High Positivity Rate of Urinary Mycobacterium tuberculosis Antigens Cocktail (ESAT-6, CFP-10, and MPT-64) in Active Tuberculosis Patients With and Without Human Immunodeficiency Virus Infection: A Cross-Sectional Study

Introduction

Human immunodeficiency virus (HIV) infection is a risk factor for the occurrence of a large of Mycobacterium tuberculosis (Mtb) antigen load in the body. The antigens cocktail namely early secretory antigenic target protein 6-kDa (ESAT-6), Culture filtrate protein 10 kDa (CFP-10), and Mycobacterium tuberculosis protein 64 (MPT-64) are secreted by Mtb during replication, hence, their concentration increase in patients with active Tuberculosis (TB). This increased levels facilitates their entry into the systemic circulation, followed by secretion by the glomerulus into the urine. The aim of this study was to determine the positivity rate of the urinary Mtb antigens cocktail between TB patients with and without HIV infection.

Methods

This is an observational descriptive comparative study conducted with a cross-sectional design. Random urine samples were collected from patients diagnosed with active TB in Dr. Hasan Sadikin Bandung Hospital in 2021. The subjects were divided into 2 groups, TB-HIV group and TB without HIV group. The samples were tested using the quantitative immunochromatography method.

Result

Sixty active TB patients consisting of TB patients with HIV infection (n = 30) and TB patients without HIV infection (n = 30). The positivity in the urinary Mtb antigens cocktail was 93.3% for TB-HIV group and 100% for TB without HIV group (P = .492). The median concentration of urinary Mtb antigens cocktail in TB patients without HIV infection was higher than that of TB patients with HIV infection (137.73 ng/mL vs 96.69 ng/mL, respectively; P = .001).

Conclusion

There was no significant difference in the positivity rate, meanwhile, there was a significant difference in concentration of the urinary Mtb antigens cocktail between active TB patients with and without HIV infection. Interestingly, this urinary Mtb antigens cocktail can be found in both groups without being affected by the patient's immune condition, thus becoming a test to assist diagnose active TB.

Absence of detectable SARS-CoV-2 replication in ex vivo cultured cornea and cornea-derived epithelial cells

PURPOSE

To study the possibility of SARS-CoV-2 to infect human corneal cells and tissues under standard corneal culture conditions using explants of COVID-19 donors and primary cornea-derived epithelial cells.

METHODS

Cornea isolated from deceased COVID-19 donors was cultured for 4 weeks, and SARS-CoV-2 replication was monitored by qRT-PCR. Furthermore, primary corneal epithelial cells from healthy donors were cultured ex vivo and infected with SARS-CoV-2 and human cytomegalovirus (HCMV) as a control. Infection status was assessed by western blotting and reporter gene expression using green fluorescent protein-expressing viral strains. ACE2 and TMPRSS2 receptor expression levels in cornea and epithelial cells were assessed by qRT-PCR.

RESULTS

We did not detect SARS-CoV-2 replication in 10 corneas isolated from deceased COVID-19 patients and cultured for 4 weeks, indicating absence of infection under natural conditions. Furthermore, high-titer SARS-CoV-2 infection of ex vivo cultured cornea-derived epithelial cells did not result in productive virus replication. In contrast, the same cells were highly permissive for HCMV. This phenotype could potentially be explained by low ACE2 and TMPRSS2 transcriptional activity in cornea and cornea-derived epithelial cells.

CONCLUSIONS

Our data suggest that cornea and limbal epithelial cells are refractory to productive SARS-CoV-2 infection. This could be due to the absence of robust receptor expression levels necessary for viral entry. This study adds further evidence to support the very low possibility of transmission of SARS-CoV-2 from an infected corneal transplant donor to a recipient in corneal organ cultures.

Pretreatment of ellagic acid protects ifosfamide-induced acute nephrotoxicity in rat kidneys: A mitochondrial, histopathological and oxidative stress approaches

Ifosfamide (IFO) kidney damage is an important organ toxicity in children and adults undergoing chemotherapy. Previous evidence has shown that IFO toxic metabolites such as acrolein and are associated with mitochondrial dysfunction, depletion of antioxidants, oxidative stress and may predispose the kidney to IFO toxicity. Bioactive food compounds such as ellagic acid (EA) found in fruits has been described as antioxidant and mitochondrial protective agents against toxicity-related mitochondrial damage and oxidative stress. In current study, the protective effects of EA on IFO-induced nephrotoxicity in male Wistar rats were investigated with histopathological, biochemical, and mitochondrial methods. The rats were randomly divided into four groups, control, IFO, IFO + EA, and EA groups. EA (25 mg/kg, i.p. daily) were administered to animals for 2 consecutive days and IFO (500 mg/kg, i.p.) was administered on third day. The results showed that pretreatment EA significantly increased mitochondrial succinate dehydrogenases (SDH) activity, and protected mitochondrial swelling, mitochondrial membrane potential (MMP), reactive oxygen species (ROS) formation, lipid peroxidation (LPO) and depletion glutathione (GSH). Histopathological findings demonstrated that EA had protective effects and reduced histopathological abnormalities caused by IFO. These results showed that EA administration protects the kidneys against mitochondrial dysfunction, oxidative stress and histopathological abnormality induced by IFO. Taken together, our results demonstrated that EA played a protective role against IFO-induced nephrotoxicity through mitochondrial protection and antioxidant properties.

Stress and Prevalence of Musculoskeletal Disorders Among the Nursing Personnel of a Tertiary Hospital Unit in Greece: A Cross-Sectional Study

BACKGROUND

Work-related musculoskeletal injuries and disorders (WMSD) are a significant cause of morbidity in the health care sector. Healthcare professionals are routinely exposed to various physical and psychosocial factors that increase the risk of developing a WMSD. Nurses are more susceptible to the manifestation of such disorders.

METHODS

A cross-sectional study was conducted during the second semester of 2020. The Nordic Questionnaire (NMQ) was used to investigate the prevalence of musculoskeletal symptoms, the Short Anxiety Screening Test (SAST) for stress detection, and a data collection sheet was developed for the registration of clinical, demographic, and anthropometric characteristics of the nursing personnel of the tertiary hospital unit of Heraklion, Crete, Greece.

RESULTS

A percentage of 82% of nurses had developed at least one musculoskeletal symptom in the last 12 months. The most common anatomical areas at which symptoms were present the last 12 months were the neck (53.9%), shoulders (50.8%), and the lower back (49.5%). The same areas were also the reported anatomical regions, most affected by musculoskeletal symptoms when stress levels were high. Absence from work was associated with the onset of musculoskeletal symptoms (p<0.001), while nurses' financial expenses (out-of-pocket payment) appeared to be associated with the onset of any symptom at 12 months, musculoskeletal symptoms limiting everyday activity at 12 months, and current musculoskeletal symptoms (p=0.001, p=0.002, and p=0.002 respectively).

CONCLUSIONS

Musculoskeletal disorders were common among the nursing personnel. Higher levels of stress were related with a higher prevalence of musculoskeletal symptoms.

Evaluating Predictors of Participation in Telephone-Based Social-Connectedness Interventions for Older Adults: A Dual Machine-Learning and Regression Approach

Social isolation is a well-documented contributor to poor mental and physical health, and interventions promoting social connectedness have been associated with various health benefits. This study examined predictors of participation in a telephone-based social connectedness intervention for socially isolated older adults. Data were obtained from a social-connectedness intervention that paired college students with Houston-area, community-dwelling adults aged 65 years and older and enrolled in Medicare Advantage plans. We combined machine learning and regression techniques to identify significant predictors of program participation. The following machine-learning methods were implemented: (1) k-nearest neighbors, (2) decision tree and ensembles of decision trees, (3) gradient-boosted decision tree, and (4) random forest. The primary outcome was a binary flag indicating participation in the telephone-based social-connectedness intervention. The most predictive variables in the ML models, with scores corresponding to the 90th percentile or greater, were included in the regression analysis. The predictive ability of each model showed high discriminative power, with test accuracies greater than 95%. Our findings suggest that telephone-based social-connectedness interventions appeal to individuals with disabilities, depression, arthritis, and higher risk scores. scores. Recognizing features that predict participation in social-connectedness programs is the first step to increasing reach and fostering patient engagement.

