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Patel N, Mittal N, Wilkinson MJ, Taub PR. Unique features of dyslipidemia in women across a lifetime and a tailored approach to management. Am J Prev Cardiol 2024; 18:100666. [PMID: 38634109 PMCID: PMC11021917 DOI: 10.1016/j.ajpc.2024.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose of Review Cardiovascular disease is a leading cause of death worldwide. Dyslipidemia is a critical modifiable risk factor for the prevention of cardiovascular disease. Dyslipidemia affects a large population of women and is especially pervasive within racial/ethnic minorities. Recent Findings Dyslipidemia in pregnancy leads to worse outcomes for patients and creates increased cardiovascular risk for women at an older age. However, women remain underscreened and undertreated compared to men. Females also comprise a small portion of clinical trial participants for lipid lowering agents with increased disease prevalence compared to trial representation. However, recent lipid trials have shown different efficacies of therapies such as ezetimibe, inclisiran, and bempedoic acid with a greater relative benefit for women. Summary Pathophysiology of dyslipidemia varies between men and women and across a woman's lifetime. While increased lipid levels or lipid imbalances are more common in postmenopausal women over age 50, conditions such as PCOS and FH produce higher cardiovascular risk for young women.Best practices for management of women with dyslipidemia include early screening with lifestyle intervention and pharmacotherapy with statin and non-statin agents to achieve guideline directed LDL-C thresholds.
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Brodeur S, Oliver D, Ahmed MS, Radua J, Venables J, Gao Y, Gigante V, Veneziano G, Vinci G, Chesney E, Nandha S, De Micheli A, Basadonne I, Floris V, Salazar de Pablo G, Fusar-Poli P. Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: Systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 161:105669. [PMID: 38599355 DOI: 10.1016/j.neubiorev.2024.105669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/16/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
The effectiveness of universal preventive approaches in reducing the incidence of affective/psychotic disorders is unclear. We therefore aimed to synthesise the available evidence from randomised controlled trials. For studies reporting change in prevalence, we simulated all possible scenarios for the proportion of individuals with the disorder at baseline and at follow-up to exclude them. We then combined these data with studies directly measuring incidence and conducted random effects meta-analysis with relative risk (RR) to estimate the incidence in the intervention group compared to the control group. Eighteen studies (k=21 samples) were included investigating the universal prevention of depression in 66,625 individuals. No studies were available investigating universal prevention on the incidence of bipolar/psychotic disorders. 63 % of simulated scenarios showed a significant preventive effect on reducing the incidence of depression (k=9 - 19, RR=0.75-0.94, 95 %CIs=0.55-0.87,0.93-1.15, p=0.007-0.246) but did not survive sensitivity analyses. There is some limited evidence for the effectiveness of universal interventions for reducing the incidence of depression but not for bipolar/psychotic disorders.
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Dexter JM, Brubaker LW, Bitler BG, Goff BA, Menon U, Moore KN, Sundaram KM, Walsh CS, Guntupalli SR, Behbakht K. Ovarian cancer think tank: An overview of the current status of ovarian cancer screening and recommendations for future directions. Gynecol Oncol Rep 2024; 53:101376. [PMID: 38590930 PMCID: PMC10999790 DOI: 10.1016/j.gore.2024.101376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
Early diagnosis and screening of ovarian cancer remain significant challenges to improving patient outcomes. There is an urgent need to implement both established and modern strategies to address the "early detection" conundrum, especially as new research continues to uncover the complexities of the disease. The discussion provided is the result of a unique research conference focused on reviewing early detection modalities and providing insight into future approaches.
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Carrillo-Larco RM, Guzman-Vilca WC, Varghese JS, Pasquel FJ, Caixeta R, Antini C, Bernabé-Ortiz A. Compliance with eye and foot preventive care in people with self-reported diabetes in Latin America and the Caribbean: Pooled, cross-sectional analysis of nine national surveys. Prim Care Diabetes 2024; 18:374-379. [PMID: 38503635 DOI: 10.1016/j.pcd.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/04/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
AIMS To estimate the proportion of people with self-reported diabetes receiving eye and foot examinations in Latin America and the Caribbean (LAC). METHODS Cross-sectional analysis of national health surveys in nine countries. Adults aged 25-64 years with self-reported diabetes. We quantified the proportion who reported having an eye examination in the last two years or a foot examination in the last year. We fitted multilevel Poisson regressions to assess socio-demographic (age and sex) and clinical (oral hypoglycemic medication and insulin treatment) variables associated with having had examinations. RESULTS There were 7435 people with self-reported diabetes included in the analysis. In three countries (Chile [64%; 95% CI: 56%-71%], British Virgin Islands [58%; 95% CI: 51%-65%], and Brazil [54%; 95% CI: 50%-58%]), >50% of people with diabetes reported having had an eye examination in the last two years. Fewer participants (<50% across all countries) reported having had a foot examination in the last year, with Ecuador having the lowest proportion (12%; 95% CI: 8%-17%). Older people, and those taking oral medication or insulin, were more likely to have eye/foot examinations. CONCLUSIONS The proportion of eye and foot examinations in people with self-reported diabetes across nine countries in LAC is low.
