Effectiveness and Safety of Remdesivir for the Treatment of COVID-19 Patients with Liver Cirrhosis: A Retrospective Cohort Study

BACKGROUND

Patients with liver cirrhosis are at an increased risk of mortality from coronavirus disease 2019 (COVID-19). Remdesivir, an adenosine analog, exhibits activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is thus recommended for inpatients with COVID-19. This study evaluated the effectiveness and safety of remdesivir in patients with COVID-19 and liver cirrhosis.

METHODS

This retrospective study was conducted using data from Taiwan's largest healthcare system. The study cohort comprised adult patients with COVID-19 and liver cirrhosis who visited our emergency department between April 2021 and September 2022. Remdesivir's adverse effects, including bradycardia, anemia, unstable glucose levels, and abnormal liver function test results, were recorded. Treatment outcomes were assessed in terms of hospitalization duration, mortality, intubation, and intensive care unit admission.

RESULTS

This study included 1368 patients with COVID-19 and liver cirrhosis, of whom 46 received remdesivir. Remdesivir recipients were older (66.5 vs. 62 years; p = 0.042) and had a higher rate of oxygen therapy use (56.52% vs. 32.22%; p = 0.001) than nonrecipients. Common adverse effects of remdesivir included lower heart rates (83 vs. 96 bpm; p < 0.001) and decreased hemoglobin levels (9.5 vs. 10.2 g/dL; p = 0.003) without fatal consequences. No statistically significant difference between remdesivir recipients and nonrecipients in hospitalization duration, intubation rates, or mortality rates was found.

CONCLUSIONS

Remdesivir is safe for treating COVID-19 in patients with liver cirrhosis. Although remdesivir recipients exhibited trends toward improved outcomes in our study, large-scale studies are required to confirm its efficacy in this population.

AI Chatbots for Psychological Health for Health Professionals: Scoping Review

Background

Health professionals face significant psychological burdens including burnout, anxiety, and depression. These can negatively impact their well-being and patient care. Traditional psychological health interventions often encounter limitations such as a lack of accessibility and privacy. Artificial intelligence (AI) chatbots are being explored as potential solutions to these challenges, offering available and immediate support. Therefore, it is necessary to systematically evaluate the characteristics and effectiveness of AI chatbots designed specifically for health professionals.

Objective

This scoping review aims to evaluate the existing literature on the use of AI chatbots for psychological health support among health professionals.

Methods

Following Arksey and O'Malley's framework, a comprehensive literature search was conducted across eight databases, covering studies published before 2024, including backward and forward citation tracking and manual searching from the included studies. Studies were screened for relevance based on inclusion and exclusion criteria, among 2465 studies retrieved, 10 studies met the criteria for review.

Results

Among the 10 studies, six chatbots were delivered via mobile platforms, and four via web-based platforms, all enabling one-on-one interactions. Natural language processing algorithms were used in six studies and cognitive behavioral therapy techniques were applied to psychological health in four studies. Usability was evaluated in six studies through participant feedback and engagement metrics. Improvements in anxiety, depression, and burnout were observed in four studies, although one reported an increase in depressive symptoms.

Conclusions

AI chatbots show potential tools to support the psychological health of health professionals by offering personalized and accessible interventions. Nonetheless, further research is required to establish standardized protocols and validate the effectiveness of these interventions. Future studies should focus on refining chatbot designs and assessing their impact on diverse health professionals.

A flexible transoral swab sampling robot system with visual-tactile fusion approach

A significant number of individuals have been affected by pandemic diseases, such as COVID-19 and seasonal influenza. Nucleic acid testing is a common method for identifying infected patients. However, manual sampling methods require the involvement of numerous healthcare professionals. To address this challenge, we propose a novel transoral swab sampling robot designed to autonomously perform nucleic acid sampling using a visual-tactile fusion approach. The robot comprises a series-parallel hybrid flexible mechanism for precise distal posture adjustment and a visual-tactile perception module for navigation within the subject's oral cavity. The series-parallel hybrid mechanism, driven by flexible shafts, enables omnidirectional bending through coordinated movement of the two segments of the bendable joint. The visual-tactile perception module incorporates a camera to capture oral images of the subject and recognize the nucleic acid sampling point using a deep learning method. Additionally, a force sensor positioned at the distal end of the robot provides feedback on contact force as the swab is inserted into the subject's oral cavity. The sampling robot is capable of autonomously performing transoral swab sampling while navigating using the visual-tactile perception algorithm. Preliminary experimental trials indicate that the designed robot system is feasible, safe, and accurate for sample collection from subjects.

Implementation of Guideline-Based Use of Proton Pump Inhibitors for Perioperative Stress Ulcer Prophylaxis: A Pre-Post Study Guided by CFIR-ERIC

Background

The overuse and misuse of proton pump inhibitors (PPIs) in perioperative patients for stress ulcers prophylactic (SUP) is crucial. This study evaluated the impact of a Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change (CFIR-ERIC)-guided intervention on the rational use of PPIs in a perioperative setting.

Methods

A single-center pre-post study was conducted at Beijing Chaoyang Hospital between April and November 2023. All hospitalized patients who used perioperative PPIs for SUP were included. Cases post-intervention were defined as the intervention group and were propensity score-matched with pre-intervention cases, which was defined as the control group. The intervention strategies were developed by following the updated CFIR framework and employing CFIR-ERIC strategies. Outcomes included rational use of PPIs, reasons for irrational use, total hospitalization and drug costs, PPI duration, costs, and average defined daily dose.

Results

1122 cases were included in the intervention group and control group after propensity score matching, respectively. The intervention group showed significant improved rate of rational PPI use (81.7% vs 42.0%, p<0.001). Rates of non-indication use, inappropriate dosage and administration, drug selection, and administration route were significantly reduced (all p<0.05). Coagulation disorders or anticoagulant/antiplatelet treatment, severe trauma or multiple injuries, severe infection or sepsis were the three most prevalent severe risk factors among patients, with 46.7% and 29.5% of the two groups, respectively. We found no significant differences between the two groups in total hospitalization costs (¥55,672.84 vs ¥57,021.73, p=0.621) and total drug costs (¥3005.38 vs ¥3260.98, p=0.206). Additionally, PPI costs (¥7.44 vs ¥93.70, p<0.001) and defined daily dose (7.00 vs 8.00, p<0.001) were significantly lower in the intervention group. We also observed a downward trend in PPI duration (6.00 days vs 5.00 days, p=0.075).

Conclusion

The CFIR-ERIC-guided intervention effectively improved the rational use of PPIs for perioperative SUP, resulting in significant reductions in both the PPI duration and costs.

An innovative approach based on health surveillance for the prevention and early detection of cardiovascular diseases in a large cohort of healthcare workers

The aim of our three-year retrospective observational study on 6000 healthcare workers, all subjected to mandatory health surveillance, is to determine the risk factors and prevalence of cardiovascular diseases (CVDs) and to analyze the results of an ad hoc designated preventive health surveillance protocol. A risk assessment was performed and a preventive health surveillance protocol was implemented, including clinical-instrumental and laboratory tests aimed at the early detection of any sign of CVD. As a result, n = 442 new diagnoses of CVDs were made and the prevalence of CVDs increased from 12 to 16.1%. The higher prevalence was observed in physicians (P = 57.8%; p < 0.0001). The main risk factors for CVDs were age, male sex and family history of CVDs. The analysis of CVDs determinants highlighted an unexpected protective role of shift work (aOR = 0.64; p < 0.0001). Our preventive health surveillance protocol allowed to reveal a high prevalence of undiagnosed CVDs, laying the foundations for future primary prevention and counseling interventions as part of the health promotion and TOTAL WORKER HEALTH programs. Further studies are needed to create solid scientific evidence that can guide public health decisions regarding new prevention models and health promotion programs also in the general population.

Percutaneous gastric embolization for obesity: A prospective mid-term outcomes study

INTRODUCTION

Obesity represents one of the most pressing public health challenges that needs to be solved globally, with serious health implications. Despite primary prevention efforts the prevalence of obesity continues to increase. Percutaneous gastric embolisation (PGE) has emerged as a promising technique in the management of this disease.

MATERIAL AND METHODS

Prospective longitudinal cohort study including 15 patients diagnosed with grade III obesity, admitted to the Haemodynamics Service of the Cardiovascular Health Institute during the year 2022.

RESULTS

The 86.7% of the PGEs were successful. Treated patients experienced significant weight loss when comparing baseline weight (101.2±23.0, SE=5.9) with weight at 6 months after the interventional procedure (91.5±19.8, SE=5.1) t(14)=5.3, P<.001, d=0.45, especially males (106.7±18.4, P=.01). No major vascular complications, gastric ulcer or ischaemia, or abdominal symptoms were documented in any of the patients included in the study. Only 6 patients (40%) presented with epigastralgia, 9 (60%) with nausea and 3 (20%) with vomiting.

CONCLUSIONS

Percutaneous gastric embolisation is an effective and safe procedure to reduce BMI with a high success rate, well tolerated by obese patients, without major complications, whose results are maintained over time.

