bluuebunny/crossref_metadata_2025 huggingface dataset:
Real world clinical outcomes of treatment of cannabis-induced psychosis and prevalence of cannabis-related primary psychosis: a retrospective study
Authors: Chuenchom Onrumpha , Suansanae Thanarat , Lukanapichonchut Lumsum , Suwanmajo Somporn , Suthisisang Chuthamanee
Published: September 2024

Background

Current treatment of cannabis-induced psychosis (CIP) focus on the presenting symptoms of individual patient. Therefore, the objective of this study was to investigate the efficacy of pharmacological treatment for CIP in a retrospective manner.

Methods

A retrospective chart review study was conducted at the Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT), Thailand. Patients aged more than 12 years who met the International Classification of Disease-10 (ICD-10) criteria of CIP, had recorded of cannabis use in medical chart, and had positive urine test of cannabis on the first day of admission from October 2013 to September 2019 were enrolled. The primary outcome was the efficacy of pharmacological treatment of CIP. Brief Psychotic Rating Scale (BPRS) on the first day and weekly after receiving treatment were used to assess the primary outcome.

Results

Four hundred and three medical charts with diagnosis of CIP were enrolled into the study and only 317 charts were analyzed. Most of them were male with an average aged of 21.0 (19.0–24.0) years old. All of them used smoked cannabis from dried leaves and flowers of cannabis plant. The presented symptoms on admission were psychosis, mood symptoms, sleep problems, weight loss, and cognitive problems (100%, 64%, 61%, 11%, and 7%, respectively). Baseline BPRS score of the first day of admission was 55.2 ± 9.6. Majority of patients received antipsychotic (98.7%) followed by the combination of antipsychotics with benzodiazepines (34.5.%), antipsychotics with antidepressants (14.4%) and antipsychotics treatment with antidepressants and benzodiazepines (25.9%). Only few patients received antipsychotic monotherapy (17.9%). Risperidone was the most frequently prescribed antipsychotics (83.6%). Mean equivalence dose of risperidone was 8.0 ± 5.9 mg/day. The average hospital length of stay was 28 days (range 22-31). BPRS at 22 days significantly improved compared to the first day of admission (p < 0.001). Schizophrenia was diagnosed in 7% at 1.3 years of follow up.

Conclusion

Antipsychotics was still a key psychotropic drug for treatment of CIP. The symptoms were decreased rapidly and sustained among the treatment period. However, antidepressants and benzodiazepines were commonly used for treatment of other symptoms beyond psychosis.

Trial registration

ClinicalTrials.gov ID: NCT04945031 (Registration Date: 30 June, 2021).
A study on the development of a fitness age prediction model: the national fitness award cohort study 2017–2021
Authors: Yoon Dong Hyun , Kim Jeong-Hyun , Lee Shi-Uk
Published: September 2024

Background

Physical fitness is considered an important indicator of the health of the general public. In particular, the physical fitness of the older adults is an important requirement for determining the possibility of independent living. Therefore, the purpose of this study was to examine the association between chronological age and physical fitness variables in the National Fitness Award Cohort study data and to develop multiple linear regression analyses to predict fitness age using dependent variables.

Methods

Data from 501,774 (359,303 adults, 142,471 older adults) individuals who participated in the Korea National Fitness Award Cohort Study from 2017 to 2021 were used. The physical fitness tests consisted of 5 candidate markers for adults and 6 candidate markers for the older adults to measure muscle strength, muscle endurance, cardiopulmonary endurance, flexibility, balance, and agility. Pearson’s correlation and stepwise regression analyses were used to analyze the data.

Results

We obtained a predicted individual fitness age values from physical fitness indicators for adults and older adults individuals, and the mean explanatory power of the fitness age for adults was [100.882 – (0.029 × VO2max) – (1.171 × Relative Grip Strength) – (0.032 × Sit-up) + (0.032 × Sit and reach) + (0.769 × Sex male = 1; female = 2)] was 93.6% (adjusted R2); additionally, the fitness age for older adults individuals was [79.807 – (0.017 × 2-min step test) – (0.203 × Grip Strength) – (0.031 × 30-s chair stand) – (0.052 × Sit and reach) + (0.985 × TUG) – (3.468 × Sex male = 1; female = 2) was 24.3% (adjusted R2).

