bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent chylothorax in a patient with serositis as the only manifestation of IgG4-related disease: the diagnostic challenge and consideration
Authors: Shao Daming , Ghimire Sadikshya , Simmons Nichelle , Zhang Yan
Published: February 2025

IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder characterised by IgG4-positive plasma cell infiltration into different tissues and organs. Among the heterogeneous clinical features of IgG4-RD, serositis, including pleural and pericardial effusions, is a rare and poorly understood presentation. We described a woman in her late 70s who developed recurrent chylothorax and failed to respond to corticosteroids, immunosuppressives and intrapleural octreotide injection while being treated for newly diagnosed IgG4-RD with serositis as the only manifestation. Her chylothorax was thought to be due to fibroinflammatory damage of the lymphatic duct system from her IgG4-RD, as other differential diagnoses have been largely excluded. We demonstrate the difficulty in establishing the diagnosis of IgG4-RD when only serositis is present, the importance of meticulous workup ruling out other causes and clinical judgement in identifying disease complications versus evaluating alternative diagnoses.
Diagnostic work-up of an incidental ultra-rare tumour, epithelioid haemangioendothelioma, in a Danish diagnostic centre
Authors: Lolk-Ottosen Line Brink , Grønnemose Rasmus Birkholm , Thye-Rønn Peter
Published: February 2025

In this case report we present a woman in her late 40s with dual clinical presentation. First, the patient presented to general practice with muscular symptoms over months, including pain and a palpable mass in her right leg. Then acute cerebral symptoms appeared that required emergency hospitalisation. MRI scan of the head, chest X-ray, upper-body18F-FDG-PET/CT and CT scan were indicative of both a benign meningioma and malignant lung metastases. Subsequent diagnostic work-up at our diagnostic centre led to the final diagnosis; epithelioid haemangioendothelioma, with the primary site in the right leg and lung metastases, an ultra-rare type of cancer.
Pulmonary sequestration causing haemoptysis in an adult
Authors: Gupta Tanya , Foo Ching Chung , Bethapudi Sarath , Shamoon Mohamed
Published: February 2025

Pulmonary sequestration (PS) is a rare congenital pulmonary anomaly with defining features of a mass of non-functioning pulmonary tissue that does not communicate with the tracheobronchial tree and with systemic blood supply usually directly from the aorta. Owing to its rarity which occurs in approximately 1 in 10 000 to 35 000 live births, as well as its variable symptomology and preponderance in paediatric population, PS is often misdiagnosed or missed with treatment delayed. This case report details a woman in her 20s who presented with haemoptysis and chest tightness. Subsequent imaging revealed a mass-like lesion in the right lower lobe which led to the diagnosis of PS. This case report highlights a rare manifestation of PS with the need for lateral thinking to avoid misdiagnosis and the value of a multidisciplinary approach in managing the condition to prevent adverse outcomes or complications from delayed treatment such as life-threatening haemoptysis and recurrent pneumonia.
Global weakness with no clear precipitant: thymoma presenting as a necrotising myositis and myasthenia gravis overlap syndrome
Authors: Larkin Edmund Hugh , Thomas Rhys , Ruiz Fernanda , Malley Tamir
Published: February 2025

Overlap syndromes involving myasthenia gravis, myositis and myocarditis are recognised adverse effects of immune checkpoint inhibitors (ICI). We report a similar syndrome of myasthenia gravis and myositis in a patient without prior ICI exposure. Diagnostic tests showed signs of both immune-mediated necrotising myopathy and myasthenia gravis. Symptoms included proximal muscle weakness, ophthalmoplegia, bulbar symptoms and neuromuscular respiratory failure. Initial treatment with glucocorticoids and intravenous immunoglobulin for myositis was partially effective. Significant improvement occurred with rituximab and an acetylcholinesterase inhibitor. Although imaging had not revealed a thymic mass suggestive of thymoma, the patient underwent thymectomy several weeks after recovering from the acute illness. Histopathological examination of the resected tissue confirmed the presence of thymoma. This case illustrates that myasthenia gravis and myositis can spontaneously co-present. Clinicians should consider the possibility that a seemingly atypical presentation of a condition may reflect a more typical presentation of two conditions, such as in this case. In this situation, paraneoplastic causes should be considered.
Very large labial swelling requiring surgical intervention
Authors: Worrall Amy P , Haggaz Elsideeg Elmuiz , Salameh Fadi
Published: February 2025

A woman in her late 30s presented with a large left-sided labial swelling at a tertiary maternity and gynaecology hospital. The swelling had been present for more than 10 years, and had previously been incised twice and partially excised once. The labial swelling had caused great discomfort as it increased in size and had a significant impact on her quality of life. Definitive surgical excision in the theatre was planned for the following week. Careful excision of the cystic structure removing the entire lesion intact was done using a mixture of blunt and sharp dissection. Subcutaneous layers were closed, excess skin was removed and a continuous non-locking suture closed the skin. The histology returned confirming a benign epithelial inclusion cyst. At a 6-week-interval postoperative follow-up, the patient reported excellent healing. A simple surgical intervention had a conclusive and positive impact on her quality of life.
Giant cell carcinoma resembling the lung in the ovary: challenges and treatment approaches
Authors: Vuppu Divya Panyam , Kunnath Neethu Puthalon , Nair Indu R , Nasser Jameera
Published: February 2025