Early Origins of Asthma and Allergies: Clues From Studies in China

Asthma and allergies have emerged as some of the most common chronic diseases, particularly in developed countries. Epidemiological studies have consistently demonstrated that children growing up in farming/rural environments are less likely to develop these conditions. Over the past three decades, China has experienced unprecedented economic development and urbanisation, accompanied by a rapid rise in the prevalence of allergic disorders. Despite the substantial number of affected individuals, allergy management in China remains inconsistent and often inadequate, compounded by variations in diagnostic criteria and limited healthcare access in less developed regions. Furthermore, the vast population, regional disparities, and methodological inconsistencies in data collection have hindered the acquisition of comprehensive, large-scale epidemiological data. This review examines the factors contributing to asthma and allergies from their early origins, focusing on modifiable factors from a specific perspective of China. Factors related to traditional lifestyle, such as early-life exposure to agricultural farming and poultry, diverse dietary patterns, and early introduction of allergenic foods, appear to offer protection against allergies. Conversely, exposure to open-fire cooking, incense burning, tobacco smoke, as well as early-life antibiotic use and perinatal factors like Caesarean section delivery and prematurity may represent potential risks. A clear understanding of the role of these factors would pave the way for developing effective interventions to mitigate the substantial health and socioeconomic burdens associated with asthma and allergies.

Predictors of post-traumatic stress disorder among healthcare workers during the COVID-19 pandemic in Poland

The COVID-19 pandemic has significantly impacted the mental health of healthcare workers globally. Given the critical role these professionals play, understanding the prevalence and predictors of post-traumatic stress disorder (PTSD) among healthcare workers is crucial for developing targeted interventions. Comprehensive data on the predictors of PTSD symptoms within this population remain limited. This cross-sectional study surveyed 852 healthcare workers across 4 Polish regions between 2021 and 2022. Data were collected using the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), which was culturally adapted and validated for Polish respondents. To identify key predictors of PTSD symptoms, researchers employed various statistical methods: Descriptive Statistics summarized key variables (e.g. age, job tenure) to provide an overview of data distribution and sample characteristics. Pearson Correlations examined linear relationships among variables like age, work experience, and PTSD severity, ensuring no multicollinearity through variance inflation factor checks. t-Tests and Mann-Whitney U tests compared PTSD symptom severity across demographic and professional subgroups, accounting for normality using the Kolmogorov-Smirnov test. And Hierarchical Regression Analysis identified significant predictors, incorporating demographic factors first and work-related variables (e.g. fear for personal health) in a second step. A total of 88.1% of participants were female, and 82.6% were nurses. The overall prevalence of PTSD symptoms was high, with a mean total PTSD score of 37.87. Gender differences were significant, with women reporting higher scores across the PTSD subscales, including avoidance and hyperarousal. Nurses had significantly higher intrusion symptoms compared to other professionals. Fear for personal health was the strongest predictor of PTSD symptoms (β = 0.15, P < .001), explaining 11% of the variance in the final regression model (R2 = 0.11, P < .001). The findings underscore the urgent need for targeted mental health interventions, particularly for women and nurses, who are disproportionately affected by PTSD during the pandemic. Predictive models should guide the development of support programs to mitigate the long-term psychological impact of COVID-19 and ensure better preparedness for future pandemics. The significant influence of fear for personal health on PTSD outcomes highlights the importance of protective measures and psychological support for frontline healthcare workers.

Influence of the pandemic on the mental health of professional workers

BACKGROUND

This study focuses on the influence of the pandemic on professional workers from an explicitly comparative perspective. High levels of stress and burnout have been reported among professional workers pre-pandemic, but the pandemic has had unique consequences for certain professional workers. Gender has emerged as a particularly important factor. While the existing research yields important insights of mental health concerns among professional workers, there is a need for more research that examines these impacts empirically, explicitly from a comparative perspective across professions taking gender more fully into consideration.

METHODS

This paper undertakes a secondary data analysis of two different pan Canadian sources to address the pandemic impact on professional workers: The Canadian Community Health Survey (2020, 2021) administered by Statistics Canada and the Healthy Professional Worker survey (2021). Across the two datasets, we focused on the following professional workers - academics, accountants, dentists, nurses, physicians and teachers - representing a range of work settings and gender composition. Inferential statistics analyses were conducted to provide prevalence rates of self-perceived worsened mental health since the pandemic and to examine the inter-group differences.

RESULTS

Statistical analysis of these two data sources revealed a significant effect of the pandemic on the mental health of professional workers, that there were differences across professional workers and that gender had a notable effect both at the individual and professional level. This included significant differences in self-reported mental health, distress, burnout and presenteeism prior to and during the pandemic, as well as the overall impact of the pandemic on mental health. The high levels of distress and burnout during the pandemic were particularly evident in nursing, teaching, and midwifery - professions where women predominate.

CONCLUSIONS

Interventions to address the mental health consequences of the pandemic, including their unique gendered and professional dimensions, should consider the intersecting influences and differences revealed through our analysis. In addition to being gender sensitive, interventions need to take into account the unique circumstances of each profession to better respond to the mental health needs of all genders within each professional group.

Workers' Psychological Distress During the Early Months of the COVID-19 Pandemic in Brazil: A Cross-Sectional Study

The COVID-19 pandemic significantly impacted the mental health of workers. This study aimed to assess the prevalence of psychological distress among Brazilian workers during the early months of the pandemic and explore its associated factors. A cross-sectional study was conducted using an online questionnaire administered to 2903 Brazilian workers, including 1752 non-healthcare workers (NHCWs) and 1151 healthcare workers (HCWs), between April and May 2020. Snowball sampling was employed for participant recruitment, and the research questionnaire was adapted for use with the Brazilian population through a process of translation and cultural adaptation, based on an instrument initially created and validated for use in Spain. Differences between NHCWs and HCWs were tested using the chi-square or Fisher's Exact test and Mann-Whitney test followed by effect size measurement. Multiple linear regression models were used to analyze the association between psychological distress and the predictor variables. Psychological distress was observed in 72.6% (95% CI 70.1-74.2%) of the participants, with no significant difference observed between NHCWs and HCWs. Although 32 variables showed statistically significant differences between NHCWs and HCWs, only 7 demonstrated clinical-epidemiological relevance, primarily related to occupational factors. Work-related stress was positively associated with psychological distress, but this relationship diminished in the absence of family members infected with COVID-19. Conversely, a higher sense of coherence was protective against psychological distress, although this effect weakened in the absence of family members infected with COVID-19. The study highlights the high prevalence of psychological distress among Brazilian workers during the pandemic's early months. Work stress played a significant role, while sense of coherence appeared to mitigate mental health challenges. These findings highlight the need for targeted mental health interventions, particularly for workers facing both professional and family-related stressors during crises.

Combating Antibiotic Resistance: Mechanisms, Multidrug-Resistant Pathogens, and Novel Therapeutic Approaches: An Updated Review

The escalating global health crisis of antibiotic resistance, driven by the rapid emergence of multidrug-resistant (MDR) bacterial pathogens, necessitates urgent and innovative countermeasures. This review comprehensively examines the diverse mechanisms employed by bacteria to evade antibiotic action, including alterations in cell membrane permeability, efflux pump overexpression, biofilm formation, target site modifications, and the enzymatic degradation of antibiotics. Specific focus is given to membrane transport systems such as ATP-binding cassette (ABC) transporters, resistance-nodulation-division (RND) efflux pumps, major facilitator superfamily (MFS) transporters, multidrug and toxic compound extrusion (MATE) systems, small multidrug resistance (SMR) families, and proteobacterial antimicrobial compound efflux (PACE) families. Additionally, the review explores the global burden of MDR pathogens and evaluates emerging therapeutic strategies, including quorum quenching (QQ), probiotics, postbiotics, synbiotics, antimicrobial peptides (AMPs), stem cell applications, immunotherapy, antibacterial photodynamic therapy (aPDT), and bacteriophage. Furthermore, this review discusses novel antimicrobial agents, such as animal-venom-derived compounds and nanobiotics, as promising alternatives to conventional antibiotics. The interplay between clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated proteins (Cas) in bacterial adaptive immunity is analyzed, revealing opportunities for targeted genetic interventions. By synthesizing current advancements and emerging strategies, this review underscores the necessity of interdisciplinary collaboration among biomedical scientists, researchers, and the pharmaceutical industry to drive the development of novel antibacterial agents. Ultimately, this comprehensive analysis provides a roadmap for future research, emphasizing the urgent need for sustainable and cooperative approaches to combat antibiotic resistance and safeguard global health.

Suboptimal antidepressant use among inpatients and outpatients with symptoms of depression: a cross-sectional analysis of the POKAL core data set

We present a cross-sectional analysis of 1391 outpatients and 280 inpatients participating in subprojects of the Research Training Group POKAL, of whom 1609 had a PHQ-9 score ≥ 5 and 62 reported depression with antidepressant use. Antidepressant use was lower among outpatients than inpatients (28.5% vs. 82.5%), with higher levels of SSRI monotherapy (44.1% vs. 25.5%). Of antidepressant users, 80.1% had potentially inadequate treatment response, 21.7% high-risk use and of those with severe symptoms, 42.1% were potentially undertreated. Key risk factors were higher anxiety levels (for inadequate treatment response) and polypharmacy (for high-risk use), while previous depressive episode was protective against potential undertreatment.

Frequent Hand Hygiene-Induced Skin Symptoms and Alterations in Hand Microbiota: A Neglected Form of Chronic Occupational Exposure Among Health Care Workers

BACKGROUND

Frequent hand hygiene is essential for infection control among health care workers (HCWs) but may cause adverse skin effects.

