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Adesina SA, Amole IO, Adefokun IG, Adegoke AO, Ano-Edward GH, Eyesan SU. Intramuscular lipomas posing diagnostic and pre-operative counselling challenges in a low-resource setting: A case series. Int J Surg Case Rep 2024; 122:110093. [PMID: 39088975 PMCID: PMC11342184 DOI: 10.1016/j.ijscr.2024.110093] [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: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/03/2024] Open
Abstract
INTRODUCTION Intramuscular lipomas (IMLs) are uncommon primary adipose tissue tumours deep within the muscle. A high likelihood of misdiagnosing them as other benign and malignant masses necessitates imaging studies to confirm the diagnosis and plan treatment. Ultrasonography is useful but CT and MRI provide a more accurate diagnosis. While diagnostic tests are suitable, they may not always be accessible or affordable in low-resource settings. We present three cases of IMLs that emphasise the difficulties posed by limited resources and the significance of a comprehensive medical history and physical examination in low-resource settings. PRESENTATION OF CASES The patients included a 57-year-old male with a distal right thigh mass, a 65-year-old female with a proximal right thigh mass, and a 60-year-old female with a mass at the left scapular area. The three patients underwent surgical excision and had an uneventful postoperative course, with no reported recurrence during their ongoing follow-up. DISCUSSION The management of IMLs is not complicated if the requisite resources are available. Conversely, in low-resource settings with limited diagnostic facilities and human expertise, management may take a challenging path. Patient 1, despite undergoing diagnostic tests confirming IML, initially declined treatment due to challenges with pre-operative counselling. Patients 2 and 3 lacked health insurance and could not afford diagnostic imaging tests. CONCLUSION Healthcare professionals in low-resource settings should familiarise themselves with the clinical characteristics and pathology of IMLs to minimise misdiagnosis and ensure appropriate counselling is provided to patients. IMLs are slow-growing mostly asymptomatic benign swelling. On physical examination, they are usually non-tender, soft, masses, not fixed to the bed or overlying tissue. The overlying skin is normal and lymphadenopathy is absent.
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Affiliation(s)
- Stephen Adesope Adesina
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria; Bowen University, P.M.B 284 Iwo, Osun State, Nigeria.
| | - Isaac Olusayo Amole
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria; Bowen University, P.M.B 284 Iwo, Osun State, Nigeria.
| | - Imri Goodness Adefokun
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria; Bowen University, P.M.B 284 Iwo, Osun State, Nigeria
| | - Adepeju Olatayo Adegoke
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria; Bowen University, P.M.B 284 Iwo, Osun State, Nigeria.
| | - Gbemi Henry Ano-Edward
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria; Bowen University, P.M.B 284 Iwo, Osun State, Nigeria.
| | - Samuel Uwale Eyesan
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria; Bowen University, P.M.B 284 Iwo, Osun State, Nigeria.
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Werner LM, Mallan KM. Associations between restrictive feeding practices and children's dietary intake: Systematic review and meta-analyses. Appetite 2024; 200:107508. [PMID: 38795944 DOI: 10.1016/j.appet.2024.107508] [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: 02/15/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Parents' attempt to limit or restrict children's intake of 'unhealthy' or discretionary foods has been widely considered as a counterproductive feeding practice associated with poorer dietary outcomes, but empirical evidence is varied. AIM The present systematic literature review aimed to investigate the association between parental restriction and children's dietary intake. METHOD Studies were identified through PsycInfo, MEDLINE, CINAHL, Web of Science, and Scopus databases on April 29th, 2022. Included were peer-reviewed, English-language articles published between 2001 and 2022, with an effect size between restriction and children's intake of foods that are 'healthy' (i.e., fruit, vegetables, other general healthy foods) or 'discretionary' (i.e., sweet or savoury energy-dense/nutrient poor foods, high-sugar foods, high-salt/fat foods, and high-energy/sugar-sweetened beverages), or overall diet quality. Risk of bias was assessed using a quality assessment checklist designed to evaluate survey studies. RESULTS Included studies (n = 44) were most often conducted in the USA, cross-sectional, and participants were mothers. Effect sizes (k = 59) from 21 studies were used in nine meta-analyses investigating various healthy and discretionary dietary intake variables. No meta-analytic effects were statistically significant. Qualitative synthesis of effect sizes ineligible for meta-analysis (k = 91) identified patterns of associations between restriction and increased intake of healthy foods, and decreased intake of discretionary foods. CONCLUSIONS Studies used a diverse selection of measures of restriction and dietary intake, limiting the ability of this review to make accurate cross-study comparisons. However, results suggest that instead of restriction being detrimental for children's dietary outcomes, it may be unrelated, or associated with more beneficial dietary outcomes. Research that utilises validated measures of restriction and dietary outcomes and a longitudinal design is needed to clarify this association.
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Affiliation(s)
- Lilly M Werner
- School of Behavioural and Health Sciences, Melbourne, Australian Catholic University, Australia
| | - Kimberley M Mallan
- School of Behavioural and Health Sciences, Brisbane, Australian Catholic University, Australia.
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Soler-Jimenez A, Gonzalez-Herranz P, Pensado-Señoris N. Guided Growth With Minifragment Plates for Angular Deformities in the Distal Radius in Skeletally Immature Patients. Preliminary Results. J Pediatr Orthop 2024; 44:e691-e697. [PMID: 38767293 DOI: 10.1097/bpo.0000000000002722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Growth modulation allows correction of progressive ulnar deviation of the distal radius in skeletally immature patients, which may occur as a consequence of various pathologies. The aim of this study is to evaluate the radiographic results and complication rate in a series of patients treated with minifragment plates. METHODS The medical records of 12 patients who underwent guided growth with a minifragment plate on the radial aspect of the distal radius as a consequence of angular deformities in the distal radius were retrospectively reviewed. Demographic data, radiographic changes, and complication rate were analyzed. RESULTS A total of 14 wrists and forearms were evaluated. The mean age at which surgery was performed was 10.5 years (interquartile range: 9.0 to 11.3). The average time between placement and removal of the material was 28.7 months (SD: 8,89). In each case, a general improvement of the radiographic parameters was obtained. There were 3 postoperative complications, but only 1 of them required reintervention (broken metaphyseal screw). CONCLUSIONS Hemiepiphysiodesis using a minifragment plate is a treatment that respects the surgical anatomy and offers an alternative surgical option for angular deformities of the distal radius in children. LEVEL OF EVIDENCE Level IV.
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Samanta D, Aungaroon G, Albert GW, Karakas C, Joshi CN, Singh RK, Oluigbo C, Perry MS, Naik S, Reeders PC, Jain P, Abel TJ, Pati S, Shaikhouni A, Haneef Z. Advancing thalamic neuromodulation in epilepsy: Bridging adult data to pediatric care. Epilepsy Res 2024; 205:107407. [PMID: 38996686 DOI: 10.1016/j.eplepsyres.2024.107407] [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: 04/02/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
Thalamic neuromodulation has emerged as a treatment option for drug-resistant epilepsy (DRE) with widespread and/or undefined epileptogenic networks. While deep brain stimulation (DBS) and responsive neurostimulation (RNS) depth electrodes offer means for electrical stimulation of the thalamus in adult patients with DRE, the application of thalamic neuromodulation in pediatric epilepsy remains limited. To address this gap, the Neuromodulation Expert Collaborative was established within the Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Special Interest Group. In this expert review, existing evidence and recommendations for thalamic neuromodulation modalities using DBS and RNS are summarized, with a focus on the anterior (ANT), centromedian(CMN), and pulvinar nuclei of the thalamus. To-date, only DBS of the ANT is FDA approved for treatment of DRE in adult patients based on the results of the pivotal SANTE (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy) study. Evidence for other thalamic neurmodulation indications and targets is less abundant. Despite the lack of evidence, positive responses to thalamic stimulation in adults with DRE have led to its off-label use in pediatric patients. Although caution is warranted due to differences between pediatric and adult epilepsy, the efficacy and safety of pediatric neuromodulation appear comparable to that in adults. Indeed, CMN stimulation is increasingly accepted for generalized and diffuse onset epilepsies, with recent completion of one randomized trial. There is also growing interest in using pulvinar stimulation for temporal plus and posterior quadrant epilepsies with one ongoing clinical trial in Europe. The future of thalamic neuromodulation holds promise for revolutionizing the treatment landscape of childhood epilepsy. Ongoing research, technological advancements, and collaborative efforts are poised to refine and improve thalamic neuromodulation strategies, ultimately enhancing the quality of life for children with DRE.
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Affiliation(s)
- Debopam Samanta
- Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gregory W Albert
- Department of Neurosurgery, University of Arkansas for Medical Sciences, USA
| | - Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, Norton Children's Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Charuta N Joshi
- Division of Pediatric Neurology, Childrens Medical Center Dallas, UTSW, USA
| | - Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's; Wake Forest University School of Medicine, USA
| | - Chima Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Ft Worth, TX, USA
| | - Sunil Naik
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Puck C Reeders
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, USA
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh School of Medicine and Department of Bioengineering, University of Pittsburgh
| | - Sandipan Pati
- The University of Texas Health Science Center at Houston, USA
| | - Ammar Shaikhouni
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Zulfi Haneef
- Neurology Care Line, VA Medical Center, Houston, TX 77030, USA; Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Haefliger R, Dries LS, Perassolo MS, Cardoso CDO. Neuropsychological assessment after long-term omeprazole treatment. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:1007-1015. [PMID: 35930436 DOI: 10.1080/23279095.2022.2106570] [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: 06/15/2023]
Abstract
Recent studies suggest that Omeprazole, a widely used treatment for gastric acid-related disorders, may have a significant effect on human cognition. However, there is no consensus on the matter. Though some studies suggest the drug is associated with an increased risk of cognitive decline, memory impairment, and dementia, this issue has not been sufficiently studied. Therefore, the goal of this study was to investigate the cognitive impairments associated with long-term Omeprazole treatment, with a focus on memory, attention, and executive functions. Additionally, we sought to verify whether the duration of treatment was associated with the magnitude of the associated cognitive impairments. The sample consisted of 30 participants of both genders treated with Omeprazole (experimental group) and 30 participants who did not use the drug (control group). The cognitive assessment battery: Verbal Fluency, Rey Auditory-Verbal Learning, Attention Assessment Battery, Five Digit Test, Hayling Test, and NEUPSILIN Subtest. The groups were compared using Student's T-tests, and the association between treatment duration and cognitive performance was examined using Pearson's coefficients. The results showed significant group differences in verbal fluency, short-term episodic memory, selective attention, and executive functions. The duration of Omeprazole treatment was also positively associated with the magnitude of cognitive impairment.
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Affiliation(s)
| | - Larissa Selbach Dries
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, Brazil
| | - Magda Susana Perassolo
- Program on Toxicology and Analytical Toxicology, Feevale University, Novo Hamburgo, Brazil
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Li H, Ai T, Huang GB, Yang J, Wei GB, Gao JM, He P, Cao XM, Du DY. Internal iliac artery ligation as a damage control method in hemodynamically unstable pelvic fractures: A systematic review of the literature. Chin J Traumatol 2024; 27:288-294. [PMID: 39025704 DOI: 10.1016/j.cjtee.2024.07.004] [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: 09/19/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE Internal iliac artery ligation (IIAL) has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years. However, there is ongoing debate regarding the effectiveness and safety of this hemostatic method. Therefore, we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis. METHODS Three major databases, PubMed, Embase, and Google Scholar, were searched to screen eligible original studies published in English journals. Two reviewers independently read the titles, abstracts, and full texts of all literature. Articles were included if they reported the use and effects of IIAL. RESULTS A total of 171 articles were initially identified, with 22 fully meeting the inclusion criteria. Among the analyzed cases, up to 66.7% of patients had associated abdominal and pelvic organ injuries, with the urethra being the most frequently injured organ, followed by the bowel. The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory, with an effective rate of 80%. Hemorrhagic shock was the leading cause of death, followed by craniocerebral injury. Notably, no reports of ischemic complications involving the pelvic organs due to IIAL were found. CONCLUSION IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia. This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.
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Affiliation(s)
- Hui Li
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Tao Ai
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Guang-Bin Huang
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Jun Yang
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Gong-Bin Wei
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Jin-Mou Gao
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Ping He
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Xue-Mei Cao
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China
| | - Ding-Yuan Du
- Department of Trauma Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, 400014, China.