Giant cell carcinoma (GCC) resembling the lung in the ovary is a rare and aggressive tumour with no established standard treatment options. In this case, a postmenopausal woman in her 50s with hypothyroidism underwent surgery for a left ovarian mass. Due to dense adhesions to the sigmoid colon, the procedure was abandoned, and she was referred to our centre. Imaging showed a necrotic pelvic mass involving adjacent organs, omental nodules and para-aortic lymphadenopathy. Her initial biopsy showed an undifferentiated carcinoma with giant cells, resembling GCC of the lung, which was confirmed by immunohistochemistry. Three cycles of carboplatin and paclitaxel reduced the tumour, enabling successful interval debulking surgery. The patient completed three more cycles and has been recurrence-free for 18 months. In this case, the use of neoadjuvant chemotherapy likely contributed to better disease control, facilitating a complete resection during the interval surgery.
Gastrointestinal symptoms and bowel habits in 53 046 healthy Danish blood donors: a nationwide cross-sectional study
Authors: Grosen Anne Karmisholt , Boldsen Jens Kjærgaard , Mikkelsen Susan , Mark Dahl Baunwall Simon , Dahlerup Jens Frederik , Dinh Khoa Manh , Topholm Bruun Mie , Aagaard Bitten , Mikkelsen Christina , Nissen Janna , Brodersen Thorsten , Petersen Mikkel Steen , Rostgaard Klaus , Hjalgrim Henrik , Sørensen Erik , Ostrowski Sisse Rye , Pedersen Ole Birger , Hvas Christian Lodberg , Erikstrup Christian
Published: February 2025

Objective

To characterise gastrointestinal symptoms and bowel habits in healthy blood donors and explore symptom phenotypes and their associated factors.

Methods

Between November 2020 and March 2023, 53 046 participants in the nationwide Danish Blood Donor Study completed a questionnaire including 13 gastrointestinal symptoms, defaecation pattern regularity, stool frequency, and stool consistency. We used a data-driven approach to explore symptom phenotypes and investigated associated factors by multinomial logistic regression.

Results

Among the 53 046 participants (52% women), 68% (95% CI 67.5% to 68.3%) reported at least one of 13 gastrointestinal symptoms. The most frequent symptoms were bloating (40%), abdominal rumbling (40%), abdominal pain (17%), acid regurgitation (13%), heartburn (12%), diarrhoea (12%), nausea (12%), and constipation (10%). Half of the participants (50%) had a regular defaecation pattern (defined as generally the same stool consistency and stool frequency) consisting of Bristol Stool Form Scale 4 stools 1–3 times per day. Symptom phenotypes and their prevalence among 51 820 near-complete case participants were as follows: (1) no gastrointestinal symptoms (32%); (2) bloating and/or rumbling only (21%); (3) acid regurgitation and/or heartburn only (4%); (4) any other one or two symptoms (14%); (5) any three or four symptoms (18%); (6) any five or six symptoms (7%); (7) at least seven symptoms (3%). The acid regurgitation and/or heartburn only phenotype associated with obesity, and the remaining symptomatic phenotypes were associated with female sex, decreasing age, and an irregular defaecation pattern, even after excluding individuals with self-reported irritable bowel syndrome, lactose intolerance, or gluten intolerance.

Conclusion

Most healthy adults, especially women younger than 50 years, experience gastrointestinal symptoms. Symptom phenotypes strongly correlate with sex, age, and bowel habits.
Exploring gender and intersecting social stratifiers at a community level: insights from three social innovation research hubs in Colombia, the Philippines and Uganda
Authors: Mier Abigail Ruth , Echavarria Maria Isabel , Awor Phyllis , del Pilar-Labarda Meredith , Kharel Chandani , Otmani del Barrio Mariam
Published: February 2025

Background

Social innovations have been recognised as potential interventions to address health disparities, particularly in low- and middle-income countries. In the context of social innovation research, understanding how gender intersects with other social stratifiers is crucial, as these intersections are shaped by power imbalances and systems and structures of oppression, influencing health vulnerability, access to services and treatment outcomes. Prompted by the Intersectional Gender Research Strategy set up by the Special Programme for Research and Training in Tropical Diseases (TDR), three hubs of the Social Innovation in Health Initiative aimed to explore how gender dimensions played a role in existing social innovation projects at a community level.

Methods

We purposefully conducted the research in selected areas where social innovations in health were operating—sites in Colombia, the Philippines and Uganda. Qualitative methods, including semistructured interviews and focus group discussions, were used to gather in-depth insights. An iterative, inductive process of open coding guided the analysis, allowing themes to emerge organically and ensuring findings were grounded and contextually relevant.

Results

The following insights were drawn: (a) vulnerability and disease exposure stem from deeply ingrained patriarchal societal structures wherein social innovations operate; (b) gender norms and gender roles influence the participation in social innovations and health programmes; (c) The lack of women’s autonomy and gender-based discrimination remains a crucial challenge in the achievement of equitable health and (d) social innovations in health recognise the unique challenges faced by women and girls and respond by designing tailor-fit interventions to address these specific needs.