Conclusions

We suggest the use of fitness age as a valid indicator of fitness in adults and older adults as well as a useful motivational tool for undertaking exercise prescription programs along with exercise recommendations at the national level.
Using best-worst scaling to inform policy decisions in Africa: a literature review
Authors: Beres Laura K. , Campoamor Nicola B. , Hawthorn Rachael , Mugambi Melissa L. , Mulabe Musunge , Vhlakis Natlie , Kabongo Michael , Schuster Anne , Bridges John F. P.
Published: September 2024

Background

Stakeholder engagement in policy decision-making is critical to inform required trade-offs, especially in low-and-middle income settings, such as many African countries. Discrete-choice experiments are now commonly used to engage stakeholders in policy decisions, but other methods such as best-worst scaling (BWS), a theory-driven prioritization technique, could be equally important. We sought to document and explore applications of BWS to assess stakeholder priorities in the African context to bring attention to BWS as a method and to assess how and why it is being used to inform policy.

Methods

We conducted a literature review of published applications of BWS for prioritization in Africa.

Results

Our study identified 35 studies, with the majority published in the past four years. BWS has most commonly been used in agriculture (43%) and health (34%), although its broad applicability is demonstrated through use in fields influencing social and economic determinants of health, including business, environment, and transportation. Published studies from eastern, western, southern, and northern Africa include a broad range of sample sizes, design choices, and analytical approaches. Most studies are of high quality and high policy relevance. Several studies cited benefits of using BWS, with many of those citing potential limitations rather than observed limitations in their study.

Conclusions

Growing use of the method across the African continent demonstrates its feasibility and utility, recommending it for consideration among researchers, program implementers, policy makers, and funders when conducting preference research to influence policy and improve health systems.

Registration

The review was registered on PROSPERO (CRD42020209745).
Examining changes in pain interference via pandemic-induced isolation among patients receiving medication for opioid use disorder: a secondary data analysis
Authors: Frohe Tessa , Janssen Tim , Garner Bryan R. , Becker Sara J.
Published: September 2024

Background

Early in the pandemic, the United States population experienced a sharp rise in the prevalence rates of opioid use, social isolation, and pain interference. Given the high rates of pain reported by patients on medication for opioid use disorder (MOUD), the pandemic presented a unique opportunity to disentangle the relationship between opioid use, pain, and social isolation in this high-risk population. We tested the hypothesis that pandemic-induced isolation would partially mediate change in pain interference levels experienced by patients on MOUD, even when controlling for baseline opioid use. Such work can inform the development of targeted interventions for a vulnerable, underserved population.

Methods

Analyses used data from a cluster randomized trial (N = 188) of patients on MOUD across eight opioid treatment programs. As part of the parent trial, participants provided pre-pandemic data on pain interference, opioid use, and socio-demographic variables. Research staff re-contacted participants between May and June 2020 and 133 participants (71% response rate) consented to complete a supplemental survey that assessed pandemic-induced isolation. Participants then completed a follow-up interview during the pandemic that again assessed pain interference and opioid use. A path model assessed whether pre-pandemic pain interference had an indirect effect on pain interference during the pandemic via pandemic-induced isolation.

Results

Consistent with hypotheses, we found evidence that pandemic-induced isolation partially mediated change in pain interference levels among MOUD patients during the pandemic. Higher levels of pre-pandemic pain interference and opioid use were both significantly associated with higher levels of pandemic-induced isolation. In addition, pre-pandemic pain interference was significantly related to levels of pain interference during the pandemic, and these pain levels were partially explained by the level of pandemic-induced isolation reported.

Conclusions

Patients on MOUD with higher use of opioids and higher rates of pain pre-pandemic were more likely to report feeling isolated during COVID-related social distancing and this, in turn, partially explained changes in levels of pain interference. These results highlight social isolation as a key risk factor for patients on MOUD and suggest that interventions promoting social connection could be associated with reduced pain interference, which in turn could improve patient quality of life.

Trial registration

NCT03931174 (Registered 04/30/2019).
Effect of a smartphone-based physical intervention on depression, fitness factors and movement characteristics in adults
Authors: Kim Hyungsook , O’Sullivan David Michael
Published: September 2024

Background

Physical activity has been shown to correlate with mental health and a reduction in symptoms of depression. However, the majority of research has focused only on the effects of either aerobic or nonaerobic exercise on depressive symptoms, while the use of novel technological innovations such as mobile phone-based activity programs and their effects on movement characteristics are underrepresented. This study had two objectives: (1) to investigate how effectively 4 weeks of mobile phone-based physical activity can affect depressive scores (CES-10-D and PHQ) and fitness levels and (2) to investigate the whether 4 weeks of mobile phone-based physical activity affected participants’ movement characteristics.