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Madhusoodanan V, Bitran J, Towe M, Ritch C. Financial and Business Literacy Among Urology Residents: Is this a Problem and How Can We Better Prepare Residents for their Careers? Curr Urol Rep 2024; 25:207-214. [PMID: 38904922 DOI: 10.1007/s11934-024-01216-6] [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] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW Although financial wellness is a predictor of physician burnout, we are yet to optimize financial education or wellness of Urology trainees. We assessed existing studies, compared them to those of other specialties, and discussed resources and methods to address this deficiency. RECENT FINDINGS Urology residents tend to be less fiscally savvy (carry significant debt, and lack retirement savings or disability insurance), and 90% of trainees and young Urologists do not feel comfortable with the business of practice, including skills like coding and billing, contract negotiation, and self-value assessment. Financial and business literacy are deficiencies of Urology training, as in other specialties. Eventually, the goal should be universal adoption of a formal curriculum that is graded in nature. In the interim, we need to propose and endorse adoption of a formal curriculum, and we should support trainees by promoting a space for easily accessible and transparent information regarding best practices in personal finance and the business of healthcare.
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Affiliation(s)
- Vinayak Madhusoodanan
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, 3313, USA.
| | - Joshua Bitran
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, 3313, USA
| | - Maxwell Towe
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, 3313, USA
| | - Chad Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, 3313, USA
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Peroz R, Hakelius M, Falk-Delgado A, Phua Y, Mani M. Patient Reported Outcome Following the Skoog Unilateral Cleft Lip Repair among Adults- a Long-Term Cohort Study and Comparison to a Non-cleft Population. Cleft Palate Craniofac J 2024; 61:1548-1558. [PMID: 37246371 PMCID: PMC11323433 DOI: 10.1177/10556656231177139] [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] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE The study primarily aimed to compare satisfaction with lip appearance among adults treated for unilateral cleft lip and palate (UCLP) with Skoog's primary lip repair procedure to those without clefts. The secondary aim was to determine whether satisfaction with lip appearance and the desire to change the lip/face appearance correlated with the number of secondary lip revisions performed. DESIGN Long-term follow-up. PATIENTS/SETTINGS All UCLP patients treated at the Uppsala University Hospital born between 1960- and 1987 (n = 109) were invited. At an average of 37 years following the primary lip repair, the participation rate was 76% (n = 83). A control group of adults without cleft (n = 67) completed the same study protocol for comparison. MAIN OUTCOME MEASURES Satisfaction with appearance was measured with The Satisfaction with Appearance Questionnaire (SWA) and a modified version of the Body Cathexis -Scale was used to assess the desire to change the lip and facial appearance. RESULTS UCLP patients were less satisfied with their lip, face, and overall appearance and reported a greater desire to change the appearance of their lips and face than non-cleft controls (p < 0.001). Dissatisfaction with lip appearance correlated to a greater willingness to change the appearance of the lip and face. No correlation was found between satisfaction with appearance and the number of the previously performed secondary lip revisions. CONCLUSION Adults treated for UCLP are less satisfied with the appearance of their lips compared to the non-cleft population. The number of secondary revisions does not necessarily correlate to greater satisfaction with lip appearance.
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Affiliation(s)
- Roshan Peroz
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University and Uppsala university hospital, Uppsala, Sweden
| | - Malin Hakelius
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University and Uppsala university hospital, Uppsala, Sweden
| | - Alberto Falk-Delgado
- Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Yun Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Maria Mani
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University and Uppsala university hospital, Uppsala, Sweden
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Galant-Swafford J, Catanzaro J, Achcar RD, Cool C, Koelsch T, Bang TJ, Lynch DA, Alam R, Katial RK, Fernández Pérez ER. Approach to diagnosing and managing granulomatous-lymphocytic interstitial lung disease. EClinicalMedicine 2024; 75:102749. [PMID: 39170934 PMCID: PMC11338122 DOI: 10.1016/j.eclinm.2024.102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024] Open
Abstract
Granulomatous-lymphocytic interstitial lung disease (GLILD) is a lymphoproliferative and granulomatous pulmonary manifestation of primary immune deficiency diseases, notably common variable immunodeficiency (CVID), and is an important contributor of excess morbidity. As with all forms of ILD, the significance of utilizing a multidisciplinary team discussion to enhance diagnostic and treatment confidence of GLILD cannot be overstated. In this review, key clinical, radiological, and pathological features are integrated into a diagnostic algorithm to facilitate a consensus diagnosis. As the evidence for diagnosing and managing patients with GLILD is limited, the viewpoints discussed here are not meant to resolve current controversies. Instead, this review aims to provide a practical framework for diagnosing and evaluating suspected cases and emphasizes the importance of a multidisciplinary approach when caring for GLILD patients.
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Affiliation(s)
- Jessica Galant-Swafford
- Department of Medicine, Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Jason Catanzaro
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Rosane Duarte Achcar
- Department of Medicine, Division of Pathology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Carlyne Cool
- Department of Pathology, University of Colorado Health Sciences Center, 12605 East 16th Avenue, Denver, CO 80045, USA
| | - Tilman Koelsch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Tami J. Bang
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - David A. Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Rafeul Alam
- Department of Medicine, Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Rohit K. Katial
- Department of Medicine, Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Evans R. Fernández Pérez
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Interstitial Lung Disease Program, National Jewish Health, Denver, CO 80206, USA
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Esteves AM, Buchfellner MC, Holmes BM, Berndsen JA, Roginski MA. Impact of a Divided Phenobarbital Load and Taper Compared With Lorazepam Symptom Triggered Therapy in Hospitalized Patients. Ann Pharmacother 2024; 58:896-905. [PMID: 38258797 DOI: 10.1177/10600280231222294] [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: 01/24/2024] Open
Abstract
BACKGROUND Benzodiazepines are the preferred treatment for alcohol withdrawal. Phenobarbital is an alternative in the setting of prescriber expertise or benzodiazepine contraindication. OBJECTIVE To evaluate the efficacy and safety of a phenobarbital dosing strategy aimed at treating a spectrum of alcohol withdrawal symptoms across various patient populations. METHODS Retrospective review of patients admitted with concerns of alcohol withdrawal between May 2018 and November 2022. Patients were separated into a before-after cohort of lorazepam or phenobarbital. The primary outcome was hospital length of stay (LOS). Secondary outcomes were intensive care unit (ICU) LOS, escalation of respiratory support, increased level of care (LOC), and incidence of delirium tremens and/or seizures. RESULTS Two hundred and seventy-seven patients received lorazepam and 198 received phenobarbital. Hospital LOS was longer in the phenobarbital cohort compared with the lorazepam cohort (6.9 vs 9.3 days). There was no difference in ICU LOS. Level of care increases were fewer in the phenobarbital cohort (4 events vs 19 events). There were higher rates of non-invasive respiratory interventions in the lorazepam cohort and higher rates of mechanical ventilation in the phenobarbital cohort. Utilization of phenobarbital was attributed to a reduction in delirium tremens and seizures. CONCLUSION AND RELEVANCE This study is novel because of the broad application of a phenobarbital order set across multiple levels of care and patient admission diagnoses. A risk targeted split load intravenous phenobarbital order set can safely be administered to patients with fewer escalations of care, seizures, delirium tremens, and respiratory care escalation.
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Affiliation(s)
- Alyson M Esteves
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Matthew C Buchfellner
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Brooke M Holmes
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Joseph A Berndsen
- Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
| | - Matthew A Roginski
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, NH, USA
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ACOG Committee Statement No. 10: Racial and Ethnic Inequities in Obstetrics and Gynecology. Obstet Gynecol 2024; 144:e62-e74. [PMID: 39146552 DOI: 10.1097/aog.0000000000005678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Indexed: 08/17/2024]
Abstract
Disparate health outcomes and unequal access to care have long plagued many communities in the United States. Individual demographic characteristics, such as geography, income, education, and race, have been identified as critical factors when seeking to address inequitable health outcomes. To provide the best care possible, obstetrician-gynecologists should be keenly aware of the existence of and contributors to health inequities and be engaged in the work needed to eliminate racial and ethnic health inequities. Obstetrician-gynecologists should improve their understanding of the etiologies of health inequities by participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.
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Zhang Z, Zhao M, Wang Q, Wang X, Wang Y, Ge Y, Wu Z, Wang W, Shan L. Forkhead box protein FOXK1 disrupts the circadian rhythm to promote breast tumorigenesis in response to insulin resistance. Cancer Lett 2024; 599:217147. [PMID: 39094826 DOI: 10.1016/j.canlet.2024.217147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/09/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
The dysregulation of circadian rhythm oscillation is a prominent feature of various solid tumors. Thus, clarifying the molecular mechanisms that maintain the circadian clock is important. In the present study, we revealed that the transcription factor forkhead box FOXK1 functions as an oncogene in breast cancer. We showed that FOXK1 recruits multiple transcription corepressor complexes, including NCoR/SMRT, SIN3A, NuRD, and REST/CoREST. Among them, the FOXK1/NCoR/SIN3A complex transcriptionally regulates a cohort of genes, including CLOCK, PER2, and CRY2, that are critically involved in the circadian rhythm. The complex promoted the proliferation of breast cancer cells by disturbing the circadian rhythm oscillation. Notably, the nuclear expression of FOXK1 was positively correlated with tumor grade. Insulin resistance gradually became more severe with tumor progression and was accompanied by the increased expression of OGT, which caused the nuclear translocation and increased expression of FOXK1. Additionally, we found that metformin downregulates FOXK1 and exports it from the nucleus, while HDAC inhibitors (HDACi) inhibit the FOXK1-related enzymatic activity. Combined treatment enhanced the expression of circadian clock genes through the regulation of FOXK1, thereby exerting an antitumor effect, indicating that highly nuclear FOXK1-expressing breast cancers are potential candidates for the combined application of metformin and HDACi.
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Affiliation(s)
- Zhaohan Zhang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Minghui Zhao
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Qian Wang
- Department of Tumor Cell Biology, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, 300060, Tianjin, China; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, 300060, Tianjin, China
| | - Xilin Wang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yu Wang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yuze Ge
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Zicheng Wu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Wenjuan Wang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China; Beijing Key Laboratory of Cancer Invasion and Metastasis Research, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Lin Shan
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China; Beijing Key Laboratory of Cancer Invasion and Metastasis Research, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
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Alex CP, Fromme HB, Greenberg L, Ryan MS, Gustafson S, Neeley MK, Nunez S, Rideout ME, VanNostrand J, Orlov NM. Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:997-1006. [PMID: 38696720 DOI: 10.1097/acm.0000000000005747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
PURPOSE Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions. METHOD This multimethod study was performed at 6 U.S.-based institutions from March to October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses. RESULTS Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]). CONCLUSIONS This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.
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Li H, Zhang M, Zheng Y, Zhang H. Gastric granular cell tumor: A case report and literature review. Oncol Lett 2024; 28:403. [PMID: 38983126 PMCID: PMC11228929 DOI: 10.3892/ol.2024.14536] [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: 01/20/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024] Open
Abstract
Granular cell tumors (GCTs) are neoplasms of uncertain histopathological etiology and therefore there are no universally accepted treatment strategies. GCTs are characterized by abundant eosinophilic granules. Since they are predominantly located in the skin and subcutaneous tissues, gastric GCTs are exceedingly rare. The present study documents the case of a 52-year-old man who visited the Gastroenterology Clinic of the People's Hospital of Putuo District (Zhoushan, China) due to upper abdominal fullness. Endoscopic ultrasonography revealed a well-defined hypoechoic nodule in the submucosal layer of the stomach body. The lesion was completely excised using endoscopic submucosal dissection and the patient made a full postoperative recovery. Immunohistochemistry showed positivity for S100 and CD68, with CD34 expression surrounding the tumor cells. At telephone follow-up until May 2024, the patient's fullness and discomfort were noted to be relieved. The characteristics of the CD34 expression pattern may serve as a novel basis for the pathological diagnosis of gastric GCTs. Endoscopic resection is a feasible option for gastric GCTs smaller than 2 cm.
