The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis

OBJECTIVES

The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population.

STUDY DESIGN

Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses).

METHODS

We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing.

RESULTS

The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases).

CONCLUSIONS

Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.

Decoding the role of the gut microbiome in gut-brain axis, stress-resilience, or stress-susceptibility: A review

Increased exposure to stress is associated with stress-related disorders, including depression, anxiety, and neurodegenerative conditions. However, susceptibility to stress is not seen in every individual exposed to stress, and many of them exhibit resilience. Thus, developing resilience to stress could be a big breakthrough in stress-related disorders, with the potential to replace or act as an alternative to the available therapies. In this article, we have focused on the recent advancements in gut microbiome research and the potential role of the gut-brain axis (GBA) in developing resilience or susceptibility to stress. There might be a complex interaction between the autonomic nervous system (ANS), immune system, endocrine system, microbial metabolites, and bioactive lipids like short-chain fatty acids (SCFAs), neurotransmitters, and their metabolites that regulates the communication between the gut microbiota and the brain. High fiber intake, prebiotics, probiotics, plant supplements, and fecal microbiome transplant (FMT) could be beneficial against gut dysbiosis-associated brain disorders. These could promote the growth of SCFA-producing bacteria, thereby enhancing the gut barrier and reducing the gut inflammatory response, increase the expression of the claudin-2 protein associated with the gut barrier, and maintain the blood-brain barrier integrity by promoting the expression of tight junction proteins such as claudin-5. Their neuroprotective effects might also be related to enhancing the expression of brain-derived neurotrophic factor (BDNF) and glucagon-like peptide (GLP-1). Further investigations are needed in the field of the gut microbiome for the elucidation of the mechanisms by which gut dysbiosis contributes to the pathophysiology of neuropsychiatric disorders.

Advanced drug delivery and therapeutic strategies for tuberculosis treatment

Tuberculosis (TB) remains a significant global health challenge, necessitating innovative approaches for effective treatment. Conventional TB therapy encounters several limitations, including extended treatment duration, drug resistance, patient noncompliance, poor bioavailability, and suboptimal targeting. Advanced drug delivery strategies have emerged as a promising approach to address these challenges. They have the potential to enhance therapeutic outcomes and improve TB patient compliance by providing benefits such as multiple drug encapsulation, sustained release, targeted delivery, reduced dosing frequency, and minimal side effects. This review examines the current landscape of drug delivery strategies for effective TB management, specifically highlighting lipid nanoparticles, polymer nanoparticles, inorganic nanoparticles, emulsion-based systems, carbon nanotubes, graphene, and hydrogels as promising approaches. Furthermore, emerging therapeutic strategies like targeted therapy, long-acting therapeutics, extrapulmonary therapy, phototherapy, and immunotherapy are emphasized. The review also discusses the future trajectory and challenges of developing drug delivery systems for TB. In conclusion, nanomedicine has made substantial progress in addressing the challenges posed by conventional TB drugs. Moreover, by harnessing the unique targeting abilities, extended duration of action, and specificity of advanced therapeutics, innovative solutions are offered that have the potential to revolutionize TB therapy, thereby enhancing treatment outcomes and patient compliance.

Feasibility of laproscopic appendectomy in appendicities and appendicular perforation

Introduction: The advent and rapid acceptance of laparoscopic surgery led to the idea of performing laparoscopic  appendectomy (LA). In 1983 Semm, a German gynecologist performed the first LA. More than three decades later, the benefits of LA are still controversial. The objective of this study is to assess the feasibility of laproscopic appendectomy in appendicitis and appendicular perforation.Methods: Thirty five patient undergoing laproscopicappendectomy for appendicitis from 14th feb 2015 to 11th feb 2016 in Grande international hospital were included in the study. Duration of surgery, requirement of analgesia, time to normal diet and regular activity as well as length of hospital stay and postoperative complications were studied.Results: A total of 35 patients underwent laparoscopic appendectomy during the study period.Ten patients have peri-appendicular pus collection of which six patients have perforation. Median duration of surgery was 59±8.64 minutes.  Mean Post operative pain score was  4.71±0.71. Mean intravenous fevastin requirement was 3.31±0.9 gm and intravenous ketorolac  was 94±27mg while oral diclofenac was 731±172.81mg. Postoperative complications were 9%.  Mean time to normal diet resumption was 1.17±0.47 days and time to normal activities was 10.5±2.44 days. Median length of hospital stay was 1.9±0.96 days.Conclusion: Laproscopic appendectomy is a feasible option for appendicitis as well as appendicular perforation. More frequent use of this procedure may lead to reduction in operating time. Continuation of laproscopic appendectomy as a therapeutic option for patients with appendicitisas well as appendicular perforation need evaluation in large study scale.