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Le Dortz LL, Rouxel C, Polack B, Boulouis HJ, Lagrée AC, Deshuillers PL, Haddad N. Tick-borne diseases in Europe: Current prevention, control tools and the promise of aptamers. Vet Parasitol 2024; 328:110190. [PMID: 38714064 DOI: 10.1016/j.vetpar.2024.110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
In Europe, tick-borne diseases (TBDs) cause significant morbidity and mortality, affecting both human and animal health. Ticks can transmit a wide variety of pathogens (bacteria, viruses, and parasites) and feed on many vertebrate hosts. The incidence and public health burden of TBDs are tending to intensify in Europe due to various factors, mainly anthropogenic and often combined. Early detection of tick-borne pathogens (TBPs), preventive measures and treatment are of great importance to control TBDs and their expansion. However, there are various limitations in terms of the sensitivity and/or specificity of detection and prevention methods, and even in terms of feasibility. Aptamers are single-stranded DNA or RNA that could address these issues as they are able to bind with high affinity and specificity to a wide range of targets (e.g., proteins, small compounds, and cells) due to their unique three-dimensional structure. To date, aptamers have been selected against TBPs such as tick-borne encephalitis virus, Francisella tularensis, and Rickettsia typhi. These studies have demonstrated the benefits of aptamer-based assays for pathogen detection and medical diagnosis. In this review, we address the applications of aptamers to TBDs and discuss their potential for improving prevention measures (use of chemical acaricides, vaccination), diagnosis and therapeutic strategies to control TBDs.
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Ourry V, Binette AP, St-Onge F, Strikwerda-Brown C, Chagnot A, Poirier J, Breitner J, Arenaza-Urquijo EM, Rabin JS, Buckley R, Gonneaud J, Marchant NL, Villeneuve S. How Do Modifiable Risk Factors Affect Alzheimer's Disease Pathology or Mitigate Its Effect on Clinical Symptom Expression? Biol Psychiatry 2024; 95:1006-1019. [PMID: 37689129 DOI: 10.1016/j.biopsych.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
Epidemiological studies show that modifiable risk factors account for approximately 40% of the population variability in risk of developing dementia, including sporadic Alzheimer's disease (AD). Recent findings suggest that these factors may also modify disease trajectories of people with autosomal-dominant AD. With positron emission tomography imaging, it is now possible to study the disease many years before its clinical onset. Such studies can provide key knowledge regarding pathways for either the prevention of pathology or the postponement of its clinical expression. The former "resistance pathway" suggests that modifiable risk factors could affect amyloid and tau burden decades before the appearance of cognitive impairment. Alternatively, the resilience pathway suggests that modifiable risk factors may mitigate the symptomatic expression of AD pathology on cognition. These pathways are not mutually exclusive and may appear at different disease stages. Here, in a narrative review, we present neuroimaging evidence that supports both pathways in sporadic AD and autosomal-dominant AD. We then propose mechanisms for their protective effect. Among possible mechanisms, we examine neural and vascular mechanisms for the resistance pathway. We also describe brain maintenance and functional compensation as bases for the resilience pathway. Improved mechanistic understanding of both pathways may suggest new interventions.
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Kondrashova R, Vogel-Claussen J. [Lung cancer screening: new frontiers]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:456-462. [PMID: 38772915 DOI: 10.1007/s00117-024-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/23/2024]
Abstract
CLINICAL/METHODICAL ISSUE Lung cancer is the leading cause of cancer-related deaths worldwide. In early, asymptomatic stages, curative treatment is possible, but the disease is often diagnosed too late. STANDARD RADIOLOGICAL METHODS Lung cancer screening (LCS) using low-dose computed tomography (LDCT) helps to detect potentially malignant lesions in early stages and to reduce lung cancer mortality. METHODOLOGICAL INNOVATIONS The application of artificial intelligence (AI) algorithms enables a more precise analysis of LDCT scans. PERFORMANCE A meta-analysis of eight LCS studies revealed a statistically significant 12% relative reduction in lung cancer mortality. ACHIEVEMENTS Based on strong scientific evidence, a recommendation for a structured lung cancer screening program using LDCT for the high-risk population in Germany was issued. PRACTICAL RECOMMENDATIONS The holistic LCS program requires a clear definition of the high-risk population, individual risk assessment, qualified personnel for conducting and reading examinations, verification of all diagnostic and therapeutic steps, central documentation and quality assurance, as well as the integration of tobacco cessation programs.