Conclusion

Incorporating an intersectional gender lens can lead to a deeper, more nuanced understanding of the relationship between social innovations in health and the communities that they operate in.
Heterogeneous association of health with patient and general practice characteristics by region, age and chronic condition: pooled cross-sectional study of patient-level data from England
Authors: Feng Yan , Gravelle Hugh , Gordeev Vladimir Sergeevich
Published: February 2025

Objectives

To investigate the association of individual patient health with their characteristics, including income deprivation, ethnicity and gender, with the size, quality and staffing of their general practices, and how these associations and income-related health inequality vary across chronic conditions, regions and age bands.

Design

Using observational pooled cross-sectional individual patient survey data linked with data on general practice clinical quality and staffing and deprivation at Lower-Layer Super Output Area level. Ordinary least-squares multiple regression models of patient health estimated on the full sample and on eight condition-specific, nine region-specific and six age-specific subsamples. Three concentration indices embodying different value judgements summarise income-related health inequality in the full sample and subsamples.

Setting

Primary care in England.

Participants

Over 1 million adult patients in 6426 general practices in 2015/2016 and 2016/2017.

Primary outcome measures

Patient-reported health (the 5-level EQ-5D version or EQ-5D-5L).

Results

Patients who are younger, male, more satisfied with their practice, have fewer chronic conditions and live in less-income or education-deprived areas report better health. White ethnicity is associated with worse health up to age 64 and better health from age 65, with better health in five of the eight chronic condition samples, and in the regional samples except for London and Yorkshire and Humber regions. Practice clinical quality is positively associated with health in the full sample but only in 4 of the 23 subsamples. Income-related health inequality is worst for patients with a mental health problem, residents in the northwest and northeast regions and is greatest for those aged 55–64. The three concentration indices are highly positively correlated across chronic condition and age-band samples. One index has a much weaker correlation relationship with the other two indices in the region-specific samples.

Conclusion

Income-related health inequality and the associations of health with patient and practice characteristics are heterogeneous by patients’ chronic condition, age and region.
Examining the relationship between incidence and mortality for commonly diagnosed cancers in the USA: an observational study using population-based SEER database
Authors: Adamson Adewole S , Patel Vishal R , Welch H Gilbert
Published: February 2025

Objective

Incidence and mortality are fundamental epidemiologic measures of cancer burden, yet few studies have examined individual cancers to determine how these measures correlate across place. We assessed the relationship between incidence and mortality for commonly diagnosed cancers in the USA.

Design

Population-based observational study of US counties.

Setting and participants

The Surveillance, Epidemiology and End Results (SEER) database was used to obtain incidence (2000–2016) and mortality (2002–2018) data for the 12 most commonly diagnosed non-haematologic cancers.

Outcome measures

County-level correlation between cancer incidence and mortality. Cancers were grouped into terciles based on the population-weighted correlation coefficient (r). We also examined the 10 year risk of death, both from the diagnosed cancer and other causes.

Results

County-level incidence and mortality were strongly correlated in some cancers, yet uncorrelated in others. Cancers in the high-correlation tercile (r range: 0.96 to 0.78) included lung, stomach, liver and pancreas. For patients with these cancers, the risk of death from the diagnosed cancer was >4-times the risk of death from other causes. The moderate-correlation tercile (r: 0.75 to 0.58) included cancers of the colon, bladder, kidney and uterus. There was little or no relationship between incidence and mortality for cancers in the low-correlation tercile (r: 0.33 to −0.10): melanoma, prostate, breast and thyroid. The risk of death from the diagnosed cancer for these patients was either lower or no different than their risk of death from other causes.

Conclusions

For some cancers in the USA, the fundamental epidemiologic measure of disease frequency—incidence—now has little relationship with cancer death (mortality). Low correlations are most likely explained by differences in diagnostic practice leading to variable amounts of cancer overdiagnosis between different US counties.
Self-reported health complaints and healthcare-seeking behaviour among adult people in rural Bangladesh: results from a cross-sectional study
Authors: Kabir Ashraful , Karim Md Nazmul , Billah Baki
Published: February 2025

Objectives

This study aims to assess self-reported health complaints and healthcare-seeking behaviours in a rural population of Bangladesh. These factors are crucial for understanding health challenges and designing effective healthcare services in rural areas.

Design

A cross-sectional survey was conducted from May to October 2021.

Setting

Four randomly selected administrative districts/regions of Bangladesh.

Participants

A total of 1645 rural participants aged 18 years and older.

Outcome measures

The study assessed the prevalence of self-reported health complaints and healthcare-seeking behaviours.