Sorafenib-Induced Capillary Leak Syndrome

Capillary leak syndrome is a rare life-threatening disorder of acute endothelial hyperpermeability. It consists of initial fluid extravasation resulting in hypotension, hypoalbuminemia, and hemoconcentration, followed by noncardiogenic pulmonary edema from rapid fluid remobilization into intravascular compartment. Drug-induced etiology is an important diagnostic consideration in cancer patients, particularly with use of antimetabolites, immunostimulants, and monoclonal antibodies. Sorafenib-mediated capillary leak syndrome has never been reported. Here, we present the case of a 29-year-old female patient with a desmoid tumor of the thigh, who was admitted for acute hypoxic respiratory failure after recent initiation of sorafenib. She was found to have extensive pulmonary edema, bilateral pleural effusions, and hemoconcentration, all of which stabilized on supportive care with noninvasive mechanical ventilation and intravenous diuresis. Her infectious and cardiac work-up were negative. Given the temporal relationship between sorafenib use and symptom onset as well as a lack of an alternative etiology of her findings, patient was deemed to have sorafenib-induced acute capillary leak syndrome. Importantly, she did not become hypotensive prior to or during this hospitalization. To our knowledge, we reported for the first time an atypical presentation of acute capillary leak syndrome due to sorafenib use without hemodynamic instability.

Miliary Tuberculosis during R-MPV Therapy in an Elderly Patient with Primary Central Nerve System Lymphoma: A Case Report

Most elderly patients with tuberculosis (TB) have previously been infected with Mycobacterium tuberculosis, which remains dormant in the body for decades and may reactivate when their immunity declines due to underlying diseases. Elderly cancer patients are at a high risk for TB, and the treatment of TB reactivation in these patients is challenging. Among cancer patients, the incidence of TB reactivation is the highest in lymphoma patients. However, the impact of chemotherapy on TB reactivation in lymphoma patients is unknown. We report the case of an immunocompetent elderly patient with primary central nervous system lymphoma (PCNSL) having no prior history of TB, who developed miliary TB during multiagent chemotherapy consisting of rituximab, high-dose methotrexate, procarbazine, and vincristine (R-MPV therapy). Retrospectively, the chest computed tomography showed calcification of the pleura, suggesting that the patient had a latent tuberculosis infection (LTBI) and developed miliary TB from the reactivation of TB triggered by the R-MPV therapy. Our case emphasizes that when chemotherapy is administered to patients with PCNSL, interferon-gamma release assay (IGRA) should be performed if there are findings on chest examination suggestive of LTBI, such as pleural calcification, and if IGRA is positive, chemotherapy should be given concurrently with LTBI treatment.

Severe Clozapine Poisoning Treated by Extracorporeal Blood Purification Therapy

Clozapine is a frequently used antipsychotic that, in case of overdose, can cause severe adverse side effects, such as hematological, cardiovascular, and neurological complications. As there is no specific antidote or reversal agent available, extracorporeal techniques such as CytoSorb hemoadsorption might represent a viable option, having already been used in a variety of intoxication scenarios with favorable rates of success. A 56-year-old male was admitted with generalized epileptic seizures and arrhythmias following ingestion of clozapine in a suicide attempt (5,000 mg). Subsequently, conventional supportive care was initiated. To accelerate drug removal, continuous veno-venous hemodiafiltration including the application of CytoSorb hemoadsorption therapy was started. Serial measurements confirmed rapid reduction of clozapine plasma levels. The patient remained hemodynamically stable throughout this period. Furthermore, there were no cardiac arrhythmias detected and liver values were normal. The patient improved and was successfully extubated 3 days after admission with good vigilance and no residual neurological abnormalities. This is the first clinical case report on the use of CytoSorb hemoadsorption in severe clozapine intoxication which helped quickly and efficiently reduce clozapine levels to nontoxic serum levels while preserving organ function. Therefore, CytoSorb might represent an alternative treatment modality to be considered for potentially lethal clozapine intoxications.

Cardiovascular risk factors among Cameroonian adolescents: Comparison between public and private schools and association with physical activity practice-a cross-sectional study

Aim

Cardiovascular diseases are the leading cause of death worldwide and physical activity (PA) practice is recommended as the most efficient preventive measure to curse their burden in sub-Saharan Africa. Our study aimed to compare cardiovascular risk factors (CVRFs) in adolescents in public and private schools in Cameroon and assess the impact of PA practice.

Methods

We conducted a cross-sectional study on students from private and public secondary schools in the city of Douala. Anthropometric parameters, blood glucose, and blood pressure (BP) were collected. PA was assessed using the short form of the International Physical Activity Questionnaire. Multivariate logistic regression was used to assess the influence of PA levels on different CVRFs. The differences were considered significant for p < .05.

Results

We recruited 771 participants, aged 16 ± 1years, 51.4% female, and 48.6% private school students. Prevalence of CVRFs was 38.4%; 11.5%; 5.6%; 5.4%, and 3% for overweight/obesity, abdominal obesity, smoking, glucose homeostasis abnormalities, and high BP (HBP) respectively. Around 41% of participants had low PA level (LPA). Abdominal obesity and LPA were more common among girls (p < .0001 both) and 1.3% of participants had more than four CVRF. In multivariate analysis, LPA was significantly associated with a higher odd of HBP (OR = 7.69; p < .0001).

Conclusion

The prevalence of various CVRF is high among Cameroonian adolescent schoolers. Public policies should focus on prevention programs through physical exercise and the reduction of smoking.

A Novel Mutation of UMOD in a Chinese Family with IgA Nephropathy: A Case Report

IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide, with varying clinical presentations. The hereditary susceptibility to IgAN is rather complex. In this report, a Chinese case of IgAN was recruited. Renal biopsy showed the tubular atrophy and dilatation, but the glomerular lesions were rather weak except slight mesangial hyperplasia. Immunological staining of kidney tissue revealed the positive immunological staining of IgA and C3. By using whole-exome sequencing, a heterozygous variant in UMOD gene was found and was confirmed by Sanger sequencing. The variant in UMOD gene might contribute to the disease and this case helps understand the correlation of genotype and phenotypes of UMOD mutations.

Delayed Bacterial Endotheliitis and Endophthalmitis 11 Years after Cataract Surgery

Infective endophthalmitis is an uncommon complication following intraocular surgery. Chronic endophthalmitis may present some time after intraocular surgery, making the diagnosis challenging. Cutibacterium acnes is a well-recognised causative agent of these chronic infections. Practitioners should be aware of the conditions required to culture this slow-growing organism. We report a case of delayed low-grade endophthalmitis presenting 11 years after cataract surgery. Cutibacterium acnes and Staphylococcus warneri were cultured from Descemet's membrane biopsy following three failed previous attempts at microbiological studies. Clinical features of the infection included discrete white granules on the iris, endothelium, and within the capsular bag of the patient's right eye. The patient presented with no signs of systemic infection and the left eye was normal on examination. Bullous keratopathy, secondary to endothelial dysfunction was a feature of this infection. This retrospective case report illustrates the prolonged periods for which Cutibacterium acnes can remain latent before causing clinical signs. While uncommon, endothelial involvement may occur and clinicians should consider low-grade infective endophthalmitis in cases with corneal oedema.

