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Indoor air pollution is a major public health concern, contributing to approximately 2.9 million deaths and 81.1 million disability-adjusted life years lost annually. This issue disproportionately affects underprivileged communities that depend on solid fuels for cooking. As a result, these communities suffer from heightened exposure to indoor air pollutants, which increases the risk of morbidity, mortality, and worsening health disparities. This study investigates the association between socioeconomic status and mortality related to indoor air pollution across multiple countries. Data from the 2019 Demographic and Health Survey, WHO, and World Bank were utilized to examine the impact of socioeconomic status on indoor air pollution-related mortality. The primary outcome was mortality associated with solid fuel use, with income quintiles as the independent variable. Linear and logistic regression analyses were applied to assess these relationships. Logistic regression analysis revealed a strong negative association where household income increases and indoor air pollution-related mortality significantly decreases. Specifically, Households in the highest income quartile showed a 22% reduction progressively in the odds of mortality risk compared to the lowest income quintile. Additionally, access to clean fuel correlated with a 0.59 times lower odds of mortality, highlighting the clean energy sources' protecting effect. The findings highlight the critical need to prioritize clean fuel access, particularly in low-income communities, to reduce indoor air pollution mortality. Policies should focus on increasing clean energy accessibility and supporting vulnerable populations through targeted subsidies and poverty alleviation programs to reduce indoor air pollution exposure disparities.

Background Surgical procedures in the heart requires protection of the heart from ischemia–reperfusion injury. Cardioplegia is the primary myocardial protective method in use. Histidine–tryptophan–ketoglutarate (HTK) solution is an intracellular cardioplegic solution that was initially used to preserve organs for transplantation. Methods A systematic electronic search was conducted in July 2021, in four databases; PubMed, Scopus, Web of Science, and Cochrane Library for eligible randomized controlled trials. The results were screened and the eligible trials were identified. Thereafter, the relevant data were extracted and pooled as mean difference or risk ratio, and 95% confidence interval in an inverse variance method using RevMan software. Results This review included 12 trials (n = 1327). HTK solution has resulted significantly in shorter intensive care unit stay (MD = − 0.09; 95% CI [− 0.15, − 0.03], p = 0.006), and shorter hospital stay (MD = − 0.51; 95% CI [− 0.71, − 0.31], p < 0.00001). Moreover, the patients who received the HTK solution had significantly lower levels of creatine kinase (after 4–7 h (MD = − 157.52; 95% CI [− 272.31, − 42.19], p = 0.007), and 24 h (MD = − 136.62; 95% CI [− 267.20, − 6.05], p = 0.04)), as well as creatine kinase muscle brain band (after 44–48 h (MD = − 3.35; 95% CI [− 5.69, − 1.02], p = 0.005)). Conclusion HTK solution had the same efficacy and safety as other cardioplegic solutions in most of the clinical parameters. Furthermore, the solution showed superiority in fastening the recovery and protecting the myocardium at the biochemical level. HTK solution provides longer myocardial protection; therefore, it limits surgical interruption. HTK solution can be used as an alternative to the currently used cardioplegic solutions.

Introduction: There are several risk factors attributed to tuberculosis (TB) mortality and morbidity. There are few studies and systematic reviews showing the association of silicosis and tuberculosis at a country level. Very limited studies have been conducted using multi-country data in studying the association of incidence of silicosis with TB mortality and morbidity. Hence, the aim of this research was to explore the association of incidence of silicosis and other important risk factors with TB mortality and morbidity using multi-country data. Methods: Data from 217 WHO region countries were utilized, sourcing TB-related statistics from the Institute of Health Metrics and Evaluation and additional risk factors from the Demographic and Health Survey, Global Burden of Disease, and World Bank for 2019. Regression analysis was conducted to examine the association between silicosis incidence and TB outcomes. Results: The study found an average silicosis incidence of 121.92 per 100,000 population. Additionally, 62.69% of the sample population are exposed to air pollution from solid fuel cooking. Sanitation access stands at an average of 59.67%. Regression outcomes indicate that while alcohol consumption’s influence on TB is not statistically significant, a unit increase in silicosis incidence significantly elevates TB deaths (235.9, p = 0.005), YLL (9399.3, p = 0.011), and YLD (910.8, p = 0.002). Conclusion: The burden of silicosis is found to be one of the important determinants of deaths, YLL, and YLD due to tuberculosis. Country-specific strategies to prevent and control silicosis is a need of the hour.

Abstract Background: India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE). Methods: Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of 'catastrophic' health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures. Results: The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE. Conclusion: Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.

