bluuebunny/crossref_metadata_2025 huggingface dataset:
Online Infectious Diseases Subspecialty Supplementary Curriculum for Medical Students and Residents: Moving Beyond “You Get What You Get”
Authors: Miller Nikki , Wick Jo , Luther Vera P , Newman Jessica R
Published: April 2023

OBJECTIVES

Students and residents rotating through infectious diseases (ID) electives are instructed primarily by participation in rounds and clinics, with teaching focused on diseases encountered. This “you get what you get” approach allows learners to apply knowledge directly to patient care, however, may miss topics encountered in standardized testing. This multisite study investigates the use of asynchronous web-based learning modules and its impact on student and resident knowledge.

METHODS

Students and residents rotating through an ID elective were assigned to their standard elective (old) or asked to complete asynchronous web-based learning modules in addition to the standard curriculum (new). Learners submitted pre- and post-tests and scores were tabulated. In the following academic year, learners at the host site were provided the learning modules and a post-elective survey.

RESULTS

Nine learners (100%) completed the pre-test and 5 (55.6%) completed the post-test in the standard (old) curriculum group, while 15 (100%) completed the pre-test and post-test in the new curriculum group. The mean percentage change in accuracy was 9% and 5.3% in the old and new curricula, respectively. Most (94%) survey respondents recommended continued use of the curriculum and expansion to other subspecialty electives.

CONCLUSIONS

Subspecialty electives have multiple purposes including assisting learners in exploring careers, providing a well-rounded medical experience, or preparing learners for content in standardized tests. Consistent curricula are not always provided with electives to supplement the clinical experience. Our web curriculum was well-received with perceived knowledge gain, though with very small pre-post-test groups a score improvement could not be determined. An asynchronous online curriculum for learners in ID was feasible and well-received among faculty, and learners felt their knowledge was enhanced. Content areas supplemented those encountered during the ID elective. While an improvement in post-test scores was not demonstrated, learners and faculty felt modules were beneficial.
The Influence of Patient Participation on Satisfaction and Compliance
Authors: Rost Kathryn
Published: April 2023

This investigation tested how patients’ participation in the medical visit is related to their satisfaction and subsequent adherence. Thirty random samples of audiotaped dialogue were used to construct estimates of patient participation during the history, examination, and concluding segment of initial medical visits of 45 older male Veterans Administration patients. The data demonstrate that patients who offer information as well as answer physician questions are significantly more likely to comply with recommendations for new medication. The frequency with which patients interrupt physicians positively correlates with patient satisfaction, and the frequency with which physicians interrupt patients negatively correlates with patient satisfaction. The paper analyzes various examples of patient participation in visits with nationally recognized diabetes educators, and discusses an agenda for further research in the area.
Welcome to possibility studies
Authors: Escobar Arturo
Published: April 2023

A main goal of Possibility Studies is to explore the complex cultural-political work of imagining the future(s). As this brief note argues, this task is deeply shaped at present by the narrow notions of reality, and hence of the possible, inherited from Western modernity. Becoming aware of the onto-epistemic foundations of modernity thus becomes essential for the collective journey into the reinvention of possibility.
How Government Health Agencies Obscure the Impact of Environmental Pollution and Perpetuate Reductionist Framings of Disease: The Case of Leukemia
Authors: Vallée Manuel
Published: April 2023

Since the 1970s, environmental health researchers have documented environmental pollution's impacts on human health, which includes the bioaccumulation of industrial chemicals and how these toxicants contribute to disease. However, the relationship between disease and pollution is often difficult to discern in the disease information provided by dominant institutions. Previous scholarship has identified that print media, television news, online medical publishers, and medical associations consistently obscure the environmental causation frame. However, less has been said about disease information provided by public health agencies. To address this gap, I analyzed the leukemia information provided by Cancer Australia, the United States’ National Institutes of Health, and the United Kingdom's National Health Service. My analysis shows that the disease information offered by these health agencies also obscures the environmental causation frame by failing to identify most toxicants that environmental health researchers have linked to leukemia and by emphasizing a biomedical framing of the medical condition. Beyond documenting the problem, this article also discusses the social consequences and sources of the problem.
Drug Counseling: The Need for a Systematic Approach
Authors: Sarriff Azmi
Published: April 2023

Objective

An approach to drug counseling that helps organize and standardize the documentation of a patient's specific drug-taking problem is presented.

Background

Patient counseling on the proper use of prescribed medications should be treated as a problem-solving session. The patient's underlying drug-taking problems may be complicated and deep-seated and may not be apparent unless specifically sought. This article introduces an approach that is intended to provide a systematic process for drug counseling: (1) establish a comprehensive, patient-specific database; (2) list patient-specific drug-taking problems; (3) provide counseling information and promote compliance; and (4) assess and monitor compliance. An important attribute of this approach is that it facilitates the dynamic nature of the counseling process.