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Affiliation(s)
- Huixi Li
- Department of Pathology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
| | - Miao Zhang
- Department of Pathology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
| | - Youyou Zheng
- Department of Gastroenterology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
| | - Hong Zhang
- Department of Obstetrics and Gynecology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
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Pence BW, Darnell D, Ranna-Stewart M, Psaros C, Gaynes BN, Grimes L, Henderson S, Parman M, Filipowicz TR, Gaddis K, Dorsey S, Mugavero MJ. Provocative Findings From a Transdiagnostic Counseling Intervention to Improve Psychiatric Comorbidity and HIV Care Engagement Among People With HIV: A Pilot Randomized Clinical Trial. J Acquir Immune Defic Syndr 2024; 97:68-77. [PMID: 39116333 PMCID: PMC11315358 DOI: 10.1097/qai.0000000000003457] [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: 11/06/2023] [Accepted: 04/19/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Depression, anxiety, post-traumatic stress, and alcohol/substance use disorders are prevalent among people with HIV (PWH), commonly co-occur, and predict worse HIV care outcomes. Transdiagnostic counseling approaches simultaneously address multiple co-occurring mental health disorders. METHODS We conducted a pilot individually randomized trial of the Common Elements Treatment Approach adapted for people with HIV (CETA-PWH), a transdiagnostic counseling intervention, compared with usual care at a large academic medical center in the southern United States. Participants were adults with HIV; at risk for HIV care disengagement; and with elevated symptoms of depression, anxiety, post-traumatic stress, and/or alcohol/substance use. Mental health and HIV care engagement were assessed at 4 and 9 months. RESULTS Among participants (n = 60), follow-up was high at 4 (92%) and 9 (85%) months. Intervention engagement was challenging: 93% attended ≥1 session, 43% attended ≥6 sessions in 3 months ("moderate dose"), and 30% completed treatment. Although not powered for effectiveness, mental health outcomes and HIV appointment attendance improved in CETA-PWH relative to usual care in intent-to-treat analyses; those receiving a moderate dose and completers showed progressively greater improvement. Viral load showed small differences between arms. The dose-response pattern was not explained by differences between those who did and did not complete treatment. CONCLUSIONS This pilot trial provides preliminary evidence for the potential of CETA-PWH to simultaneously address co-occurring mental health comorbidities and support HIV appointment attendance among PWH. Additional strategies may be an important part of ensuring that clients can engage in the full course of treatment and realize its full benefits.
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Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, the University of North Carolina at Chapel Hill
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, the University of Washington
| | | | | | - Bradley N. Gaynes
- Department of Epidemiology, the University of North Carolina at Chapel Hill
- Department of Psychiatry, the University of North Carolina at Chapel Hill
| | - LaKendra Grimes
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Savannah Henderson
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Mariel Parman
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | | | - Kathy Gaddis
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Shannon Dorsey
- Department of Global Health, the University of Washington
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Wall J, Cook DL, Meehan WP, Wilson F. Adolescent athlete low back pain diagnoses, characteristics, and management: A retrospective chart review. J Sci Med Sport 2024; 27:618-623. [PMID: 38981776 DOI: 10.1016/j.jsams.2024.05.004] [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: 08/02/2023] [Revised: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The aim of this study was to characterise the presentation, treatment, and management of adolescent athlete low back pain (LBP) as diagnosed in a clinical setting. The objectives were to 1) identify diagnoses associated with LBP in adolescent athletes; 2) categorise the differences in LBP diagnosis and presentation by sport, sex, BMI, and age; and 3) examine treatment and management methods of LBP in adolescent athletes. DESIGN Retrospective chart review. METHODS This retrospective medical chart review was conducted in the Sports Medicine Division of Boston Children's Hospital (BCH), a tertiary paediatric academic hospital. Data were collected and analysed from 363 adolescent athletes who had experienced LBP between 2015 and 2020. Chi-squared tests for association were used to assess for associations between LBP diagnoses and age, sex, BMI, and sport. Statistical analysis was conducted using SAS software version 9.4 (SAS Institute, Cary NC). RESULTS Non-specific LBP was the most common LBP diagnosis amongst 363 adolescent athletes with LBP (34 %). This was closely followed by spondylolysis (28 %). There was a higher proportion of female athletes amongst participants diagnosed with facet-joint related pain (90 %) and SI-joint related pain (89 %) compared to the proportion of female athletes amongst participants diagnosed with spondylolysis (50 %). There was a high rate of diagnostic MRI usage in this cohort. Commonly used management techniques in this cohort were diagnostic MRI, physical therapy, relative rest, and bracing. CONCLUSIONS An awareness of the sex-based differences in adolescent athlete LBP diagnoses may be useful for clinicians. It may be important to refine methods of diagnosis of LBP in this group, as there was a high rate of diagnostic MRI use. Future research should be directed towards the development of management guidelines specific to LBP in adolescent athletes to assist in the optimal management of this diagnosis.
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Affiliation(s)
- Julia Wall
- Trinity College Dublin Discipline of Physiotherapy, Ireland.
| | - Danielle L Cook
- Boston Children's Hospital Division of Sports Medicine, United States of America
| | - William P Meehan
- Boston Children's Hospital Division of Sports Medicine, United States of America
| | - Fiona Wilson
- Trinity College Dublin Discipline of Physiotherapy, Ireland. https://twitter.com/FionaWilsonf
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He X, Li Y, Zou D, Zu H, Li W, Zheng Y. An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion. Bioact Mater 2024; 39:456-478. [PMID: 38873086 PMCID: PMC11170442 DOI: 10.1016/j.bioactmat.2024.04.026] [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: 12/29/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 06/15/2024] Open
Abstract
Due to matching biomechanical properties and significant biological activity, Mg-based implants present great potential in orthopedic applications. In recent years, the biocompatibility and therapeutic effect of magnesium-based implants have been widely investigated in trauma repair. In contrast, the R&D work of Mg-based implants in spinal fusion is still limited. This review firstly introduced the general background for Mg-based implants. Secondly, the mechanical properties and degradation behaviors of Mg and its traditional and novel alloys were reviewed. Then, different surface modification techniques of Mg-based implants were described. Thirdly, this review comprehensively summarized the biological pathways of Mg degradation to promote bone formation in neuro-musculoskeletal circuit, angiogenesis with H-type vessel formation, osteogenesis with osteoblasts activation and chondrocyte ossification as an integrated system. Fourthly, this review followed the translation process of Mg-based implants via updating the preclinical studies in fracture fixation, sports trauma repair and reconstruction, and bone distraction for large bone defect. Furthermore, the pilot clinical studies were involved to demonstrate the reliable clinical safety and satisfactory bioactive effects of Mg-based implants in bone formation. Finally, this review introduced the background of spine fusion surgeryand the challenges of biological matching cage development. At last, this review prospected the translation potential of a hybrid Mg-PEEK spine fusion cage design.
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Affiliation(s)
- Xuan He
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Ye Li
- Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hong Kong SAR, PR China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Haiyue Zu
- Department of Orthopaedics, The First Affiliated Hospital of Suchow University, PR China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Huayuan Road, Haidian, Beijing, PR China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Comprehensive Scientific Research Building, Beijing, PR China
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Whitmer SL, Whitesell A, Mobley M, Talundzic E, Shedroff E, Cossaboom CM, Messenger S, Deldari M, Bhatnagar J, Estetter L, Zufan S, Cannon D, Chiang CF, Gibbons A, Krapiunaya I, Morales-Betoulle M, Choi M, Knust B, Amman B, Montgomery JM, Shoemaker T, Klena JD. Human Orthohantavirus disease prevalence and genotype distribution in the U.S., 2008-2020: a retrospective observational study. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100836. [PMID: 39100240 PMCID: PMC11296052 DOI: 10.1016/j.lana.2024.100836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 06/06/2024] [Accepted: 06/26/2024] [Indexed: 08/06/2024]
Abstract
Background In the United States (U.S.), hantavirus pulmonary syndrome (HPS) and non-HPS hantavirus infection are nationally notifiable diseases. Criteria for identifying human cases are based on clinical symptoms (HPS or non-HPS) and acute diagnostic results (IgM+, rising IgG+ titers, RT-PCR+, or immunohistochemistry (IHC)+). Here we provide an overview of diagnostic testing and summarize human Hantavirus disease occurrence and genotype distribution in the U.S. from 2008 to 2020. Methods Epidemiological data from the national hantavirus registry was merged with laboratory diagnostic testing results performed at the CDC. Residual hantavirus-positive specimens were sequenced, and the available epidemiological and genetic data sets were linked to conduct a genomic epidemiological study of hantavirus disease in the U.S. Findings From 1993 to 2020, 833 human hantavirus cases have been identified, and from 2008 to 2020, 335 human cases have occurred. Among New World (NW) hantavirus cases detected at the CDC diagnostic laboratory (representing 29.2% of total cases), most (85.0%) were detected during acute disease, however, some convalescent cases were detected in states not traditionally associated with hantavirus infections (Connecticut, Missouri, New Jersey, Pennsylvania, Tennessee, and Vermont). From 1993 to 2020, 94.9% (745/785) of U.S. hantaviruses cases were detected west of the Mississippi with 45.7% (359/785) in the Four Corners region of the U.S. From 2008 to 2020, 67.7% of NW hantavirus cases were detected between the months of March and August. Sequencing of RT-PCR-positive cases demonstrates a geographic separation of Orthohantavirus sinnombreense species [Sin Nombre virus (SNV), New York virus, and Monongahela virus]; however, there is a large gap in viral sequence data from the Northwestern and Central U.S. Finally, these data indicate that commercial IgM assays are not concordant with CDC-developed assays, and that "concordant positive" (i.e., commercial IgM+ and CDC IgM+ results) specimens exhibit clinical characteristics of hantavirus disease. Interpretation Hantaviral disease is broadly distributed in the contiguous U.S, viral variants are localised to specific geographic regions, and hantaviral disease infrequently detected in most Southeastern states. Discordant results between two diagnostic detection methods highlight the need for an improved standardised testing plan in the U.S. Hantavirus surveillance and detection will continue to improve with clearly defined, systematic reporting methods, as well as explicit guidelines for clinical characterization and diagnostic criteria. Funding This work was funded by core funds provided to the Viral Special Pathogens Branch at CDC.
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Affiliation(s)
- Shannon L.M. Whitmer
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Amy Whitesell
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Melissa Mobley
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Emir Talundzic
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Elizabeth Shedroff
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Caitlin M. Cossaboom
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Sharon Messenger
- Zoonotic and Vector-borne Diseases Section, Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, 94804, USA
| | - Mojgan Deldari
- Zoonotic and Vector-borne Diseases Section, Viral and Rickettsial Disease Laboratory, California Department of Public Health, Richmond, CA, 94804, USA
| | - Julu Bhatnagar
- Infectious Diseases Pathology Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Lindsey Estetter
- Infectious Diseases Pathology Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Sara Zufan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Debi Cannon
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Cheng-Feng Chiang
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Ardith Gibbons
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Inna Krapiunaya
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Maria Morales-Betoulle
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Mary Choi
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Barbara Knust
- Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Bangkok, Thailand
| | - Brian Amman
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
| | - John D. Klena
- Viral Special Pathogens Branch, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., NE Atlanta, GA, 30333, USA
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Butler SE, Wallace EM, Bisits A, Selvaratnam RJ, Davey MA. Induction of labor and cesarean birth in lower-risk nulliparous women at term: A retrospective cohort study. Birth 2024; 51:521-529. [PMID: 38173333 DOI: 10.1111/birt.12806] [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: 04/12/2023] [Revised: 10/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. METHODS Population-based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi-square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. RESULTS Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower-risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13-1.32)), 39 (aOR 1.31(1.23-1.40)), 40 (aOR 1.42(1.35-1.50)), and 41 weeks of gestation (aOR 1.43(1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. DISCUSSION For lower-risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only.
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Affiliation(s)
- Sarah E Butler
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Health, Melbourne, Victoria, Australia
| | - Andrew Bisits
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Roshan J Selvaratnam
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Samad A, Wobma H, Casey A. Innovations in the care of childhood interstitial lung disease associated with connective tissue disease and immune-mediated disorders. Pediatr Pulmonol 2024; 59:2321-2337. [PMID: 38837875 DOI: 10.1002/ppul.27068] [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: 10/16/2023] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
Childhood interstitial lung disease (chILD) associated with connective tissue and immune mediated disorders is the second most common chILD diagnostic category. As knowledge of the molecular and genetic underpinnings of these rare disorders advances, the recognized clinical spectrum of associated pulmonary manifestations continues to expand. Pulmonary complications of these diseases, including ILD, confer increased risk for morbidity and mortality and contribute to increased complexity for providers tasked with managing the multiple organ systems that can be impacted in these systemic disorders. While pulmonologists play an important role in diagnosis and management of these conditions, thankfully they do not have to work alone. In collaboration with a multidisciplinary team of subspecialists, the pulmonary and other systemic manifestations of these conditions can be managed effectively together. The goal of this review is to familiarize the reader with the classic patterns of chILD and other pulmonary complications associated with primary immune-mediated disorders (monogenic inborn errors of immunity) and acquired systemic autoimmune and autoinflammatory diseases. In addition, this review will highlight current, emerging, and innovative therapeutic strategies and will underscore the important role of multidisciplinary management to improving outcomes for these patients.