Klippel-Trenaunay Syndrome: A Case Report

Klippel-Trenaunaysyndrome(KTS) is a rare congenital condition usually presenting with port wine stains, excessive growth of bones and soft tissue and varicose veins which most commonly occurs in the legs, but it also may affect the arms, face, head, or internal organs. We report a case of term male neonate with clinical findings of Port-wine stain, multiple cystic swellings with ultrasonographic findings suggestive of vascular malformations and limb abnormalities in the form ofsoft tissue hypertrophy of right upper limb, polydactyly of right hand and syndactyly of left hand consistent withKlippel-Trenaunay syndrome.

Idiopathic cases of male infertility from a region in India show low incidence of Y-chromosome microdeletion

Chromosomal and Y-chromosomal microdeletion analysis has been done in cases of idiopathic infertility with the objective of evaluating the frequency of chromosomal and molecular anomaly as the causal factor of infertility. Barring a few cases of Klinefelter syndrome (XXY or XY/XXY mosaics), no chromosomal anomaly was encountered. Y-microdeletion was analysed by PCR-screening of STSs from different regions of the AZF (AZFa, AZFb, AZFc) on the long arm of the Y, as well as by using DNA probes of the genes RBM, DAZ (Yq), DAZLA (an autosomal homologue of DAZ) and SRY (Yp; sex determining gene). Out of 177 cases examined, 9 (azoospermia - 8 and oligoasthenospermia - 1) showed partial deletion of AZF. The size of deletion varied among patients but AZFc was either totally or partially removed in all of them. In contrast, no deletion was detected in AZFa. Testis biopsy done on a limited number of cases (50) showed diverse stages of spermatogenic arrest with no specific correlation with the genotype. The frequency of Y-chromosome microdeletion in our samples (approximately 5%) is much lower than the frequency (approximately 10%) reported globally and the two previous reports from India. We contend that the frequency may be affected by population structures in different geographical regions.

Significance of Qt Dispersion to Improve the Diagnostic Accuracy of Exercise Stress Tests for Myocardial Ischaemia

Background: This study consisted of 60 randomly selected patients (49 men and 11women) who had undergone both symptom-limited treadmill exercise tests andcoronary angiography, within one month, for clinical indications. This was a prospectivestudy done during the period of December 1998 to July 1999 in NICVD, DhakaBangladesh. The ECG is generally considered to provide a summation of the electricalactivity of the heart and to be insensitive to local electrophysiological events. Recentstudies suggest that important local electrophysiological differences can be detectedfrom a standard 12 -lead ECG, allowing new insights into the electrical behavior ofpatient’s hearts. The QT dispersion recorded as the difference between maximumand minimum QT intervals on a 12-lead ECG, is sensitive to myocardial ischaemiaand may improve the accuracy of exercise testing.Methods and Results: Exercise ECGs were analyzed in 60 patients who had undergoneexercise ECG and coronary angiography for clinical indications:1) The true-positive (TP) group consisted of 22 patients with mean ±SD age of 52 ± 9years. These patients had a positive treadmill test result with ³1 mm horizontal STsegmentdepression and an abnormal coronary angiogram, defined as ³ 50% diameterstenosis of a major epicardial coronary artery. Two patients were female in this group.2) The true negative (TN) group consisted of 20 patients who had a negative exercisetest and non significant CAD based on coronary angiography. The mean ± SD age ofthe group was 44 ± 8 years. Five patients were female in this group.3) Eight patients with positive treadmill test result with abnormal exercise ECGs andnon significant coronary artery disease (False positive [FP] group). This group had amean age of 43± 10 years. Three patients were female in this group.4) The false negative (FN) group consisted of 10 patients with mean ±SD age of 48± 7years. These patients had negative exercise ECG and an abnormal coronary angiogram.This group had one female patient.The exercise QTD Was 41±14ms in TN, 78±22ms in TP (P<0.001 versus TP) and47±16ms in FP (P=NS versus TN and P< 0.001 versus TP) groups. The exercise QTDwas 84±17ms in FN (P=NS versus TP) group.A stress QTD of >60ms had a sensitivity of 88% and specificity of 93% for the diagnosisof significant CAD compared with 68% (P<0.05) and 71% (P<0.01) respectively, for³ 1mm ST-segment depression during stress. When QTD of >60ms was added to STsegmentdepression as a condition for positive test, the specificity increased to 100%.Conclusion: Exercise QTD is an easily measurable ECG variable that significantlyincreases the accuracy of exercise testing.Key Words: QT dispersion . coronary disease . electrocardiography . exercise.