Conclusions

This approach to drug counseling serves as a guideline for patient counseling. Additional experience with this system is necessary to determine its effectiveness at achieving the desired counseling outcomes.
Reducing Outpatient Costs of Nonsteroidal Antiinflammatory Drugs at a Department of Veterans Affairs Teaching Hospital
Authors: Drexler Paul G. , Lambdin Charles S.
Published: April 2023

Objective

To determine how formulary changes, based on the recommendations of a clinical pharmacy specialist, affected outpatient nonsteroidal antiinflammatory drug (NSAID) prescribing patterns and drug costs in a Department of Veterans Affairs (VA) teaching hospital.

Design

Cost-benefit analysis.

Setting

VA teaching hospital.

Patients

Outpatient veterans.

Interventions

Sulindac, piroxicam, and diflunisal were removed from the formulary and made available only on a case-by-case review process. Buffered aspirin and phenylbutazone also were removed from the formulary; these drugs were made unavailable altogether. Ibuprofen, indomethacin, salsalate, enteric-coated aspirin, and plain aspirin retained their formulary status and were available for routine prescribing.

Main Outcome Measures

Changes in the number of prescriptions dispensed and in prescription costs for each NSAID were measured 3 months before and 5 and 21 months after implementation of formulary changes.

Results

No prescriptions were dispensed for diflunisal, buffered aspirin, and phenylbutazone 21 months after implementation of the formulary changes. During this same period, prescriptions for sulindac and piroxicam declined 95.7 and 97.1 percent, respectively. The average cost per outpatient NSAID prescription declined from $14.78 to $4.75 (67.9 percent) after 21 months. An extrapolated yearly savings of $137,704 was calculated.

Conclusions

Formulary changes based on recommendations of a clinical pharmacy specialist resulted in altered physician prescribing patterns and reduced outpatient drug costs for NSAIDs in a VA teaching hospital.
Educating Patients’ Families on Their Level
Authors: Knapp Judy A. , Hyde Victoria S.
Published: April 2023

Objective

To provide well-written, easy-to-read, comprehensible education materials without losing sight of their medical accuracy.

Participants and Their Duties

Employees from all hospital departments develop first drafts. A multidisciplinary committee, patient-education program (PEP), composed of a pharmacist, dietitian, respiratory therapist, radiology technician, medical illustrator, and inpatient and outpatient nurses facilitate these handouts. Laypeople critique the readability and experts evaluate content.

Method

Patient-education handouts are coded into one of seven divisions and tracked through the stages of writing, word processing, proofing by experts, proofing for readability, illustrating, printing, and distribution.

Pharmacy PEP Design

A medication template is used to standardize the format and general information that needs to be included in all medication education materials.

Conclusions

Through better-written and more comprehensible educational materials, patients’ families are able to understand the medical treatment being rendered, thereby easing stress and encouraging their participation in total care.
Issues in Contemporary Drug Delivery
Authors: DeSimone Edward M. , Banakar Umesh V.
Published: April 2023

Objective

To provide an overview of the selection criteria for and proper use of sunscreen products. The effects of ultraviolet (UV) radiation on the skin are also discussed.

Data Sources

References were selected from published bibliographies of books and articles dealing with UV radiation and sunscreen agents, manufacturers’ product information, and topical searches in MEDLINE computerized database (English language, through 1991).

Study Selection

Studies that investigated the short- and long-term effects of UV radiation (UVA and UVB) on human skin were reviewed. Equal weight was given to information published in authoritative textbooks by prominent photobiologists and dermatologists. Data relating to human skin were selected in preference to animal data, and data involving ingredients approved for use in the US were used in preference to those of products approved in foreign countries.

Data Synthesis

The literature describing the effects of both UVA and UVB on human skin is substantial. However, there is considerably less information on UVA in terms of how its effects impact the formulation and use of commercially produced sunscreen products. Information regarding the proper use of currently available sunscreen products and the appropriate patient counseling information for pharmacists is both considerable and consistent.

Conclusions

In recent years, the concerns about UV radiation have shifted from the short-term hazards of sunburn to the long-term hazards of skin cancer and premature aging of the skin. Available data suggest that a life-long approach to minimizing exposure to UV radiation including the use of sunscreens with a minimum sun protection factor of 15 will reduce overall morbidity and mortality. Authorities in the field are calling for the continuing development of commercial sunscreen products that provide a broad spectrum of protection against both UVA and UVB and their proper use by the public.
Retrospective Analysis of Neuropathic Pain Control in Patients with Advanced Cancer
Authors: Snare Alison J. , Tett Susan E. , Kaye Karen , Lickiss Norelle
Published: April 2023

Objective

To describe the use of sodium valproate in patients with advanced cancer for the relief of neuropathic pain.

Design

Case series. A retrospective, descriptive review using medical records.

Setting

Ambulatory and hospitalized patients referred to the Central Sydney Palliative Care Service, based at the Royal Prince Alfred Hospital, an 800-bed teaching hospital, in Sydney, Australia.