Results

Among the participants, 66% (1084 out of 1645) reported experiencing health complaints, with 80% seeking care and 20% either not seeking care or opting for self-care. Multivariable analysis revealed that participants with formal occupations (adjusted OR (aOR) = 0.609; 95% CI 0.396 to 0.938; p=0.025), those from the second (aOR=1.742; 95% CI 1.014 to 2.991; p=0.044) and fifth quintiles (aOR=1.210; 95% CI 0.726 to 2.019; p=0.465), with non-communicable disease (NCD) related complaints (aOR=5.299; 95% CI 3.673 to 7.643; p <0.001), and those living more than 5 km from healthcare facilities (aOR=1.725; 95% CI 1.040 to 2.861; p=0.034), were more likely to seek healthcare. Additionally, participants in the wealthiest quintile (aOR=1.963; 95% CI 1.080 to 3.569; p=0.027), those with non-NCD complaints (aOR=5.299; 95% CI 3.673 to 7.643; p<0.001) and those living further than 5 km (aOR=4.615; 95% CI 3.121 to 6.824; p<0.001), were more likely to seek care from skilled providers or healthcare facilities.

Conclusion

A high prevalence of self-reported health complaints, particularly related to NCDs, was observed. Despite this, many participants did not seek healthcare, indicating the need to address barriers to healthcare access and improve health-seeking behaviours in rural Bangladesh.
Interventions for the management of post-COVID-19 condition (long COVID): protocol for a living systematic review and network meta-analysis
Authors: Zeraatkar Dena , Ling Michael , Kirsh Sarah , Jassal Tanvir , Pitre Tyler , Chakraborty Samantha , Turner Tari , Turkstra Lyn , McIntyre Roger S , Izcovich Ariel , Mbuagbaw Lawrence , Agoritsas Thomas , Flottorp Signe A , Garner Paul , Couban Rachel J , Busse Jason W
Published: February 2025

Background

Up to 15% of survivors of COVID-19 infection experience long-term health effects, including fatigue, myalgia and impaired cognitive function, termed post-COVID-19 condition or long COVID. Several trials that study the benefits and harms of various interventions to manage long COVID have been published and hundreds more are planned or are ongoing. Trustworthy systematic reviews that clarify the benefits and harms of interventions are critical to promote evidence-based practice.

Objective

To create and maintain a living systematic review and network meta-analysis addressing the benefits and harms of pharmacologic and non-pharmacologic interventions for the treatment and management of long COVID.

Methods

Eligible trials will randomise adults with long COVID to pharmacologic or non-pharmacologic interventions, placebo, sham or usual care. We will identify eligible studies by searching MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and CENTRAL from inception, without language restrictions.

Reviewers will work independently and in duplicate to screen search records, collect data from eligible trials, including trial and patient characteristics and outcomes of interest and assess risk of bias. Our outcomes of interest will include patient-reported fatigue, pain, postexertional malaise, changes in education or employment status, cognitive function, mental health, dyspnoea, quality of life, physical function, recovery and serious adverse events.

For each outcome, when possible, we will perform a frequentist random-effects network meta-analysis. When there are compelling reasons to suspect that certain interventions are only applicable or effective for a subtype of long COVID, we will perform separate network meta-analyses. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach will guide our assessment of the certainty of evidence.

We will update our living review biannually, on the publication of a seminal trial, or when new evidence emerges that may change clinical practice.

Conclusion

This living systematic review and network meta-analysis will provide comprehensive, trustworthy and up-to-date summaries of the evidence addressing the benefits and harms of interventions for the treatment and management of long COVID. We will make our findings available publicly and work with guideline-producing organisations to inform their recommendations.

Ethics and dissemination

The study describes the protocol for a systematic review that uses data from published trial reports. Therefore, the study is exempt from ethics review. We intend to deposit all data in a public repository and publish each iteration of the living review online.
Analysis of epidemiological trends and risk factors in high-risk areas for pulmonary tuberculosis: an observational longitudinal study in Xinjiang, China
Authors: Haritebieke Salawati , Lu Yaoqin , Wu Di , Liu Guangchao , Zheng Yanling , Zhang Liping
Published: February 2025

Objective

To explore the spatial and temporal variations in the long-term risk of developing tuberculosis (TB) and the factors influencing it in order to contribute to the goal of eradicating TB.

Design

Observational longitudinal study.

Setting

Xinjiang, China, 2005–2019.

Primary and secondary outcome measures

Comparison of TB incidence across age, period, cohort and space using socioeconomic (including gross domestic product per capita, population density, public budget revenue and total retail sales of consumer goods), public health (including the number of hospital beds, health technicians and basic medical insurance for urban residents) and environmental variables (PM2.5, mean air temperature, mean wind speed, mean relative humidity and precipitation). The relative importance of these variables to pulmonary TB (PTB) is revealed by the Q-value (0, 1), with larger values indicating that the spatial heterogeneity of the explanatory variables to PTB is more pronounced.

Participants

All clinically diagnosed and confirmed cases in Xinjiang, China, were collected. The descriptive analysis included confirmed cases from 2005 to 2019, while cases from various districts and counties between 2011 and 2019 were subjected to further analysis.

Results

From 2005 to 2019, a total of 642 332 cases of PTB were reported in Xinjiang, with an average annual incidence rate of 172/100 000. The age risk of PTB presented a bimodal distribution, namely 20–24 years and the elderly (>60 years). The high prevalence of PTB was distributed in the southern part of Xinjiang. Among the influencing factors that had a greater effect on the incidence of PTB, the lower GDP per capita (Q-value=0.65) had a largest effect on PTB in Xinjiang compared with others factors (higher PM2.5: Q-value=0.56, lower health personnel: Q-value=0.49, higher average temperature: Q-value=0.47 and higher urban residents’ health insurance: Q-value=0.46). The main influencing factors were heterogeneous in different regions. Furthermore, the interactions among these factors enhanced the explanatory power regarding the incidence of the disease.