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Oleribe OO, Taylor-Robinson SD, Taylor-Robinson AW. COVID-19 post-pandemic reflections from sub-Saharan Africa: what we know now that we wish we knew then. PUBLIC HEALTH IN PRACTICE 2024; 7:100486. [PMID: 38495538 PMCID: PMC10943955 DOI: 10.1016/j.puhip.2024.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
The commonly heard aphorism about history repeating itself suggests an endless cycle of recurring events. However, George Santayana offered a similar sentiment when he said, "Those who do not learn from history are doomed to repeat it". This emphasises that the responsibility for the recurrence of events lies not with history itself, but with humanity. It underscores that if we desire change, it is our responsibility to initiate it, rather than attributing it to external forces such as fate, luck, or time. With this thought in mind, here we offer a narrative view from sub-Saharan Africa, focusing primarily on our own experiences in Nigeria and Uganda, on what harsh lessons can be learnt from the COVID-19 pandemic regarding emergency preparedness to respond effectively to the next major infectious disease outbreak. Four strategies are suggested, the implementation of which may contribute substantially to safeguarding against an experience similar to the catastrophic public health, social and economic costs borne by African nations during COVID-19 and in its immediate aftermath.
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Mayerhöfer T, Perschinka F, Joannidis M. [Recent developments in acute kidney injury : Definition, biomarkers, subphenotypes, and management]. Med Klin Intensivmed Notfmed 2024; 119:339-345. [PMID: 38683229 PMCID: PMC11130018 DOI: 10.1007/s00063-024-01142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
Acute kidney injury (AKI) is a common problem in critically ill patients and is associated with increased morbidity and mortality. Since 2012, AKI has been defined according to the KDIGO (Kidney Disease Improving Global Outcome) guidelines. As some biomarkers are now available that can provide useful clinical information, a new definition including a new stage 1S has been proposed by an expert group of the Acute Disease Quality Initiative (ADQI). At this stage, classic AKI criteria are not yet met, but biomarkers are already positive defining subclinical AKI. This stage 1S is associated with a worse patient outcome, regardless of the biomarker chosen. The PrevAKI and PrevAKI-Multicenter trial also showed that risk stratification with a biomarker and implementation of the KDIGO bundle (in the high-risk group) can reduce the rate of moderate and severe AKI. In the absence of a successful clinical trial, conservative management remains the primary focus of treatment. This mainly involves optimization of hemodynamics and an individualized (restrictive) fluid management. The STARRT-AKI trial has shown that there is no benefit from accelerated initiation of renal replacement therapy. However, delaying too long might be associated with potential harm, as shown in the AKIKI2 study. Prospective studies are needed to determine whether artificial intelligence will play a role in AKI in the future, helping to guide treatment decisions and improve outcomes.
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Ferrante L, Almeida ACL, Leão J, Steinmetz WAC, Vassão RC, Vilani RM, Tupinambás U, Fearnside PM. Misinformation Caused Increased Urban Mobility and the End of Social Confinement Before the Second Wave of COVID-19 in Amazonia. J Racial Ethn Health Disparities 2024; 11:1280-1285. [PMID: 37095286 PMCID: PMC10124928 DOI: 10.1007/s40615-023-01607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
Tendentious projections about COVID-19 in Brazil provided an appealing excuse for individuals and decision-makers to justify poor choices during a critical phase of the pandemic. The erroneous results likely contributed to premature resumption of in-person school classes and easing of restrictions on social contact, favoring the resurgence of COVID-19. In Manaus, the largest city in the Amazon region, the COVID-19 pandemic did not end in 2020 of its own accord, but rather rebounded in a disastrous second wave of the disease.