Patients

Of all the 364 patients who were referred to the Service in 1987, 64 received sodium valproate for neuropathic pain and were eligible for inclusion in the study.

Main Outcome Measures

Documentation by physicians of pain control and the dose of sodium valproate.

Results

Forty-three of the 64 patients (67 percent) had an indication of efficacy noted on their record. In 26 of these 43 patients (60 percent), sodium valproate was the only therapy introduced or the dosage was increased immediately prior to the documentation of pain relief. Only 3 patients totally discontinued sodium valproate. The 1 patient who experienced an adverse effect of sedation temporally related to institution of sodium valproate had therapy successfully reintroduced at a lower dosage. The dosages used for analgesia were much lower than those used for epilepsy. The mode and median doses were 400 mg/d (interquartile range 200–600 mg).

Conclusions

This medical record review raises the hypothesis that sodium valproate may be useful therapy in the management of cancer-related neuropathic pain.
Epidural, Intrathecal, and Patient-Controlled Analgesic Use in a University Medical Center
Authors: Erstad Brian L. , Snyder Beth A. , Kramer Thomas H.
Published: April 2023

Objective

To determine the number and profile of surgical patients receiving epidural, intrathecal, and patient-controlled analgesia.

Design

Two-month audit of epidural, intrathecal, and patient-controlled analgesia.

Setting

A 300-bed, tertiary care, university medical center.

Patients

All patients undergoing surgery and receiving epidural, intrathecal, or patient-controlled analgesia.

Results

Of 1123 operations performed during the two-month audit, 185 patients (16 percent) received one of the three forms of analgesia studied. Sixty-three percent of the 185 patients received patient-controlled analgesia and 33 percent received epidural injections for pain control. The most common types of surgery associated with the use of these specialized pain-control techniques were obstetric/gynecologic, orthopedic, general, urologic, and cardiothoracic.

Conclusions

Specialized forms of analgesia are becoming increasingly common. Our audit defined the number of patients receiving such therapies according to type of surgery. Collection of such information by other institutions should allow for targeted evaluations of cost-effectiveness (e.g., drug use evaluations).
Use of Intravenous Acyclovir for Prophylaxis of Cytomegalovirus Infection in Renal Transplant Recipients
Authors: Sturgill Marc G. , Hatton Jimmi
Published: April 2023

Objective

To review the incidence and risk factors for cytomegalovirus (CMV) infection and disease following renal transplantation, and the use of intravenous acyclovir for infection prophylaxis.

Data Sources

An English-language literature search using MEDLINE (1982–93), Index Medicus (1982–93), and bibliographic reviews of related textbooks and review articles.

Study Selection

One hundred forty-five articles were selected. Articles were assessed for study quality and specific information addressing the stated purpose. In articles reporting the results of clinical trials, emphasis was placed on comparative pharmacokinetic parameters, efficacy, and toxicity.

Synthesis

A review of human trials suggests that acyclovir is effective for prevention of CMV infection and disease following renal transplantation. When compared with active or passive CMV immunization, ganciclovir, and foscamet sodium, acyclovir appears to exhibit the most favorable combination of safety and efficacy in the renal transplant population. However, the optimal dose of intravenous acyclovir when compared with oral administration is not clearly established.

Conclusions

Acyclovir will continue to be widely used for CMV prophylaxis following renal transplantation. Postoperative complications often require the use of intravenous medications, and the optimal dosing schedule for intravenous acyclovir in this population is an issue that needs to be addressed. A randomized, concentration-controlled clinical trial may be the best approach to establish a safe and effective dosing schedule for intravenous acyclovir administration in the renal transplant population.
Sumatriptan: A New Treatment for Migraine and Cluster Headaches
Authors: Ross Mary B. , Mulcahy Michelle M. , Mutnick Alan H.
Published: April 2023

Objective

To provide an overview of the pharmacology, pharmacokinetics, clinical trials, adverse drug reactions, and dosing recommendations for sumatriptan, a new agent for treating migraine headaches.

Data Sources

Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles dealing with the use of sumatriptan in the treatment of migraine and/or cluster headache.

Study Selection

Clinical studies, review articles, and editorials were selected for review if they addressed the clinical use, pharmacokinetic profile, adverse drug reaction profile, and dosing recommendations for sumatriptan.

Data Extraction

Data were used from clinical trials and reviews when the information was obtainable from multiple sources.

Data Synthesis

Sumatriptan is a serotonin-selective receptor agonist approved by the Food and Drug Administration for the acute treatment of migraine headaches. Clinical trials have reported that sumatriptan is very effective in the rapid reversal of acute migraine headaches. The drug is not without adverse effects and must be used cautiously in patients with ischemic heart disease and coronary vasospasm. In addition, nausea, dizziness, malaise, and fatigue have been reported with sumatriptan's use.