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Affiliation(s)
- Aaida Samad
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Holly Wobma
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Toni E, Ayatollahi H, Abbaszadeh R, Fotuhi Siahpirani A. Adverse Drug Reactions in Children with Congenital Heart Disease: A Scoping Review. Paediatr Drugs 2024; 26:519-553. [PMID: 39044096 DOI: 10.1007/s40272-024-00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the leading causes of death. Safe and timely medical interventions, especially in children, can prolong their survival. The drugs prescribed for children with CHD are mainly based on the outcomes of drug therapy in adults with cardiovascular diseases, and their adverse drug reactions (ADRs) might be different. Therefore, the aim of this study was to investigate ADRs in children with CHD. METHODS This was a scoping review conducted in 2023. PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, ProQuest, and Google Scholar databases were searched. All studies that reported ADRs for children with CHD and were published in English by 1 November 2023 were included in this study. Finally, the results were reported using a content analysis method. RESULTS A total of 87 articles were included in the study. The results showed that symptoms/signs/clinical findings, and cardiovascular disorders were the most common ADRs reported in children with CHD. The results also showed that most of the ADRs were reported for prostaglandin E1, amiodarone, prostaglandin E2, dexmedetomidine, and captopril, respectively. CONCLUSION The review underscores the wide array of ADRs in children with CHD, particularly in antiarrhythmics, diuretics, beta-blockers, anticoagulants, and vasodilators, which affected cardiovascular, respiratory, endocrine, metabolic, genitourinary, gastrointestinal, and musculoskeletal systems. Tailored treatment is imperative, considering individual patient characteristics, especially in the vulnerable groups. Further research is essential for optimizing dosing, pharmacogenetics, and alternative therapies to enhance patient outcomes in CHD management.
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Affiliation(s)
- Esmaeel Toni
- Medical Informatics, Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Medical Informatics, Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Reza Abbaszadeh
- Pediatric Cardiology, Heart Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Fotuhi Siahpirani
- Department of Bioinformatics, Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
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Dow T, Davis C, ElAbd R, Lalonde D, Williams J. Cancer Metastases to the Hand: A Systematic Review and Meta-analysis. Hand (N Y) 2024; 19:865-874. [PMID: 36856295 PMCID: PMC11342693 DOI: 10.1177/15589447231153175] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. METHODS An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. RESULTS Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. CONCLUSION Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.
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Affiliation(s)
- Todd Dow
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada
| | - Caitlin Davis
- Department of Obstetrics and Gynecology, Dalhousie Unviersity, Halifax, NS, Canada
| | - Rawan ElAbd
- Division of Plastic and Reconstructive Surgery, McGill Univeristy, Montreal, Canada
- Division of Plastic and Reconstructive Surgery, Jaber Al Ahmed Al Jaber Al Sabah Hopsital, Surra, Kuwait
| | - Donald Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, NB, Canada
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada
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Koç ZP, Özcan PP, Tuncel F, İsbir C, Usta Y. SPECT/CT in the Diagnosis of Ectopic Gastric Mucosa-Meckel's Diverticulum. World J Nucl Med 2024; 23:176-179. [PMID: 39170839 PMCID: PMC11335389 DOI: 10.1055/s-0044-1787719] [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] [Indexed: 08/23/2024] Open
Abstract
Aim The imaging of Meckel's diverticulum (MD) is based of accumulation of Tc-99m pertechnetate in the ectopic gastric mucosa (EGM) content. Although the diagnostic accuracy of this imaging modality is high, there are some overlap patients with coexisting gastrointestinal bleeding and false positive causes hampering diagnostic power. The aim of this study was to evaluate the possible contribution of single-photon emission computed tomography/computed tomography (SPECT/CT) in EGM-MD diagnosis and to determine the indication of this additional imaging modality. Materials and Methods Fifty-two pediatric patients (24 girls, 28 boys; mean age: 8.06 ± 5.22 years old) who have suspicion of MD and referred for scintigraphy were evaluated retrospectively. Additional SPECT/CT were performed to selected five cases among the group. The results of the scintigraphy as well as SPECT/CT were compared with endoscopy, pathology, and/or follow-up results. Results There were 9 patients with equivocal study results, 12 positive results, and the others were considered negative MD scintigraphy. One patient was out of follow-up and 10 patients underwent surgery. Only one single patient was negative during surgery but scintigraphy was also negative. The diagnostic sensitivity, specificity, and accuracy were 100, 95, and 96%, respectively. Among five patients with SPECT/CT results one patient was diagnosed by only SPECT/CT who had EGM in duplication cyst, one equivocal patient was diagnosed as descending colon bleeding, and one patient's lesion was clearly delineated by SPECT/CT. Conclusion SPECT/CT has clear advantage over standard planar scintigraphy imaging in EGM-MD determination. This modality might decrease equivocal and false positive results but this issue has to be addressed with further studies.
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Affiliation(s)
- Zehra Pınar Koç
- Department of Nuclear Medicine, Mersin University, Mersin, Türkiye
| | | | - Ferah Tuncel
- Department of Pathology, Mersin University, Mersin, Türkiye
| | - Caner İsbir
- Department of Pediatric Surgery, Mersin University, Mersin, Türkiye
| | - Yusuf Usta
- Department of Pediatric Gastroenterology, Mersin University, Mersin, Türkiye
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Babiker S, Hajalamin M. An atypical encounter: Mounir-Kuhn syndrome and aspergilloma coexistence: A case report. Radiol Case Rep 2024; 19:3962-3965. [PMID: 39050651 PMCID: PMC11267993 DOI: 10.1016/j.radcr.2024.06.001] [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: 05/14/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
We report a coexistence of Mounir-Kuhn syndrome and aspergilloma in a 69-year-old male presented with hemoptysis, cough, shortness of breath and fever. This patient has a history of recurrent hospital admissions for infective exacerbations of chronic obstructive pulmonary disease. Diagnostic imaging revealed the presence of aspergilloma and marked dilatation of the trachea and main bronchi, leading to a diagnosis of Mounier-Kuhn syndrome. Given the frequent association of Mounier-Kuhn syndrome with recurrent respiratory infections, we recommend that clinicians consider this syndrome when evaluating patients with recurrent pneumonia.
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Affiliation(s)
- Sima Babiker
- Geriatric Medicine, St Mary's Hospital Phoenix Park, Dublin 20, Dublin D20 TY72, Ireland
| | - Mohamed Hajalamin
- Rheumatology Department, University Hospital Galway, Newcastle Road, Galway City, Galway H91 YR71, Ireland
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Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024; 139:532-548. [PMID: 38379269 PMCID: PMC11344984 DOI: 10.1177/00333549241228525] [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: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
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Affiliation(s)
- Caroline J. Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S. Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M. Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A. Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K. Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C. Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Karlin J, Newmark RL, Oberman N, Dehlendorf C. A Scoping Review of Patient-Centered Perinatal Contraceptive Counseling. Matern Child Health J 2024; 28:1454-1484. [PMID: 39088140 DOI: 10.1007/s10995-024-03946-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] [Accepted: 05/19/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Contraceptive counseling during the perinatal period is an important component of comprehensive perinatal care. We synthesized research about contraceptive counseling during the perinatal period, which has not previously been systematically compiled. METHODS We developed search criteria to identify articles listed in PubMed, Embase, and Popline databases published between 1992 and July 2022 that address patients' preferences for, and experiences of, perinatal contraceptive counseling, as well as health outcomes associated with this counseling. Search results were independently reviewed by multiple reviewers to assess relevance for the present review. Methods were conducted in accordance with PRISMA guidelines. RESULTS Thirty-four articles were included in the final full text review. Of the included articles, 10 included implementation and evaluation of a contraceptive counseling method or protocol, and 24 evaluated preferences for or experiences of existing contraceptive counseling in the perinatal period. Common themes included the acceptability of contraceptive counseling in the peripartum and postpartum periods, and a preference for contraceptive counseling at some point during the antenatal period and before the inpatient hospital experience, and direct provider-patient discussion instead of video or written material. Multiple studies suggest that timing, content, and modality should be individualized. In general, avoiding actual or perceived directiveness and providing multi-modal counseling that includes both written educational materials and patient-provider conversations was desired. DISCUSSION The perinatal period constitutes a critical opportunity to provide contraceptive counseling that can support pregnant and postpartum people's management of their reproductive futures. The reviewed studies highlight the importance of patient-centered approach to providing this care, including flexibility of timing, content, and modality to accommodate individual preferences.
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Affiliation(s)
- Jennifer Karlin
- Family and Community Medicine, University of California, San Francisco, CA, 94110, USA.
| | - Rebecca L Newmark
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
- San Francisco Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Nina Oberman
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Christine Dehlendorf
- Family and Community Medicine, University of California, San Francisco, CA, 94110, USA
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Hijleh AA, Berton DC, Neder-Serafini I, James M, Vincent S, Domnik N, Phillips D, O'Donnell DE, Neder JA. Sex- and age-adjusted reference values for dynamic inspiratory constraints during incremental cycle ergometry. Respir Physiol Neurobiol 2024; 327:104297. [PMID: 38871042 DOI: 10.1016/j.resp.2024.104297] [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: 04/08/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 06/15/2024]
Abstract
Activity-related dyspnea in chronic lung disease is centrally related to dynamic (dyn) inspiratory constraints to tidal volume expansion. Lack of reference values for exertional inspiratory reserve (IR) has limited the yield of cardiopulmonary exercise testing in exposing the underpinnings of this disabling symptom. One hundred fifty apparently healthy subjects (82 males) aged 40-85 underwent incremental cycle ergometry. Based on exercise inspiratory capacity (ICdyn), we generated centile-based reference values for the following metrics of IR as a function of absolute ventilation: IRdyn1 ([1-(tidal volume/ICdyn)] x 100) and IRdyn2 ([1-(end-inspiratory lung volume/total lung capacity] x 100). IRdyn1 and IRdyn2 standards were typically lower in females and older subjects (p<0.05 for sex and age versus ventilation interactions). Low IRdyn1 and IRdyn2 significantly predicted the burden of exertional dyspnea in both sexes (p<0.01). Using these sex and age-adjusted limits of reference, the clinician can adequately judge the presence and severity of abnormally low inspiratory reserves in dyspneic subjects undergoing cardiopulmonary exercise testing.
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Affiliation(s)
- Abed A Hijleh
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Danilo C Berton
- Pulmonary Function Tests Laboratory, Federal University of Rio Grande to Sul, Rua Ramiro Barcelos, 2350 Bloco A, Av. Protásio Alves, 211 - Bloco B e C - Santa Cecília, Porto Alegre, RS 90035-903, Brazil
| | - Igor Neder-Serafini
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Matthew James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Sandra Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Nicolle Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Devin Phillips
- School of Kinesiology and Health Science, Faculty of Health, York University, Norman Bethune College, 170 Campus Walk Room 341, Toronto, ON M3J 1P3, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada.
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Melo VD, Saifuddin H, Peng LT, Wolanskyj-Spinner AP, Marshall AL, Leep Hunderfund AN. Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:987-996. [PMID: 38648293 DOI: 10.1097/acm.0000000000005744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school. METHOD The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) in June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective. RESULTS Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers. CONCLUSIONS This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.
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Harris SJ, Stine JG. Frailty in liver transplantation: Exploring prescribing exercise as medicine to improve patient outcomes. Liver Int 2024; 44:2251-2262. [PMID: 38899635 DOI: 10.1111/liv.15986] [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: 04/01/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
Liver transplantation (LT) represents a curative avenue for individuals with advanced chronic liver disease. Given the inherent illness severity of LT candidates, identifying patients at greater risk for adverse outcomes before and after transplantation is paramount. Approximately 50% of cirrhotic patients are frail and have considerable functional impairment. Various measures have been used to assess frailty, including performance-based tests and functional status evaluations. Frailty carries significant prognostic implications and predicts both mortality and pre- and post-LT complications. Contributing factors to frailty in this population include sarcopenia, malnutrition, inflammation, and psychosocial factors. Recognizing the prevalence of frailty among LT candidates, exercise interventions have been developed to improve physical frailty and offer potential to improve patient outcomes. While many interventions have demonstrated efficacy without notable adverse events, the absence of a universally accepted standard for exercise prescription underscores the variability in intervention elements and patient adherence. Given the safety profile of exercise interventions, there remains a critical need for standardized protocols and guidelines to optimize exercise regimens for LT candidates. This review delves into the landscape of frailty among LT candidates, elucidating its etiological underpinnings, impact on outcomes, utilization of exercise interventions, and the efficacy of exercise programs in reducing the burden frailty in those awaiting LT.