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Markström I, Falk-Brynhildsen K, Bachrack-Lindström M, Hollman Frisman G, Mernelius S, Bjerså K. Impact of postoperative skin disinfection with chlorhexidine on bacterial colonisation following shoulder arthroplasty surgery: a controlled randomised study. Infect Prev Pract 2024; 6:100365. [PMID: 38765917 PMCID: PMC11098957 DOI: 10.1016/j.infpip.2024.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Background Surgical site infections are a significant threat to patient safety. Shoulder arthroplasty carries an increased risk due to foreign implants. Skin preparation in general is a key preoperative preventive intervention, and the use of chlorhexidine can have a prolonged effect on bacterial colonisation. There is a lack of evidence regarding whether postoperative disinfection has an impact on bacterial colonisation during the first 48 hours after surgery. Our hypothesis was that applying postoperative antiseptic with 5 mg/ml chlorhexidine in 70% ethanol would lead to reduced bacterial colonisation with Staphylococcus aureus, coagulase-negative staphylococcus and Cutibacterium acnes around the surgical wound within the initial 48 hours after elective shoulder surgery, compared with the use of sodium chloride. Methods A single-blinded, controlled study was conducted at a county hospital in Sweden. Swabs from the skin were collected four times: at baseline, preoperatively, after the intervention and after 48 hours. Results Our hypothesis was not confirmed. Although not statistically significant, the chlorhexidine group had a higher prevalence of bacterial colonisation of clinically relevant bacteria. Conclusions Our study could not confirm that postoperative disinfection with chlorhexidine reduces bacterial colonisation compared with sodium chloride. The results highlight the complexity of SSIs and the importance of evidence-based preventive skin preparation to ensure patient safety. Further research is needed, considering the study's limitations, to explore and evaluate the effectiveness of different skin cleansing solutions and preventive strategies in diverse surgical contexts.
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Escobar VAP, Wyant WA, Debs LH, Jamshidi A, Kiehna EN, McCrea HJ. Evaluating the potential role of determinants of health on encephalocele patient outcomes - a combined retrospective study and systematic review. Childs Nerv Syst 2024; 40:1751-1763. [PMID: 38347306 DOI: 10.1007/s00381-024-06312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/30/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION To evaluate the outcomes and demographics of encephalocele patients who were born and received treatment in our neonatal ICU and conduct a PRISMA literature review. METHODS An Institutional Review Board (IRB)-approved retrospective cohort study was undertaken to investigate the results of treating encephalocele patients at Jackson Memorial Hospital (JMH) from 1998 to 2022. The study focused on assessing outcomes and the impact of maternal socioeconomic factors, such as religion, age, and education, along with the timing of diagnosis, in connection with a systematic review. RESULTS A total of 20 encephalocele patients were identified (13 females and 7 males), with 15 having available medical records for review. Most of these cases involved occipital encephaloceles (73.3%). Maternal ages at the time of delivery ranged from 15 to 42 years, with a mean age of 27.3 years. The average gestational age at birth was 37 weeks. Ten cases had a prenatal diagnosis documented, occurring between 12 and 24.5 weeks of gestation. Three of the surviving patients had records of prenatal counseling that included discussions about termination. No infections were reported. Among the 15 cases, 11 patients (73.3%) were alive at the last follow-up, with a mean age at follow-up of 4.12 years, ranging from 6 weeks to 15 years post-birth. Hydrocephalus was noted in 26.7%. Only 1 mother had completed high school. Most mothers were either on Medicaid (9 patients) or uninsured (3 patients), with only 3 having commercial insurance. Religious affiliations varied among the mothers, with 14 out of 15 identifying with a particular religion. The systematic review identified 22 articles from various countries, with 11 articles meeting the inclusion criteria for qualitative analysis. These articles revealed potential maternal risk factors for encephaloceles, including low-nutrient diets, inadequate folic acid intake, young maternal age, advanced maternal age, low socioeconomic status, and limited educational attainment. CONCLUSIONS In the twenty-first century, there is a positive trend in the survival rates of children born with encephalocele. However, maternal factors such as low socioeconomic status and limited educational attainment remain prominent, affecting their ability to access timely prenatal care and impacting follow-up medical care for these children.
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Scarselli A, Corfiati M, DI Marzio D, Marinaccio A. Occupational carcinogens in Italy: an overview on exposure to cadmium and its compounds. INDUSTRIAL HEALTH 2024; 62:170-181. [PMID: 38148027 DOI: 10.2486/indhealth.2023-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Given the recognized carcinogenicity of cadmium, several regulatory interventions have been carried out over the years to protect exposed workers. The aim of the study is to investigate the prevalence and extent of exposure to cadmium among Italian workers. Data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2022). Gender-specific statistical analysis was carried out for some exposure-related variables (cadmium compound, activity sector, occupational group, firm size). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Overall 4,264 measurements were analyzed. Four industrial sectors were found to be most involved by cadmium exposure: base metal manufacturing, fabricated metal products, machinery and equipment, and other transport equipment (55% of measurements). Jewellery/precious-metal workers, and glass/ceramic plant operators were found to be most at exposure risk. A total of 26,470 workers potentially exposed was estimated (69% men). Concurrent exposures to other occupational carcinogens were detected quite frequently (52% of workers). Several situations of exposure and co-exposure to cadmium deserve attention and awareness in order to minimize the risks associated with workers' health. Recognition of potentially hazardous exposure conditions is an important step in prevention strategies to better protect workers against cancer-causing agents.