Conclusions

Sumatriptan may have a significant impact on the lives of patients with migraine headaches. However, because no other serotonin agonists have been released for treating migraine, it will be important that pharmacy personnel have a clear understanding of the uses, adverse effects, administration guidelines, and costs associated with sumatriptan. This will allow pharmacy personnel to educate patients on sumatriptan to ensure the most positive outcomes possible.
Minocycline Treatment for a Methicillin-Resistant Staphylococcus aureus Wound Infection
Authors: Sofia Robert D. , Swanson Keith A. , Sivaprassad R.
Published: April 2023

Objective

To report a case illustrating the possible role of minocycline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections.

Case Summary

Following revision of a total hip replacement, an elderly patient developed an abscess at the site of the surgical wound infection. Initial cultures were positive for multiple organisms indicating colonization. One week after admission, MRSA was cultured from the wound and was thought to represent an infection rather than colonization. The isolate was sensitive to vancomycin, but was resistant to all other routinely tested antistaphylococcal antibiotics. Minocycline 100 mg orally twice daily and topical mupirocin 2.0% ointment applied with dressing changes every 3 days was used to treat the infection after the patient refused placement of the central venous catheter needed for intravenous vancomycin therapy. Following 15 days of minocycline and mupirocin therapy, repeat cultures were positive only for non-group D, alpha-hemolytic streptococci, which was believed to represent colonization of the site.

Discussion

A brief review of the literature concerning minocycline activity against staphylococcal infections suggests a possible role for minocycline in the treatment of MRSA infections. Case studies illustrating clinical response of MRSA infections to minocycline in various types of combination therapy are reviewed and discussed. The potential link is suggested between minocycline plus mupirocin therapy and the clearance of MRSA from wound cultures in the case presented.

Conclusions

A possible role of minocycline plus mupirocin for treating non-systemic MRSA infection is suggested by results found in this case. Although they might offer an attractive alternative to intravenous vancomycin therapy, the use of minocycline and topical mupirocin require additional study before they can be routinely recommended for the treatment of MRSA infections.
Intrathecal Baclofen Effective in Treating Spasticity
Authors: Wong Wai-Yip , Hart Linda L.
Published: April 2023

Objective

To provide an overview of the chemistry, adverse-effect profile, and risk-benefit issues of intrathecal administration of baclofen in treating spasticity.

Data Sources

Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of intrathecal baclofen.

Study Selection

Studies, review articles, and editorials that addressed the chemistry, clinical use, and risk-benefit issues of intrathecal baclofen were reviewed.

Data Extraction

Data were extracted from clinical trials, reviews, and editorials when the information pertained to the purpose of the objective.

Data Synthesis

Baclofen is a GABAB-receptor agonist that has presynaptic and postsynaptic inhibitory action. Intrathecal administration of baclofen is a rational approach to delivering the drug directly to the GABAB receptors in the spinal cord. The literature demonstrates that long-term intrathecal baclofen administration via a programmable infusion pump is effective in the management of spasticity. Complications of delivering baclofen intrathecally via an infusion pump include pump failure, catheter dislocation, and infection related to the initial procedure or to pump refills. Dosage requirements increase over time as tolerance to baclofen develops. Tolerance is not a serious concern because the dosage requirement is maximized in about one year.

Conclusions

In treating intractable spasticity, intrathecal baclofen is a viable, safe alternative to destructive surgical neurectomy, which carries risks of serious neurologic complications. Long-term intrathecal baclofen treatment via an implanted programmable infusion pump not only is effective in treating spasticity, but also improves functional capacities in patients who are unresponsive to high-dose oral antispastic agents.
Germanium Use and Associated Adverse Effects: A Review
Authors: Ohri Linda K. , Vicari Susan M. , Malone Patrick M.
Published: April 2023

Objective

To review the trace element germanium, including its use as a nutritional supplement, the published medical research on potential therapeutic applications, and its potential toxicity. The case report and review literature regarding nephrotoxicity are addressed.

Data Sources

Relevant English-language articles were identified from a MEDLINE, EMBASE, and BIOSIS search using the primary search term germanium. Additional references were identified from the bibliographies of these articles.

Study Selection/Data Extraction

The main details of the case report and review literature were covered. The reader is referred to review articles as well as case reports for in-depth reviews of the case reports evaluated.

Data Synthesis

Germanium products are being sold in the US as nutritional supplements for a variety of unproven indications. Published medical research has not clearly substantiated a place for germanium as established drug therapy. Substantial evidence exists associating chronic germanium use with nephrotoxicity.

Conclusions

Pharmacists and other healthcare practitioners should question patients on their use of nutritional supplements, including germanium, when conducting medication histories. This is especially important for patients with unexplained renal dysfunction. Pharmacists should consider removing germanium products from stock where it is currently included on inventory.
Therapeutic Applications and Economic Opportunities in the Biotechnologic Pharmaceutical Industry
Authors: Wertheimer Albert I. , Grumer Sondra
Published: April 2023

Objective

To discuss the expected future development and implications of the US biotechnologic pharmaceutical industry. Foreign competition and internal forces that might impede the industry are also discussed.

Data Sources

Searches were conducted in the Business Periodicals Index and the International Pharmaceutical Abstracts databases.