Documented Reperfusion of the Retina on Fluorescein Angiography after Administration of Intravenous Prostaglandin E1 for Central Retinal Artery Occlusion: A Case Report

Central retinal artery occlusion (CRAO) can result in devastating permanent vision loss. Presently, there is no evidence-based treatment for CRAO that is widely accepted. In the literature, multiple studies propose intravenous (IV) prostaglandin E1 (IV PGE1) as a potential treatment option for patients with CRAO. We illustrate 2 cases of CRAO successfully treated with IV PGE1. In both cases, our patients with vascular risk factors were diagnosed with CRAO of the left eye. They were started on twice daily IV 40 μg PGE1 in 100 mL normal saline, with each dose administered over 3 h. In the first case, we documented reperfusion of the retina on fluorescein angiography after administration of IV PGE1. In the second case, our patient improved from no light perception visual acuity (VA) to count fingers VA within 48 h of treatment with IV PGE1. Our study highlights the vasodilatory effect of IV PGE1. Due to its mechanism of action and safety profile, it should be considered a potential treatment option for CRAO. Further randomized controlled trials are necessary to determine the overall therapeutic effect of IV PGE1 for CRAO.

A Case of Nocardia africana-Related Keratitis

Nocardia spp. are gram positive, aerobic, weakly acid-fast bacteria. Nocardia spp. keratitis is a rare ocular infection classically described following corneal injury or vegetative and soil exposure. However, keratitis caused by Nocardia africana had never been reported in the literature. We first reported a 70-year-old male who had a traumatic ocular injury to his left eye a month ago. With his complaint of left eye pain, reduced vision, and light sensitivity, the slit-lamp biomicroscopy showed the superficial multi-lobulated epithelial infiltration located at the inferior cornea with a positive fluorescein stain. Microscopic workup from corneal specimens demonstrated dry and chalky white colonies on blood agar and Lowenstein-Jensen media resembling Nocardia spp. The MALDI-TOF MS analyses using VITEK® MS exhibited N. africana. The corneal lesion was treated with 2% amikacin topical eye drops and responded well. The careful history-taking, precise clinical examinations, and meticulous microscopic assessment were the cornerstones of diagnosis. Definite diagnosis and timely treatment were essential to prevention of ocular morbidity in N. africana.

A Rare Case of Direct Spontaneous Carotid-Cavernous Fistula in a 6-Month-Old Infant and Review of the Literature

Direct or type A CCFs are the direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus. While most direct CCFs are caused by trauma, spontaneous direct CCFs are extremely rare in infants. In this report, we describe a 6-month-old child with bulges in the right eye that had been present since 20 days after birth. On examination, there was a right eye abduction limitation with no deviation associated with proptosis. Bruit was present during auscultation. CEMRI showed an enlarged right cavernous sinus with dilatation of the superior ophthalmic vein, suggesting a carotid-cavernous fistula. The patient was referred to an advanced center where he was advised patch therapy to prevent amblyopia. He was kept under observation by a neurosurgeon until 3 years, after which he was scheduled to undergo transarterial coiling.

CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

Background

Carbon dioxide (CO2) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI).

Objectives

To examine the efficacy of CO2 laser therapy for management of SUI-related symptoms in women.

Design

A systematic review and meta-analysis of randomized controlled trials and cohort studies.

Data sources and methods

Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model.

Results

A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [n = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113), p < 0.001], 6 months [n = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008), p = 0.005], and 12 months [n = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [n = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626), p < 0.001] and 12-months [n = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [n = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865), p = 0.002] and 12 months [n = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [n = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699), p < 0.001], but not at 6 months [n = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027].

Conclusion

CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.

Awareness of and Confidence to Address Equity-Related Concepts Across the US Governmental Public Health Workforce

OBJECTIVE

To assess the governmental public health (GPH) workforce's awareness of and confidence to address health equity , social determinants of health ( SDoH ), and social determinants of equity ( SDoE ) in their work.

DESIGN, SETTING, AND PARTICIPANTS

A nationally representative population of US local and state GPH employees (n = 41 890) were surveyed through the 2021 Public Health Workforce Interests and Needs Survey (PH WINS 2021).

MAIN OUTCOME MEASURES

Self-reported awareness and confidence were explored by self-identified racial and ethnic group identity, public health degree attainment, and supervisory status.

RESULTS

GPH employees reported higher levels of awareness across concepts ( health equity -71%, 95% confidence interval [CI]: 70.5-71.6; SDoH -62%, 95% CI: 62.3-63.5; SDoE -48%, 95% CI: 47.2-48.4) than confidence ( health equity -48%, 95% CI: 47.8-49.0; SDoH -46%, 95% CI: 45.4-46.7; SDoE -34%, 95% CI: 33.4-34.6). Self-identified Black or African American employees reported higher confidence across all concepts ( health equity -56%, 95% CI: 54.3-57.6; SDoH -52%, 95% CI: 50.8-54.1; SDoE -43%, 95% CI: 41.3-44.6) compared to other self-identified racial groups. Employees with a PH degree reported higher confidence across all concepts ( health equity -65%, 95% CI: 63.8-68.8; SDoH -73%, 95% CI: 71.3-74.1; SDoE -39%, 95% CI: 36.9-40.1) compared with employees without a PH degree ( health equity -45%, 95% CI: 44.8-46.1; SDoH -41%, 95% CI: 40.6-41.9; SDoE -33%, 95% CI: 32.6-33.8). We found an inverse relationship between supervisory status and confidence to address SDoE : Nonsupervisors reported higher confidence (35%, 95% CI: 29.2-31.9) than supervisors (31%, 95% CI: 29.2-31.9), managers (31%, 95% CI: 28.8-32.6), and executives (32%, 95% CI: 27.5-34.4).

CONCLUSION

PH WINS 2021 reveals that GPH employees are aware of equity-related concepts but lack confidence to address them. Public health agencies should build employees' confidence by prioritizing and operationalizing equity internally and externally in collaboration with communities and partners.

Mandibular Metastasis as the First Manifestation of Hepatocellular Carcinoma: A Case Report

Metastatic malignancies of the oral cavity are rare lesions, accounting for only 1-4% of all oral malignancies, and can occur in the jaw bones, the oral soft tissues, or even both. Although hepatocellular carcinoma is the most common primary hepatic tumor, no more than 1% of the cases show oral involvement. When metastatic tumor involves the oral cavity, the most frequent site is the posterior angle of the mandible. Histologically, hence, immunohistochemical markers are used for diagnosis. Glypican-3 and HepPar1 are the markers that can be used to confirm the microscopic diagnosis of HCC. Very rarely, hepatocellular carcinoma (HCC) metastasizes to the oral cavity, and such cases have a poor prognosis due to delay in diagnosis. We present a 74-year-old male with a metastasis of HCC in the left mandibular body as the first manifestation. Histologic examination confirmed metastatic hepatocellular carcinoma in the oral mucosa with immunohistochemical (IHC) markers. A review of pertinent literature was performed. Given the rarity of the disease, treatment principles are based mainly on retrospective series and case reports. We report an exceptionally unusual presentation with few cases (<70) reported in the literature, thus representing a diagnostic challenge.

Haemostatic support in postpartum haemorrhage: A review of the literature and expert opinion

Postpartum haemorrhage (PPH) remains the leading cause of pregnancy-related deaths worldwide. Typically, bleeding is controlled by timely obstetric measures in parallel with resuscitation and treatment of coagulopathy. Early recognition of abnormal coagulation is crucial and haemostatic support should be considered simultaneously with other strategies as coagulopathies contribute to the progression to massive haemorrhage. However, there is lack of agreement on important topics in the current guidelines for management of PPH. A clinical definition of PPH is paramount to understand the situation to which the treatment recommendations relate; however, reaching a consensus has previously proven difficult. Traditional definitions are based on volume of blood loss, which is difficult to monitor, can be misleading and leads to treatment delay. A multidisciplinary approach to define PPH considering vital signs, clinical symptoms, coagulation and haemodynamic changes is needed. Moreover, standardised algorithms or massive haemorrhage protocols should be developed to reduce the risk of morbidity and mortality and improve overall clinical outcomes in PPH. If available, point-of-care testing should be used to guide goal-directed haemostatic treatment. Tranexamic acid should be administered as soon as abnormal bleeding is recognised. Fibrinogen concentrate rather than fresh frozen plasma should be administered to restore haemostasis where there is elevated risk of fibrinogen deficiency (e.g., in catastrophic bleeding or in cases of abruption or amniotic fluid embolism) as it is a more concentrated source of fibrinogen. Lastly, organisational considerations are equally as important as clinical interventions in the management of PPH and have the potential to improve patient outcomes.