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Rezae A, Fakak R, Alexander KG, Constantinou C. The Overlooked Association Between Nutrition and the Development of Acute Myeloid Leukaemia: A Scoping Review. Curr Nutr Rep 2024; 13:113-125. [PMID: 38430336 PMCID: PMC11133215 DOI: 10.1007/s13668-024-00522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Acute Myeloid Leukaemia (AML) constitutes a mere 1% of global cancer cases. This scoping review aims to investigate the association between nutrition and the development of AML, providing a foundation for future research in this field. RECENT FINDINGS A systematic search was conducted across PubMed, EBSCO, Taylor and Francis, Science Direct and Cochrane Library using specific keywords. Inclusion criteria comprised observational studies and clinical trials examining the association between nutrition and the development of AML. Articles selected for analysis were restricted to those published in English between 1990-2023, and available as full text articles. Among the twenty-five articles that were screened, only six met the criteria for data extraction. Four studies did not reveal statistically significant correlations between nutrition and the development of AML, while two studies provided evidence for significant associations. The findings indicated increased AML risk associated with (a) heightened caloric intake, consumption of white potatoes, and red meat (pork and beef) and (b) diminished consumption of vegetables, seafood, nuts, and seeds. The scarcity of comprehensive studies exploring the connection between nutrition and AML, highlights the urgent need for additional research, encompassing pre-clinical studies. This imperative is critical for enhancing our understanding of the molecular mechanisms that underlie the connection between diet and the aetiology of AML. Such knowledge is paramount in advancing effective strategies for both prevention and management of this significant disease.
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Tolera BD, Gebremedhin KB. Nurses' knowledge and practice regarding venous-thromboembolism prevention in tertiary hospitals of Addis Ababa, Ethiopia: A cross-sectional study. JOURNAL OF VASCULAR NURSING 2024; 42:123-130. [PMID: 38823972 DOI: 10.1016/j.jvn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/19/2024] [Accepted: 02/19/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The prevalence of venous thromboembolism is steadily increasing in developing nations including Ethiopia. Nurses play a vital role in the prevention of venous thromboembolism. However, the level of nurses' knowledge, practice, and associated factors in venous thromboembolism prevention is not well-known across Ethiopia. This study aimed to assess nurses' knowledge, practice, and associated factors regarding venous-thromboembolism prevention in tertiary Hospitals of Addis Ababa, Ethiopia METHODS: An institutional-based cross-sectional study was conducted among 339 randomly selected nurses working at tertiary hospitals in Addis Ababa, Ethiopia. A validated questionnaire was used to collect data. Data were analyzed with SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables. RESULTS Out of the total 339 participants, only (51.6%) and (45.4%) had adequate knowledge and practice towards venous thromboembolism prevention respectively. Attending in-service training (AOR=1.701, p = 0.044) was significantly associated with knowledge of VTE prevention. Educational level (AOR= 3.871, P = 0.048), work experience (AOR=5.207, P<0.001), work location (AOR= 0.507, P = 0.019), working department (AOR= 2.959, P = 0.048), knowledge level (AOR= 0.477, P=0.005) were significantly associated with better preventive practice. CONCLUSION This study suggests that nurses' level of knowledge and practice towards venous thromboembolism prevention was inadequate. Nurses' educational level, attending in-service training, work experience, work location, and working department were determinant factors associated with nurses' knowledge and practice towards venous thromboembolism prevention. Therefore, upgrading nurses' educational level and providing in-service training on venous thromboembolism prevention is crucial for positive patient outcomes.
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Martel-Duguech L, Poirier J, Bourdeau I, Lacroix A. Diagnosis and management of secondary adrenal crisis. Rev Endocr Metab Disord 2024; 25:619-637. [PMID: 38411891 DOI: 10.1007/s11154-024-09877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 02/28/2024]
Abstract
Adrenal crisis (AC) is a life threatening acute adrenal insufficiency (AI) episode which can occur in patients with primary AI but also secondary AI (SAI), tertiary AI (TAI) and iatrogenic AI (IAI). In SAI, TAI and IAI, AC may develop when the HPA axis is unable to mount an adequate glucocorticoid response to severe stress due to pituitary or hypothalamic disruption. It manifests as an acute deterioration in multi-organ homeostasis that, if untreated, leads to shock and death. Despite the availability of effective preventive strategies, its prevalence is increasing in patients with SAI, TAI and IAI due to more frequent exogenous steroid administration, pituitary immune-related effects of immune checkpoint inhibitors and opioid use in pain management. The delayed diagnosis of acute AI which remains infrequently suspected increases the risk of AC. Its main precipitating factors are infections, emotional distress, surgery, cessation or reduction in GC doses, pituitary infarction or surgical cure of endogenous Cushing's syndrome. In patients not known previously to have SAI/TAI/IAI, recognition of its symptoms, signs, and biochemical abnormalities can be challenging and cause delay in proper diagnosis and therapy. Effective therapy of AC is rapid intravenous administration of hydrocortisone (initial bolus of 100 mg followed by 200 mg/24 h as continuous infusion or bolus of 50 mg every 6 h) and 0.9% saline. In diagnosed patients, preventive education in sick-day rules adjustment of glucocorticoid replacement and hydrocortisone parenteral self-administration must be performed repeatedly by trained health care providers. Strategies to improve the adequate preventive education in patients at risk for secondary AI should be promoted in collaboration with various medical specialist societies and patients support associations.