Study Selection

All studies pertaining to the business of biotechnology were reviewed.

Conclusions

Biotechnologically produced agents will require a shorter period of development and a less costly production process, and will be generally safer than conventional drugs. Furthermore, these agents will afford superior pharmacotherapy to that of conventional drugs, enhancing the diagnosis and treatment of diseases as harrowing as AIDS and neoplastic disorders.
CNL and aCML should be considered as a single entity based on molecular profiles and outcomes
Authors: Carreño-Tarragona Gonzalo , Álvarez-Larrán Alberto , Harrison Claire , Martínez-Ávila José Carlos , Hernández-Boluda Juan Carlos , Ferrer-Marín Francisca , Radia Deepti H. , Mora Elvira , Francis Sebastian , González-Martínez Teresa , Goddard Kathryn , Pérez-Encinas Manuel , Narayanan Srinivasan , Raya José María , Singh Vikram , Gutiérrez Xabier , Toth Peter , Amat-Martínez Paula , Mcilwaine Louisa , Alobaidi Magda , Mayani Karan , McGregor Andrew , Stuckey Ruth , Psaila Bethan , Segura Adrián , Alvares Caroline , Davidson Kerri , Osorio Santiago , Cutting Robert , Sweeney Caroline P. , Rufián Laura , Moreno Laura , Cuenca Isabel , Smith Jeffery , Morales María Luz , Gil-Manso Rodrigo , Koutsavlis Ioannis , Wang Lihui , Mead Adam J. , Rozman María , Martínez-López Joaquín , Ayala Rosa , Cross Nicholas C. P.
Published: April 2023

Chronic neutrophilic leukemia (CNL) and atypical chronic myeloid leukemia (aCML) are rare myeloid disorders that are challenging with regard to diagnosis and clinical management. To study the similarities and differences between these disorders, we undertook a multicenter international study of one of the largest case series (CNL, n = 24; aCML, n = 37 cases, respectively), focusing on the clinical and mutational profiles (n = 53 with molecular data) of these diseases. We found no differences in clinical presentations or outcomes of both entities. As previously described, both CNL and aCML share a complex mutational profile with mutations in genes involved in epigenetic regulation, splicing, and signaling pathways. Apart from CSF3R, only EZH2 and TET2 were differentially mutated between them. The molecular profiles support the notion of CNL and aCML being a continuum of the same disease that may fit best within the myelodysplastic/myeloproliferative neoplasms. We identified 4 high-risk mutated genes, specifically CEBPA (β = 2.26, hazard ratio [HR] = 9.54, P = .003), EZH2 (β = 1.12, HR = 3.062, P = .009), NRAS (β = 1.29, HR = 3.63, P = .048), and U2AF1 (β = 1.75, HR = 5.74, P = .013) using multivariate analysis. Our findings underscore the relevance of molecular-risk classification in CNL/aCML as well as the importance of CSF3R mutations in these diseases.
meth-SemiCancer: a cancer subtype classification framework via semi-supervised learning utilizing DNA methylation profiles
Authors: Choi Joung Min , Park Chaelin , Chae Heejoon
Published: April 2023

Background

Identification of the cancer subtype plays a crucial role to provide an accurate diagnosis and proper treatment to improve the clinical outcomes of patients. Recent studies have shown that DNA methylation is one of the key factors for tumorigenesis and tumor growth, where the DNA methylation signatures have the potential to be utilized as cancer subtype-specific markers. However, due to the high dimensionality and the low number of DNA methylome cancer samples with the subtype information, still, to date, a cancer subtype classification method utilizing DNA methylome datasets has not been proposed.

Results

In this paper, we present meth-SemiCancer, a semi-supervised cancer subtype classification framework based on DNA methylation profiles. The proposed model was first pre-trained based on the methylation datasets with the cancer subtype labels. After that, meth-SemiCancer generated the pseudo-subtypes for the cancer datasets without subtype information based on the model’s prediction. Finally, fine-tuning was performed utilizing both the labeled and unlabeled datasets.

Conclusions

From the performance comparison with the standard machine learning-based classifiers, meth-SemiCancer achieved the highest average F1-score and Matthews correlation coefficient, outperforming other methods. Fine-tuning the model with the unlabeled patient samples by providing the proper pseudo-subtypes, encouraged meth-SemiCancer to generalize better than the supervised neural network-based subtype classification method. meth-SemiCancer is publicly available at https://github.com/cbi-bioinfo/meth-SemiCancer.
Genome-wide identification and molecular characterization of CRK gene family in cucumber (Cucumis sativus L.) under cold stress and sclerotium rolfsii infection
Authors: Nanda Satyabrata , Rout Priyadarshini , Ullah Ikram , Nag Swapna Rani , Reddy Velagala Veerraghava , Kumar Gagan , Kumar Ritesh , He Shuilian , Wu Hongzhi
Published: April 2023

Background

The plant cysteine-rich receptor-like kinases (CRKs) are a large family having multiple roles, including defense responses under both biotic and abiotic stress. However, the CRK family in cucumbers (Cucumis sativus L.) has been explored to a limited extent. In this study, a genome-wide characterization of the CRK family has been performed to investigate the structural and functional attributes of the cucumber CRKs under cold and fungal pathogen stress.