Psychometric Properties of the Spanish Burnout Inventory in University Teachers in Hybrid Education

Introduction

The scientific literature argues the urgent need for adequate tools to assess burnout in human service professionals, however, little progress has been made on this in university teachers in hybrid environments, even though after the pandemic, these work scenarios are predominant.

Objective

To determine the psychometric properties of invariance between male and female teachers of hybrid education in the Spanish Burnout Inventory (SBI).

Method

The anonymous, self-administered SBI was administered to 1060 university teachers in Lima, Peru, from online random sampling. Of the total number of participants, 626 were women (59.1%) and 434 were men (40.9%), with an age range of 22 to 76 years, with a mean of 46.97 and a standard deviation of 10.256. It should be noted that 74.5% of the teachers worked full time. The analysis used the statistical programs AMOS v24, SPSS v26 and R-Project v4.1.2. First, a descriptive analysis of the data was performed, as well as a multivariate normality test of the data. Secondly, confirmatory factor analysis was performed; finally, a factorial invariance test was performed.

Results

Cronbach's alpha of the SBI was 0.827, and for each subscale: Enthusiasm toward the job (0.742), Psychological exhaustion (0.889), Indolence (0.819), Guilt (0.816). According to the fit indicators, the confirmatory factor model is adequate. The results supported configural invariance, metric invariance, scalar invariance, and strict invariance in the male and female groups, although further investigation of some items specific to the indolence factor is needed.

Conclusion

The SBI is a valid instrument to assess burnout in university teachers in hybrid environments. Studies associated with the SBI focus on its psychometric properties, burnout prevalence, related variables, and literature reviews. The validation of the SBI in various countries and service areas is discussed, as well as future implications for intervention in burnout prevention and mastery.

Endocannabinoid signaling in brain diseases: Emerging relevance of glial cells

The discovery of cannabinoid receptors as the primary molecular targets of psychotropic cannabinoid Δ⁹ -tetrahydrocannabinol (Δ⁹ -THC) in late 1980s paved the way for investigations on the effects of cannabis-based therapeutics in brain pathology. Ever since, a wealth of results obtained from studies on human tissue samples and animal models have highlighted a promising therapeutic potential of cannabinoids and endocannabinoids in a variety of neurological disorders. However, clinical success has been limited and major questions concerning endocannabinoid signaling need to be satisfactorily addressed, particularly with regard to their role as modulators of glial cells in neurodegenerative diseases. Indeed, recent studies have brought into the limelight diverse, often unexpected functions of astrocytes, oligodendrocytes, and microglia in brain injury and disease, thus providing scientific basis for targeting glial cells to treat brain disorders. This Review summarizes the current knowledge on the molecular and cellular hallmarks of endocannabinoid signaling in glial cells and its clinical relevance in neurodegenerative and chronic inflammatory disorders.

Impact of a Resident-Driven Research Club on Scholarly Activity in an Academic Internal Medicine Residency Program During the COVID-19 Pandemic

OBJECTIVES

Traditional journal clubs have been shown to be insufficient in improving residents' scholarly productivity, often due to the inability to sustain residents' interest and participation. Additionally, the 2019 novel coronavirus (COVID-19) pandemic restrictions caused a decline in academic scholarly productivity across residency programs. We evaluated the impact of a resident-led research club called 'journal café' on residents' scholarly productivity by comparing scholarly output between the journal café members and non-members during the COVID-19 pandemic.

METHODS

The journal café was established in the 2012/2013 academic year by internal medicine residents of a university residency program in Atlanta, Georgia, to foster self-directed collaboration among residents based on shared interests in academic research. The journal café runs independently of the residency program's journal club. We categorized IM residents at our institution into journal café members and non-members and collected data on their research productivity during residency training and the COVID-19 pandemic. The survey was conducted between April and June 2021 and analyzed data presented using frequencies, tables, and appropriate charts.

RESULTS

Sixty-eight residents (29 journal café members and 39 non-members) completed the survey (response rate of 85%). A significantly higher number of journal café members reported having five or more research publications (55.1% vs 7.1%, P < .001) and scientific presentations (48.3% vs 2.6%, P < .001) compared with non-members. Additionally, more journal café members published COVID-19-related research in peer-reviewed journals compared with non-members (68% vs 32%, n  =  19). Finally, most of the residents cited the opportunity of a platform to share and brainstorm on research ideas as the reason for joining the journal café.

CONCLUSION

We found an association between journal café participation and increased scholarly activity, particularly during the COVID-19 pandemic. Independent resident-led research clubs supported by the residency program may complement the traditional journal clubs and enhance residents' participation in research.

Medical Student Experiential Learning in Telesimulation

OBJECTIVES

Telesimulation utilizes telecommunication technology to engage learners in simulation while in different physical locations. Despite this potential advantage, understanding of the student experience and assessment of student learning in telesimulation activities is limited. This study evaluates medical student emotional experience and self-identified learning in telesimulation through the Kolb experiential learning framework and qualitative analysis.

METHODS

Fourth-year medical students enrolled in the Spencer Fox Eccles School of Medicine at the University of Utah participated in 3 telesimulation activities as part of a required internal medicine course. Students were surveyed regarding their satisfaction with the activity (N = 114) and responded to questions about their emotional experience and self-identified areas of learning. Free-text responses were analyzed using qualitative content analysis to identify themes until thematic saturation (N = 66).

RESULTS

Students were highly satisfied with telesimulation, with greater than 90% of students expressing a positive view of simulation realism, debrief quality, and group size. Themes of anxiety and uncertainty, confidence versus incompetence, team dynamics, fun, and difficult patient interaction were identified regarding the emotional experience. Themes of communication and teamwork, managing emotions, information gathering, differential diagnosis, resource reference, executing treatment, and medical knowledge were identified regarding student-identified learning.

CONCLUSION

In this analysis of medical student experiences with telesimulation, we found students have rich emotional, cognitive, and behavioral experiences and self-identify learning across a variety of domains. Our findings support further study of telesimulation for medical student learning and demonstrate how assessment of outcomes via Kolb framework, using the learner's reflective observation and self-identified learning, may help better define learning outcomes from simulation.

ESCAPE the Boring Lecture: Tips and Tricks on Building Puzzles for Medical Education Escape Rooms

Escape rooms in medical education are a novel, game-based learning approach for teaching medical topics. In these escape rooms, learners complete a sequential series of medical-themed puzzles leading them to "escape" a specific story. Designing puzzles can be anxiety-provoking and may be the gatekeeper for educators in medicine to create their own escape rooms. Though there have been publications on the importance and methods of building a healthcare-themed-escape room, there is a gap in the literature on designing puzzles to teach specific learning objectives successfully. In this Scholarly Perspective, the authors share puzzle ideas and support tools and use Bloom's taxonomy as the framework to teach educators how to design challenging and engaging escape room puzzles.

Exocrine Pancreatic Insufficiency Possibly Related to Atypical Chronic Graft-versus-Host Disease

We report the case of a 66-year-old woman who presented with diarrhea and weight loss approximately 14 months after unrelated allogeneic bone marrow transplantation for acute myeloid leukemia. Her early post-transplant course was notable for mild acute skin graft-versus-host disease (GVHD) and biopsy-proven upper gastrointestinal (GI) acute GVHD, both of which resolved with treatment. She then developed weight loss and diarrhea treated with prednisolone for what was thought to be GI late acute GVHD. However, her diarrhea and weight loss persisted. Colonoscopy showed a grossly intact mucosa, and stool studies only confirmed steatorrhea. However, an atrophic pancreas was found on an abdominal computed tomography (CT) scan. Exocrine pancreatic enzymes, such as lipase and pancreatic amylase, were markedly decreased, yet pancreatic endocrine function remained intact. The patient's diarrhea and weight loss improved upon treatment with pancrelipase. Therefore, we suggest that her exocrine pancreatic insufficiency was likely partly caused by atypical chronic GVHD.