Conclusions

Identifying the high-risk groups, regions, influencing factors and interactions of PTB in Xinjiang, China, will expand the epidemiological knowledge of PTB in high-risk areas and potentially aid in designing targeted interventions.
Cohort profile: Noncommunicable diseases and ideal cardiovascular health among people living with and without HIV in Zambia and Zimbabwe (NCDzz cohort)
Authors: Chihota Belinda Varaidzo , Mandiriri Ardele , Muula Guy , Banda Esau , Shamu Tinei , Bolton-Moore Carolyn , Chimbetete Cleophas , Bosomprah Samuel , Wandeler Gilles
Published: February 2025

Purpose

The NCDzz study is a prospective cohort of people living with and without HIV attending primary care clinics in Zambia and Zimbabwe and was established in 2019 to understand the intersection between noncommunicable diseases (NCDs) and HIV in Southern Africa. Here, we describe the study design and population and evaluate their ideal cardiovascular health (ICVH) using the Life’s Simple 7 (LS7) score according to the American Heart Association.

Participants

Antiretroviral therapy-naïve people living with HIV (PLWH) and people living without HIV (PLWOH) 30 years or older were recruited from three primary care clinics in Lusaka and Harare, and underwent comprehensive clinical, laboratory and behavioural assessments. All study measurements are repeated during yearly follow-up visits. PLWOH were recruited from the same neighbourhoods and had similar socioeconomic conditions as PLWH.

Findings to date

Between August 2019 and March 2023, we included 1100 adults, of whom 618 (56%) were females and 539 (49%) were PLWH. The median age at enrolment was 39 years (IQR 34–46 years). Among 1013 participants (92%) with complete data, the median LS7 score was 11/14 (IQR 10–12). Overall, 60% of participants met the criteria of ICVH metrics (5–7 ideal components) and among individual components of the LS7, more females had poor body mass index (BMI) than males, regardless of HIV status (27% vs 3%, p<0.001). Our data show no apparent difference in cardiovascular health determinants between men and women, but high BMI in women and overall high hypertension prevalence need detailed investigation. Untreated HIV (OR: 1.36 (IQR 1.05–1.78)) and being a Zambian participant (OR: 1.81 (IQR 1.31–2.51)) were associated with having ICVH metrics, whereas age older than 50 years (OR: 0.46 (IQR 0.32–0.65)) was associated with not having ICVH metrics.

Future plans

Our study will be regularly updated with upcoming analyses using prospective data including a focus on arterial hypertension and vascular function. We plan to enrich the work through conducting in-depth assessments on the determinants of cardiovascular, liver and kidney end-organ disease outcomes yearly. Additionally, we seek to pilot NCD interventions using novel methodologies like the trials within cohorts. Beyond the initial funding support, we aim to collect at minimum yearly data for an additional 5-year period.
Efforts to strengthen anatomic pathology diagnostic services for cancer in sub-Saharan Africa: a scoping review protocol
Authors: Ng Dianna L. , Edelweiss Marcia , Kimambo Asteria Herman , Vuhahula Edda , Mushi Beatrice Paul , Adegoke Omolade , Goldberg Johanna , Ibrahim Pendo M. , Illonga Zainab , Jackman Julia , Jamisse Luisa , Van Loon Katherine , Mmbaga Elia John
Published: February 2025

Introduction

Sub-Saharan Africa bears a disproportionate burden of cancer-related morbidity and mortality compared with high-resource settings. Although pathology services are essential to providing optimal oncological care, diagnostic capacity in sub-Saharan Africa is insufficient for the cancer burden. This scoping review will be conducted to summarise the current state of practices and evidence for interventions and implementation strategies to improve anatomic pathology services for cancer in the region. The objective of this scoping review is to describe efforts to strengthen capacity for anatomic pathology services in sub-Saharan Africa. The information gathered will be used to inform the design of future pathology capacity-building interventions. The primary aim of the scoping review is to comprehensively map the existing evidence on initiatives aimed at enhancing the capacity for pathology services.

Methods and analysis

This study will follow Joanna Briggs Institute methodology for scoping reviews. MEDLINE, Embase, Cochrane Central and African Index Medicus will be searched for articles published in English and Portuguese with no limitations placed on date or publication type. A limited search for grey literature will be conducted using the WHO Institutional Repository for Information Sharing. Two independent reviewers will screen all articles, extract data and complete the descriptive analysis. All discrepancies will be resolved using a third reviewer. The results will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider scientific literature from published primary studies as well as scoping and systematic reviews related to capacity-building efforts to strengthen anatomic pathology services in any sub-Saharan African country. All study designs will be considered, including quantitative, qualitative and/or mixed-methods studies.

Ethics and dissemination

Ethical approval is not required for this study. Dissemination of findings from this work will include the publication of the results in a peer-reviewed journal and presentations at conferences.