PURPOSE

To assess the relationships between frequent hand hygiene practices, skin symptoms, and microbiota alterations in HCWs.

METHODS

A comprehensive search of 7 databases was conducted to identify articles published between January 2014 and July 2024 in English and Chinese.

RESULTS

A total of 24 studies were included in the review. Frequent hand hygiene was associated with reduced microbial flora in 2 studies and high incidences of skin dryness, itching, peeling, erythema, fissures, burning, and pain in 18 studies. Fifteen studies linked frequent hand hygiene to eczema, dermatitis, acne, and folliculitis, while 1 study found higher Staphylococcus aureus detection in severe eczema cases.

CONCLUSIONS

Prolonged frequent hand hygiene alters hand microbiota and induces various skin symptoms, necessitating attention to chronic occupational exposure among HCWs.

Compassion fatigue and satisfaction among frontline staff in long term care facilities: psychometric properties of the Serbian version of the professional quality of life scale

Introduction

This study explored the complex relationship between anxiety, depression, compassion fatigue, and satisfaction among long-term care (LTC) workers following the COVID-19 pandemic. In addition, the study assessed psychometric properties of the Professional Quality of Life (ProQOL) scale, to ensure a reliable and valid instrument for identifying compassion fatigue and satisfaction in the Serbian healthcare system.

Methods

A cross-sectional study was conducted across LTC facilities in the Republic of Serbia. A ProQOL was administered to physicians, nurses, and aids, to measure compassion fatigue (including burnout and secondary traumatic stress) and compassion satisfaction. The following standardized instruments were also distributed: Secondary Traumatic Stress Scale (STSS), Depression Anxiety and Stress Scale 21 (DASS-21) and 12-Item Short-Form Health 36 Survey (SF-12).

Results

A total of 300 LTC workers participated, mostly women (86.3%), with an average age of 45.4 ± 10.5 years and a median work experience of 15 years (range: 1 to 42 years). The study reported a significant presence of anxiety and depression symptoms (53.3% and 43.3%, respectively), with LTC workers experiencing moderate levels of compassion fatigue, as indicated by burnout (58.3%) and stress (57.3%) subscales, and moderate or high levels of compassion satisfaction (49.0% and 50.0%, respectively). The study demonstrated that anxiety impacts depression both directly and indirectly (p<0.05). Specifically, burnout and compassion satisfaction mediated the positive effect of anxiety on depression, indicating that increased anxiety led to higher burnout and lower compassion satisfaction, which resulted in greater depression (p<0.05). The three-factor structure of the ProQOL was validated (IFI, TLI, and CFI were above the cut-off of ≥0.95, and the RMSEA was below the suggested value of ≤ 0.06). The Cronbach α of the three subscales was above 0.8, indicating good scale reliability.

Conclusion

This study contributes to the broader literature on LTC workers wellbeing by examining the complex interplay between professional quality of life, anxiety, and depression. The findings should guide decision-makers in developing targeted interventions and policies that promote the psychological resilience and well-being of LTC workers, thereby enhancing both individual and organizational outcomes in the healthcare sector.

Access to single-inhaler triple medicines for chronic obstructive pulmonary disease in China: a national survey on accessibility and utilisation

Background

The maintenance medicines for chronic obstructive pulmonary disease (COPD) include inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting β2-agonists (LABA). Budesonide/glycopyrronium/formoterol (BUD/GLY/FOR) and fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) are two representative drugs for prefixed ICS/LAMA/LABA association in a single inhaler and have shown comparable efficacy and safety with other ICS/LAMA/LABA open combination therapies in patients with moderate-to-very severe COPD. This study aimed to investigate the availability, price, affordability, and utilisation of single-inhaler triple medicines for COPD in China.

Methods

Quarterly data about the use of BUD/GLY/FOR and FF/UMEC/VI from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. We used the adjusted World Health Organization and Health Action International methodology to calculate the availability and affordability of the two investigated medicines in 596 tertiary general hospitals and 299 secondary general hospitals in 31 provincial administrative regions in China.

Results

The availability and consumption of BUD/GLY/FOR were significantly higher than those of FF/UMEC/VI during the study period. At the end of 2022, the availability of BUD/GLY/FOR and FF/UMEC/VI in tertiary general hospitals was 69.80% and 52.01% respectively, while in secondary general hospitals, it was 52.51% and 28.76% respectively. Both medications were equally affordable at 1.3 days of the minimum wage after reimbursement in 2022. In the first quarter of 2021, with the inclusion of both drugs in the Medicare catalog, their DDDc decreased significantly, which was accompanied by notable improvements in their availability, affordability and consumption.

Conclusions

The overall accessibility and consumption of BUD/GLY/FOR and FF/UMEC/VI were improved in China from 2020 to 2022. The implementation of the national drug price negotiation policy reduces the cost of drugs in China and plays an important role in improving the availability of the investigated drugs.

Leveraging agents of change to improve the use of an electronic hand hygiene monitoring system

BACKGROUND

We evaluated the effectiveness of an "agents of change" intervention in enhancing hand hygiene compliance (HHC) with an electronic hand hygiene monitoring system (EHHMS), and improving perceptions of the EHHMS among health care workers.

METHODS

Two intervention units and 1 control unit were selected. Thirteen agents received training, then worked independently on the intervention units to improve their colleagues' perceptions and behaviors toward the EHHMS. Agents and unit health care workers were surveyed before and after the intervention to measure perceptions of the EHHMS and impact of the intervention. HHC was electronically monitored across all units 8weeks before, 5weeks during, and 8weeks after the intervention.

RESULTS

Postintervention, 70% of agents believed they influenced their colleagues' behaviors, but 50% felt they changed attitudes. Unit-level surveys confirmed minimal change in attitudes and culture. Average HHC rates increased by 6.8% and 5% in the intervention units during the intervention (both P<.01), whereas the control did not. One intervention unit maintained improvement in the post period, whereas the other returned to baseline. Compliance rates for all units were similar in the post period.

CONCLUSIONS

Implementing an agents of change program to target EHHMS compliance is feasible, but sustained improvement is less certain.

Evaluating imatinib in severe COVID-19: a systematic review and meta-analysis

BACKGROUND

Considering the potential antiviral and immunomodulatory properties of imatinib, this drug has been investigated in several studies as a potential treatment option for severe cases of COVID-19, given that treatment modalities available remain limited.

OBJECTIVES

To evaluate the benefits or otherwise of imatinib for COVID-19 in severely ill patients, we performed a systematic review of studies that tested the efficacy and the safety of imatinib for COVID-19 and executed a meta-analysis.

METHODS

We searched Medline, Embase and Cochrane with the following search terms: 'coronavirus', 'SARS-Cov2', 'covid', 'covid-19' and 'imatinib'. The latest search date was November 2023. We used Cochrane Collaboration's tool to assess bias in randomized trials.

RESULTS

We included three randomized controlled trials with 561 participants. A total of 276 patients received imatinib and 285 received placebo. The mortality results showed no statistically significant differences between imatinib and controls (RR 0.61; 95% CI 0.37 to 1.01; p=0.06). There was no significant difference in length of hospital stay or severe adverse events occurring between groups.

CONCLUSIONS

Current evidence suggests that the potential benefits of imatinib should be further evaluated in randomized controlled trials in patients hospitalized for COVID-19.

Generalized anxiety disorder and major depressive disorder among healthcare professionals in Mbarara city, southwestern Uganda: the relationship with professional quality of life and resilience

BACKGROUND

Marking the lives of healthcare professionals (HCPs) are tensions arising from the conflict between fulfilling their duty of care and the demands of the healthcare setting, creating concern for HCPs' mental. In our study, we aim to determine the prevalence of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among HCPs in Southwestern Uganda and to establish how the disorders' prevalence affects professional quality of life and resilience.

METHOD

In total, 200 HCPs from two health facilities (one private and one public) in Southwestern Uganda enrolled in an analytical cross-sectional study. We used the Patient Health Questionnaire-9 (PHQ-9) to determine MDD, the Generalized Anxiety Disorder-7 (GAD-7) to determine GAD, the Professional Quality of Life Scale-5 (ProQOL-5) to determine professional quality of life and the Nicholson McBride Resilience Questionnaire (NMRQ) to determine resilience.

RESULTS

The prevalence of MDD was 11.0% and of GAD was 14.5%. High compassion fatigue increased the likelihood of MDD [aPR = 3.38, p value < 0.001]. However, high compassion satisfaction and exceptional resilience reduced the likelihood of GAD i.e., [aPR = 0.50, p value < 0.001] and [aPR = 0.50, p value < 0.001] respectively. Being male [aPR = 2.41, p value = 0.005] and being married [aPR = 1.79, p value = 0.017] increased the likelihood of having MDD. The likelihood of GAD among HCPs decreased with age, [aPR = 0.97, p value = 0.022].

CONCLUSION

There is a significant occurrence of MDD and GAD among healthcare professionals (HCPs) in Southwestern Uganda. Compassion fatigue is linked to an elevated prevalence of MDD, while compassion satisfaction and high resilience scores are associated with a reduced prevalence of GAD. We recommend creation and execution of extensive mental health initiatives designed for HCPs.