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Krichene MA, Hasnaoui I, Hassina S, Tebbay N, Sinnate A, Serghini L, Abdallah E. [Atypical ocular toxocariasis in a child: A case report]. J Fr Ophtalmol 2024; 47:104191. [PMID: 38713931 DOI: 10.1016/j.jfo.2024.104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/17/2024] [Accepted: 03/07/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment. OBSERVATION A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved. DISCUSSION Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis. CONCLUSION Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.
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Schwarzkopf L, Bickl A, Daniel J, Papastefanou G, Neyer MA, Gomes de Matos E, Hoch E, Olderbak S, Kraus L, Loy JK. Do breaks in online gambling affect neuropsychological arousal? Conceptual approach and lessons learned from the TESSA-pilot trial. Addict Behav Rep 2024; 19:100530. [PMID: 38327759 PMCID: PMC10848032 DOI: 10.1016/j.abrep.2024.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Mandatory breaks have been discussed as a harm reduction strategy in the context of gambling for several years, but their effectiveness remains unclear. The TESSA pilot study examines the association of physiological arousal (PA) and mandatory breaks during gambling with an aim to conceptualize the framework for a subsequent randomized controlled trial. Material and methods In a one-armed experimental pilot study 28 participants engaged in a simulated online slot game with mandatory breaks. PA, disentangled into fear, anger, joy, attraction, balance, and retraction, was continuously monitored via skin conductivity and skin temperature. The occurrence of PA in distinct phases (phase 1: initiation, phase 2: pre-break, phase 3: post-break) was contrasted by multilevel logistic regression. Results Fear and attraction did not change. Compared to phase 1, anger (OR = 0.698; p = 0.015) and joy (OR = 0.714; p = 0.032) were less likely in phase 2, with joy also being less likely in phase 3 (OR = 0.690; p = 0.023). Balance was more likely in phase 2 (OR = 5.073; p < 0.0001) than in phase 1 and less likely in phase 3 (OR = 0.348; p < 0.0001) whilst retraction declined from phase to phase. Discussion Mandatory breaks appear suited to offset changes in PA response evolving during gambling, but a sustained effect on initial PA levels should not to be expected. However, to sensitively judge the role of breaks additional framework conditions that impact on gambling behavior (e. g. wins/losses) should be considered.
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Layer G, Wessling J. [Colorectal cancer screening with virtual colonography]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:471-478. [PMID: 38739177 DOI: 10.1007/s00117-024-01321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Since 2003, a decline in the age-standardized incidence rates of colorectal cancer (CRC) has been observed in Germany. Nonetheless, one in eight cancer cases still affects the colon or rectum. The prognosis has improved, with the relative 5‑year survival rate for CRC being approximately 65%. METHODS This positive trend is probably a result of preventive measures introduced over the last 20 years. This could be further improved, however, as CRC can not only be detected early but in almost all cases also prevented through the identification of benign precursors. Less than half of all eligible individuals participate in screening via colonoscopy. This implies that further, possibly even imaging, screening test methods should be explored and offered. Studies have reported that virtual colonography techniques have a comparable accuracy to endoscopy of about 90% for polyp sizes larger than 5 mm. The data for computed tomography (CT) is more extensive than for magnetic resonance imaging (MRI). CONCLUSION Significant challenges are posed however by the fact that in Germany CT colonography (CTC) is not considered a viable screening option due to radiation protection concerns, and MRI screening is not an established screening method. Radiologists should be familiar with classification using the CT Colonography Reporting and Data System (C-RADS), which uses criteria such as CT density, morphology, size, and location for classification. C‑RADS classification follows the categories: C0 (inadequate study), C1 (normal), C2a (indeterminate), C2b (benign), C3 (suspicious), and C4 (malignant), as well as extracolonic categories E1/2 (no clinically significant findings), E3 (likely insignificant findings), and E4 (likely significant findings).