How Much Speech Data Is Needed for Tracking Language Change in Alzheimer's Disease? A Comparison of Random Length, 5-Min, and 1-Min Spontaneous Speech Samples

Introduction

Changes in speech can act as biomarkers of cognitive decline in Alzheimer's disease (AD). While shorter speech samples would promote data collection and analysis, the minimum length of informative speech samples remains debated. This study aims to provide insight into the effect of sample length in analyzing longitudinal recordings of spontaneous speech in AD by comparing the original random length, 5- and 1-minute-long samples. We hope to understand whether capping the audio improves the accuracy of the analysis, and whether an extra 4 min conveys necessary information.

Methods

110 spontaneous speech samples were collected from decades of Youtube videos of 17 public figures, 9 of whom eventually developed AD. 456 language features were extracted and their text-length-sensitivity, comparability, and ability to capture change over time were analyzed across three different sample lengths.

Results

Capped audio files had advantages over the random length ones. While most extracted features were statistically comparable or highly correlated across the datasets, potential effects of sample length should be acknowledged for some features. The 5-min dataset presented the highest reliability in tracking the evolution of the disease, suggesting that the 4 extra minutes do convey informative data.

Conclusion

Sample length seems to play an important role in extracting the language feature values from speech and tracking disease progress over time. We highlight the importance of further research into optimal sample length and standardization of methods when studying speech in AD.

Tannin-based product in feedlot diet as a strategy to reduce enteric methane emissions of Nellore cattle finished under tropical conditions

A total of 120 Nellore bulls, [initial body weight (BW) = 307 ± 11.6 kg and 12 mo of age] were allocated into 12 collective pens (10 bulls per pen) in a commercial feedlot to evaluate the effects of a specific blend of tannin and saponins on enteric methane (CH4) emissions. The study was a completely randomized design, in which pens were considered the experimental units (N = 6 pens per treatment) and were randomly allocated into one of two treatments: 1) Control (CON), a basal diet with monensin supplementation (25 mg/kg dry matter [DM]; Rumensin, Elanco Animal Health, Greenfield, IN, USA), or 2) Control + a specific blend of tannin and saponins (TAN; 7 g/kg DM; composed of quebracho and chestnut tannin extracts along with carriers from cereals rich in saponins; SilvaFeed BX, Silvateam, San Michele Mondovi, CN, Italy). After the adaptation period (20 d), the experiment was divided into two phases: growing phase (21 to 53 d; total of 33 d) and fattening phase (54 to 139 d; total of 86 d). Enteric methane emissions were estimated using the sulfur hexafluoride (SF6) tracer gas technique. Interactions between treatment and period (growing vs. fattening) were detected for daily CH4 emissions, in which animals fed TAN reduced CH4 emissions by 17.3% during the fattening period compared to bulls fed CON (P = 0.05). In addition, bulls fed TAN had lower CH4 emissions expressed by dry matter intake (DMI) during the fattening period compared to bulls fed CON (P = 0.06). The findings presented herein indicate that a specific blend of tannin and saponins can be used as a strategy to reduce enteric CH4 emissions and its intensity of Nellore bulls finished in feedlot systems under tropical conditions.

D1 receptor-expressing neurons in ventral tegmental area alleviate mouse anxiety-like behaviors via glutamatergic projection to lateral septum

Dopamine (DA) acts as a key regulator in controlling emotion, and dysfunction of DA signal has been implicated in the pathophysiology of some psychiatric disorders, including anxiety. Ventral tegmental area (VTA) is one of main regions with DA-producing neurons. VTA DAergic projections in mesolimbic brain regions play a crucial role in regulating anxiety-like behaviors, however, the function of DA signal within VTA in regulating emotion remains unclear. Here, we observe that pharmacological activation/inhibition of VTA D1 receptors will alleviate/aggravate mouse anxiety-like behaviors, and knockdown of VTA D1 receptor expression also exerts anxiogenic effect. With fluorescence in situ hybridization and electrophysiological recording, we find that D1 receptors are functionally expressed in VTA neurons. Silencing/activating VTA D1 neurons bidirectionally modulate mouse anxiety-like behaviors. Furthermore, knocking down D1 receptors in VTA DA and glutamate neurons elevates anxiety-like state, but in GABA neurons has the opposite effect. In addition, we identify the glutamatergic projection from VTA D1 neurons to lateral septum is mainly responsible for the anxiolytic effect induced by activating VTA D1 neurons. Thus, our study not only characterizes the functional expression of D1 receptors in VTA neurons, but also uncovers the pivotal role of DA signal within VTA in mediating anxiety-like behaviors.

Fulminant Marginal Keratitis Induced by Atezolizumab, a Programmed Death Ligand 1 Inhibitor for Lung Cancer

Introduction

With the increasing use of immune checkpoint inhibitors, ocular adverse events have gained attention. We describe a case of atypical keratitis presumably induced by atezolizumab, a programmed cell death ligand 1 inhibitor.

Case Presentation

A 73-year-old Japanese woman developed ring-shaped marginal infiltrations with epithelial breakdown of the corneas in both eyes. The patient had advanced small cell lung cancer and had received intravenous carboplatin, etoposide, and atezolizumab. She was treated with topical administration of 0.1% sodium phosphate betamethasone and 0.5% moxifloxacin six times daily. On day 14 following initial presentation, marked reduction of bilateral corneal infiltration was observed. During the succeeding cycles of chemotherapy, marginal keratitis did not recur, and then, the topical steroid was gradually tapered.

Conclusions

Cancer immunotherapy, including atezolizumab, may lead to active T-cell recruitment into the cornea, which result in autoimmune corneal keratitis. We believe that this report is informative to both ophthalmologists and oncologists involved in the treatment of patients receiving cancer immunotherapy.

Associations of Prenatal First Trimester Essential and Nonessential Metal Mixtures with Body Size and Adiposity in Childhood

BACKGROUND

Prenatal nonessential metals may contribute to postnatal adiposity, whereas essential metals may have metabolic benefits. We evaluated joint and individual associations between prenatal metals and childhood adiposity.

METHODS

We measured concentrations of six nonessential (arsenic, barium, cadmium, cesium, lead, and mercury) and four essential (magnesium, manganese, selenium, and zinc) metals in first trimester maternal blood from a prebirth cohort. We collected anthropometric measures in early childhood, mid-childhood, and early adolescence including subscapular+tricep skinfold thickness (mm) (N = 715-859), waist circumference (cm) (N = 717-882), and body mass index (BMI) (z-score) (N = 716-875). We measured adiposity in mid-childhood and early adolescence using bone densitometry total- and trunk- fat mass index (kg/m 2 ) (N = 511-599). We estimated associations using adjusted quantile g-computation and linear regression.

RESULTS

The nonessential metal mixture was associated with higher total (β = 0.07, 95% CI = 0.01, 0.12) and trunk fat mass index (β = 0.12, CI = 0.02, 0.22), waist circumference (β = 0.01, CI = 0.00, 0.01), and BMI (β = 0.24, CI = 0.07, 0.41) in mid-childhood, and total fat mass index (β = 0.07, CI = 0.01, 0.14), and BMI (β = 0.19, CI = 0.02, 0.37) in early adolescence. The essential metal mixture was associated with lower early adolescence total-(β = -0.11, CI = -0.17, -0.04) and trunk- fat mass index (β = -0.13, CI = -0.21, -0.05), subscapular+tricep skinfold thickness (β = -0.02, CI = -0.03, -0.00), waist circumference (β = -0.003, CI = -0.01, -0.00), and BMI (β = -0.16, CI = -0.28, -0.04). Cadmium and cesium were individually associated with childhood adiposity at different timepoints.

CONCLUSIONS

Prenatal first-trimester essential metals were associated with lower childhood adiposity, whereas nonessential metals were associated with higher adiposity into adolescence.