Self-reports vs clinician ratings of efficacies of psychotherapies for depression: a meta-analysis of randomized trials

AIMS

The comparability between self-reports and clinician-rated scales for measuring depression following treatment has been a long-standing debate, with studies finding mixed results. While the use of self-reports in psychotherapy trials is very common, it has been widely assumed that these tools pose a validity threat when masking of participants is not possible. We conducted a meta-analysis across randomized controlled trials (RCTs) of psychotherapy for depression to examine if treatment effect estimates obtained via self-reports differ from clinician-rated outcomes.

METHODS

We identified studies from a living database of psychotherapies for depression (updated to 1 January 2023). We included RCTs measuring depression at post-treatment with both a self-report and a clinician-rated scale. As our main model, we ran a multilevel hierarchical meta-analysis, resulting in a pooled differential effect size (Δg) between self-reports and clinician ratings. Moderators of this difference were explored through multimodel inference analyses.

RESULTS

A total of 91 trials (283 effect sizes) were included. In our main model, we found that self-reports produced smaller effect size estimates compared to clinician-rated instruments (Δg= 0.12; 95% CI: 0.03-0.21). This difference was very similar when only including trials with masked clinicians (Δg= 0.10; 95% CI: 0.00-0.20). However, it was more pronounced for unmasked clinical ratings (Δg= 0.20; 95% CI: -0.03 to 0.43) and when trials targeted specific population groups (e.g., perinatal depression) (Δg= 0.20; 95% CI: 0.08-0.32). Effect sizes between self-reports and clinicians were identical in trials targeting general adults (Δg= 0.00; 95% CI: -0.14 to 0.14).

CONCLUSIONS

Self-report instruments did not overestimate the effects of psychotherapy for depression and were generally more conservative than clinician assessments. Patients' perception of improvement should not be considered less valid by default, despite the inherent challenge of masking in psychotherapy.

A Regional Approach to Strengthening the Implementation of Sustainable Antimicrobial Stewardship Programs in Five Countries in East, Central, and Southern Africa

Background: Antimicrobial stewardship (AMS) programs optimize the use of antimicrobials and reduce antimicrobial resistance (AMR). This study evaluated the implementation of AMS programs in Africa using a harmonized regional approach. Methods: This was an exploratory cross-sectional study across five countries involving 32 hospitals using an adapted Periodic National and Hospitals Assessment Tool from the World Health Organization (WHO) policy guidance on integrated AMS activities in human health. Results: This study found baseline scores for AMS core elements ranging from 34% to 79% at the baseline which improved to 58% to 92% at the endline. At baseline, Drugs and Therapeutics Committee (DTC) functionality in updating facility-specific medicines and medical devices ranged from 58% to 100%, and this ranged from 79 to 100% at endline. Classifying antibiotics by WHO AWaRe, classification ranged from 33% to 83% at baseline and 64% to 100% at endline. Leadership commitment scores were 47% at baseline and 66% at endline. Education and training scores were 42% and 63% at baseline and endline, respectively. Reporting and feedback scores were 34% at baseline and 58% at endline. Conclusions: Our study showed that understanding context and standardizing regional stewardship approaches enhanced cross-country learning and improved AMS implementation. Although the challenges in Low- and Middle-Income Countries (LMICs) are similar, they vary by country and can be addressed by strengthening AMS regulatory frameworks and surveillance systems.

Enhanced Antibiotic Stewardship Program's Effect on Antibiotic Stewardship in Four Thai Hospitals

BACKGROUND

An antimicrobial stewardship program (ASP) is crucial for reducing inappropriate antimicrobial use, improving patient outcomes, and combating increasing antimicrobial resistance. However, data on the implementation of enhanced ASP networks in Asia are limited.

METHODS

This quasi-experimental study evaluated an ASP collaborative network across four hospitals in Thailand (two university hospitals, a tertiary care center, and a private hospital) during 2021 and 2022. Baseline ASP activities were assessed using gap analysis surveys. Effectiveness was measured through antibiotic consumption (daily defined dose, [DDD] per 1,000 patient-days), appropriateness of antibiotic use, and the incidence of multidrug-resistant organisms (MDROs).

RESULTS

The enhanced ASP network addressed key challenges, leading to significant improvements in ASP implementation. Notable achievements included an increase in the overall appropriateness of target antibiotic use (86.5% vs. 74.4 %, p < 0.05) and a reduction in target antibiotic consumptions in all hospitals. The incidence of MDROs, including carbapenem-resistant Acinetobacter baumannii (30.22 vs. 6.08 per 1,000 patient-days, p < 0.05) and methicillin-resistant Staphylococcus aureus (1.90 vs. 0.46 per 1,000 patient-days, p < 0.05), declined significantly in one hospital. The incidence of multidrug-resistant pathogens declined after the implementation of the enhanced ASP in two hospitals.

CONCLUSION

The enhanced networking program in this study significantly improved ASP implementation across diverse hospital settings in Thailand. It addressed challenges such as insufficient financial support. Notable improvements were observed in the appropriateness of antibiotic use and overall antibiotic consumption, potentially contributing to the reduction in multidrug-resistant pathogens. These findings highlight the effectiveness of a collaborative ASP network in Asia.

The effect of leader-member exchange on turnover intention in healthcare employees

PURPOSE

This study aims to evaluate the effects of perceived leader--member exchange and working conditions on turnover intention among healthcare employees.

DESIGN/METHODOLOGY/APPROACH

The study population consisted of healthcare employees working in a medical faculty hospital in Türkiye. A stratified sampling method was used in sample selection. The data were obtained by the questionnaire method, and voluntary participation was taken as a basis. The questionnaire included sociodemographic information, a leader--member exchange (LMX) scale and a turnover intention scale. The research was conducted between April and May 2022 and completed with 400 participants. Descriptive statistics, correlation analysis and multiple linear stepwise regression analyses were chosen for data analysis.

FINDINGS

The findings showed that the participants had a medium-level perception of leader--member exchange and a medium-level turnover intention. Multiple linear stepwise regression analysis revealed that especially "affect and professional respect" sub-dimensions of LMX had a statistically significant and negative effect on turnover intention scores. In addition, weekly working hours had a statistically significant and positive effect on turnover intention (p < 0.05). Finally, it was determined that the variance in turnover intention score was explained by the "affect and professional respect" sub-dimensions of LMX and weekly working hours (R2 = 0.241).

ORIGINALITY/VALUE

This study provides evidence on the impact of the "affect" and "professional respect" sub-dimensions of leader-member exchange as well as work environment factors on the turnover intentions of healthcare employees. The results are expected to guide healthcare organization leaders and managers on how to create a collaborative work environment that leads to employee retention.

Network pharmacological evaluation of Cressa cretica L.- an integrated approach of modern and ancient pharmacology

Cressa cretica L. is immensely valuable in pharmacology. Computational approach through network pharmacology has been attempted to understand lead molecules of Cressa and their interactions with multiple targets. The phytochemical components of methanolic extracts of Cressa leaves were identified using GC-MS analysis, revealing 16 compounds. Using the identified lead molecules, target proteins were predicted using SWISS-target prediction and were analyzed using Cytoscape. This led to the identification of 56 candidate protein targets, which were used to construct a network using CytoHubba, Centiscape, MCODE, and KEGG pathways. The STRING network was created using Cytoscape for analyzing protein-protein interactions, and the top 5 genes were chosen from a total of 12 algorithms in CytoHubba. The antioxidant effects of C. cretica were investigated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, which showed an increase in the trend activity of the plant extract with an inhibition percentage of 51.53 ± 0.003%. This was further validated by ferric reducing antioxidant power (FRAP) assay that resulted in an antioxidant activity of 6.64 µg/mL at a high concentration of 500 µg/mL. Molecular docking and simulation were performed to study the interaction of human cyclooxygenase-2 (PDB ID: 5KIR) with Cressa metabolites. 5KIR exhibited a higher interaction with methyl stearate, forming two H-bond interactions with Arg 120 and Tyr 355. Molecular dynamics simulation analysis confirmed the stability of the protein-ligand complex. The network pharmacology analysis of putative proteins obtained from C. cretica revealed that the peroxisome proliferator-activated receptor gamma (PPARG) gene is found in numerous cancer pathways and can be inhibited.

Introduction to network meta-analysis: understanding what it is, how it is done, and how it can be used for decision-making

Network meta-analysis (NMA), a statistical technique that allows systematic reviewers to simultaneously compare more than 2 alternatives, makes use of indirect evidence from studies comparing interventions of interest to a common comparator. The capacity for multiple simultaneous comparisons makes NMA appealing for evidence-based decision-makers. This article, aimed at users of systematic reviews (SRs) with NMAs and at those who are considering conducting SRs with NMAs, provides an introductory level overview of this topic. We describe the main considerations that those conducting systematic reviews with NMA should bear in mind, including decisions regarding grouping interventions into analysis nodes, and testing the assumptions that assure the validity of NMA. We explain and illustrate how both systematic reviewers and users should draw conclusions from NMA that are appropriate and useful for decision-making. Finally, we provide a list of tools that facilitate the conduct and interpretation of NMAs.

Anxiety or reflection? exploring profiles of death awareness among chinese nurses: a latent profile analysis

BACKGROUND

Nurses frequently encounter death due to their professional roles, impacting their perceptions of mortality. Previous research has largely focused on the negative aspect of death awareness, known as death anxiety, while the other aspect, death reflection, has been less explored. This study aims to investigate the profiles of death awareness among Chinese nurses and identify factors influencing these profiles, such as socio-demographic characteristics, work-related characteristics, death education, and resilience.