Methods

A total of 31 participants were included and divided into an exercise group (n = 21) and a control group (n = 10). The exercise group was instructed to use a mobile phone-based exercise program 5 times per week for 4 weeks. Pre- and post-exercise, the participants’ depression score (CES-10-D, PHQ9), fitness level (YMCA, grip strength) and movement characteristics (postural sway, movement ROM, movement speeds, etc.) for three Azure Kinect physical activity games based on different fitness factors (balance game, cardiovascular game, reaction game) were measured.

Results

Mixed model ANOVA revealed significant differences between pre- and post-intervention depression scores on the PHQ9 (P = .001) and CES-10-D (P < .001) in both the exercise group and the control group, but not between groups. In terms of movement characteristics, there was an increase in body sway (P = .045) and vertical head movement (P = .02) in the cardiovascular game jogging condition for the exercise group. In the reaction game, the exercise group showed a significant reduction in the number of mistakes (P = .03). There were no other significant differences for the other variables.

Conclusion

The results revealed no differences in the reduction in depression scores between the exercise group and the control group. However, this study showed that a mobile phone-based physical activity intervention affects in-game movement characteristics such as body sway and vertical head movement and therefore may show the potential of using activity-promoting mobile games for improving movement.
An intervention to determine the effectiveness of the Sanubari optimal health program (OHP) in improving mental well-being among junior doctors in Malaysia: a quasi-experimental study
Authors: Abd Razak Mohamad Aznuddin , Silim Umi Adzlin , Suhaimi Aida Farhana , Ramly Siti Salwa , Ismail Nurul Nadia , Mohd Salleh Adlin , Mohamad Aina Waheeda
Published: September 2024

Background

Mental health problems among junior doctors in Malaysia pose a significant concern, as they not only adversely affect their overall well-being but also impact the quality of health services they provide. Therefore, it is important to implement interventions aimed at preserving their mental health. This study aimed to evaluate the effectiveness of the Sanubari Optimal Health Program (OHP) intervention in enhancing the mental well-being of junior doctors in Malaysia.

Methods

The study utilised a quasi-experimental design involving 204 junior doctors who participated in the intervention. The Sanubari OHP Intervention Package was employed alongside self-administered questionnaires for mental health and well-being assessment. To evaluate the effects over time, repeated measures ANOVA was employed to analyse within-group and between-group changes in various endpoints, as measured at different assessment time points.

Results

The study revealed that self-efficacy and adaptive coping behaviours scores increased over time among the intervention group and decreased among the control group. Yet, depression and anxiety scores decreased significantly over time among the intervention group but not in the control group. No significant differences were observed in well-being and maladaptive coping strategies among the groups.

Conclusions

This study showed promising results regarding the effectiveness of Sanubari OHP in improving mental well-being among junior doctors.
Purchasing medicines and functional foods on the internet: a cross-sectional study investigating the knowledge, attitudes, and experience of Vietnamese people in 2023
Authors: Doan Dung Anh , Vu Nhung Hong , Nguyen Phuong Lan , Nguyen An Duc , Dinh Dai Xuan
Published: September 2024

Objective

To investigate Vietnamese people’s knowledge, attitudes, and experience in purchasing medicines and functional foods online.

Methods

Via an online survey, the data of 1,070 participants were collected, including their general characteristics, Internet use, previous experience, knowledge, and attitudes towards purchasing medicines/functional foods online. Factors associated with their knowledge and attitudes were identified via multivariate linear regression models.

Results

During 2022–2023, about 97.2% of participants used the Internet to seek health information (self-diagnosis: 65.0%, self-medication: 72.6%). Roughly 52.8% bought medicines and/or functional foods online. Among 565 buyers, 41.8% felt satisfied. Only 19.9% understood that selling medicines online was illegal in Vietnam. The main benefits of purchasing medicines/functional foods online that many people agreed on included convenience (87.1%), freedom from location (84.8%), and being able to order/buy products after opening hours (84.7%). Many people felt worried about the ability to buy counterfeit or substandard products (87.7%), inaccurate product information (85.0%), the lack of supervision of the authorities (83.7%), and increasing risks of drug abuse, self-medication, and treatment non-adherence (82.5%). Roughly 84.3% found distinguishing between legal and illegal online pharmacies difficult. Participants’ average knowledge and attitude scores were 6.514 ± 2.461 (range: 0–16) and 89.330 ± 13.720 (range: 23–115), respectively. The main factors associated with people’s knowledge and attitudes towards purchasing these products online included their frequency of Internet use, seeking health information online for self-medication, feeling satisfied with previous experience, and having at least one chronic disease.