Protocol registration number

Open Science Framework,https://osf.io/6cmhg.
Protocol of an open-label safety and feasibility pilot study of ketamine-assisted psychotherapy for methamphetamine use disorder (the KAPPA trial)
Authors: Fletcher Kathryn , Ezard Nadine , Siefried Krista J , MacDonald Harriet , Acheson Liam , Bedi Gillinder , Guerin Alexandre , Knock Elizabeth , Millard Michael , May Robert , Brett Jonathan , Doumany Jess , Morgan Celia , Clifford Brendan
Published: February 2025

Introduction

Methamphetamine use disorder is a significant public health concern. No pharmacological treatment options currently exist for methamphetamine use disorder, and psychotherapy is only moderately effective. Preliminary evidence suggests that ketamine-assisted psychotherapy produces sustained improvements in substance use and mental health symptomatology. In addition to direct antidepressant properties, ketamine is hypothesised to increase synaptogenesis and facilitate neuroplasticity, in turn prolonging and enhancing the effects of psychotherapy. Given the withdrawal-associated dysphoria and neurocognitive impairments characterising methamphetamine use disorder, ketamine-assisted psychotherapy may improve the efficacy of psychotherapy alone by addressing these features and facilitating therapeutic engagement. This pilot study aims to investigate the safety and feasibility (time taken to recruit sample, proportion of ineligible participants at pre-screening and screening, number of participants who complete four sessions of psychotherapy, retention rate over full duration of study, acceptability of the intervention) of subanaesthetic ketamine in combination with psychotherapy (cognitive behavioural therapy) for adults with methamphetamine use disorder. Changes in methamphetamine use, cravings and withdrawal, quality of life, and treatment satisfaction will also be explored.

Methods and analysis

This is an open-label, single-arm clinical trial. 20 adults meeting DSM-5-TR criteria for methamphetamine use disorder who are seeking to reduce or cease methamphetamine use will be enrolled in the study through a single-site specialist outpatient stimulant treatment service in inner Sydney (St Vincent’s Hospital, Sydney). A 4-week course with three subcutaneous ketamine doses (0.75 mg/kg to 0.9 mg/kg, titrated according to tolerability) at weekly intervals and four sessions of cognitive behavioural therapy (one at treatment initiation and three within 24–48 hours following each ketamine administration session) will be delivered. Safety and feasibility will be assessed over an 8-week period. Secondary outcomes (changes in methamphetamine use, cravings, withdrawal, quality of life and treatment satisfaction) will be assessed over a 24-week period.

Ethics and dissemination

This study has been approved by the St Vincent’s Hospital Human Research Ethics Committee, reference 2023/ETH00530. Study findings will be disseminated through articles in scientific, peer-reviewed journals, and at national and international conferences.

Trial registration number

ANZCTR: ACTRN12624000895583.

Protocol version

The trial protocol (Version 4.0) was approved on 24 June 2024.
Establishing primary care physician commitment in Canadian long-term care homes: a protocol for a modified e-Delphi study
Authors: Dash Darly , Potter Maya , Siu Henry Yu-Hin , Quail Patrick , Katz Paul , McCarthy Lisa M , Peck Samantha , Tripp Dee , Costa Andrew P , Rochon Paula , Savage Rachel D , Jones Aaron , Stall Nathan
Published: February 2025

Introduction

The delivery of medical services by primary care physicians (PCPs) in long-term care (LTC) homes lacks consistency. There is no Canadian standard for PCP commitment in the LTC home setting, which can influence the quality of care delivered and resident health outcomes. The PCP’s commitment to LTC practice is theorised as the proportion of a physician’s practice dedicated to LTC, the number of residents for whom they provide care and the time spent on individual resident encounters. We aim to establish consensus on expectations concerning PCP commitment in Canadian LTC homes.

Methods and analysis

We describe a protocol for a two-round modified e-Delphi study assessing the consensus of an expert panel, guided by the RAND methodological guidance for conducting Delphi panels and the ACcurate COnsensus Reporting Document (ACCORD) guideline for healthcare-based consensus studies. We will recruit pan-Canadian experts who demonstrate extensive knowledge and experience in medical care delivery and medical practice models in the Canadian LTC sector. A literature review will generate a candidate list of statements constituting PCP commitment. The first round evaluates the relevance and feasibility of candidate statements through an online questionnaire. Panellists may also write open-ended, qualitative responses to add rationales, suggest alternatives and share new ideas. We will then host a virtual synchronous meeting to have an in-depth discussion about the results from round one. A second questionnaire will be distributed to evaluate the remaining statements that have not reached consensus, and any new statements added based on the same criteria.

Ethics and dissemination

The Hamilton Integrated Research Ethics Board (Project ID #17321) approved our study. The findings will be disseminated through manuscripts, presentations, and the lead author’s thesis.

Trial registration number

The ISRCTN Registry: #35125526.
Keeping Active with Texting after Stroke (KATS): a single-arm feasibility and acceptability study of a behavioural intervention to promote community-based physical activity after stroke rehabilitation
Authors: Morris Jacqui H , Irvine Linda A , Breckenridge Jenna , Farre Albert , Ozakinci Gozde , Jenkinson Keith , Murphy Andrew , Dombrowski Stephan U
Published: February 2025

Objectives

To test the feasibility and acceptability of a text-message-delivered behavioural intervention to promote and maintain physical activity and recovery after stroke rehabilitation.