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Affiliation(s)
- Sara J Harris
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Fatty Liver Program, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, The Pennsylvania State University - College of Medicine, Hershey, Pennsylvania, USA
- Cancer Institute, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Freitas-Santos J, Brito IRR, Santana-Melo I, Oliveira KB, de Souza FMA, Gitai DLG, Duzzioni M, Bueno NB, de Araujo LA, Shetty AK, Castro OWD. Effects of cocaine, nicotine, and marijuana exposure in Drosophila Melanogaster development: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111049. [PMID: 38844126 DOI: 10.1016/j.pnpbp.2024.111049] [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: 11/07/2023] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Abuse-related drug usage is a public health issue. Drosophila melanogaster has been used as an animal model to study the biological effects of these psychoactive substances in preclinical studies. Our objective in this review is to evaluate the adverse effects produced by cocaine, nicotine, and marijuana during the development of D. melanogaster. We searched experimental studies in which D. melanogaster was exposed to these three psychoactive drugs in seven online databases up to January 2023. Two reviewers independently extracted the data. Fifty-one studies met eligibility criteria and were included in the data extraction: nicotine (n = 26), cocaine (n = 20), and marijuana (n = 5). Fifteen studies were eligible for meta-analysis. Low doses (∼0.6 mM) of nicotine increased locomotor activity in fruit flies, while high doses (≥3 mM) led to a decrease. Similarly, exposure to cocaine increased locomotor activity, resulting in decreased climbing response in D. melanogaster. Studies with exposure to marijuana did not present a profile for our meta-analysis. However, this drug has been less associated with locomotor changes, but alterations in body weight and fat content and changes in cardiac function. Our analyses have shown that fruit flies exposed to drugs of abuse during different developmental stages, such as larvae and adults, exhibit molecular, morphological, behavioral, and survival changes that are dependent on the dosage. These phenotypes resemble the adverse effects of psychoactive substances in clinical medicine.
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Affiliation(s)
- Jucilene Freitas-Santos
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Isa Rafaella Rocha Brito
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Igor Santana-Melo
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Kellysson Bruno Oliveira
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | | | - Daniel Leite Góes Gitai
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Marcelo Duzzioni
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Nassib Bezerra Bueno
- Faculty of nutrition (FANUT), Federal University of Alagoas (UFAL), Maceio, AL, Brazil
| | - Lucas Anhezini de Araujo
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Cell Biology and Genetics, Texas A&M University School of Medicine, College Station, TX, USA
| | - Olagide Wagner de Castro
- Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió, AL, Brazil.
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Zhang A, Xiao Y, Han Y, Huang Y, Kan B, Liang W. Characterization of Quorum regulatory small RNAs in an emerging pathogen Vibrio fluvialis and their roles toward type VI secretion system VflT6SS2 modulation. Emerg Microbes Infect 2024:2396872. [PMID: 39193622 DOI: 10.1080/22221751.2024.2396872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
AbstractThe type VI secretion system (T6SS) is essential for Gram-negative bacteria to antagonize a wide variety of prokaryotic and eukaryotic competitors and thus gain survival advantages. Two sets of T6SS have been found in Vibrio fluvialis, namely VflT6SS1 and VflT6SS2, among which VflT6SS2 is functionally expressed. The CqsA/LuxS-HapR quorum sensing (QS) system with CAI-1 and AI-2 as signal molecules can regulate VflT6SS2 by regulators LuxO and HapR, with LuxO repressing while HapR activating VflT6SS2. Quorum regulatory small RNAs (Qrr sRNAs) are Hfq-dependent trans-encoded sRNAs that control Vibrio quorum sensing. In V. fluvialis, Qrr sRNAs have not been characterized and their regulatory function were unknown. In this study, we first identified four Qrr sRNAs in V. fluvialis and demonstrated that these Qrr sRNAs are regulated by LuxO and involved in the modulation of VflT6SS2 function. On the one hand, Qrr sRNAs act on HapR, the activator of both the major and the auxiliary clusters of VflT6SS2, and then indirectly repress VflT6SS2. On the other hand, they directly repress VflT6SS2 by acting on tssB2 and tssD2_a, the first gene of the major cluster and the highly transcriptional one among the two units of the first auxiliary cluster, respectively. Our results give insights into the role of Qrr sRNAs in CAI-1/AI-2 based QS and VflT6SS2 modulation in V. fluvialis and further enhance understandings of the network between QS and T6SS regulation in Vibrio species.
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Affiliation(s)
- Anran Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
- Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Yue Xiao
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
| | - Yu Han
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
| | - Yuanming Huang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
| | - Biao Kan
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
| | - Weili Liang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
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Ng JY, Kochhar J, Cramer H. Oncology researchers' and clinicians' perceptions of complementary, alternative, and integrative medicine: an international, cross-sectional survey. Support Care Cancer 2024; 32:615. [PMID: 39196463 DOI: 10.1007/s00520-024-08785-9] [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: 03/03/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Complementary, alternative, and integrative medicine (CAIM) has become an increasingly popular supportive therapy option for patients with cancer. The objective of this study was to investigate how researchers and clinicians in the oncology field perceive CAIM. METHODS We conducted an online, anonymous, cross-sectional survey for researchers and clinicians who have published their work in oncology journals that are indexed in MEDLINE. The link to the survey was sent to 47, 991 researchers and clinicians whose contact information was extracted from their publications. The survey included various multiple-choice questions, and one open-ended question at the end to allow for any additional comments. RESULTS 751 respondents completed the survey, and they mostly identified themselves as researchers (n = 329, 45.13%), or as both researchers and clinicians (n = 332, 45.45%) in the field of oncology. Over half of the respondents perceive mind-body therapies (n = 354, 54.97%) to be the most promising CAIM category with regards to the prevention, treatment, and/or management of diseases related to oncology, and many respondents agreed that most CAIM therapies are safe (n = 218, 37.39%), and that clinicians should receive training on CAIM therapies via formal (n = 225, 38.59%) and supplemental education (n = 290, 49.83%). However, many respondents were unsure when asked if most CAIM therapies are effective (n = 202, 34.77%). CONCLUSIONS The findings from this study demonstrated great current interest in the use of CAIM in oncology. This information can serve as a foundation for conducting additional research and creating customized educational materials for researchers and clinicians in oncology.
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Affiliation(s)
- Jeremy Y Ng
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany.
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany.
| | - Jassimar Kochhar
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
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83
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Mal S, Das TK, Pradhan S, Ghosh K. Probiotics as a Therapeutic Approach for Non-infectious Gastric Ulcer Management: a Comprehensive Review. Probiotics Antimicrob Proteins 2024:10.1007/s12602-024-10348-7. [PMID: 39190267 DOI: 10.1007/s12602-024-10348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 08/28/2024]
Abstract
A gastric ulcer is a stomach lining or nearby intestine disruption caused by acid and pepsin. Helicobacter pylori (H. pylori) and NSAIDs are the primary culprits behind stomach infections that can lead to gastric ulcers and other digestive disorders. Additionally, lifestyle choices such as alcohol consumption and cigarette smoking, stress, and exposure to cold environments can also contribute to non-infectious gastric ulcers. Various treatments are available for gastric ulcers, including antibiotics, anticholinergics, and antacids. However, potential concerns include antibiotic resistance, side effects, and treatment failure. Considering this, there is a need for an alternative approach to manage it. Fortunately, probiotics, typically Lactobacillus and Bifidobacterium, show potential for healing gastric ulcers, offering a non-invasive alternative to conventional treatments. A notable concern arises from applying probiotic bacteria stemming from the propensity of pathogenic bacteria to develop antimicrobial resistance in response to antibiotic therapies. Therefore, the use of yeast becomes more imperative due to its natural resistance to antibacterial antibiotics for antibacterial-treated patients. Probiotic bacteria and yeasts could heal gastric ulcers by regulating the immune response, reducing inflammation, and restoring the balance between defensive and aggressive factors of the gastric layer. This comprehensive review provides an in-depth analysis of the benefits of probiotics and their potential as a therapeutic treatment for non-infectious gastric ulcers, along with other probiotic options. In particular, this review provides a succinct summary of multiple literature studies on probiotics, emphasising the distinctive properties of yeast probiotics, as well as their (bacteria and yeasts) application in the management of non-infectious gastric ulcers.
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Affiliation(s)
- Subhasree Mal
- Department of Biological Sciences, Midnapore City College, Midnapore, West Bengal, India
- Biodiversity and Environmental Studies Research Centre, Midnapore City College Affiliated to Vidyasagar University, Midnapore, West Bengal, India
| | - Tridip K Das
- Department of Biological Sciences, Midnapore City College, Midnapore, West Bengal, India
- Biodiversity and Environmental Studies Research Centre, Midnapore City College Affiliated to Vidyasagar University, Midnapore, West Bengal, India
| | - Shrabani Pradhan
- Department of Paramedical and Allied Health Sciences, Midnapore City College, Midnapore, West Bengal, India
| | - Kuntal Ghosh
- Department of Biological Sciences, Midnapore City College, Midnapore, West Bengal, India.
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84
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Jang W, Kim S, Son Y, Kim S, Kim HJ, Jo H, Park J, Lee K, Lee H, Tully MA, Rahmati M, Smith L, Kang J, Woo S, Kim S, Hwang J, Rhee SY, Yon DK. Prevalence, Awareness, Treatment, and Control of Type 2 Diabetes in South Korea (1998 to 2022): Nationwide Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e59571. [PMID: 39190907 DOI: 10.2196/59571] [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: 04/16/2024] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Type 2 diabetes poses an increasing disease burden in South Korea. The development and management of type 2 diabetes are closely related to lifestyle and socioeconomic factors, which have undergone substantial changes over the past few decades, including during the COVID-19 pandemic. OBJECTIVE This study aimed to investigate long-term trends in type 2 diabetes prevalence, awareness, treatment, and control. It also aimed to determine whether there were substantial alterations in the trends during the pandemic and whether these changes were more pronounced within specific demographic groups. METHODS This study examined the prevalence, awareness, treatment, and control of type 2 diabetes in a representative sample of 139,786 South Koreans aged >30 years, using data from the National Health and Nutrition Examination Survey and covering the period from 1998 to 2022. Weighted linear regression and binary logistic regression were performed to calculate weighted β coefficients or odds ratios. Stratified analyses were performed based on sex, age, region of residence, obesity status, educational background, household income, and smoking status. β (difference) was calculated to analyze the trend difference between the prepandemic period and the COVID-19 pandemic. To identify groups more susceptible to type 2 diabetes, we estimated interaction terms for each factor and calculated weighted odds ratios. RESULTS From 1998 to 2022, a consistent increase in the prevalence of type 2 diabetes was observed among South Koreans, with a notable rise to 15.61% (95% CI 14.83-16.38) during the pandemic. Awareness followed a U-shaped curve, bottoming out at 64.37% (95% CI 61.79-66.96) from 2013 to 2015 before increasing to 72.56% (95% CI 70.39-74.72) during the pandemic. Treatment also increased over time, peaking at 68.33% (95% CI 65.95-70.71) during the pandemic. Control among participants with diabetes showed no substantial change, maintaining a rate of 29.14% (95% CI 26.82-31.47) from 2020 to 2022, while control among treated participants improved to 30.68% (95% CI 27.88-33.48). During the pandemic, there was a steepening of the curves for awareness and treatment. However, while the slope of control among participants being treated increased, the slope of control among participants with diabetes showed no substantial change during the pandemic. Older populations and individuals with lower educational level exhibited less improvement in awareness and control trends than younger populations and more educated individuals. People with lower income experienced a deceleration in prevalence during the pandemic. CONCLUSIONS Over the recent decade, there has been an increase in type 2 diabetes prevalence, awareness, treatment, and control. During the pandemic, a steeper increase in awareness, treatment, and control among participants being treated was observed. However, there were heterogeneous changes across different population groups, underscoring the need for targeted interventions to address disparities and improve diabetes management for susceptible populations.
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Affiliation(s)
- Wonwoo Jang
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seokjun Kim
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Yejun Son
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Hyesu Jo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Kyeongmin Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, United Kingdom
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jiseung Kang
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jiyoung Hwang
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sang Youl Rhee
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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85
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Sadan O, Jeong YS, Cohen-Sadan S, Sathialingam E, Buckley EM, Kandiah PA, Grossberg JA, Asbury W, Jusko WJ, Samuels OB. Reply to: Comment: Cerebrospinal Fluid Pharmacokinetics of Nicardipine Following Intrathecal Administration in Subarachnoid Hemorrhage Patients. J Clin Pharmacol 2024. [PMID: 39190004 DOI: 10.1002/jcph.6123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Ofer Sadan
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - Yoo-Seong Jeong
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Shany Cohen-Sadan
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - Eashani Sathialingam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Erin M Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA, USA
- Children's Research Scholar, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Prem A Kandiah
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - William Asbury
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - William J Jusko
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Owen B Samuels
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA, USA
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86
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Schaeffer D, Griese L, Haarmann A. [Professional Health Literacy of General Practitioners - Results of the HLS-PROF]. DAS GESUNDHEITSWESEN 2024. [PMID: 39191374 DOI: 10.1055/a-2350-6377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
AIM To date, there are only a few studies analyzing health professionals' health literacy (HL). Mostly, the focus has been on personal rather than professional HL. To bridge this gap, a new concept and an associated survey instrument have been developed in a three-country consortium. The aim of this article was to examine the professional HL of general practitioners (GPs) in Germany. METHOD The survey instrument used consists of 34 items and assesses subjective difficulties in four dimensions to be addressed in promoting patients' HL: "information and knowledge management", "conveying information and knowledge", "patient-centred communication", "professional digital HL". A total of 297 GPs and internists working in general practice were surveyed online over the summer of 2022. The professional HL (score from 0 to 100) was analyzed descriptively and examined in relation to gender, selected job-related, and organizational characteristics, using multiple linear regression. RESULTS Depending on the four areas, GPs achieved approximately half to almost three-quarters of the highest possible score. The dimension "patient-centred communication" was perceived as the easiest, followed by "information and knowledge management", and "conveying information and knowledge". The most challenging dimension was "professional digital HL". According to the multivariate analysis, professional HL shows a relation to gender, organizational framework and training conditions, job duration, and coping with the diversity of digital information. The strength of correlation varies by area and is rather weak in some instances. CONCLUSIONS The results demonstrate the importance of promoting professional HL of GPs and provide numerous indications of where to start. They also indicate that the regression models should be extended by additional determinants, since the included variables can explain only a small amount of variance.