METHOD

A cross-sectional study was conducted using a convenience sample of 2882 nurses across China. Data were collected through an online survey from September to November 2023. Latent Profile Analysis was utilized to identify distinct profiles of death anxiety and death reflection among nurses. Multinomial logistic regression was used to analyze the predictive factors for different death awareness profiles.

RESULTS

Three distinct profiles were identified: Calm Reflectors (low death anxiety, high death reflection), The Anxious (high death anxiety, low death reflection), and Anxious Reflectors (high levels of both death anxiety and death reflection). Factors such as resilience, years of service, parental status, education level, and read death education-related information significantly predicted the classification into these profiles. Specifically, higher resilience and engagement in death education were associated with the Calm Reflectors profile.

CONCLUSIONS

Our study suggests that nurses' death awareness can be categorized into three distinct profiles: Calm Reflectors, The Anxious, and Anxious Reflectors. Key predictors of these profiles include resilience, educational level, years of service, parental status, and read death education-related information. The findings suggest that enhancing resilience and targeted educational interventions are crucial for supporting nurses in managing death-related emotional and cognitive responses effectively.

Barriers and facilitators to seeking psychological support among healthcare professionals: a qualitative study using the Theoretical Domains Framework

BACKGROUND

Despite facing significant mental health risks, healthcare professionals often demonstrate a low frequency of seeking psychological support. This study aimed to explore the factors influencing healthcare professionals' psychological help-seeking behaviours in order to enhance the mental health of this critical population.

METHODS

Semi-structured interviews were conducted with registered clinical doctors, nurses, and hospital managers aged 21-55 years, recruited from comprehensive public hospitals in China. Participants were selected through purposive and snowball sampling to ensure diversity in roles, specialities, and work experiences. The interview guide was developed using the Theoretical Domains Framework (TDF) to explore the reasons for seeking psychological support. Data were analyzed using framework analysis and relevant domains were identified according to the frequency of participants' belief statements. The facilitators and barriers in each domain were summarized using the coded reference points.

RESULTS

A total of 34 participants were interviewed (12 nurses, 8 physicians, 14 hospital managers). We identified seven relevant domains in influencing the behaviour of seeking psychological support: knowledge, beliefs about capabilities, environmental context and resources, social/professional role and identity, emotion, social influences, and behavioural regulation. The most common facilitators of psychological help-seeking include accessible resources, positive interpersonal relationships, increased awareness, effective behavioural strategies, and emotional acknowledgement, while barriers include privacy concerns, stigma, time constraints, doubts about the effectiveness of psychological services, limited knowledge, and perceived professional role conflicts.

CONCLUSION

The behaviour of healthcare professionals seeking psychological support is complex and influenced by the interaction of multiple factors. The findings highlight the need for targeted interventions that enhance mental health literacy, address stigma, provide accessible psychological support resources, and cultivate a supportive organisational culture to improve their well-being.

The Role of Religious Involvement as a Moderator of Perceived Health and Somatic Anxiety Among Hispanic Seventh-Day Adventists During COVID-19

This study investigated whether the relationship between perceived health and somatic anxiety is moderated by religious involvement among a sample of Hispanic Seventh-day Adventists (n = 365) during the COVID-19 pandemic. Using PROCESS moderation analysis, we examined the interaction between perceived health and religious involvement on somatic anxiety. Results indicated a significant interaction effect, suggesting that the inverse relationship between perceived health and somatic anxiety was stronger when religious involvement was present.

An Examination of Knowledge, Attitudes, and Intentions Related to Human Papillomavirus (HPV) Vaccination Among Undergraduate Students in Saint Lucia

OBJECTIVE

 In the Caribbean, cancer ranks as the second leading cause of mortality. Without interventions, the incidence is predicted to increase by 66% within the next decade, with over 56,000 women being diagnosed with cervical cancer annually and more than 28,000 succumbing to the disease. However, lifesaving prevention and treatment measures are available. This research sought to explore potential differences in knowledge, attitudes, and willingness to receive human papillomavirus (HPV) vaccinations among male and female undergraduate students at a chosen Community College in St. Lucia.

METHODS

 This investigation utilized a descriptive, quantitative, and cross-sectional approach. Participants (n = 100) were chosen through random sampling and completed 59-item self-administered questionnaires addressing the targeted variables. Multivariable statistical techniques were employed to determine independent predictors of HPV vaccine acceptance among participants.

RESULTS

 Despite recognizing the associated risks, the findings highlighted a substantial deficit in public health promotion efforts. First, although HPV is widespread in St. Lucia and causes cancer in both genders, there is insufficient awareness-raising about HPV. Second, the vaccine is not accessible in St. Lucia. Third, the high expenses associated with the vaccine ($500 US) and HPV test ($275 EC) hinder obtaining them. Finally, HPV vaccine uptake was minimal among participants; only seven out of 100 had been vaccinated and received it in the US. Despite low vaccine uptake, 53% acknowledged the urgent need for vaccination.

CONCLUSIONS

 Integrating HPV vaccination within healthcare and HPV awareness initiatives can yield positive outcomes in mitigating cancer's long-term impact on St. Lucia's male and female populations. Educational programs could prove advantageous in enhancing knowledge about HPV and vaccinations.

Adolescent primary hyperparathyroidism

Adolescent primary hyperparathyroidism (PHPT) is a rare endocrine disorder bearing distinctions from the adult form. This review examines its unique aspects, focusing on clinical presentation, genetic etiologies, genotype-phenotype correlations, and therapeutic management. Adolescent PHPT often has a genetic basis, whether familial, syndromic, or apparently sporadic, and identifying the underlying genetic cause is important for patient care. The clinical presentation is predominantly symptomatic worldwide. Unique manifestations in this age group include rickets, short stature, and slipped capital femoral epiphysis. Genotype-specific differences are evident in the adolescent PHPT characteristics. Diagnostic evaluation requires careful interpretation of biochemical and dual-energy X-ray absorptiometry findings using age and gender-specific reference ranges, with targeted screening for syndrome-associated neoplasms. Surgery remains the cornerstone of management. Current knowledge gaps in their management include treatment protocols for multiple endocrine neoplasia type 1-associated PHPT, the efficacy and safety of nonsurgical options, and long-term post-surgical outcomes.

Perception About Factors Affecting Patient Adherence With Cardiac Medicines: A Cross-Sectional Study

Background and Aims

Long-term medicines are frequently recommended to cardiovascular patients to control hypertension and lower heart burden. Patient adherence to cardiovascular medicine is crucial since stopping it increases the risk of cardiac adverse events and poses a bigger risk to health. Perception of manufacturers, prescribers and patients were taken into account to identify the most important variables that can have a positive impact on patient satisfaction and thereby increase adherence to prescribed cardiovascular drug therapy.

Methods

The empirical study was conducted using quantitative survey method. Questionnaire contained variables influencing patient compliance measured by a 5-point Likert scale where 1 is strongly disagree and 5 strongly agree. Questions were handed over by drop-off and collect method. This study was conducted in 15 tertiary health-care service centers and 18 pharmaceutical companies across Dhaka district, Bangladesh. A total of 156 cardiologists, 200 cardiac patients and 180 marketing professionals (manufacturers) were included in the survey.

Results

A total of 11 variables that can affect patient compliance were utilized to create correlation matrix and subsequently to carry on exploratory factor analysis. Hypothesis testing was done by using the regression model. Forty-eight percent of respondents strongly agreed that efficacy of cardiac medicine influences patient compliance. Most of the stakeholders (69%) agreed that the company reputation of cardiac medicine suppliers is an important criterion. Availability and affordability were highly positively correlated variables. The variables were grouped under four categories according to factor loading scores. The four factors were medicinal issues of product strategies, economic issues of price strategies, convenience issues of place strategies and communication issues of promotional strategies.

Conclusion

The findings of this study contribute to the comprehension of the factors influencing patient compliance from multiple dimensions. Policy makers should implement and promote policies that encourage patient adherence to long-term prescription drugs.

Estimating the minimum clinically important difference (MCID) of the five-repetition sit-to-stand test in patients with lumbar disc herniation

BACKGROUND

The impact of surgical interventions on lumbar disc herniation (LDH) is often assessed using objective functional impairment (OFI) tests like the five-repetition sit-to-stand (5R-STS) test. This study calculates the minimum clinically important difference (MCID) for 5R-STS improvement in patients with LDH one year after surgery.

METHODS

Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Numeric Rating Scale for back and leg pain, EQ-5D-3L health-related quality of life questionnaire and EQ5D-VAS were recorded preoperatively, at 6-weeks and 1-year post-operatively. The MCID was calculated using anchor-based methods (within-patient change; between-patient change; and receiver-operating characteristic approaches) and distribution-based methods (0.5 standard deviation (SD); effect size; standard error of measurement; standardized response mean; and 95% minimum detectable change (MDC)). The final MCID value was based on the "gold standard": an averaging of the anchor-based methods using ODI and RMDQ as the closest available anchors.

RESULTS

We prospectively recruited 134 patients. One-year follow-up was completed by 103 (76.8%) of patients. The MCID values derived using different methods varied from 0.7 to 5.1 s (s). The final, averaged, anchor-based MCID for improvement was 3.6 s. Within distribution-based methods, 95% MDC and 0.5SD approach, yielded an MCID of 3.0 and 3.8 s, respectively, aligning closely with the overall anchor-derived MCID for 5R-STS.

