physics governing the observed RS behavior is a substantial step for the growing progress in the memristor device research, as well as for its potential exploitation in diverse CMOS-compatible applications.

Economic impact assessment of foot-and-mouth disease burden and control in pastoral local dairy cattle production systems in Northern Nigeria: A cross-sectional survey

Milk has been envisaged as a major source of high-quality protein and bioavailable nutrients to humans. Its production is constraint by foot and mouth disease (FMD), a contagious viral disease of very high economic importance worldwide. This study was aimed at assessing the economic impact of FMD in pastoral dairy cattle herds in Nigeria and determines returns to investments in its control to better inform policy decisions. An interview questionnaire-based cross-sectional study was conducted in 660 nomadic and agro-pastoral dairy cattle herds in 2019. Economic impact analyses were conducted using the total economic cost and benefit-cost analysis models. Of the 660 pastoralists enrolled, 92.6% (n = 611) participated. Nomadic pastoralists constituted 50.7% (n = 310) of the respondents while 49.3% (n = 301) were agro-pastoralists. Most of the respondents (66.4%, n = 406) had no formal education. The value of visible losses to the herders was estimated at USD 15,591,694.30 and the cost of control by treatment of secondary infections was USD 463,673.70. The economic impact of FMD due to production losses and costs of treatment to pastoralists was estimated to be USD 16,055,368.00. Return on investment in FMD control was positive with a benefit-cost ratio of 33.6. The estimated total economic costs due to FMD have indicated that it is a disease of high economic importance to dairy production herds and must be controlled to assure food security, local incomes to herders, and protein requirement of human population, especially the children in FMD endemic countries.

An Audit of Comparison of Perioperative Outcomes with the Introduction of Standardized Preoperative Evaluation form at a Tertiary Care Hospital in Rural India

Introduction:

Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures.

Aim:

The aim of the study was to conduct an audit to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized pre-operative evaluation form.

Study Design:

This was a retrospective study, using a sample of 3000 files of patients who underwent elective surgery in a tertiary care hospital of rural India. We devised 11 quality indicators, looking at factors in the pre-operative, peri-operative and post-operative period, and used them to audit 3000 patient records in our Hospital.

Results:

We found several areas where quality could be significantly improved;last minute postponement/change of plan of planned surgeries has reduced from 134 (8.9%) to 23 (1.53%) cases after implementation of standardised PEF. 784 (52.26%) patients were not formally handed over to the theatre recovery staff before implementation of standardised PEF compared to 147(9.8%) after implementation of standardised PEF.

Conclusion:

This audit found several areas of practice that fall below expected standards before the introduction of standardised PEF, but after the introduction of standardised PEF there is a significant improvement in quality of pre anaesthetic evaluation and overall outcome of the patient. We therefore advocate the use of such standardised PEFs for performing preoperative and perioperative assessment of surgical patients.

Comparison of clinical and radiological results of posterolateral fusion, posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine

INTRODUCTION

Lower back pain due to degenerative disc disease is a common problem that requires surgical treatment, such as posterolateral fusion and posterior instrumentation (PLF), posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). This retrospective study aimed to compare the clinical and radiological outcomes of these techniques.

METHODS

81 patients were treated between 2003 and 2006. The patients were divided into three groups: Group I (PLF n = 17 [43 levels]); Group II (PLIF n = 27 [52 levels]); and Group III (TLIF n = 37 [70 levels]). All patients underwent the same pre- and postoperative clinical and radiological evaluations (using Oswestry Disability Index [ODI], Stanford score and local criteria). Follow-ups were performed at three months and yearly for three years.

RESULTS

There was no significant difference in the rates of intra-operative complications (Group I: 17.6%; Group II: 11.1%; Group III: 18.9%; p = 0.688) and postoperative complications (Group I: 11.8%; Group II: 25.9%; Group III: 13.5%; p = 0.343) among the groups. There was a significant decrease in the ODI scores over time (p < 0.005) but no significant difference among the groups at different follow-up times. Radiographic fusion rates for Groups I, II and III were 88%, 88.9% and 91.9%, respectively.

CONCLUSION

Surgical techniques such as PLF, PLIF and TLIF are equally suitable for treating degenerative disc disease, with no differences observed in complications and clinical outcomes. However, in our study, the best radiological outcome was found in patients treated with TLIF.

Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease

BACKGROUND

Beta-blockers (BB) improve morbidity and mortality in ischaemic heart disease. There is a general reluctance to use BB, especially in patients with chronic obstructive pulmonary disease (COPD), which is perceived as an absolute contraindication. As large numbers of patients are labelled with COPD without objective evidence, they may miss out on the benefit from these drugs.

AIM

To assess the use of BB in patients with COPD admitted with acute coronary syndrome (ACS), and to assess the supporting evidence for the diagnosis of COPD in these patients.

METHOD

Case-note review and retrospective analysis of 457 consecutive patients admitted with troponin-positive ACS between October 2002 and October 2003.

RESULTS

Of 457 ACS patients studied, 246 (54%) were discharged on a BB. Cardiologists prescribed BB in ACS patients more frequently than did general physicians, (70% vs. 30%, respectively). The reasons for withholding BB were: not documented 27%, COPD 33%, heart failure 24%, others 16%. Ninety-four patients (21%) had a diagnosis of COPD; only 58 (62%) of these had been reviewed by a chest physician or had previous pulmonary function tests. Of the 94 patients with COPD, only 15 (16%) were prescribed BB during the admission: 9 by cardiologists and 6 by non-cardiologists. BB were discontinued in two patients due to an increase in dyspnoea.

CONCLUSION

Many patients with a diagnosis of COPD have no objective evidence to support the diagnosis and are denied the prognostic benefits of BB when presenting with ACS. Before withholding beta-blockers, COPD and reversibility should be ascertained by pulmonary function testing. The overall use of beta-blockers remains sub-optimal and could be improved in this setting.