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Affiliation(s)
- Doris Schaeffer
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
| | - Lennert Griese
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
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87
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Ekici A, Ayan B, Kazancı EG, Kuşku ZB, Orcan CG, Havalı C, Dorum S, Metin T, Orhaner BB. Central nervous system complications during treatment in childhood acute leukemia. Acta Neurol Belg 2024:10.1007/s13760-024-02602-0. [PMID: 39192159 DOI: 10.1007/s13760-024-02602-0] [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: 03/05/2024] [Accepted: 07/11/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE Central nervous system (CNS) complications can be seen in patients with leukemia, depending on the disease itself and the chemotherapeutic agents used. This study focused on CNS complications during treatment in children with acute leukemia in a single pediatric institution. METHODS CNS complications were evaluated retrospectively in 115 patients with ALL and AML. Patients with CNS leukemia infiltration at the time of diagnosis or during a neurological event, late-onset encephalopathy, peripheral neuropathy, or a previous history of neurological abnormalities were excluded from the study. RESULTS A total of 115 children's clinical records with acute leukemia over a four-year period were reviewed. Acute CNS complications developed in 23.1% of acute myeloid leukemia (AML) patients and in 13.5% of acute lymphoblastic leukemia (ALL) patients. CNS complications developed most frequently during the induction phase of the treatment (66.7%). Seizures were the most common symptom (9 patients, 50%), followed by hemiparesis (4 patients, 22.2%) and headache (4 patients, 22.2%). Six patients (33.3%) had chemotherapy-induced toxic leukoencephalopathy, two (11.1%) had Wernicke's encephalopathy, and one patient (5.6%) each had sinus vein thrombosis, posterior reversible encephalopathy syndrome, and CNS infection. Sequelae occurred in three patients (16.7%), and only one patient (5.6%) died due to a CNS complication. CONCLUSION A wide variety of symptoms can be observed in childhood leukemia, depending on the disease itself, the chemotherapeutic agents used and a lot of other conditions such as nutritional problems. Our research shows that several CNS complications might manifest with similar symptoms; differentiated diagnosis between the underlying etiological reasons can be made by neuroimaging.
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Affiliation(s)
- Arzu Ekici
- Department of Pediatrics, Division of Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Avenue, Yıldırım, Bursa, Turkey.
| | - Bilgen Ayan
- Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Elif Güler Kazancı
- Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Zeynep Beyza Kuşku
- Department of Pediatrics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Cengiz Gökhan Orcan
- Department of Radiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Cengiz Havalı
- Department of Pediatrics, Division of Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Avenue, Yıldırım, Bursa, Turkey
| | - Sevil Dorum
- Department of Pediatrics, Division of Metabolism, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Taha Metin
- Department of Pediatrics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Betül Biner Orhaner
- Department of Pediatrics, Division of Hematology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Carrara A, Bertelli C, Gardiol C, Marquis B, Andrey DO, Schrenzel J, Pillonel T, Greub G. Association of pathogenic determinants of Fusobacterium necrophorum with bacteremia, and Lemierre's syndrome. Sci Rep 2024; 14:19804. [PMID: 39191804 DOI: 10.1038/s41598-024-70608-y] [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: 04/22/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
Fusobacterium necrophorum is a Gram-negative anaerobic bacterium responsible for localized infections of the oropharynx that can evolve into bacteremia and/or septic thrombophlebitis of the jugular vein or peritonsillar vein, called Lemierre's syndrome. To identify microbial genetic determinants associated with the severity of this life-threatening disease, 70 F. necrophorum strains were collected and grouped into two categories according to the clinical presentation: (i) localized infection, (ii) bacteremia with/without Lemierre's syndrome. Comparative genomic analyses revealed two clades with distinct genetic content, one clade being significantly enriched with isolates from subjects with bacteremia. To identify genetic determinants contributing to F. necrophorum pathogenicity, genomic islands and virulence factor orthogroups (OVFs) were predicted. The presence/absence profiles of OVFs did not group isolates according to their clinical category, but rather according to their phylogeny. However, a variant of lktA, a key virulence factor, with a frameshift deletion that results in two open reading frames, was associated with bacteremia. Moreover, a genome-wide association study identified three orthogroups associated with bacteremic strains: (i) cas8a1, (ii) a sodium/solute symporter, and (iii) a POP1 domain-containing protein. Further studies must be performed to assess the functional impact of lktA mutation and of these orthogroups on the physiopathological mechanisms of F. necrophorum infections.
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Affiliation(s)
- Alessia Carrara
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claire Bertelli
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline Gardiol
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bastian Marquis
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Diego O Andrey
- Service of Bacteriology and Infectious Diseases, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Service of Bacteriology and Infectious Diseases, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Trestan Pillonel
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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89
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Ramírez SI, Partin M, Snyder AH, Ko E, Aruma J, Castaneda MC, Casas RS. A Scoping Review of Obstetrics and Gynecology Curricula in Primary Care Residency Programs. J Gen Intern Med 2024:10.1007/s11606-024-08987-1. [PMID: 39187722 DOI: 10.1007/s11606-024-08987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND While Women's Health (WH) is a priority for primary care, (Family Medicine (FM), Internal Medicine (IM), Pediatrics (Peds), and combined Medicine/Pediatrics (Med/Peds)), residency curricula remain heterogeneous with deficits in graduates' WH expertise and skills. The overall objective of this study was to assess the quality of WH curricula at primary care residency programs in the United States (US), with a focus on topics in obstetrics and gynecology (OBGYN). METHODS PubMed®, ERIC, The Cochrane Library, MedEdPORTAL, and professional organization websites were systematically searched in 2019 and updated in 2021. Included studies described OBGYN educational curricula in US primary care residency programs. Following abstract screening and full-text review, data from eligible studies was abstracted and quality assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 109 studies met the inclusion criteria. Over a quarter of studies were interdepartmental or interdisciplinary. The most common single-department studies were IM (38%) and FM (26%). Twenty (25%) studies addressed comprehensive OBGYN curricula; the most common individual topics were cervical and breast cancer screening (31%) and contraception (16%). Most studies utilized multiple instructional modalities, most commonly didactics (54%), clinical experiences (41%), and/or simulation (21%). Most studies included self-reported outcomes by residents (70%), with few (11%) reporting higher-level assessments (i.e., patient, or clinical outcomes). Most studies were single-group pre- and post-test (42%) with few randomized controlled trials (4%). The mean MERSQI score for studies with sufficient data (90%) was 9.8 (range 3 to 15.5). DISCUSSION OBGYN educational curricula for primary care trainees in the US was varied with gaps in represented residents, content, assessments, and study quality.
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Affiliation(s)
- Sarah I Ramírez
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA.
| | - Michael Partin
- Department of Family and Community Medicine, Penn State College of Medicine, 500 University Drive; HP 11, Hershey, PA, 17033, USA
| | - Ashley H Snyder
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Elizabeth Ko
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jane Aruma
- Anesthesiology, Northwestern University, Evanston, IL, USA
| | - Marie C Castaneda
- Harrell Health Sciences Library: Research and Learning Commons, Penn State College of Medicine, Hershey, PA, USA
| | - Rachel S Casas
- Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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90
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Miyano G, Suzuki T, Masuda R, Ito M, Iida H, Kaneko K, Abe E, Ikegami M, Nikai K, Ishii J, Lane GJ, Yamataka A, Okazaki T. Questioning the Correlation Between Incidence of Hirschsprung Disease And Indications for Rectal Biopsy. J Laparoendosc Adv Surg Tech A 2024. [PMID: 39180427 DOI: 10.1089/lap.2023.0534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024] Open
Abstract
Aim: To review the indications for rectal mucosal/submucosal biopsy (RMSBx) used for diagnosing Hirschsprung's disease (HD) in pediatric patients. Methods: The medical records of all children between 1 and 15 years old assessed for chronic constipation between 2012 and 2022 were reviewed. Until the end of 2018, enema usage (E+) was a major indication for RMSBx. In 2019, laxative use for 3 months irrespective of enema use was added as an indication (L+). To determine the relevance of enema usage, L+ was subdivided by enema usage into (L+E+) and (L+E-) groups. The effect of changing the indications for RMSBx on the incidence of HD was investigated. Results: Of 562 eligible subjects, E+ = 410, L+ = 152; demographics are similar. RMSBx rate in E+ (E+RMSBx) was 36/410 (8.8%) and in L+ (L+RMSBx) was 42/152 (27.6%;) (P < .05). For L+RMSBx, 15/42 were L+E+ and 27/42 were L+E-. HD incidence in E+RMSBx was 8/36 (22.2%; E+HD) and in L+RMSBx was 13/42 (31.0%; L+HD) (p = ns). In L+RMSBx, HD incidence in L+E+ was 5/15 (33.3%; L+E+HD) and in L+E- was 8/27 (29.6%; L+E-HD) (P = ns). Differences in daily bowel motion frequency 6 months postoperatively were not statistically significant; E+HD (1.75/d) versus L+HD (2.03/d) and L+E+HD (1.60/day) versus L+E-HD (2.31/day). Unassisted voluntary defecation was confirmed 12 months postoperatively in 7/8 (87.5%) E+HD, 11/13 (84.6%) L+HD, 4/5 (80.0%) L+E+HD, and 7/8 (87.5%) L-E-HD; differences were not significant. Laxatives were still required in 2/8 (25.0%) E+HD, 3/13 (23.1%) L+HD, in 1/5 (20.0%) in L+E+HD, and 2/8 (25.0%) L+E-HD; differences were not significant. Conclusion: Incidence of HD was higher in L+HD, but not significantly different suggesting that indications for RMSBx have potential to influence incidence of HD and hint that the incidence of HD could actually be higher. Further assessment of additional indications is warranted to diagnose HD with greater accuracy.
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Affiliation(s)
- Go Miyano
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Takamasa Suzuki
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Risa Masuda
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Masaki Ito
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hisae Iida
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Kotaro Kaneko
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Eri Abe
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Michiaki Ikegami
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Koki Nikai
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Junya Ishii
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Geoffrey J Lane
- Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tadaharu Okazaki
- Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
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Lee DU, Shaik MR, Bhowmick K, Fan GH, Schuster K, Yousaf A, Reefat M, Shaik NA, Lee KJ, Yang S, Bahadur A, Urrunaga NH. Racial and ethnic disparities in post-liver transplant outcomes for patients with acute-on-chronic liver failure: An analysis of the UNOS database. Aliment Pharmacol Ther 2024. [PMID: 39185724 DOI: 10.1111/apt.18221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/08/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The incidence of hospitalisations related to acute-on-chronic liver failure (ACLF) is increasing. Liver transplantation (LT) remains the definitive treatment for the condition. AIM To evaluate the influence of race and ethnicity on LT outcomes in ACLF. METHODS We conducted a retrospective analysis utilising LT data from the United Network for Organ Sharing (UNOS) database. White patients served as the control group and patients of other races were compared at each ACLF grade. The primary outcomes assessed were graft failure and all-cause mortality. RESULTS Blacks exhibited a higher all-cause mortality (Grade 1: aHR 1.36, 95% CI 1.18-1.57, p < 0.001; Grade 2: aHR 1.27, 95% CI 1.08-1.48, p = 0.003; Grade 3: aHR 1.19, 95% CI 1.04-1.37, p = 0.01) and graft failure (Grade 1: aHR 2.05, 95% CI 1.58-2.67, p < 0.001; Grade 2: aHR 1.91, 95% CI 1.43-2.54, p < 0.001; Grade 3: aHR 1.50, 95% CI 1.15-1.96, p = 0.002). Hispanics experienced a lower all-cause mortality at grades 1 and 3 (Grade 1: aHR 0.83, 95% CI 0.72-0.96, p = 0.01; Grade 3: aHR 0.80, 95% CI 0.70-0.91, p < 0.001) and Asians with severe ACLF demonstrated decreased all-cause mortality (Grade 3: aHR 0.55, 95% CI 0.42-0.73, p < 0.001). CONCLUSION Black patients experienced the poorest outcomes and Hispanic and Asian patients demonstrated more favourable outcomes compared to Whites.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohammed Rifat Shaik
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kuntal Bhowmick
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kimberly Schuster
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abdul Yousaf
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Mohamed Reefat
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Nishat Anjum Shaik
- Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sarah Yang
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aneesh Bahadur
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nathalie H Urrunaga
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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92
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Tsikas SA, Dauer K. Examining interviewer bias in medical school admissions: The interplay between applicant and interviewer gender and its effects on interview outcomes. PLoS One 2024; 19:e0309293. [PMID: 39186521 PMCID: PMC11346660 DOI: 10.1371/journal.pone.0309293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/09/2024] [Indexed: 08/28/2024] Open
Abstract
Selection interviews have long been integral to medical school admissions, yet their limited predictive validity and susceptibility to bias raise concerns. This study delves into potential interviewer bias within the dynamics of interviewee and interviewer gender. We analyze a dataset of 5,200 applicants and over 370 selection committees engaged in semi-structured interviews from 2006 to 2019 at a large German medical school with multiple linear and non-linear regression analyses. Our findings reveal that all-female committees tended to award male candidates, on average, one point more than their female counterparts, significantly enhancing the chances of submission for male applicants despite lower academic grades, which constituted 51% of the selection process points. All-male and mixed-gender committees exhibited similar ratings for both genders. The role of valuing voluntary services emerged prominently: all-male and mixed committees acknowledged women's volunteer work but not men's, while all-female committees demonstrated the opposite pattern. Our results attribute variations in interview outcomes to the absence of standardization, such as insufficient interviewer training, divergent rating strategies, variations in interviewer experience, and imbalances in candidate allocation to selection committees, rather than to a "gender bias", for example by favoritism of males because of their gender.