Design

A single-arm acceptability and feasibility study.

Setting

Community rehabilitation services in two Health Board areas in Scotland.

Participants

People with stroke who could participate in physical activities and use a mobile phone were recruited during rehabilitation and community rehabilitation.

Intervention

Keeping Active with Texting after Stroke (KATS) is an automated text message-delivered intervention informed by behaviour change theory. It delivers a structured sequence of 103 messages over 14 weeks to support the uptake and maintenance of physical activities following stroke rehabilitation.

Outcomes

Data on recruitment, retention and satisfaction were collected. Semistructured interviews explored intervention acceptability. Preintervention and postintervention measures provided preliminary information on step count, functional independence, mental well-being, self-efficacy and quality of life.

Results

18 men and 13 women were recruited; three withdrew before intervention commencement. All 28 participants who received at least one text message completed the study, indicating 100% retention. Median satisfaction score was 23/25 (range 12–25). All but one participant read and responded to texts, indicating good engagement. Effect sizes (Cohen’s d; per cent change) were demonstrated in step count (0.2; 13%), extended activities of daily living (0.24; 8.3%) and mental well-being (0.35; 7%). Participants perceived KATS as acceptable, valuing messages and motivational prompts, but personalised tailoring was desired by some.

Conclusions

Recruitment, retention and outcome measure completion were feasible, and KATS was perceived as acceptable. Findings suggest some modifications of messages and goal-setting processes are required to accommodate participants with diverse physical activity capabilities before a definitive trial. Promising indicators of effects were detected, although interpretation must be cautious because the study was not powered to determine efficacy, and there was no control group. Based on these findings, KATS will be further optimised before evaluating effectiveness in a randomised controlled trial.

Trial registration number and protocol availability

ISRCTN 13704805https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/keeping-active-with-texting-after-stroke-kats/

Protocol availablehttps://www.isrctn.com/ISRCTN13704805?q=13704805&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10
Association of early versus late care seeking for sport-related concussion in adolescent athletes in Canada: a historical cohort study
Authors: Oh David Youngwoo , Germann Darrin , Cancelliere Carolina , Kazemi Mohsen , Marshall Cameron , Hogg-Johnson Sheilah
Published: February 2025

Objectives

This study aims to examine the association of time to recovery between early versus late presentation to outpatient community-based concussion management clinics following sport-related concussion (SRC) among adolescent Canadian athletes.

Methods

Using electronic health records (between January 2017 and December 2019) from the Complete Concussion Management Inc (CCMI) database, this was a historical cohort study of Canadian athletes aged 12–18 presenting for care early (0–7 days) or late (8–28 days) after SRC. Time-to-recovery was defined as the date of clinician clearance to return to sport. Propensity scores were first derived from logistic regression with early versus late clinical presentation as the outcome. Cox proportional hazards regression analysis was then used to model the relationship between early versus late clinical presentation and time to recovery, while including the propensity score to adjust for confounding. The association was expressed using hazard rate ratios (HRR) with 95% CIs.

Results

A total of 4696 patient records (mean age of 14.71 (±1.69 SD); 57.7% male) were eligible. Early presentation to a concussion management clinic following SRC was associated with faster time to recovery (adjusted HRR 1.23; 95% CI 1.14 to 1.32, p<0.001). This association was consistent within each quintile of the propensity score. The median time to recovery was 18 versus 22 days in the early and late groups, respectively.

Conclusion

Adolescent athletes with SRC have favourable recovery trajectories when presenting for care up to 28 days. Time to recovery (clinician clearance to return to sport) may be quicker with an earlier presentation which can lead to a faster return to sport.
Relational epistemic humility in the clinical encounter
Authors: Muyskens Kathryn , Ang Chloe , Kerr Eric Thomson
Published: February 2025

Epistemic humility has garnered increased attention in recent years, including within the realm of clinical ethics and is increasingly accepted as an important part of patient-centred practice and clinical care. However, while literature on the topic often states what epistemic humility isnot, there have been few positive definitions given for the term. Further, these few positive definitions downplay the relational nature of epistemic humility, in other words, the ways in which epistemic humility is developed within the clinical encounter through the relationship between doctor and patient. In this paper, we will present a positive account of epistemic humility, situated in ethical medical education and practice, and show how it can be identified, modelled and cultivated. We provide a character-based account of epistemic humility that emphasises the relational nature of epistemic humility, that is, that views epistemic humility as formed through relationships rather than solely inhering in an individual’s internal mental processes or external presentation and which is embedded in a social context such as a clinical encounter.
Endovascular management of extracranial vertebral artery stenosis
Authors: Chen Huanwen , Colasurdo Marco , Costa Matias Luis , Kan Peter
Published: February 2025

Approximately 20% of ischemic strokes involve the posterior circulation, primarily supplied by the vertebrobasilar system. While much is known about the stroke risk of vertebrobasilar stenotic disease in general, particularly those involving intracranial pathology, extracranial vertebral artery stenosis remains an underinvestigated pathology. In this narrative review, we highlight retrospective, prospective, and randomized trial data on extracranial vertebral artery diseases with a particular focus on the role of endovascular stenting in its management. We also discuss the role of advanced imaging modalities such as quantitative magnetic resonance angiography for stroke risk stratification and patient selection for stenting.
Mesothelioma risks and cumulative exposure to elongate mineral particles of various sizes in Minnesota taconite mining industry
Authors: Shao Yuan , Ramachandran Gurumurthy , Mandel Jeffrey H , MacLehose Richard F , Alexander Bruce H
Published: February 2025

Objectives

An excess of mesothelioma has been previously observed in iron ore miners in Northeastern Minnesota. This study explored the potential association between mesothelioma and elongate mineral particle (EMP) exposures in the Minnesota taconite mining industry, examining both regulated and non-regulated EMP dimensions.