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Karroum PJ, Padda I, Piccione G, Hashmi R, Taik S, Kavarthapu A, Tantry B, Villaneuva K, Vandenborn S, Otiwaah J, Diaz K. Preventing aspiration incidents: redesigning inhalers for enhanced safety: A case study of coin aspiration. Radiol Case Rep 2024; 19:2531-2534. [PMID: 38585390 PMCID: PMC10997799 DOI: 10.1016/j.radcr.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
The conventional metered dose inhaler (MDI) has long served as a cornerstone in the management of asthma and chronic obstructive pulmonary disease (COPD), affecting millions annually. Despite its advantages, a persistent challenge is seen in the form of patient education and the unchanged design of these inhalers since their inception in 1956. This lack of progress in MDI design has inadvertently contributed to incidences of foreign body inhalation. In this case presentation we report a 50-year-old male with a past medical history of asthma, who faced an incident of foreign body inhalation with use of his inhaler. The patient aspirated a dime when he administered his inhaler, as it had become lodged in the device's mouthpiece, which was uncapped. This case, like many others, demonstrates the need for innovative changes in MDI inhaler design. While numerous articles or cases concentrate on foreign body removal, the primary objective of this case report is to investigate preventative measures and solutions aimed at averting incidents of inhalation.
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Engel DR, Wagenlehner FME, Shevchuk O. Scientific Advances in Understanding the Pathogenesis, Diagnosis, and Prevention of Urinary Tract Infection in the Past 10 Years. Infect Dis Clin North Am 2024; 38:229-240. [PMID: 38575493 DOI: 10.1016/j.idc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Urinary tract infection (UTI) is a very common disease that is accompanied by various complications in the affected person. UTI triggers diverse inflammatory reactions locally in the infected urinary bladder and kidney, causing tissue destruction and organ failure. Moreover, systemic responses in the entire body carry the risk of urosepsis with far-reaching consequences. Understanding the cell-, organ-, and systemic mechanisms in UTI are crucial for prevention, early intervention, and current therapeutic approaches. This review summarizes the scientific advances over the last 10 years concerning pathogenesis, prevention, rapid diagnosis, and new treatment approaches. We also highlight the impact of the immune system and potential new therapies to reduce progressive and recurrent UTI.
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Zhou RX, Liao HJ, Hu JJ, Xiong H, Cai XY, Ye DW. Global Burden of Lung Cancer Attributable to Household Fine Particulate Matter Pollution in 204 Countries and Territories, 1990 to 2019. J Thorac Oncol 2024; 19:883-897. [PMID: 38311022 DOI: 10.1016/j.jtho.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/28/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Household particulate matter (PM) air pollution is substantially associated with lung cancer. Nevertheless, the global burden of lung cancer attributable to household PM2.5 is still uncertain. METHODS In this study, data from the Global Burden and Disease Study 2019 are used to thoroughly assess the burden of lung cancer associated with household PM2.5. RESULTS The number of deaths and disability-adjusted life-years (DALYs) attributable to household PM2.5 was found to be 0.08 million and 1.94 million, respectively in 2019. Nevertheless, the burden of lung cancer attributable to household PM2.5 decreased from 1990 to 2019. At the sociodemographic index (SDI) district level, the middle SDI region had the most number of lung cancer deaths and DALYs attributable to household PM2.5. Moreover, the burden of lung cancer was mainly distributed in low-SDI regions, such as Sub-Saharan Africa. Conversely, in high-SDI regions, the age-standardized mortality rate and age-standardized DALY rate of lung cancer attributable to household PM2.5 exhibit the most rapid declines. The burden of lung cancer attributable to household PM2.5 is heavier for men than for women. The sex difference is more obvious in the elderly. CONCLUSIONS The prevalence of lung cancer attributable to household PM2.5 has exhibited a declining trend from 1990 to 2019 owing to a concurrent decline in household PM2.5 exposure.
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Lyu Y, Cui H, Liu Y, Lin F. Current perception and knowledge of preventing medical device related pressure injury among nursing staff in intensive care units: A national descriptive cross-sectional study. Intensive Crit Care Nurs 2024; 82:103656. [PMID: 38359599 DOI: 10.1016/j.iccn.2024.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Sufficient knowledge is crucial for nurses in intensive care unit to prevent medical device related pressure injuries. This study was aimed to explore the Chinese intensive care nurses' perceptions and knowledge of medical device related pressure injury prevention and identify associated factors. METHODS This descriptive cross-sectional study included a convenience sample of 1286 intensive care nurses recruited from professional networks across China. Participants completed the demographic data form and the adapted 23-item Medical device related pressure injury Knowledge Assessment Questionnaire (MKAQ) questionnaire. Multiple linear regression was used to determine the associated factors. RESULTS The medical device related pressure injury knowledge assessment questionnaire scores among intensive care nurses were relatively high, with a correct rate of 78.3 %. Multiple regression analysis revealed that management position (β = 0.131, P < 0.001) was the strongest associated factor of knowledge scores, followed by academic position (β = 0.114, P = 0.009) and received training on medical device related pressure injury (β = 0.112, P < 0.001). Hospital level (β = 0.087, P = 0.004) and sex (β = 0.068, P = 0.016) were also significant associated factors. Collectively, these five variables accounted for 18.2 % of the variance in knowledge scores. CONCLUSION Sufficient knowledge is a prerequisite for safe nursing practice. Although nurses demonstrated relatively high level of knowledge, it is essential for nursing managers to implement specific measures to enhance the knowledge among junior nursing staff, especially in non-tertiary hospitals, to promote medical device related pressure injury prevention in all intensive care settings. IMPLICATIONS FOR CLINICAL PRACTICE This study highlights the importance of sociodemographic and professional characteristics in promoting satisfactory perception and knowledge of preventing medical device related pressure injury among intensive care nurses. It is necessary for nurse managers and leaders to develop strategic interventions, along with targeted training programs and quality improvement plans that correspond to the actual training needs to improve the medical device related pressure injury prevention.