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Affiliation(s)
- Stefanos A. Tsikas
- Dean of Studies Office, Academic Controlling, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Karina Dauer
- Dean of Studies Office, Academic Controlling, Hannover Medical School, Hannover, Lower Saxony, Germany
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93
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Puhakka AM, Macharey G, Ziller V, Gissler M, Tekay A, Keil C, Hilfiker-Kleiner D. Peripartum heart failure in Finland: A population-based record linkage study. ESC Heart Fail 2024. [PMID: 39183443 DOI: 10.1002/ehf2.14996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 08/27/2024] Open
Abstract
AIMS Heart failure in late pregnancy and the postpartum period (HFPP) is a rare but potentially life-threatening condition, with peripartum cardiomyopathy (PPCM) being the most common subtype. This study aims to comprehensively investigate the prevalence of HFPP in the Finnish population and identify the underlying risk factors associated with its occurrence. METHODS We conducted a retrospective analysis using data from the Finnish Medical Birth Register and the Finnish Care Register for Health Care, covering 1996 to 2021. The dataset comprised 1 387 457 deliveries. HFPP cases were identified based on specific ICD-10 codes. To ensure the accuracy of our findings, we excluded cases with pre-existing cardiomyopathies and other significant cardiac diseases diagnosed before pregnancy. We employed logistic regression models to evaluate the associations between maternal factors and the incidence of HFPP. RESULTS We identified 159 cases of HFPP, resulting in an incidence rate of 11.5 per 100 000 deliveries. This incidence is comparable with rates reported in other Scandinavian countries and lower than those observed in Germany. Consistent with findings from European cohorts, our study confirmed that pregnancy-associated hypertensive disorders, particularly preeclampsia, as well as complications such as preterm delivery, twin pregnancy and elective caesarean section, are substantial risk factors for HFPP. These results support previous research linking angiogenic imbalance to the pathogenesis of PPCM. Significant risk factors for HFPP included maternal pre-pregnancy body mass index ≥35 [adjusted odds ratio (aOR) 2.04, 95% confidence interval (CI) 1.28-3.25, P = 0.003], history of maternal hypertensive disorder (aOR 2.44, 95% CI 1.22-4.88, P = 0.012), gestational hypertension without significant proteinuria (aOR 2.14, 95% CI 1.27-3.61, P = 0.004), preeclampsia (aOR 2.43, 95% CI 1.39-4.23, P = 0.002), type 1 or type 2 diabetes (aOR 3.27, 95% CI 1.66-6.45, P < 0.001) and twin pregnancy (aOR 2.74, 95% CI 1.37-5.49, P = 0.005). Additionally, extensive prepartum [odds ratio (OR) 2.86, 95% CI 1.18-6.98, P = 0.018] and postpartum blood loss (OR 2.50, 95% CI 1.44-5.02, P = 0.001) and maternal mental disorders (OR 7.39, 95% CI 4.10-13.31, P < 0.001) were significantly more common among HFPP patients. CONCLUSIONS The incidence of HFPP among women in Finland from 1996 to 2021 was low. HFPP exhibited a strong association with several risk factors, including preeclampsia, obesity, preterm delivery, twin pregnancy, elective caesarean section, multifoetal births, type 1 and type 2 diabetes, significant prepartum and postpartum blood loss and maternal mental health disorders. These findings underscore the importance of targeted interventions and careful monitoring in high-risk groups to mitigate the impact of HFPP on maternal health.
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Affiliation(s)
- Antti M Puhakka
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Georg Macharey
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Volker Ziller
- Clinic for Gynecology and Obstetrics, Department of Endocrinology, Reproductive Medicine and Osteology, University Hospital Gießen and Marburg, Philipps University Marburg, Marburg, Germany
- Department of Obstetrics and Perinatology, Clinic for Gynecology and Obstetrics, University Hospital Gießen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute of Health and Welfare (THL), Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Aydin Tekay
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Corinna Keil
- Department of Obstetrics and Perinatology, Clinic for Gynecology and Obstetrics, University Hospital Gießen and Marburg, Philipps University Marburg, Marburg, Germany
- Faculty of Medicine Baldingerstraße, Philipps-University Marburg, Marburg, Germany
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Kill C, Manegold RK, Fistera D, Risse J. Airway management and ventilation techniques in resuscitation during advanced life support: an update. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:58. [PMID: 39182146 PMCID: PMC11344389 DOI: 10.1186/s44158-024-00195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR.
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Affiliation(s)
- Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - Randi Katrin Manegold
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - David Fistera
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, Essen, D-45147, Germany.
- Center of Emergency Medicine, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany.
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95
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Liao Q, Yu Q, Yu C, Zhang M, Xiao E. Pulmonary mucosa-associated lymphoid tissue lymphoma: insights from a 15-year study at a single institution involving 14 clinical cases. World J Surg Oncol 2024; 22:219. [PMID: 39182101 PMCID: PMC11344348 DOI: 10.1186/s12957-024-03500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE This study aims to delineate the clinical presentations, imaging features, pathological characteristics, therapeutic strategies, and outcomes of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma, thereby deducing the most efficacious treatment paradigm. METHODS We conducted a retrospective review of 14 patients diagnosed with pulmonary MALT lymphoma at the Second Xiangya Hospital, affiliated with Central South University, between September 2007 and September 2022, focusing on their clinical profiles, diagnostic pathways, treatment modalities, and prognostic outcomes. RESULTS The cohort's median age was 60 years (ranging from 44 to 81 years), with 64.29% being female and only 14.29% having a history of smoking. The incidence of immunodeficiency diseases among the patients was notably low. Imaging typically revealed pulmonary nodules and masses, with air bronchogram signs evident in 9 patients and pleural effusion in 2. CD20 expression was markedly positive across the board in all patients with pulmonary MALT lymphoma. Among the 12 patients who received intervention, 6 were treated with chemotherapy alone, 2 underwent surgical resection, and 4 benefitted from a combined approach of chemotherapy and surgery. Over the monitoring period, 2 patients succumbed to their disease. The estimated 5- and 10-year overall survival (OS) rates were 91.67% and 76.39%, respectively, with the median progression-free survival (PFS) reaching 7 years. Comparative analysis revealed no significant disparity in PFS between patients treated exclusively with chemotherapy and those receiving both chemotherapy and surgical intervention (P = 0.22). CONCLUSION Pulmonary MALT lymphoma typically exhibits a slow course, with gradual progression and a predominantly positive prognosis. Chemotherapy emerges as the preferred therapeutic option for managing this malignancy.
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Affiliation(s)
- Qiuling Liao
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Middle Road, Changsha City, 410011, Hunan Province, China
| | - Qilin Yu
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Middle Road, Changsha City, 410011, Hunan Province, China
| | - Cheng Yu
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Middle Road, Changsha City, 410011, Hunan Province, China
| | - Minping Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Middle Road, Changsha City, 410011, Hunan Province, China
| | - Enhua Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Middle Road, Changsha City, 410011, Hunan Province, China.
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96
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Zasada W, Cholerzyńska H, Kłosiewicz T, Rozmarynowska M, Konieczka P, Lasik J, Jankowski T, Kubiak S, Bielska IA. Why do patients who are triaged as low-acuity visit the emergency department? - A Polish perspective. Int Emerg Nurs 2024; 76:101506. [PMID: 39182473 DOI: 10.1016/j.ienj.2024.101506] [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: 04/29/2024] [Revised: 08/01/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Emergency departments (EDs) worldwide are dealing with overcrowding, system fragmentation, and coordination problems, which impact patient wait times, staff job satisfaction, and patient outcomes. Inappropriate ED visits, particularly those for low acuity conditions, exacerbate these challenges. However, the motivations behind these visits are poorly understood, with limited data from the patient perspective. This study investigated patient-reported motives behind ED visits triaged as low acuity in Poznan, Poland, to propose health care system flow enhancements. MATERIAL AND METHODS A cross-sectional survey and retrospective chart review were conducted in the ED of the Hipolit Cegielski Medical Center in Poznań, Poland, over three months in 2022-23. Patients who were triaged to have low acuity conditions were invited to participate in the survey. The data collected through the questionnaire included patient and ED visit characteristics. Additional information on the visits was extracted from the patient charts. MAIN RESULTS This study involved 293 patients who underwent low-acuity triage. Among them, 58 % were deemed to have conditions that could have been treated in primary care. Most of the patients (74 %) visited the ED of their own volition due to concerns about their health. Other reasons for ED attendance were challenges accessing primary care or a specialist clinic (11 %), system navigation problems (5 %), or a lack of trust in their primary care provider (2 %). CONCLUSIONS This study showed that of the patients surveyed, the majority had conditions that could have been treated outside of the ED setting. We recommend prioritizing education, particularly among younger adults, to increase awareness about nonurgent care options while improving health care policies.
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Affiliation(s)
- Wiktoria Zasada
- Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Hanna Cholerzyńska
- Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland.
| | - Tomasz Kłosiewicz
- Chair of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Monika Rozmarynowska
- Chair of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Patryk Konieczka
- Chair of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Julian Lasik
- Chair of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Tomasz Jankowski
- University Clinical Hospital in Poznań, 49 Przybyszewskiego Street, 60-355 Poznań, Poland
| | - Sebastian Kubiak
- University Clinical Hospital in Poznań, 49 Przybyszewskiego Street, 60-355 Poznań, Poland
| | - Iwona A Bielska
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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97
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Zeng Q, Zeng L, Yu X, Yuan X, Ma W, Song Z, Chen D. Clinical value of prokineticin 2 in the diagnosis of neonatal necrotizing enterocolitis. Biomarkers 2024:1-7. [PMID: 39141663 DOI: 10.1080/1354750x.2024.2393342] [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: 01/20/2024] [Accepted: 08/12/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is an inflammatory and necrotizing intestinal emergency that occurs in preterm infants and low birth weight newborns; however, no specific serum biomarkers for the diagnosis of NEC has been identified so far. METHODS Serum samples were collected from healthy neonatal controls and patients with NEC newly admitted to the Children's Hospital of Chongqing Medical University. ELISA was used to measure serum PK2 levels, and ROC curve analysis was sued to evaluate the diagnostic efficacy of PK2 and other clinical biomarkers. RESULTS Serum PK2 levels in the NEC group (n = 53) were significantly lower than those in the control group (n = 18), but increased to near-normal levels after the postoperative recovery period. The NLR value of NEC group was higher than that of control group (P < 0.05). There was no significant difference in WBC and PLT count between NEC group and control group (P > 0.05). Serum CRP and PCT levels in NEC group were significantly higher than those in control group (P < 0.001 for CRP and P < 0.05 for PCT, respectively). After surgery, serum CRP, NLR and PCT levels were lower than before surgery, while serum PK2 levels were higher than before surgery (P < 0.05). The areas under the ROC curve (AUC) of PK2, PCT and CRP for the diagnosis of NEC were 0.837, 0.662 and 0.552, respectively. The AUC of PK2 combined with PCT, PK2 combined with CRP, and PK2 combined with PCT and CRP were 0.908, 0.854 and 0.981, respectively. PK2 exhibited the highest diagnostic efficacy for NEC. CONCLUSION PK2 has higher diagnostic efficacy than PCT and CRP in the diagnosis of NEC; the combination of PK2 and PCT or CRP can significantly improve its diagnostic efficiency, especially when the three are combined at the same time.