Methods

A nested case–control study design within the Mineral Resources Health Assessment Programme cohort analysed 104 mesothelioma cases and 410 controls. Cumulative EMP exposures were assessed across various dimensional definitions, including regulated (National Institute for Occupational Safety and Health, NIOSH) and non-regulated EMPs. Conditional logistic regression models were applied to estimate mesothelioma risk linked to employment duration and cumulative EMP exposure while adjusting for potential confounding variables.

Results

Consistent with earlier assessments, mesothelioma was associated with the number of years employed in the taconite industry (rate ratio (RR) 1.02, 95% CI 1.00 to 1.05) and cumulative NIOSH EMP exposure ((EMP/cc)×years) in taconite mining and processing (RR 1.20, 95% CI 0.99 to 1.46). Positive associations were also observed with mesothelioma and cumulative exposure to non-regulated EMPs.

Conclusions

This study supported the main conclusions in the previous study that the data were consistent with an association between mesothelioma and employment duration and with NIOSH EMP exposure in taconite mining and processing. However, the 95% CI indicates the data are also compatible with a null effect. Given the limitations we cite in the manuscript, additional study is needed to clarify the effect. Additionally, this study found possible evidence of a positive association between mesothelioma and cumulative exposure to Chatfield EMP, Suzuki EMP and Cleavage Fragments in the Minnesota taconite worker population.
Nonstatic Reissner–Nordstr$$\phi $$m metric in the perturbative f(R) theory: embedding in the background of the FLRW cosmology, uniqueness of solutions, the TOV equation
Authors: Ky Pham Van
Published: February 2025

This article introduces a nonstatic Reissner–Nordstr

$$\phi $$

ϕ

m metric, a metric that does not emit electromagnetic waves but can emit gravitational waves. We first use the GR theory to study a charged spherically symmetric gravitational source (CSSGS), the obtained results are further improved in comparison with the previous studies. In particular, this article considers that the field is not necessarily static. The metric tensors

$$ g_{\mu \nu } $$

g

μ
ν

are considered both outside and inside the gravitational source (the results show that in the first case

$$ g_{\mu \nu } $$

g

μ
ν

are time independent, in the latter case they are time dependent). The gravitational acceleration and the event horizon of a charged black hole are investigated. The results prove that the gravitational field is always attractive. We then use the perturbative f(R) theory to consider CSSGS. The obtained results not only correct the solution of Einstein’s equation in magnitude (this will describe astronomical and cosmological quantities more accurately than Einstein’s equation), but also reveal new effects. Outside the gravitational source, the metric tensors can depend on time, this makes it possible for a spherically symmetric gravitational source to emit gravitational waves (Einstein’s equation cannot give this effect). However, a spherically symmetric field still does not emit electromagnetic waves. Next, we present a new method for embedding the spherically symmetric metrics of a star (or a black hole) in the background of the FLRW cosmological. Finally, we discuss the uniqueness of the solutions of the f(R) theory. The perturbative TOV equation is also found.
Quantifying greenspace with satellite images in Karachi, Pakistan using a new data augmentation paradigm
Authors: Zhang Miao , Arshad Hajra , Abbas Manzar , Jehanzeb Hamzah , Tahir Izza , Hassan Javerya , Samad Zainab , Chunara Rumi
Published: February 2025

Greenspaces in communities are critical for mitigating effects of climate change and have important impacts on health. Today, the availability of satellite imagery data combined with deep learning methods allows for automated greenspace analysis at high resolution. We propose a novel green color augmentation for deep learning model training to better detect and delineate types of greenspace (trees, grass) with satellite imagery. Our method outperforms gold standard methods, which use vegetation indices, by 33.1% (accuracy) and 77.7% (intersection-over-union; IoU). The proposed augmentation technique also shows improvement over state-of-the-art deep learning-based methods by 13.4% (IoU) and 3.11% (accuracy) for greenspace segmentation. We apply the method to high-resolution (0.27
m
/pixel) satellite images covering Karachi, Pakistan and illuminates an important need; Karachi has 4.17
m
2
of greenspace per capita, which significantly lags World Health Organization recommendations. Moreover, greenspaces in Karachi are often in areas of economic development (Pearson’s correlation coefficient shows a 0.352 correlation between greenspaces and roads,
p
< 0.001), and corresponds to higher land surface temperature in localized areas. Our greenspace analysis and how it relates to infrastructure and climate is relevant to urban planners, public health and government professionals, and ultimately the public, for improved allocation and development of greenspaces.