Results

A total of 15 C. sativus CRKs (CsCRKs) have been characterized in the cucumber genome. Chromosome mapping of the CsCRKs revealed that 15 genes are distributed in cucumber chromosomes. Additionally, the gene duplication analysis of the CsCRKs yielded information on their divergence and expansion in cucumbers. Phylogenetic analysis divided the CsCRKs into two clades along with other plant CRKs. Functional predictions of the CsCRKs suggested their role in signaling and defense response in cucumbers. The expression analysis of the CsCRKs by using transcriptome data and via qRT-PCR indicated their involvement in both biotic and abiotic stress responses. Under the cucumber neck rot pathogen, Sclerotium rolfsii infection, multiple CsCRKs exhibited induced expressions at early, late, and both stages. Finally, the protein interaction network prediction results identified some key possible interacting partners of the CsCRKs in regulating cucumber physiological processes.

Conclusions

The results of this study identified and characterized the CRK gene family in cucumbers. Functional predictions and validation via expression analysis confirmed the involvement of the CsCRKs in cucumber defense response, especially against S. rolfsii. Moreover, current findings provide better insights into the cucumber CRKs and their involvement in defense responses.
Researchers in rheumatology should avoid categorization of continuous predictor variables
Authors: Salis Zubeyir , Gallego Blanca , Sainsbury Amanda
Published: April 2023

Background

Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology.

Methods

We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes.

Results

For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association).

Conclusions

Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.
Symptoms and signs of urogenital cancer in primary care
Authors: Holtedahl Knut , Borgquist Lars , Donker Gé A. , Buntinx Frank , Weller David , Campbell Christine , Månsson Jörgen , Hammersley Victoria , Braaten Tonje , Parajuli Ranjan
Published: April 2023

Background

Urogenital cancers are common, accounting for approximately 20% of cancer incidence globally. Cancers belonging to the same organ system often present with similar symptoms, making initial management challenging. In this study, 511 cases of cancer were recorded after the date of consultation among 61,802 randomly selected patients presenting in primary care in six European countries: a subgroup analysis of urogenital cancers was carried out in order to study variation in symptom presentation.

Methods

Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. The general practitioner (GP) provided follow-up data after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients.

Results

The most common symptoms were mainly associated with one or two specific types of cancer: ‘Macroscopic haematuria’ with bladder or renal cancer (combined sensitivity 28.3%), ‘Increased urinary frequency’ with bladder (sensitivity 13.3%) or prostatic (sensitivity 32.1%) cancer, or to uterine body (sensitivity 14.3%) cancer, ‘Unexpected genital bleeding’ with uterine cancer (cervix, sensitivity 20.0%, uterine body, sensitivity 71.4%). ‘Distended abdomen, bloating’ had sensitivity 62.5% (based on eight cases of ovarian cancer). In ovarian cancer, increased abdominal circumference and a palpable tumour also were important diagnostic elements. Specificity for ‘Macroscopic haematuria’ was 99.8% (99.7–99.8). PPV > 3% was noted for ‘Macroscopic haematuria’ and bladder or renal cancer combined, for bladder cancer in male patients. In males aged 55–74, PPV = 7.1% for ‘Macroscopic haematuria’ and bladder cancer. Abdominal pain was an infrequent symptom in urogenital cancers.

Conclusions

Most types of urogenital cancer present with rather specific symptoms. If the GP considers ovarian cancer, increased abdominal circumference should be actively determined. Several cases were clarified through the GP’s clinical examination, or laboratory investigations.
A case of septic shock due to delayed diagnosis of Cryptosporidium infection after liver transplantation
Authors: Tie Xin , Zhang Zhongwei , Zhou Ran , Li Yi , Xu Jinmei , Yin Wanhong
Published: April 2023

Background

Cryptosporidium is recognized as a significant pathogen of diarrhea disease in immunocompromised hosts, and studies have shown that Cryptosporidium infection is high in solid organ transplantation (SOT) patients and often has serious consequences. Because of the lack of specificity of diarrheasymptoms cased by Cryptosporidium infection, it is rarely reported in patients undergoing liver transplantation (LT). It frequently delays diagnosis, coming with severe consequences. In clinical work, diagnosing Cryptosporidium infection in LT patients is also complex but single, and the corresponding anti-infective treatment regimen has not yet been standardized. A rare case of septic shock due to a delayed diagnosis of Cryptosporidium infection after LT and relevant literature are discussed in the passage.