Effect of sodium ascorbate on the shear bond strength of orthodontic brackets to bleached enamel using universal dental adhesive

Background

The aim of this study was to investigate the effect of bleaching agent, sodium ascorbate as an antioxidant, and delay time on the shear bond strength (SBS) of orthodontic brackets to enamel using Transbond XT and universal adhesive.

Materials and Methods

In this in vitro experimental study, 80 extracted maxillary premolars without any defect or decay were randomly divided into eight groups of 1: no bleaching + Transbond XT (NB/TX) bonding agent, 2: no bleaching + All-Bond Universal (NB/AB), 3: bleaching + Transbond XT (B/TX), 4: bleaching + All-Bond Universal (B/AB), 5: bleaching + sodium ascorbate + Transbond XT (B/SA/TX), 6: bleaching + sodium ascorbate + All-Bond Universal (B/SA/AB), 7: bleaching + Transbond XT after a 3-week delay (B/3W/TX), and 8: bleaching + All-Bond Universal after a 3-week delay (B/3W/AB). After thermocycling (1000 cycles, 5-55°C), the SBS was measured, and the adhesive remnant index scores were determined to assess the failure mode. Data were analyzed by one-way analysis of variance, Tamhane's post hoc test, Kruskal-Wallis, and Mann-Whitney U-test at the significance level of P < 0.05.

Results

The mean SBS range was 5.5-29.78 MPa. The highest SBS values were related to Group 2 (NB/AB) which were significantly higher than all groups (P < 0.05) and the lowest values were observed in Group 5 (B/SA/TX) which were significantly lower than all groups except Group 3 (B/TX) (P < 0.05).

Conclusion

Bleaching with 40% hydrogen peroxide significantly decreased the SBS of orthodontic brackets, and 10% sodium ascorbate could not reverse the adverse effect of bleaching on SBS. Delaying the bonding procedure by 3 weeks using Universal adhesive considerably decreased the adverse effect of bleaching on SBS and increased the SBS to a clinically acceptable level for orthodontic treatment.

"It helps me to stay on the right path, rather than give in": Mixed-method process evaluation of the ImpulsePal app-based intervention for weight management

Background

Empirical research indicates that impulsive processes that operate below conscious monitoring can undermine peoples' attempts to change behaviour patterns, especially those that have become habitual. This may, therefore, be a serious challenge for those trying to lose weight. A novel smartphone app-based intervention (ImpulsePal) offers practical strategies to manage impulsive urges to facilitate reductions in the consumption of energy-dense processed food and overeating.

Aim

This process evaluation of ImpulsePal aimed to explore what was delivered/received and used, mechanisms of action, and potential contextual factors impacting intervention engagement and outcomes.

Methods

A mixed-methods process evaluation, with composite analysis of the quantitative (app usage statistics) and qualitative data (semi-structured interviews), was conducted alongside a feasibility randomised controlled trial with individuals with a body mass index of at least 25 kg/m2 who wanted to lose weight.

Results

Of 58 participants receiving ImpulsePal, 56 had successfully shared app usage statistics, and 36 (62%) were interviewed. Although usage statistics indicated reductions in the use of some features, interviews indicated that participants were still using app-recommended strategies without requiring them to open ImpulsPal. Overall, interviews highlighted that participants valued having access to in-the-moment support, felt more aware of their own eating behaviour and influences on it, and felt an increased ability to avoid and reconceptualise, in-the-moment temptations.

Conclusion

This process evaluation offers support for a logic model suggesting that impulse management, using ImpulsePal, can promote healthier eating among those motivated to lose weight. It also highlights the necessity of using multimodal methods to explore the delivery and use of digital interventions.

Feasibility and acceptability of ChatGPT generated radiology report summaries for cancer patients

Objective

Patients now have direct access to their radiology reports, which can include complex terminology and be difficult to understand. We assessed ChatGPT's ability to generate summarized MRI reports for patients with prostate cancer and evaluated physician satisfaction with the artificial intelligence (AI)-summarized report.

Methods

We used ChatGPT to summarize five full MRI reports for patients with prostate cancer performed at a single institution from 2021 to 2022. Three summarized reports were generated for each full MRI report. Full MRI and summarized reports were assessed for readability using Flesch-Kincaid Grade Level (FK) score. Radiation oncologists were asked to evaluate the AI-summarized reports via an anonymous questionnaire. Qualitative responses were given on a 1-5 Likert-type scale. Fifty newly diagnosed prostate cancer patient MRIs performed at a single institution were additionally assessed for physician online portal response rates.

Results

Fifteen summarized reports were generated from five full MRI reports using ChatGPT. The median FK score for the full MRI reports and summarized reports was 9.6 vs. 5.0, (p < 0.05), respectively. Twelve radiation oncologists responded to our questionnaire. The mean [SD] ratings for summarized reports were factual correctness (4.0 [0.6], understanding 4.0 [0.7]), completeness (4.1 [0.5]), potential for harm (3.5 [0.9]), overall quality (3.4 [0.9]), and likelihood to send to patient (3.1 [1.1]). Current physician online portal response rates were 14/50 (28%) at our institution.

Conclusions

We demonstrate a novel application of ChatGPT to summarize MRI reports at a reading level appropriate for patients. Physicians were likely to be satisfied with the summarized reports with respect to factual correctness, ease of understanding, and completeness. Physicians were less likely to be satisfied with respect to potential for harm, overall quality, and likelihood to send to patients. Further research is needed to optimize ChatGPT's ability to summarize radiology reports and understand what factors influence physician trust in AI-summarized reports.

Phylogenetic diversity of eastern Asia-eastern North America disjunct plants is mainly associated with divergence time

The underlying causes of biodiversity disparities among geographic regions have long been a fundamental theme in ecology and evolution. However, the patterns of phylogenetic diversity (PD) and phylogenetic beta diversity (PBD) of congeners that are disjunctly distributed between eastern Asia-eastern North America (EA-ENA disjuncts) and their associated factors remain unknown. Here we investigated the standardized effect size of PD (SES-PD), PBD, and potentially associated factors in 11 natural mixed forest sites (five in EA and six in ENA) where abundant EA-ENA disjuncts occur. We found that the disjuncts in ENA possessed higher SES-PD than those in EA at the continental scale (1.96 vs -1.12), even though the number of disjunct species in ENA is much lower than in EA (128 vs 263). SES-PD of the EA-ENA disjuncts tended to decrease with increasing latitude in 11 sites. The latitudinal diversity gradient of SES-PD was stronger in EA sites than in ENA sites. Based on the unweighted unique fraction metric (UniFrac) distance and the phylogenetic community dissimilarity, PBD showed that the two northern sites in EA were more similar to the six-site ENA group than to the remaining southern EA sites. Based on the standardized effect size of mean pairwise distances (SES-MPD), nine of eleven studied sites showed a neutral community structure (-1.96 ≤ SES-MPD ≤ 1.96). Both Pearson's r and structural equation modeling suggested that SES-PD of the EA-ENA disjuncts was mostly associated with mean divergence time. Moreover, SES-PD of the EA-ENA disjuncts was positively correlated with temperature-related climatic factors, although negatively correlated with mean diversification rate and community structure. By applying approaches from phylogenetics and community ecology, our work sheds light on historical patterns of the EA-ENA disjunction and paves the way for further research.

Surgical Management of Hidradenitis Suppurativa: Factors Associated with Postoperative Complications and Disease Recurrence

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder. Treatment of HS remains challenging, and surgical procedures commonly follow attempts of conservative therapy. To date, a consensus regarding the optimal surgical technique has not been reached, and the implications of conservative therapy on future surgical outcomes have yet to be studied.

METHODS

A retrospective cohort study of 65 patients surgically treated for HS at a tertiary care center was conducted. Patients' medical records were screened for demographical, clinical, and surgical characteristics. Statistical analysis was conducted to determine associations with postoperative complications and disease recurrence.