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Affiliation(s)
- Qiuli Zeng
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Li Zeng
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xiaoyan Yu
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xi Yuan
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Wenjing Ma
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Zhixin Song
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Dapeng Chen
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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Hoffmann M, Poschenrieder JM, Incudini M, Baier S, Fritz A, Maier A, Hartung M, Hoffmann C, Trummer N, Adamowicz K, Picciani M, Scheibling E, Harl MV, Lesch I, Frey H, Kayser S, Wissenberg P, Schwartz L, Hafner L, Acharya A, Hackl L, Grabert G, Lee SG, Cho G, Cloward ME, Jankowski J, Lee HK, Tsoy O, Wenke N, Pedersen AG, Bønnelykke K, Mandarino A, Melograna F, Schulz L, Climente-González H, Wilhelm M, Iapichino L, Wienbrandt L, Ellinghaus D, Van Steen K, Grossi M, Furth PA, Hennighausen L, Di Pierro A, Baumbach J, Kacprowski T, List M, Blumenthal DB. Network medicine-based epistasis detection in complex diseases: ready for quantum computing. Nucleic Acids Res 2024:gkae697. [PMID: 39175109 DOI: 10.1093/nar/gkae697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 07/12/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024] Open
Abstract
Most heritable diseases are polygenic. To comprehend the underlying genetic architecture, it is crucial to discover the clinically relevant epistatic interactions (EIs) between genomic single nucleotide polymorphisms (SNPs) (1-3). Existing statistical computational methods for EI detection are mostly limited to pairs of SNPs due to the combinatorial explosion of higher-order EIs. With NeEDL (network-based epistasis detection via local search), we leverage network medicine to inform the selection of EIs that are an order of magnitude more statistically significant compared to existing tools and consist, on average, of five SNPs. We further show that this computationally demanding task can be substantially accelerated once quantum computing hardware becomes available. We apply NeEDL to eight different diseases and discover genes (affected by EIs of SNPs) that are partly known to affect the disease, additionally, these results are reproducible across independent cohorts. EIs for these eight diseases can be interactively explored in the Epistasis Disease Atlas (https://epistasis-disease-atlas.com). In summary, NeEDL demonstrates the potential of seamlessly integrated quantum computing techniques to accelerate biomedical research. Our network medicine approach detects higher-order EIs with unprecedented statistical and biological evidence, yielding unique insights into polygenic diseases and providing a basis for the development of improved risk scores and combination therapies.
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Affiliation(s)
- Markus Hoffmann
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
- Institute for Advanced Study (Lichtenbergstrasse 2 a) Technical University of Munich, D-85748 Garching, Germany
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Julian M Poschenrieder
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Massimiliano Incudini
- Dipartimento di Informatica, Universit'a di Verona, Strada le Grazie 15 - 34137 Verona, Italy
| | - Sylvie Baier
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Amelie Fritz
- Department of Health Technology, Section for Bioinformatics, Technical University of Denmark, DTU, 2800 Kgs. Lyngby, Denmark
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Maier
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Michael Hartung
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Christian Hoffmann
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Nico Trummer
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Klaudia Adamowicz
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Mario Picciani
- Computational Mass Spectrometry, Technical University of Munich, Freising, Germany
| | - Evelyn Scheibling
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Maximilian V Harl
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
- Department of Health Sciences and Technology, Neuroscience Center Zürich (ZNZ), Swiss Federal Institute of Technology (ETH Zürich), Zürich 8092, Switzerland
| | - Ingmar Lesch
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Hunor Frey
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Simon Kayser
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Paul Wissenberg
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Leon Schwartz
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Leon Hafner
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
- Institute for Advanced Study (Lichtenbergstrasse 2 a) Technical University of Munich, D-85748 Garching, Germany
| | - Aakriti Acharya
- Division Data Science in Biomedicine, Peter L. Reichertz Institute for Medical Informatics, Technische Universität Braunschweig and Hannover Medical School, Rebenring 56, 38106 Braunschweig, Germany
- Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Rebenring 56, 38106 Braunschweig, Germany
| | - Lena Hackl
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Gordon Grabert
- Division Data Science in Biomedicine, Peter L. Reichertz Institute for Medical Informatics, Technische Universität Braunschweig and Hannover Medical School, Rebenring 56, 38106 Braunschweig, Germany
- Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Rebenring 56, 38106 Braunschweig, Germany
| | - Sung-Gwon Lee
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
- School of Biological Sciences and Technology, Chonnam National University, Gwangju, Korea
| | - Gyuhyeok Cho
- Department of Chemistry, Gwangju Institute of Science and Technology, Gwangju, Korea
| | | | - Jakub Jankowski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Hye Kyung Lee
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Olga Tsoy
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Nina Wenke
- Institute for Computational Systems Biology, University of Hamburg, Germany
| | - Anders Gorm Pedersen
- Department of Health Technology, Section for Bioinformatics, Technical University of Denmark, DTU, 2800 Kgs. Lyngby, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Antonio Mandarino
- International Centre for Theory of Quantum Technologies, University of Gdańsk, 80-309 Gdańsk, Poland
| | - Federico Melograna
- BIO3 - Systems Genetics; GIGA-R Medical Genomics, University of Liège, Liège, Belgium
- BIO3 - Systems Medicine; Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Laura Schulz
- Leibniz Supercomputing Centre of the Bavarian Academy of Sciences and Humanities (LRZ), Garching b. München, Germany
| | | | - Mathias Wilhelm
- Computational Mass Spectrometry, Technical University of Munich, Freising, Germany
- Munich Data Science Institute (MDSI), Technical University of Munich, Garching, Germany
| | - Luigi Iapichino
- Leibniz Supercomputing Centre of the Bavarian Academy of Sciences and Humanities (LRZ), Garching b. München, Germany
| | - Lars Wienbrandt
- Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Kiel, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Kiel, Germany
| | - Kristel Van Steen
- BIO3 - Systems Genetics; GIGA-R Medical Genomics, University of Liège, Liège, Belgium
- BIO3 - Systems Medicine; Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Michele Grossi
- European Organization for Nuclear Research (CERN), Geneva1211, Switzerland
| | - Priscilla A Furth
- Departments of Oncology & Medicine, Georgetown University, Washington, DC, USA
| | - Lothar Hennighausen
- Institute for Advanced Study (Lichtenbergstrasse 2 a) Technical University of Munich, D-85748 Garching, Germany
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Alessandra Di Pierro
- Dipartimento di Informatica, Universit'a di Verona, Strada le Grazie 15 - 34137 Verona, Italy
| | - Jan Baumbach
- Institute for Computational Systems Biology, University of Hamburg, Germany
- Computational BioMedicine Lab, University of Southern Denmark, Denmark
| | - Tim Kacprowski
- Department of Health Sciences and Technology, Neuroscience Center Zürich (ZNZ), Swiss Federal Institute of Technology (ETH Zürich), Zürich 8092, Switzerland
- Division Data Science in Biomedicine, Peter L. Reichertz Institute for Medical Informatics, Technische Universität Braunschweig and Hannover Medical School, Rebenring 56, 38106 Braunschweig, Germany
| | - Markus List
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, Freising, Germany
- Biomedical Network Science Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Haji Mohamad A, Al-Jawad M, Anadani A, Matar H, Niazi A. Surgical removal of the largest transgastric migrated gossypiboma: A case report. Medicine (Baltimore) 2024; 103:e39227. [PMID: 39183438 PMCID: PMC11346831 DOI: 10.1097/md.0000000000039227] [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: 04/16/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Gossypiboma is a term that refers to the condition of accidentally retained surgical gauze after surgeries. While many manifestations and complications are possible in this case, the migration of the retained gauze into the gastric cavity is one of the rarest. In this paper, we report the largest migrated surgical towel to the gastric cavity in the literature, measuring 90 cm × 90 cm. PATIENT CONCERNS A 33-year-old woman with recurrent epigastric pain unresponsive to treatment was referred to our hospital. She had undergone an open surgery cholecystectomy 11 years before admission during wartime in Syria. DIAGNOSES Abdominal computed tomography with contrast showed a large mass in the stomach, indicating malignancy. However, upper gastrointestinal endoscopy revealed a gray-black foreign body occupying the entire gastric lumen, which indicated the presence of bezoar. Upon surgery, the final diagnosis of gastric gossypiboma was made; which was a retained surgical towel from the previous cholecystectomy that had fully migrated to the stomach and resembled both malignancy and bezoar upon investigation. INTERVENTIONS The patient underwent open surgery to excise the foreign body. OUTCOMES The gossypiboma was successfully removed, and the patient was discharged 5 days after the operation without complications. LESSONS Retained surgical items, such as gossypiboma, can lead to significant medical complications. The migration of gossypiboma to the stomach, though rare, poses challenges in diagnosis and management, often requiring open surgical removal to prevent adverse outcomes. Early detection and intervention are crucial to avoiding associated morbidity and mortality. It is important to consider gossypiboma in patients with unexplained abdominal pain following surgery and to emphasize meticulous sponge counting to prevent this complication.
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Affiliation(s)
- Aya Haji Mohamad
- Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | | | | | - Hilal Matar
- Department of General Surgery, Faculty of Medicine, Aleppo University Hospital, Aleppo, Syria
| | - Ammar Niazi
- Department of General Surgery, Faculty of Medicine, Aleppo University Hospital, Aleppo, Syria
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100
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Picchianti Diamanti A, Cattaruzza MS, Salemi S, Di Rosa R, Sesti G, De Lorenzo C, Felice GM, Frediani B, Baldi C, Chimenti MS, D'Antonio A, Crepaldi G, Luchetti MM, Paci V, Zabotti A, Giovannini I, Canzoni M, Sebastiani G, Scirocco C, Perricone C, Laganà B, Iagnocco A. Clinical and Ultrasonographic Remission in Bio-naïve and Bio-failure Patients with Rheumatoid Arthritis at 24 Weeks of Upadacitinib Treatment: The UPARAREMUS Real-Life Study. Rheumatol Ther 2024:10.1007/s40744-024-00712-y. [PMID: 39177745 DOI: 10.1007/s40744-024-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Clinical remission is the main target in the management of patients with rheumatoid arthritis (RA). However, several authors found synovitis in patients with RA in clinical remission at ultrasonography (US). Upadacitinib is a selective Janus kinase 1 inhibitor that achieved significantly higher remission rates than adalimumab and abatacept in patients with RA. Here we present the 24-week data of the UPAdacitinib Rheumatoid Arthritis REmission UltraSonography (UPARAREMUS) study. METHODS This is a longitudinal multicenter observational study, enrolling bio-naïve and bio-inadequate responder patients affected by RA. The primary endpoint was the proportion of patients achieving both clinical and US remission at week 24. The proportion of patients achieving clinical remission with different composite indexes at week 12 and 24 was also evaluated. US of four target joints (wrists and second metacarpophalangeal bilaterally) was performed at baseline and weeks 12/24, and US remission was defined as the absence of power Doppler (PD) signal ≥ 2 in one target joint, or PD ≥ 1 in two target joints. RESULTS After 12 weeks and 24 weeks, 40% and 63.6% of patients achieved US plus clinical remission. The following parameters were associated with US plus clinical remission: being bio-naïve and having a shorter disease duration, although at multivariate analysis significant odds ratio (OR) was found only for being bio-naïve. CONCLUSIONS UPARAREMUS is the first study evaluating the efficacy of upadacitinib in reaching both clinical and US remission in patients with RA. At 24 weeks, 63.6% of patients reached the primary endpoint, the only baseline associated parameter was being bio-naïve.
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Affiliation(s)
- Andrea Picchianti Diamanti
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy.
| | - Maria Sofia Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy
| | - Chiara De Lorenzo
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy
| | - Gloria Maria Felice
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Caterina Baldi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 53100, Siena, Italy
| | - Maria Sole Chimenti
- Department of System Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Arianna D'Antonio
- Department of System Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Gloria Crepaldi
- Academic Rheumatology Centre, Department of Clinical and Biological Science, University of Turin, AO Mauriziano Torino, 10128, Turin, Italy
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Valentino Paci
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Marco Canzoni
- ASL Rome 1 UOSD Reumatologia, Ospedale Nuovo Regina Margherita, 00153, Rome, Italy
| | | | - Chiara Scirocco
- U.O.C. Reumatologia, A.O. San Camillo-Forlanini, Rome, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, S. Andrea University Hospital, 00189, Rome, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Science, University of Turin, AO Mauriziano Torino, 10128, Turin, Italy
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