Case presentation

A patient who had received LT for two years was admitted to the hospital with diarrhea more than 20 days after eating an unclean diet. After failing treatment at a local hospital, he was admitted to Intensive Care Unit after going into septic shock. The patient presented hypovolemia due to diarrhea, which progressed to septic shock. The patient's sepsis shock was controlled after receiving multiple antibiotic combinations and fluid resuscitation. However, the persistent diarrhea, as the culprit of the patient's electrolyte disturbance, hypovolemia, and malnutrition, was unsolved. The causative agent of diarrhea, Cryptosporidium infection, was identified by colonoscopy, faecal antacid staining, and blood high-throughput sequencing (NGS). The patient was treated by reducing immunosuppression and Nitazoxanide (NTZ), which proved effective in this case.

Conclusion

When LT patients present with diarrhea, clinicians should consider the possibility of Cryptosporidium infection, in addition to screening for conventional pathogens. Tests such as colonoscopy, stool antacid staining and blood NGS sequencing can help diagnose and treat of Cryptosporidium infection early and avoid serious consequences of delayed diagnosis. In treating Cryptosporidium infection in LT patients, the focus should be on the patient's immunosuppressive therapy, striking a balance between anti-immunorejection and anti-infection should be sought. Based on practical experience, NTZ therapy in combination with controlled CD4 + T cells at 100–300/mm3 was highly effective against Cryptosporidium without inducing immunorejection.
Cutaneous Mycobacterium szulgai infection in a patient with Cushing's syndrome: a case report and literature review
Authors: Ye Haiyan , Harris Vanessa C. , Chiu Kelvin Hei-Yeung , Chen Shuang , Xing Fanfan , Sun Linlin , Deng Chaowen , Yang Jin , Chan Jasper Fuk-Woo , Yuen Kwok-Yung
Published: April 2023

Background

Opportunistic infection is an under-recognized complication of Cushing’s syndrome, with infection due to atypical mycobacterium rarely reported. Mycobacterium szulgai commonly presents as pulmonary infection, with cutaneous infection seldom reported in the literature.

Case Presentation

48-year-old man with a newly-diagnosed Cushing’s syndrome secondary to adrenal adenoma presented with a subcutaneous mass on the dorsum of his right hand, was diagnosed with cutaneous Mycobacterium szulgai infection. The most likely source of the infection was through minor unnoticed trauma and inoculation from a foreign body. The patient’s Cushing’s syndrome, high serum cortisol levels and secondary immune suppression facilitated mycobacterial replication and infection. The patient was successfully treated with adrenalectomy, surgical debridement of cutaneous lesion, and a combination of rifampicin, levofloxacin, clarithromycin, and ethambutol for 6 months. There were no signs of relapse one year after cessation of anti-mycobacterial treatment. A literature review on cutaneous M. szulgai infection to further characterize the clinical characteristics of this condition, identified 17 cases of cutaneous M. szulgai infection in the English literature. Cutaneous M. szulgai infections with subsequent disease dissemination are commonly reported in immunocompromised hosts (10/17, 58.8%), as well as in immunocompetent patients with a history of breached skin integrity, such as invasive medical procedures or trauma. The right upper extremity is the most commonly involved site. Cutaneous M. szulgai infection is well controlled with a combination of anti-mycobacterial therapy and surgical debridement. Disseminated infections required a longer duration of therapy than localized cutaneous infections. Surgical debridement may shorten the duration of antibiotics.

Conclusions

Cutaneous M. szulgai infection is a rare complication of adrenal Cushing’s syndrome. Further studies are needed to provide evidence-based guidelines on the best combination of anti-mycobacterial and surgical therapy for managing this rare infective complication.
Ischaemic stroke with multi-focal venous and arterial thrombosis due to hyperhomocysteinemia: anabolic androgenic steroid use and MTHFR c.667 C > T variant – a case report
Authors: Chen JPK , Rees A , Coughlan CH , Goodison W , Murphy E , Chandratheva A
Published: April 2023

Background

Severely elevated serum homocysteine is a rare cause of ischaemic stroke and extra-cranial arterial and venous thrombosis. Several factors can lead to mild elevation of homocysteine including dietary folate and B12 deficiency, and genetic variants of the methylenetetrahydrofolate reductase (MTHFR) enzyme. The use of Anabolic androgenic steroid (AAS) is under-reported, but increasingly linked to ischaemic stroke and can raise homocysteine levels.

Case Report

We present a case of a man in his 40s with a large left middle cerebral artery (MCA) territory ischaemic stroke and combined multifocal, extracranial venous, and arterial thrombosis. His past medical history was significant for Crohn’s disease and covert use of AAS. A young stroke screen was negative except for a severely elevated total homocysteine concentration, folate and B12 deficiencies. Further tests revealed he was homozygous for the methylenetetrahydrofolate reductase enzyme thermolabile variant (MTHFR c.667 C > T). The etiology of this stroke was a hypercoagulable state induced by raised plasma homocysteine. Raised homocysteine in this case was likely multifactorial and related to chronic AAS use in combination with the homozygousMTHFR c.677 C > Tthermolabile variant, folate deficiency and, vitamin B12 deficiency.