RESULTS

Fifty patients (75.8%) were treated with systemic antibiotics before opting for surgical resection. Previous treatment with systemic rifampicin was associated with higher rates of postoperative complications (P = 0.029); however, systemic cephalexin and topical clindamycin were associated with a lower rate of complications (P = 0.007 and 0.040, accordingly). Medical history of smoking and surgical management with split-thickness skin grafts were associated with higher rates of postoperative complications (P = 0.012 and 0.014, accordingly). Patients with a greater number of lesions, and those treated with split-thickness skin graft, had higher rates of disease recurrence (P = 0.0018 and 0.003, accordingly).In a multivariate analysis a greater number of lesions (P = 0.0498) and the use of autologous split-thickness skin graft (P = 0.022) were independently associated with higher rates of disease recurrence.

CONCLUSIONS

Previous conservative medical therapy bears the potential to modulate postoperative outcomes in HS patients, and should be taken into consideration. Despite reports of reliable results with split-thickness skin grafts, we found them to be associated with increased rates of diseases recurrence and postoperative complications.

Perirenal Fat and Kidney Function Deterioration in Patients With Acute Decompensated Heart Failure

BACKGROUND AND OBJECTIVES

The thick perirenal fat pad can induce high intracapsular pressure and cause compression of the renal vasculature and resultant congestive nephropathy. The current study investigated the association of perirenal fat thickness with kidney dysfunction in patients with acute decompensated heart failure (ADHF).

METHODS

Data from 266 patients hospitalized with ADHF were analyzed. Patients were divided into two groups according to the glomerular filtration rate (GFR) at admission (preserved kidney function [GFR ≥60 mL/min/1.73 m²] and reduced kidney function [GFR <60 mL/min/1.73 m²] groups). Right and left posterior perirenal fat thicknesses were measured using computed tomography, and their average values were calculated. Associated factors with reduced kidney function was assessed by logistic regression model, presenting with odds ratio (OR) and confidence interval (CI).

RESULTS

Increasing age (OR, 1.08; 95% CI, 1.04-1.12; p<0.001), diabetes mellitus (OR, 2.46; 95% CI, 1.18-5.12; p<0.017), increased log N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR, 1.82; 95% CI, 1.32-2.52; p<0.001), and increased average perirenal fat thickness (OR, 1.11; 95% CI, 1.06-1.16; p<0.001) were independently associated with reduced kidney function. In the subgroup analyses, patients over 70 years old, the ratio of mitral-to-mitral annular velocity >15, elevated log NT-proBNP had a significantly higher association with increased perirenal fat thickness with reduced kidney function.

CONCLUSIONS

Thick perirenal fat pads were independently associated with kidney function deterioration in patients hospitalized with ADHF.

[Breast Imaging Reporting and Data System (BI-RADS): Advantages and Limitations]

Breast Imaging Reporting and Data System (BI-RADS) is a communication and data tracking system that standardizes and controls the quality of reporting by presenting lexicon descriptors, assessment categories, and recommendations for managing breast lesions. Using standardized terminology recommended by BI-RADS, radiologists can concisely and reproducibly communicate breast imaging results to clinicians. They can also provide the estimated malignant probability of the lesions found and guide management for them by determining the final assessment category. The limitations of BI-RADS 5th edition currently in use are that there are some areas for which standardized terminologies still need to be established, and that the diagnostic criteria of MRI assessment categories 3 and 4 are ambiguous compared to those for mammography or ultrasound. The next revision of BI-RADS is expected to include solutions for overcoming current limitations.

Isolated Adrenal Gland Hemorrhage: A Case of a Car Accident

Due to the specific features of the adrenal glands, traumatic adrenal injury is a rare phenomenon. The majority of these rare types of traumas are caused by blunt force injuries and rarely by penetrating mechanisms. In such cases, a whole-body computed tomography scan is essential for early diagnosis. This paper describes an uncommon case of adrenal hematoma and contusion followed by blunt abdominal trauma. A 35-year-old woman was admitted to the emergency department after a high-speed vehicle-pedestrian collision. She presented with decreasing level of consciousness. Additionally, a thoracoabdominal CT scan revealed a left flank hematoma. Blunt adrenal injury, often accompanied by multiorgan damage, is a rare occurrence resulting from severe accidents. Accurate diagnosis based on clinical symptoms requires high clinical suspicion, particularly in isolated cases, and treatment depends on the patient's condition.

Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation

Background

Calcium channel blockers and angiotensin II receptor blockers are commonly prescribed to treat hypertension. Massive overdoses can cause both distributive and cardiogenic shock because of their effects on vascular smooth muscles and severe myocardial depression.

Case Presentation

We present the case of a 46-year-old man who was brought to our emergency department after ingesting 1210 mg amlodipine and 936 mg candesartan. The patient's hemodynamic status deteriorated despite treatment with vasopressors, calcium gluconate, and hyperinsulinemia-euglycemia therapy with mechanical ventilation. Venoarterial extracorporeal membrane oxygenation was initiated for refractory shock. The patient was weaned off extracorporeal membrane oxygenation on day 5 and discharged on day 18 of hospitalization.

Conclusion

When medical therapies are ineffective, aggressive venoarterial extracorporeal membrane oxygenation should be considered for the management of refractory shock in the setting of calcium channel blocker with angiotensin II receptor blocker overdose.

Exploring genetic loci of type 2 diabetes and cancer: a review

Diabetes and cancer are two heterogenous diseases which are rapidly increasing in prevalence globally. A link between these two non-communicable diseases was first identified over 100 years ago; however, recent epidemiological studies and advances in genomic research have provided greater insight into the association between diabetes and cancer. Epidemiological studies have suggested that individuals with diabetes have an increased risk of several types of cancer (including liver, pancreas, colorectal, breast, and endometrial) and an increased risk of cancer mortality. However, this increased risk is not observed in all cancers, for example, there is a reduced risk of prostate cancer in individuals with diabetes. It has also been observed that cancer patients have an increased risk of developing diabetes, highlighting that the relationship between these diseases is not straightforward. Evidence of a shared genetic aetiology along with numerous lifestyle and clinical factors have made it challenging to establish if the relationship between the two diseases is causal or a result of confounding factors. This review takes a pan-cancer approach to highlight the complexities of the interactions between type 2 diabetes and cancer development, indicating where advances in genomic research have enabled a greater insight into these two diseases.

Halomethoxybenzenes in air of the Nordic region

Halomethoxybenzenes (HMBs) are a group of compounds with natural and anthropogenic origins. Here we extend a 2002-2015 survey of bromoanisoles (BAs) in the air and precipitation at Råö on the Swedish west coast and Pallas in Subarctic Finland. New BAs data are reported for 2018 and 2019 and chlorinated HMBs are included for these and some previous years: drosophilin A methyl ether (DAME: 1,2,4,5-tetrachloro-3,6-dimethoxybenzene), tetrachloroveratrole (TeCV: 1,2,3,4-tetrachloro-5,6-dimethoxybenzene), and pentachloroanisole (PeCA). The order of abundance of HMBs at Råö was ΣBAs > DAME > TeCV > PeCA, whereas at Pallas the order of abundance was DAME > ΣBAs > TeCA > PeCA. The lower abundance of BAs at Pallas reflects its inland location, away from direct marine influence. Clausius-Clapeyron (CC) plots of log partial pressure (P_air)/Pa versus 1/T suggested distant transport at both sites for PeCA and local exchange for DAME and TeCV. BAs were dominated by distant transport at Pallas and by both local and distant sources at Råö. Relationships between air and precipitation concentrations were examined by scavenging ratios, SR = (ng m^-3)_precip/(ng m^-3)_air. SRs were higher at Pallas than Råö due to greater Henry's law partitioning of gaseous compounds into precipitation at colder temperatures. DAME is produced by terrestrial fungi. We screened 19 fungal species from Swedish forests and found seven of them contained 0.01-3.8 mg DAME per kg fresh weight. We suggest that the volatilization of DAME from fungi and forest litter containing fungal mycelia may contribute to atmospheric levels at both sites.