CONCLUSION

In a patient with LDH, an improvement in 5R-STS performance of at least 3.6 s can be regarded as a clinically relevant improvement.

Prediction model of malnutrition in hospitalized patients with acute stroke

OBJECTIVE

The prognosis of stroke patients is greatly threatened by malnutrition. However, there is no model to predict the risk of malnutrition in hospitalized stroke patients. This study developed a predictive model for identifying high-risk malnutrition in stroke patients.

METHODS

Stroke patients from two tertiary hospitals were selected as the objects. Binary logistic regression was used to build the model. The model's performance was evaluated using various metrics including the receiver operating characteristic curve, Hosmer-Lemeshow test, sensitivity, specificity, Youden index, clinical decision curve, and risk stratification.

RESULTS

A total of 319 stroke patients were included in the study. Among them, 27% experienced malnutrition while in the hospital. The prediction model included all independent variables, including dysphagia, pneumonia, enteral nutrition, Barthel Index, upper arm circumference, and calf circumference (all p < 0.05). The AUC area in the modeling group was 0.885, while in the verification group, it was 0.797. The prediction model produces greater net clinical benefit when the risk threshold probability is between 0% and 80%, as revealed by the clinical decision curve. All p values of the Hosmer test were > 0.05. The optimal cutoff value for the model was 0.269, with a sensitivity of 0.849 and a specificity of 0.804. After risk stratification, the MRS scores and malnutrition incidences increased significantly with escalating risk levels (p < 0.05) in both modeling and validation groups.

CONCLUSIONS

This study developed a prediction model for malnutrition in stroke patients. It has been proven that the model has good differentiation and calibration.

Comparative bibliometric study of mental health research trends during COVID-19, Mpox, dengue, and Ebola outbreaks infectious diseases

As the prevalence of mental health issues continues to rise, the impact of widespread diseases on mental health has garnered increasing attention. This study employs bibliometric analysis to evaluate the state of research on mental health concerns associated with four infectious diseases: COVID-19, mpox, dengue fever, and Ebola. Utilizing Citespace, we conducted an in-depth analysis encompassing publication trends, author networks, institutional affiliations, and international collaborations, alongside themes in references and keywords. Our findings reveal that each of these diseases has significantly affected mental health over the last two decades. Notably, the volume of mental health literature related to COVID-19 far surpasses that of the other diseases, with 34 833 documents compared to 36 for mpox, 62 for dengue, and 279 for Ebola. The United States emerges as the most influential country in this field. International cooperation during infectious diseases was not strong, and the contribution of low-middle income countries was lower than that of high income countries. Our research underscores the growing societal relevance of mental health, influenced by factors including social distancing and mortality due to these diseases. Looking ahead, there is a crucial need for enhanced international cooperation and a focused attention on the mental health of vulnerable populations during pandemics.

Persistence and Recurrence of Primary Hyperparathyroidism

Persistent and recurrent primary hyperparathyroidism (PHPT) represent significant challenges in the management of PHPT. Persistent PHPT is defined as persistence of hypercalcemia following parathyroidectomy (PTX) or the recurrence of hypercalcemia within the first 6 months following surgery. Recurrent PHPT is defined as recurrence of hypercalcemia after 6 months following PTX and requires normalization of serum calcium prior to the recurrence. These conditions are often attributed to missed or ectopic glands, multiglandular disease, surgeon inexperience, or rare causes such as parathyromatosis and parathyroid carcinoma. Diagnosis requires a detailed biochemical evaluation, imaging studies, and exclusion of other causes of hypercalcemia as well as secondary causes of hyperparathyroidism. Preoperative imaging modalities, including neck ultrasound, SPECT-CT with 99m Tc-sestamibi scan, 4D-CT, 18F-Fluorocholine PET/CT, and PET/MRI are helpful in localizing abnormal parathyroid glands in cases requiring repeat surgery. Repeat surgery is associated with higher risk and requires an experienced surgeon. When surgery is not indicated or possible, medical management with cinacalcet and antiresorptive therapies may be considered. This review highlights the etiology, diagnostic approaches, and management strategies for persistent and recurrent PHPT, emphasizing the importance of multidisciplinary care in order to optimize outcomes.

Discovery of the microbiota-gut-brain axis mechanisms of acupuncture for amnestic mild cognitive impairment based on multi-omics analyses: A pilot study

OBJECTIVES

Acupuncture is a promising therapy for amnestic mild cognitive impairment (aMCI). Growing evidence suggest that alterations in the microbiota-gut-brain (MGB) axis contribute to the development and progression of aMCI. However, little is known about whether and how acupuncture change the MGB axis of aMCI individuals.

METHODS

This was a randomized, controlled, clinical trial. Forty patients with aMCI were randomly allocated to either the acupuncture group or the waitlist group. The primary outcome was the change in the Alzheimer's Disease Assessment Scale-Cognitive Scale (ADAS-Cog) score. In addition, multi-omics was performed to detect changes in brain function, gut microbiota, and serum metabolites. Generalized estimating equations were used to estimate the outcomes, and correlational analyses were performed to explore the relationships between the clinical and multi-omics data.

RESULTS

Compared to a mean baseline to week 12 change of -3.94 in the acupuncture group, the mean change in the waitlist group was 1.72 (net difference, -5.66 [95 % CI, -6.98 to -4.35]). Compared to the waitlist group, acupuncture's MGB axis modulatory effect exhibited altered the regional homogeneity values of Frontal_Med_Orb_L, Cingulum_Mid_L, and Frontal_Sup_Medial_L, relative abundance of gut Ruminococcus_sp_AF43_11 and s_Eubacterium_coprostanoligenes, and levels of serum (11E,15Z)-9,10,13-trihydroxyoctadeca-11,15-dienoic acid, dipropylene glycol dimethyl ether, N6-Me-dA, and DPK, which correlated with changes in ADAS-Cog scores.

CONCLUSIONS

Our data imply that acupuncture ameliorates overall cognitive function, along with changes in brain activity, gut microbiota, and serum metabolites, providing preliminary evidence of the mechanisms acting through the MGB axis underlying the effects of acupuncture on aMCI.

A Systematic Literature Review of Important and Meaningful Differences in the EQ-5D Index and Visual Analog Scale Scores

OBJECTIVES

We aimed to provide a comprehensive summary, synthesis, and appraisal of minimally important difference (MID) estimates for EQ-5D instruments.

METHODS

We conducted a systematic search using relevant terms related to "minimally/clinically, meaningful/ important difference/change" and "EQ-5D" in 6 major databases, including MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Cochrane Library (up to January 2023). We included studies that provided at least 1 original MID estimate for the EQ-5D.

RESULTS

A total of 90 studies reporting 840 MID estimates were included. MID estimates for the EQ-5D-3L index score ranged from 0.075 to 0.8 using distribution-based approaches (239 estimates; 20 studies), from 0.003 to 0.72 using anchor-based approaches (189 estimates; 43 studies), and from 0.038 to 0.082 using instrument-defined approaches (4 estimates; 1 study). For the EQ-5D-5L, MID estimates ranged from 0.023 to 0.115 using distribution-based approaches (17 estimates; 12 studies), from 0.01 to 0.41 using anchor-based approaches (97 estimates; 15 studies), and from 0.037 to 0.101 using instrument-defined approaches (62 estimates; 8 studies). For the EQ visual analog scale, MID estimates ranged from 0.96 to 16.6 using distribution-based approaches (87 estimates; 14 studies) and from 0.42 to 51.0 using anchor-based approaches (84 estimates; 24 studies). MID estimates varied by underlying clinical conditions, baseline scores, and direction of change.

CONCLUSIONS

A wide range of MID estimates for EQ-5D instruments were identified, highlighting the variability of MID across populations, estimation methods, direction of change, baseline scores, and EQ-5D versions. These factors should be carefully considered when selecting an appropriate MID for interpreting EQ-5D scores.

"Sleep Quality and Depression Level in Nurses in COVID-19 Pandemic"

The COVID-19 spread rapidly all over the world and pandemic process has negatively affected nurses. Sleep disorders and depression are among these negative effects. Managers' awareness of problems experienced by nurses and taking precautions will increase employee and patient satisfaction and provide quality patient care. The study was conducted in descriptive, cross-sectional and correlational design to explain nurses' sleep quality and depression levels and relationship between them during the COVID-19 pandemic with 142 nurses who completed Personel Information Form, Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Index (BDI). Sleep quality of nurses (64.8%) was poor, 33.1% had depression, and high school education, having a chronic illness and PSQI score increased the risk of depression level of nurses. Results highlight COVID-19 pandemic affected nurses' sleep quality and depression levels. All managers should be pioneers in providing psychological support to nurses and preparing and implementing a program for prevention of insomnia and depression.

Air, surface, and wastewater surveillance of SARS-CoV-2; a multimodal evaluation of COVID-19 detection in a built environment

BACKGROUND

Environmental surveillance of infectious organisms holds tremendous promise to reduce human-to-human transmission in indoor spaces through early detection.

OBJECTIVE

In this study we determined the applicability and limitations of wastewater, indoor high-touch surfaces, in-room air, and rooftop exhaust air sampling methods for detecting SARS-CoV-2 in a real world building occupied by residents recently diagnosed with COVID-19.