Background and Objectives: Vitiligo is a chronic autoimmune skin disorder characterized by the loss of pigmentation, resulting in depigmented patches due to the destruction of melanocytes. This condition can lead to considerable psychological distress, and research indicates a possible connection with major depressive disorder (MDD). Nonetheless, the depth and nature of this association, particularly within the Saudi population, have not been thoroughly investigated. This case–control study seeks to explore the relationship between vitiligo and depressive symptomatology, evaluate the severity of depressive symptoms in vitiligo patients compared to control subjects, and examine the association between the clinical severity of vitiligo (assessed using the Vitiligo Area Scoring Index, VASI) and depressive symptoms (measured using the PHQ-9, a validated screening instrument based on DSM criteria). Materials and Methods: A total of 700 participants were included, comprising 340 individuals with vitiligo and 360 controls with other skin conditions. Participants completed a web-based questionnaire that collected sociodemographic data and included the PHQ-9 assessment. The severity of vitiligo was determined using the VASI. Statistical analysis involved using the computer program IBM Statistical Program for Social Sciences (SPSS) (version 26.0). Results: The average PHQ-9 score was significantly higher for patients with vitiligo (8.28 ± 7.36) compared to controls (6.30 ± 4.70, p = 0.028). While the overall rates of mild to severe depression were comparable (41.5% in vitiligo patients versus 40.3% in controls, p = 0.748), vitiligo patients exhibited higher occurrences of moderately severe depression (11.8%) and severe depression (10.9%) compared to controls (5.8% and 0.8%, respectively; p < 0.001). A weak, yet significant, positive correlation was found between VASI and PHQ-9 scores (ρ = 0.184, p < 0.001). The vulgaris and segmental types of vitiligo exhibited the highest median depression scores (PHQ-9: 11 and 9, respectively; p < 0.001). Logistic regression analysis indicated that those with genital vitiligo had greater odds of experiencing depression (OR = 12.10, p = 0.039), while those with universalis vitiligo faced even higher odds (OR ≈ 26,837.84, p = 0.001). Interestingly, higher VASI scores were linked to lower odds of depression (OR = 0.927, p = 0.029). Additionally, the risk of depression significantly increased with higher income levels and among individuals aged 50 years and older. Conclusions: Although the overall prevalence of depression was not significantly different between vitiligo patients and controls, the degree of depressive symptoms was notably more severe in those with vitiligo. Specific clinical subtypes, particularly genital and universalis vitiligo, were found to be more closely associated with an increased risk of depression. These results highlight the importance of regular mental health screenings and customized psychosocial support in dermatological care, especially for high-risk groups.

Background Hypertensive disorders of pregnancy (HDP) can significantly impact maternal, neonatal, and fetal health. For controlling these disorders, frequent blood pressure measurements are required. Home blood pressure monitoring (HBPM) is a suggested alternative to conventional office monitoring that requires frequent visits. This systematic review was conducted to evaluate the efficacy and safety of HBPM in the control of HDP. Methods We systematically conducted databases search for relevant studies in June 2022. The relevant studies were identified, and qualitative synthesis was performed. An inverse variance quantitative synthesis was conducted using RevMan software. Continuous outcome data were pooled as means differences, whereas dichotomous ones were summarized as risk ratios. The 95% confidence interval was the measure of variance. Results Fifteen studies were included in our review ( n  = 5335). Our analysis revealed a superiority of HBPM in reducing the risk of induction of labor, and postpartum readmission ( P  = 0.02, and 0.01 respectively). Moreover, the comparison of birth weights showed a significant variation in favor of HBPM ( P  = 0.02). In the analysis of other outcomes, HBPM was equally effective as office monitoring. Furthermore, HBPM did not result in an elevated risk of maternal, neonatal, and fetal adverse outcomes. Conclusion Home monitoring of blood pressure showed superiority over office monitoring in some outcomes and equal efficacy in other outcomes.

Introduction High percentage of OOP (Out-of-Pocket) costs can lead to poverty and exacerbate existing poverty, with 21.9% of India's 1.324 billion people living below the poverty line. Factors such as increased patient cost-sharing, high-deductible health plans, and expensive medications contribute to high OOP costs. Understanding the poverty-inducing impact of healthcare payments is essential for formulating effective measures to alleviate it. Methods The study used data from the 75th round of the National Sample Survey Organization (Household Social Consumption in India: Health) from July 2017-June 2018, focusing on demographic-socio-economic characteristics, morbidity status, healthcare utilization, and expenditure. The analysis included 66,237 hospitalized individuals in the last 365 days. Logistic regression model was used to examine the impact of OOP expenditures on impoverishment. Results Logistic regression analysis shows that there is 0.2868 lower odds of experiencing poverty due to OOP expenditures in households where there is the presence of at least one child aged 5 years and less present in the household compared to households who do not have any children. There is 0.601 higher odds of experiencing poverty due to OOP expenditures in urban areas compared to households in rural areas. With an increasing duration of stay in the hospital, there is a higher odds of experiencing poverty due to OOP health expenditures. There is 1.9013 higher odds of experiencing poverty due to OOP expenditures if at least one member in the household used private healthcare facility compared to households who never used private healthcare facilities. Conclusion In order to transfer demand from private to public hospitals and reduce OOPHE, policymakers should restructure the current inefficient public hospitals. More crucially, there needs to be significant investment in rural areas, where more than 70% of the poorest people reside and who are more vulnerable to OOP expenditures because they lack coping skills.