Conclusion

In summary, hyperhomocysteinemia is an important potential cause of ischaemic stroke and may result from genetic, dietary, and social factors. Anabolic androgenic steroid use is an important risk factor for clinicians to consider, particularly in cases of young stroke with elevated serum homocysteine. Testing forMFTHRvariants in stroke patients with raised homocysteine may be useful to guide secondary stroke prevention through adequate vitamin supplementation. Further studies looking into primary and secondary stroke prevention in the high-risk MTHFR variant cohort are necessary.
Transnational prenatal care among migrant women from low-and-middle-income countries who gave birth in Montreal, Canada
Authors: Merry Lisa , Kim Ye Na , Urquia Marcelo L. , Goulet Julie , Villadsen Sarah Fredsted , Gagnon Anita
Published: April 2023

Objectives

There is little research examining transnational prenatal care (TPC) (i.e., prenatal care in more than one country) among migrant women. Using data from the Migrant-Friendly Maternity Care (MFMC) - Montreal project, we aimed to: (1) Estimate the prevalence of TPC, including TPC-arrived during pregnancy and TPC-arrived pre-pregnancy, among recently-arrived migrant women from low- and middle-income countries (LMICs) who gave birth in Montreal, Canada; (2) Describe and compare the socio-demographic, migration and health profiles and perceptions of care during pregnancy in Canada between these two groups and migrant women who received no TPC (i.e., only received prenatal care in Canada); and (3) Identify predictors of TPC-arrived pre-pregnancy vs. No-TPC.

Methods

The MFMC study used a cross-sectional design. Data were gathered from recently-arrived (< 8 years) migrant women from LMICs via medical record review and interview-administration of the MFMC questionnaire postpartum during the period of March 2014-January 2015 in three hospitals, and February-June 2015 in one hospital. We conducted a secondary analysis (n = 2595 women); descriptive analyses (objectives 1 & 2) and multivariable logistic regression (objective 3).

Results

Ten percent of women received TPC; 6% arrived during pregnancy and 4% were in Canada pre-pregnancy. The women who received TPC and arrived during pregnancy were disadvantaged compared to women in the other two groups (TPC-arrived pre-pregnancy and No-TPC women), in terms of income level, migration status, French and English language abilities, access barriers to care and healthcare coverage. However, they also had a higher proportion of economic migrants and they were generally healthier compared to No-TPC women. Predictors of TPC-arrived pre-pregnancy included: ‘Not living with the father of the baby’ (AOR = 4.8, 95%CI 2.4, 9.8), ‘having negative perceptions of pregnancy care in Canada (general experiences)’ (AOR = 1.2, 95%CI 1.1, 1.3) and younger maternal age (AOR = 1.1, 95%CI 1.0, 1.1).

Conclusion

Women with more capacity may self-select to migrate during pregnancy which results in TPC; these women, however, are disadvantaged upon arrival, and may need additional care. Already-migrated women may use TPC due to a need for family and social support and/or because they prefer the healthcare in their home country.
Unusual presentation of a case of fetal hepatic mass: a case report
Authors: Liu Dongmei , Yu Jiali , Yang Yang , Ouyang Minzhi , Zhang Ming , Zeng Shi , Xu Ganqiong
Published: April 2023

Background

Giant hepatic hemangiomas are rare and can cause serious complications that contribute to a high risk of perinatal mortality. The purpose of this article is to review the prenatal imaging features, treatment, pathology, and prognosis of an atypical fetal giant hepatic hemangioma and to discuss the differential diagnosis of fetal hepatic masses.

Case presentation

A gravida 9, para 0 woman at 32 gestational weeks came to our institution for prenatal ultrasound diagnosis. A complex, heterogeneous hepatic mass measuring 5.2 × 4.1 × 3.7 cm was discovered in the fetus using conventional two-dimensional ultrasound. The mass was solid and had both a high peak systolic velocity (PSV) of the feeding artery and intratumoral venous flow. Fetal magnetic resonance imaging (MRI) revealed a clear, hypointense T1-W and hyperintense T2-W solid hepatic mass. Prenatal diagnosis was very difficult due to the overlap of benign and malignant imaging features on prenatal ultrasound and MRI. Even postnatally, neither contrast-enhanced MRI nor contrast-enhanced computed tomography (CT) was useful in accurately diagnosing this hepatic mass. Due to persistently elevated Alpha-fetoprotein (AFP), a laparotomy was performed. Histopathological examination of the mass showed atypical features such as hepatic sinus dilation, hyperemia, and hepatic chordal hyperplasia. The patient was ultimately diagnosed with a giant hemangioma, and the prognosis was satisfactory.

Conclusions

When a hepatic vascular mass is found in a third trimester fetus a hemangioma should be considered as a possible diagnosis. However, prenatal diagnosis of fetal hepatic hemangiomas can be challenging due to atypical histopathological findings. Imaging and histopathological assays can provide useful information for the diagnosis and treatment of fetal hepatic masses.