METHODS

We concurrently examined the results of three 24-hour environmental surveillance techniques, indoor surface sampling, exhaust air sampling and wastewater surveillance, to the known daily census fluctuations in a COVID-19 isolation dormitory. Additionally, we assessed the ability of aerosol samplers placed in the large volume lobby to detect SARS-CoV-2 multiple times per day.

RESULTS

Our research reveals an increase in the number of individuals confirmed positive with COVID-19 as well as their estimated human viral load to be associated with statistically significant increases in viral loads detected in rooftop exhaust aerosol samples (p = 0.0413), wastewater samples (p = 0.0323,), and indoor high-touch surfaces (p < 0.001)). We also report that the viral load detected in lobby aerosol samples was statistically higher in samples collected during presence of occupants whose COVID-19 diagnostic tests were confirmed positive via qPCR compared to periods when the lobby was occupied by either contact-traced (suspected positive) individuals or during unoccupied periods (p = 0.0314 and <2e-16).

SIGNIFICANCE

We conclude that each daily (24h) surveillance method, rooftop exhaust air, indoor high-touch surfaces, and wastewater, provide useful detection signals for building owner/operator(s). Furthermore, we demonstrate that exhaust air sampling can provide spatially resolved signals based upon ventilation exhaust zones. Additionally, we find that indoor lobby air sampling can provide temporally resolved signals useful during short duration sampling periods (e.g., 2-4 hours) even with intermittent occupancy by occupants diagnosed with COVID-19.

IMPACT

Our research demonstrates that aerosol sampling can detect COVID-19 positive individuals in a real world lobby setting during very short occupancy periods. We demonstrate the effectiveness of rooftop exhaust aerosol, surface, and wastewater environmental surveillance in monitoring viral load in building occupants, both at the building scale and with ventilation zone-level resolution for aerosols. We provide actionable data for researchers, health officials and building managers who seek to determine which monitoring method is best for their building or study. This study is relevant in the fields of epidemiology, exposure sciences, biomonitoring, virology, public health, and healthy building design and management.

Review of the WHO guideline on preventive chemotherapy for public health control of strongyloidiasis

Strongyloidiasis is a soil-transmitted helminthiasis that is estimated to affect 300-600 million people across Asia, Africa, South and central America, and the Pacific. This neglected parasitic disease is most known for its ability to persist as a lifelong infection due to autoinfection and its risk of hyperinfection and disseminated disease during immunosuppression, which has a more than 60% case fatality. Despite the large global burden of strongyloidiasis, there have been no large-scale public health programmes or WHO guidelines directed towards its control and elimination. However, over the past decade, key scientific and policy changes along with requests from endemic countries have led to WHO incorporating strongyloidiasis into its 2021-30 roadmap and public health targets for control and elimination of neglected tropical diseases. In 2024, WHO published its first guideline on public health control of strongyloidiasis with a single recommendation: in endemic settings with a Strongyloides stercoralis infection prevalence of 5% or higher (measured either with Baermann or agar plate culture from stool specimens), WHO conditionally recommends mass drug administration with single-dose ivermectin (200 μg/kg; oral therapy) in all age groups from 5 years and older to reduce strongyloidiasis. This Review, written by the 2023-24 strongyloidiasis guidelines development group along with WHO colleagues and international experts, presents a summary of the recently published WHO guideline recommendation for strongyloidiasis, and the supporting evidence, considerations for public health implementation, and future research needs.

Unexplained Gastric Ulcer: Role of Cinacalcet

Peptic ulcer disease (PUD) most commonly arises as a complication of Helicobacter pylori (H. pylori) or impaired mucosal defense mechanisms against acid exposure by medications such as non-steroidal anti-inflammatory drugs (NSAIDs). Hypercalcemia can present with peptic ulcer-related symptoms, and cinacalcet is an effective medical treatment for primary hyperparathyroidism (PHPT) for non-surgical candidates. We present a case of a 66-year-old male patient with a history of primary hypercalcemia as a result of hyperparathyroidism, on chronic cinacalcet, who was found to have gastric ulcers on endoscopy. After the reduction of the cinacalcet dose in one year, there was a complete resolution of inflammation in the gastric body.

Association Between Occupational Stress and Mental Health in Healthcare Workers During the Coronavirus Pandemic in 2019

Background During the coronavirus pandemic in 2019, deterioration of mental health was reported among healthcare workers. However, few studies have examined the relationship between healthcare workers' mental health and occupational stress in healthcare settings during the spread of coronavirus disease 2019 (COVID-19). This study aimed to identify job stressors associated with mental health issues among healthcare workers. Methods The study was conducted from May 2020 to January 2021. We analyzed the impact of job stressors on mental health issues using the nine-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder, Impact of Event Scale-Revised, and the Brief Job Stress Questionnaire in 204 healthcare workers working at a hospital treating patients with COVID-19. Results The results indicate that job stressors affecting depression, anxiety, and post-traumatic stress differed. High total Interpersonal Conflicts and Job Fitness stress scores were significantly associated with depressive symptoms (Interpersonal Conflicts OR:1.77; 95% CI:1.15-2.70; p = 0.001, Job Fitness OR:1.84; 95% CI:1.05-3.23; p = 0.04). High total Job Overload and Interpersonal Conflicts stress scores were significantly associated with anxiety symptoms (Job Overload OR:1.76; 95% CI:1.06-2.93; p = 0.003, Interpersonal Conflicts OR1.90; 95% CI:1.09-3.31; p = 0.002). High total Job Overload and Job Control stress scores were significantly associated with post-traumatic stress (Job Overload OR1.37; 95% CI:1.01-1.85; p = 0.04, Job Control OR1.69; 95%CI:1.17-2.43; p < 0.001). Conclusions These findings suggest that strategies addressing job stressors to maintain or improve mental health during an infectious disease epidemic should be tailored to individual stress responses. Additionally, the results indicate that maintaining positive interpersonal relationships in the workplace and reducing workload are particularly important for supporting mental health among healthcare workers.

Post-pandemic depression, anxiety, and stress: A look at the mental health of medical and administrative staff

INTRODUCTION

Research has shown how mental health among hospital staff worldwide was affected during the COVID-19 pandemic. However, evidence of the physiological status of healthcare and administrative workers at the first level of medical care post-pandemic is scant. Therefore, it is necessary to identify mental health problems among hospital staff following the COVID-19 pandemic.

OBJECTIVE

To determine the prevalence of symptoms and severity of depression, anxiety, and stress among health personnel in the primary care post-pandemic of the Institute of Social Security and Services for State Workers in Puebla.

MATERIALS AND METHODS

A cross-sectional observational study was conducted on medical and administrative staff, comprising 190 participants who worked during the pandemic. A data collection instrument and the 21 item Depression, Anxiety, and Stress Scale were used to determine the prevalence of symptoms and severity of these three mental health issues.

RESULTS

The prevalence of symptoms of depression was 20.5 %, with a moderate predominant severity index (38.5 %), anxiety was 33.2 %, with an extremely severe predominant index (36.5 %), and stress was 30.0 %, with a moderate predominant severity index (36.8 %), respectively. The nursing subgroup, within the medical area staff, exhibited a prevalence of anxiety symptoms of 44.7 %, which was statistically significant (p = 0.008).

CONCLUSION

Despite the post-pandemic period during which this study was conducted, the nursing staff was the most affected group in terms of the prevalence of symptoms of anxiety and depression. Another relevant finding was that administrative workers showed an extremely severe intensity of symptoms of depression, anxiety, and stress.

Evaluating binding and interaction of selected pesticides with serum albumin proteins by Raman, 1H NMR, mass spectrometry and molecular dynamics simulation

Addressing the acute pesticide poisoning and toxicity to humans, is a global challenge of top priority. Serum albumin is the most abundant plasma protein, capable of binding with herbicide and pesticide residues. This study reports multifaceted approaches for in-depth and robust investigation of the molecular interactions of selected pesticides, including propanil (PPL), bromoxynil (BXL), metolachlor (MLR) and glyphosate (GPE) with bovine serum albumin (BSA) proteins using experimental (Raman and FTIR spectroscopy, native mass spectrometry and high field 1H NMR), molecular dynamics (MD) simulation and principal component analysis (PCA). The binding of pesticides with BSA resulted in BSA amide I and amide II Raman spectral shifts. PCA of Raman spectra of serum-pesticide complexes showed the grouping of pesticides on the score plot based on the similarities and differences in pesticides' chemical structures. Native mass spectrometry results revealed strong adduct formation of the pesticides with the protein. The observed changes in chemical shifts, peak broadening or peak disappearance of characteristic proton signals of the pesticides, indicated altered chemical environments due to binding BSA-pesticides interactions. The results of MD simulation conducted for over 500 ns revealed strong pesticides interaction with LEU197, LEU218, LEU237, TRP213, SER286 and ILE289 residues to the site I of BSA. Free energy landscapes provided insights into the conformational changes in BSA on the binding of pesticides. Overall, the experimental and computational results are in consonant and indicate the binding of pesticides into the site I and site II (sub-domain IIA) of the BSA via hydrogen bonding, non-covalent and hydrophobic interactions.

Does enteral nutrition protect against stress ulceration in the critically ill?

PURPOSE OF REVIEW

Critically ill patients are at risk of gastrointestinal bleeding (GIB) due to stress ulceration. Strategies to reduce the risk include administration of prophylactic ulcer healing medications. Enteral nutrition (EN) may be favourably associated with GIB risks. This manuscript summarizes available evidence regarding EN effects on GIB.