Background Recent clinical and basic research implicated a strong correlation between NAFLD/NASH phenotypes with ectopic manifestations including neuroinflammation and neurodegeneration, but the mediators and critical pathways involved are not well understood. Lipocalin 2 (Lcn2) is one of the important mediators exclusively produced in the liver and circulation during NASH pathology. Methods Using murine model of NASH, we studied the role of Lcn2 as a potent mediator of neuroinflammation and neurodegeneration in NASH pathology via the liver-brain axis. Results Results showed that high circulatory Lcn2 activated 24p3R (Lipocalin2 receptor) in the brain and induced the release of high mobility group box 1 (HMGB1) preferably from brain cells. Released HMGB1 acted as a preferential ligand to toll-like receptor 4 (TLR4) and induced oxidative stress by activation of NOX-2 signaling involving activated p65 protein of the NF-κB complex. Further, the HMGB1-derived downstream signaling cascade activated NLRP3 inflammasome and release of proinflammatory cytokines IL-6 and IL-1β from brain cells. In addition, to advance our present understanding, in vitro studies were performed in primary brain endothelial cells where results showed high circulatory Lcn2 influenced HMGB1 secretion. Mechanistically, we also showed that elevated Lcn2 level in underlying NASH might be a likely cause for induction of blood-brain barrier dysfunction since the adipokine decreased the expression of tight junction protein Claudin 5 and caused subsequent elevation of pro-inflammatory cytokines IL-6 and IL-1β. Conclusion In conclusion, the NASH-induced brain pathology might be because of increased Lcn2-induced release of HMGB1 and accompanying neuroinflammation.

Background and aim: Candida infection is a significant cause of morbidity and mortality in neonatal intensive care units (NICU) globally. We aimed to conduct a systematic review to investigate the prevalence of candida among causative organisms of neonatal sepsis and identify the distribution of candida species infecting Saudi neonates. Methods: We comprehensively searched Web of Science, Scopus, PubMed, and Cochrane Library from their inception till November 2023. After screening titles, abstracts, and full texts, we ultimately included 21 eligible studies. The designs of the included studies were randomized clinical trials, cohorts, case–control, and case reports; the methodological quality was appraised using the Cochrane risk of bias assessment tool, NIH tool for observational studies, and Murad tool for assessing case reports. Results: Our systematic review and meta-analysis pooled data reported in 21 studies in the Saudi populations, which provided data on different types of candidal infections in 2346 neonates. The pooled data of ten retrospective studies enrolling 1823 neonates revealed that candida species resembled 4.2% of the causative organisms of neonatal sepsis among Saudi neonates (95%CI [2.5%; 5.9%], p = 0.000). Additionally, out of a total of 402 candida species that were identified among the included studies, C. albicans prevailed mostly among Saudi neonates, followed by C. parapsilosis, NS candida, and C. tropicalis (50.25%, 21.40%, 12.44%, and 9.45%, respectively). Conclusions: We found that candida species prevailed in 4.2% of 1823 cases of neonatal sepsis; the most common candida species was C. albicans. We could not pool data regarding risk factors or susceptibility of candida species to different treatment modalities due to insufficient data, requiring future large-scale, high-quality studies to be conducted.

Background: Tuberculosis affects around 30% of the population of the world. Tuberculosis causes an increase in early mortality and thus has the potential to increase the number of years of life lost. Globalization directly or indirectly by affecting the factors that increase the susceptibility for tuberculosis infection has the potential to increase the spread and mortality due to tuberculosis. This study assessed the causal link between globalization and the years of life lost due to tuberculosis. Methods: Data from the Demographic and Health Survey (DHS) and World Bank for 2004 and 2005 were used for a number of covariates and possible mediators. Data from the Institute of Health Metrics and Evaluation (IHME) were used for the outcome variable and important globalization indicators. The primary health outcome that was studied is tuberculosis and the measure that was used to quantify tuberculosis mortality is the years of life lost (YLL). Path analysis was used. Results: The main independent variables of economic and social integration were not statistically significant. For every unit increase in the proportion of people that were using treated drinking water, there was a -0.0002 decrease in the YLL due to tuberculosis. For every unit increase in the proportion of people with earth floor, there was a 0.0002 units increase in YLL due to tuberculosis. For every unit increase in the proportion of people living using clean fuel, there was a 0.0004 decrease in the YLL due to tuberculosis. Conclusions: Social and economic globalization have no effect on the years of life lost due to tuberculosis, highlighting that globalization actually does not contribute to tuberculosis mortality. However, improving other important determinants such as sanitation, providing safe drinking water and clean households will reduce the mortality due to tuberculosis, highlighting the need to invest in them.