Simulation and prediction of the effect of aeration, recirculation and degradation on landfill temperature in aerobic operation

Much heat is released in aerobic landfills, which leads to temperature change. Quantitative prediction of temperature change with time and space is essential for the safe aerobic operation of landfill. In this article, based on the theory of porous media seepage mechanics and heat transfer, a seepage-temperature coupling model considering aeration, recirculation and degradation was established, which included internal energy change, heat conduction, convection and heat transfer. Moreover, combined with the long-time on-site monitoring temperature data from Wuhan Jinkou Landfill, the model's reliability was preliminarily verified. Sensitivity analysis was carried out for aeration intensity, aeration temperature, recirculation intensity and recirculation temperature. Among the four factors, recirculation intensity influences the peak temperature most with a decrease of 20.11%. Compared with Borglin's and Hao's models, it is found that waste should not be assumed as a cell for temperature prediction. By comparing the results of Non-linear Ascent Stage model, Linear Ascent Stage model and Absent Ascent Stage model, it showed that the temperature difference of the three models decreases with the increase of operation time. In addition, the time point of peak temperature, t₀, affects the temperature distribution. The above results provide a reference for predicting the spatial and temporal distribution of temperature and regulations for long-term aerobic landfill operations.

Physicochemical and antioxidative properties of ultrasound-assisted extraction of mahua (Madhuca longifolia) seed oil in comparison with conventional Soxhlet and mechanical extractions

Ultrasound-assisted solvent extraction (UAE) was applied to extract underutilized Madhuca longifolia seed oil. The effect of extraction time, temperature, solvent type, solvent/sample ratio, and amplitude on the oil yield and recovery were investigated. Approximately 56.97% of oil yield and 99.54% of oil recovery were attained using mild conditions of 35 min, 35 °C, 40% amplitude, isopropanol to acetone (1:1), and solvent to sample (20 mL/g). UAE oil yield and recovery were comparable with Soxhlet extraction (SXE) whilst mechanical pressing (ME) yielded < 50% of UAE recovery. UAE does not affect the fatty acids composition (46% C18:1; 22% C16:0; 21% C18:0, 10% C18:2), and triacylglycerol profile (23% POO, 17% POS, 16% SOO, and 14% POP). Interestingly, UAE extracted oil conferred remarkably (P < 0.05) higher antioxidant capacity (IC₅₀ of DPPH 106.60 mg/mL and ABTS 39.80 mg/mL) than SXE (IC₅₀ of DPPH 810.40 mg/mL and ABTS 757.43 mg/mL) or ME (IC₅₀ of DPPH 622.38 mg/mL and ABTS 392.87 mg/mL).

COVID-19-Induced Redundancy and Socio-Psychological Well-Being of Tourism Employees: Implications for Organizational Recovery in a Resource-Scarce Context

Drawing on social and psychological well-being literature underpinned by the concept of resilience, this study examines the impact of COVID-19 induced redundancy on the socio-psychological well-being of redundant employees (laid-off or working reduced hours), and its effect on their commitment to work and support recovery in the tourism industry. Utilizing a quantitative-dominant mixed methods design, 457 questionnaires were administered, and 15 interviews conducted with redundant employees in Ghana between May and August 2020. Results from a binary logistic regression analysis of the survey data supported by qualitative interview analysis indicate that marital status, education, status of dependents, and the types of tourism businesses employed in, significantly influenced psychological well-being while marital status, age, education, and rank in the organization influenced the social well-being of respondents. Meanwhile, psychological well-being significantly influenced future work commitment in the industry. Managerial implications for supporting employee resilience, well-being, and future recovery strategies are critically examined.

Positive Spillovers from Negative Campaigning

Negative advertising is frequent in electoral campaigns, despite its ambiguous effectiveness: Negativity may reduce voters' evaluation of the targeted politician but may have a backlash effect for the attacker. We study the effect of negative advertising in electoral races with more than two candidates with a large-scale field experiment during an electoral campaign for mayor in Italy and a survey experiment in a fictitious mayoral campaign. In our field experiment, we find a strong, positive spillover effect on the third main candidate (neither the target nor the attacker). This effect is confirmed in our survey experiment, which creates a controlled environment with no ideological components or strategic voting. The negative ad has no impact on the targeted incumbent, has a sizable backlash effect on the attacker, and largely benefits the idle candidate. The attacker is perceived as less cooperative, less likely to lead a successful government, and more ideologically extreme.

Analysis of the evolution of ultra-filtered water quality in a drinking water distribution system by particle size distribution: Influence of pre-ozonation

An experimental drinking water distribution system (DWDS) was used to evaluate the evolution of particle size distribution (PSD) and basic quality parameters of ultrafiltered water with or without pre-ozonation. An ultrafiltration (UF) module was set up, associated with a pre-ozonation system (3.7 g O₃ /m³ ). The permeate was circulated in the DWDS (300 m; 0.9 m/s) with 0.4 mg/L of chlorine, and the analysis of the PSD was performed using a β-variable mathematical model. A better control of membrane fouling was obtained with pre-ozonation, and PSD was necessary to observe water quality differences between permeates and in the DWDS. A decrease in particle concentration of 1.8 logarithms was obtained with the application of UF membranes, while a decrease of only 1.2 logarithms was obtained with pre-ozonation. The system without pre-ozonation showed a higher efficiency at removing smaller particles (around 2 μm), with the absence of particles larger than 23 μm during both stages. The PSD revealed a worsening of water quality in the DWDS with an increase of particles smaller than 5 μm during the application of UF membranes, while with pre-ozonation, all particle sizes analyzed increased their concentration. PRACTITIONER POINTS: Pre-ozonation led to a better control of membrane fouling, but a worsening of permeate quality according to particle size distribution. Pre-ozonation does not improve the turbidity, dissolved organic carbon or UV254 removal capacity of ultrafiltration during drinking water treatment. Particles size distribution reveals the deterioration of water quality in a drinking water distribution system better than turbidity or DOC. Ozone prior to ultrafiltration membranes led to a worsening of permeate quality, more significant in the drinking water distribution system.

Mental illness stigma and employer evaluation in hiring: Stereotypes, discrimination and the role of experience

Mental illness stigma can constitute a significant barrier to entering employment. Drawing on 20 interviews with Norwegian employers, this article investigates how mental illness stigma affects employer evaluation of jobseekers who disclose a history of mental illness. It also explores how employers use accounts of their previous experience with employees with mental illness in their evaluations. Prior to the interviews, the employers received pairs of fictitious applications in which one of the candidates disclosed a history of mental illness. Thus, the interview data were paired with behavioural data on how the employers responded to mental illness disclosure in a genuine recruitment situation. The analysis reveals common stereotypes of people with mental illness as fragile and unreliable. Furthermore, discriminating and inclusive employers are juxtaposed in their approach to mental health stigma, characterised by either taboo and avoidance or empathetic dialogue. The findings indicate how negative experience is coupled with negative attitudes and behaviour and how positive experience is coupled with positive attitudes and behaviour. A central argument is that experience is something that employers play an active part in constructing by choosing to either engage or not engage in a two-way dialogue with employees struggling with mental illness.

Variation in the infant health effects of the women, infants, and children program by predicted risk using novel machine learning methods

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has an extensive literature documenting positive effects on infant health outcomes, specifically preterm birth, low birthweight, small size for gestational age, and infant mortality. However, existing studies focus on average effects for these relatively infrequent outcomes, thus providing no evidence for how WIC affects those at greatest risk of negative infant health outcomes. Our study focuses on documenting how WIC's infant health effects vary by level of risk. In doing so, we leverage a uniquely rich database describing maternal and infant outcomes and risk factors. Additionally, we use high dimensional data to generate predictions of risk and combine these predictions with the novel double machine learning method to stratify the effects of WIC by predicted risk. Our estimates of WIC's average treatment effects align with those in the existing literature. More importantly, we document significant variation in the effects of WIC on infant health by predicted risk level. Our results show that WIC is most beneficial among those at greatest risk of poor outcomes.