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Norman H, Marzano L, Fields B, Brown S, MacDonald Hart S, Kruger I. Characteristics and circumstances of rail suicides in England 2019-2021: A cluster analysis and autopsy study. J Affect Disord 2024; 354:397-407. [PMID: 38461900 DOI: 10.1016/j.jad.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Around 4 % of all suicide deaths in Great Britain occur on the railways. This exploratory study was designed to increase understanding of the individuals that take their lives in this way, and the circumstances of their death. METHOD Data were obtained from fatality investigation files compiled by the British Transport Police (BTP) relating to suspected suicides on the mainline railway in England from April 2019 to March 2021. Cluster analysis was carried out to identify grouped associations of characteristics and circumstances relating to rail suicide. RESULTS A total of 436 files were analysed, representing 93 % of all suspected railway suicides during this period. Cluster analysis identified four groups of almost equal size, distinguished principally by age, living arrangements, employment status and location of death. The study is novel in the way it integrates individual characteristics and circumstances of death. The identified clusters may provide a multidimensional way of conceptualising suicide risk that could inform more targeted interventions at rail locations. LIMITATIONS A high proportion of missing data means that the findings need to be interpreted with caution. It also restricted the multivariate analysis to those categories of information for which sufficient information was available. CONCLUSION The characteristics and circumstances of suicide deaths on the railways are complex and multifaceted. The typology identified in this study may help to target preventative strategies prior to the incident as well as at different location types.
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Marcovecchio ML, Hendriks AEJ, Delfin C, Battelino T, Danne T, Evans ML, Johannesen J, Kaur S, Knip M, Overbergh L, Pociot F, Todd JA, Van der Schueren B, Wicker LS, Peakman M, Mathieu C. The INNODIA Type 1 Diabetes Natural History Study: a European cohort of newly diagnosed children, adolescents and adults. Diabetologia 2024; 67:995-1008. [PMID: 38517484 PMCID: PMC11058619 DOI: 10.1007/s00125-024-06124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/24/2024] [Indexed: 03/24/2024]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is an heterogenous condition. Characterising factors explaining differences in an individual's clinical course and treatment response will have important clinical and research implications. Our aim was to explore type 1 diabetes heterogeneity, as assessed by clinical characteristics, autoantibodies, beta cell function and glycaemic outcomes, during the first 12 months from diagnosis, and how it relates to age at diagnosis. METHODS Data were collected from the large INNODIA cohort of individuals (aged 1.0-45.0 years) newly diagnosed with type 1 diabetes, followed 3 monthly, to assess clinical characteristics, C-peptide, HbA1c and diabetes-associated antibodies, and their changes, during the first 12 months from diagnosis, across three age groups: <10 years; 10-17 years; and ≥18 years. RESULTS The study population included 649 individuals (57.3% male; age 12.1±8.3 years), 96.9% of whom were positive for one or more diabetes-related antibodies. Baseline (IQR) fasting C-peptide was 242.0 (139.0-382.0) pmol/l (AUC 749.3 [466.2-1106.1] pmol/l × min), with levels increasing with age (p<0.001). Over time, C-peptide remained lower in participants aged <10 years but it declined in all age groups. In parallel, glucose levels progressively increased. Lower baseline fasting C-peptide, BMI SD score and presence of diabetic ketoacidosis at diagnosis were associated with lower stimulated C-peptide over time. HbA1c decreased during the first 3 months (p<0.001), whereas insulin requirement increased from 3 months post diagnosis (p<0.001). CONCLUSIONS/INTERPRETATION In this large cohort with newly diagnosed type 1 diabetes, we identified age-related differences in clinical and biochemical variables. Of note, C-peptide was lower in younger children but there were no main age differences in its rate of decline.
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