RECENT FINDINGS

There are few data available to directly compare the effect of EN on GIB. Direct comparison in animal models generally indicate a beneficial effect. Human data provide indirect evidence from pharmacological stress ulcer prophylaxis studies. EN exposure has been randomized in nutrition trials of critically ill patients, but GIB outcomes were not recorded. Detailed EN exposure data were recorded in two large pharmacological stress ulcer trials. One finds EN is associated with lower GIB, lower mortality, and increased pneumonia, and notes a possible interaction between EN and pharmacological stress ulcer prophylaxis. The second has yet to report associations with EN.

SUMMARY

EN may reduce the risk of GIB, although robust direct evidence is absent. Potential interactions between EN and pharmacological stress ulcer prophylaxis require further study.

Study on the mechanism of activating SIRT1/Nrf2/p62 pathway to mediate autophagy-dependent ferroptosis to promote healing of diabetic foot ulcers

Diabetic foot (DF), a prevalent and grave diabetes sequela, is considered as a notable clinical concern, with SIRT1 downregulation observed in DF patients' blood specimens. Nonetheless, the regulatory mechanisms of SIRT1 in diabetic foot ulcer (DFU) remain unclear. Thus, in the current study, we investigated the role and mechanisms of SIRT1 in alleviating DFU. Western blotting was used to detect the expression of autophagy and ferroptosis-related proteins, CCK8 assay was used to measure cell proliferation. Plate colony method was used to measure bacterial growth, and the inhibitory effect on intracellular and extracellular Staphylococcus aureus was observed after drug intervention. ELISA was used to detect inflammatory cytokines and oxidative stress markers levels. ROS, total iron, and Fe2+ levels were detected using corresponding assays. Additionally, HE staining detected the thickness of the epidermis and dermis of the rat wound tissue while the collagen deposition in the wound tissue was detected using Masson staining. In addition, Prussian blue staining was used to detect iron deposition, and C11 BODIPY 581/591 lipid peroxidation probe was used to detect lipid ROS. Our results suggested that the activation of SIRT1/Nrf2/p62 signaling affects cell proliferation, colony formation, ferroptosis, and the production of lipid ROS in DFU-infected cell model through autophagy. In vivo experiments indicated that activating SIRT1/Nrf2/p62 signaling affects oxidative stress, inflammation, and autophagy in wound tissue and promotes wound healing in DFU rats through mediating autophagy-dependent ferroptosis. Taken together, the activation of SIRT1/Nrf2/p62 pathway can promote DFU healing, which might be mediated by autophagy-dependent ferroptosis.

A Longitudinal RCT on the Effectiveness of a Psychological Intervention for Hospital Healthcare Workers During the COVID-19 Pandemic: What We Learned to Date

The COVID-19 pandemic has led to significant psychological distress among frontline healthcare workers (HCWs), with a particular increase in trauma-related symptoms. This study investigated the longitudinal course of trauma-associated symptoms and behaviors in HCWs and the effectiveness of a brief dialectical behavior therapy (DBT)-informed intervention in mitigating these symptoms over 12 months. The trial included 225 HCWs randomly assigned to one of three groups: no intervention (control), in-person DBT-informed intervention, or online DBT-informed intervention. Over time, a natural decrease in PTSD symptoms was observed in all groups. Contrary to expectations, no difference was found between the control and intervention groups. However, for participants with severe PTSD symptoms, the intervention significantly mitigated their distress. No differences emerged between in-person and online interventions, suggesting equal effectiveness. Females reported higher trauma-related symptoms, while no differences emerged among different professional roles. These findings underscore the importance of targeted interventions for HCWs experiencing severe symptoms and highlight the potential of online modalities. Further research is needed to optimize the deployment of mental health resources within the healthcare setting, particularly during crises.

Social Support for Grief, Attachment, and Mental Health Among Bereaved Spouses During COVID-19 Pandemic

This study explored the associations of grief support between social support for grief and pandemic grief symptoms, attachment, and mental health through accounting for sociodemographic factors among bereaved spouses widowed as a result of the COVID-19 pandemic. From September 10 to November 23, 2020, a cross-sectional mobile online survey was conducted, involving 92 participants with a mean age of 44.21 years. The sample was predominantly Islamic (91%) and female (88.8%), with an average marriage duration of 18.73 years. Participants completed assessments, including the Grief Support Assessment Scale, Brief Symptom Rating Scale-5, Pandemic Grief Scale, Revised Adult Attachment Scale, and Couple Interaction Scale for Marital Support. Results showed that the extent to which grief support was received (β = -0.36, p = 0.03) and that bereaved spouses were satisfied with (β = -0.29, p = 0.03) grief support were negatively correlated with pandemic grief. Age, education, and attachment directly influenced mental health. A k-means cluster analysis identified a younger cluster (Mage = 34.76 ± 4.63) experiencing greater mental health difficulties (14.84 ± 3.9), pandemic grief (7.23 ± 3.06), and attachment needs (51.80 ± 8.06). The findings highlight that the grief support needed was higher than the support received and the satisfaction with that support during the COVID-19 pandemic. Additionally, participants were dissatisfied with the higher demand for resources from governmental and nongovernmental organizations. The study emphasizes the importance of accessible, high-quality grief support services that are culturally and religiously sensitive, especially in diverse contexts like Indonesia.

Exploring the dynamics of SARS-CoV-2 and HIV Co-infection: Mutation risks, therapeutic efficacy, and future variant prevention

High mutation rates in SARS-CoV-2, particularly among immunocompromised patients living with HIV, continue to complicate the current COVID-19 pandemic. The threshold for severe COVID-19 and a greater risk of mortality have increased in many immunocompromised individuals due to a weakened immune system. Low CD4+ T-cell counts in people living with both HIV and COVID-19 lead to prolonged disease duration and, therefore, an increased likelihood of viral infection with SARS-CoV-2 mutations in such individuals. These mutations could decrease the efficiency of ongoing vaccines and cause new outbreaks. Recently, the rise of new mutations in this patient population has created increasing concern; however, few data are currently available on the direct association of HIV infection with SARS-CoV-2 mutations. This review highlights the implications of SARS-CoV-2 and HIV co-infection, highlighting the need for extra caution and monitoring of the immune-compromised population during a pandemic. Access to HIV care and COVID-19 treatments, careful surveillance, and adapted health strategies are key to reducing risks and protecting these populations. Further research is required to elucidate the dynamics of mutations and develop intervention methods to manage COVID-19 among immunocompromised patients.

Public participation willingness in out-of-hospital cardiopulmonary resuscitation: A systematic review and meta-analysis

Objective

This systematic review and meta-analysis aimed to identify the main factors influencing the public's willingness to participate in out-of-hospital emergency care.

Methods

Studies were searched in online databases, including PubMed, Embase, Web of Science, and the Cochrane Library. The articles included in this review were published from inception to July 31, 2024. The Iain Crombie assessment tool was used to assess study quality. Meta-analysis was performed using RevMan (version 5.4) software. The review protocol has been registered with PROSPERO (CRD42024570491).

Results

A total of 1,434 research articles were initially identified, among which 18 were incorporated into this study, and all of the included studies were cross-sectional. Meta-analysis results demonstrated that gender (male; OR = 1.37, 95%CI: 1.28-1.47), profession (healthcare provider; OR = 0.17, 95%CI: 0.06-0.47), knowledge and skill level (OR = 1.63, 95%CI: 1.25-2.11), willingness to undergo training (OR = 2.68, 95%CI: 1.89-3.79), interest in first aid (OR = 2.08, 95%CI: 1.60-2.69), previous training (OR = 2.14, 95%CI: 1.49-3.08), and previous first-aid experience (OR = 1.70, 95%CI: 1.37-2.11) were the principal influencing factors of the public's willingness to engage in out-of-hospital cardiopulmonary resuscitation.

Conclusion

Demographic factors, knowledge, belief, and behavior are crucial in influencing public emergency decision-making. Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.

First insight into eosinophils as a biomarker for the early distinction of COVID-19 from influenza A in outpatients

Coronavirus disease 2019 (COVID-19) and influenza A outbreaks have spread rapidly in China. It is difficult to accurately differentiate these two different respiratory tract infections on the basis of their similar early-stage symptoms and lymphocytopenia. In the present study, the age, sex and white blood cell, neutrophil, lymphocyte, monocyte and eosinophil counts, as well as the neutrophil-to-lymphocyte ratio (NLR) of 201 outpatients with confirmed COVID-19 and 246 outpatients with influenza A were investigated and compared. A receiver operating characteristic curve was drawn to determine the thresholds in distinguishing COVID-19 from influenza A Our study found that the monocyte count and NLR were significantly elevated, while the eosinophil count/percentage was higher in outpatients with COVID-19 than in those with influenza A (0.06±0.07 vs. 0.04±0.09, P=0.002; 0.95±1.12 vs. 0.56±0.95, P<0.001, respectively). Logit(P)=-1.11 + 1.29 x eosinophil percentage -12.07 x eosinophil count +1.10 x monocyte count, deduced from the eosinophil count/percentage and monocyte count, had the largest area under the curve at 0.67, with high specificity (80.1%) and a sensitivity of 47.3%. The present study demonstrated that a higher eosinophil count/percentage may be a potential biomarker to significantly differentiate early COVID-19 from influenza A.