Conclusions

Many Vietnamese people’s knowledge about purchasing medicines/functional foods online was limited. With the increasing need for online shopping, enhancing their knowledge is paramount. In the forthcoming years, when the Ministry of Health and relevant authorities publish legal documents and enact laws involving online pharmacies and trading medicines on the Internet, ways to recognize licensed online pharmacies must be widely propagated and disseminated in the community.
The prevalence of occupational injuries and associated risk factors among workers in iron and steel industries: a systematic review and meta-analysis
Authors: Shabani Saumu , Bachwenkizi Jovine , Mamuya Simon Henry , Moen Bente Elisabeth
Published: September 2024

Background

The iron and steel industries are among the most dangerous workplaces in the world compared to other manufacturing industries. Workers are exposed to multiple occupational hazards, which predispose them to high risks of both fatal and non-fatal injuries. Currently, the data on the global prevalence and associated risk factors for occupational injuries in the iron and steel industries is fragmented and incomplete. This study was undertaken to address this issue by pooling data relating to the prevalence of occupational injuries and its associated factors among workers in iron and steel industries studies around the world.

Methods

The search was conducted systematically using PubMed, HINARI, EMBASE and Google Scholar for published studies in English that reported on occupational injuries and associated risk factors among workers in iron and steel industries. MetaXL version 5.3 software was used in the meta-analysis to estimate the pooled prevalence of occupational injuries and associated risk factors among workers in the iron and steel industries. The study protocol has been registered with PROSPERO, number CRD42022344258.

Results

Of the 447 articles identified, 15 studies from 9 countries met the inclusion criteria. The pooled prevalence estimate of occupational injury was 0.55 (95% CI: 0.15, 0.93). The pooled results indicated that the odds of having an occupational injury were 4.06 times higher among workers who did not use personal protective equipment compared to those who used such equipment. Likewise the odds of occupational injuries was increased by 1.65 among night shift workers compared to the counterpart.

Conclusions

The global prevalence of occupational injuries in iron and steel industries was 55%. The results indicate that night work shift and the lack of use of personal protective equipment has a higher impact than other factors in the occurrence of occupational injuries in the iron and steel industries.
Systematic design and evaluation of aptamers for VEGF and PlGF biomarkers of Preeclampsia
Authors: Mallawarachchi Samavath , Cebecioglu Rümeysa E. , Althumayri Majed , Beker Levent , Fernando Sandun , Ceylan Koydemir Hatice
Published: September 2024

Preeclampsia is a potentially life-threatening condition for both mother and baby, characterized by hypertension and potential organ damage. Early diagnosis is crucial to mitigate its adverse health effects. Traditional diagnostic methods, which focus on late-manifesting symptoms like hypertension and proteinuria, underscore the need for molecular diagnostic approaches for timely detection. This study successfully designs and evaluates novel aptamers with high specificity and affinity for Vascular Endothelial Growth Factor (VEGF) and Placental Growth Factor (PlGF), biomarkers closely associated with preeclampsia. Using molecular docking, molecular dynamics simulations, and BioLayer Interferometry (BLI), we identified aptamers that demonstrated strong binding affinities, comparable or superior to traditional antibodies. Our findings suggest that these aptamers have the potential to be integrated into cost-effective, point-of-care diagnostic tools, significantly improving early detection and intervention strategies for preeclampsia. The robust performance of these aptamers marks a pivotal step toward the development of more reliable and accessible diagnostic solutions, with implications for better maternal and fetal health outcomes.
Barriers to correct pronoun usage in healthcare settings
Authors: Makara Jodie , Cain Roman , Glock Lucas , Ioerger Michael , Holliday Scott
Published: September 2024

Background

Using correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this.

Objective

This study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients’ correct pronouns.

Methods

A 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients’ correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology.

Results

Of 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions.

Conclusion

The study identifies important barriers to medical professionals correctly using TGNB patients’ pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns.
Coding rules for uncertain and “ruled out” diagnoses in ICD-10 and ICD-11
Authors: Atolagbe Oluseun O. , Romano Patrick S. , Southern Danielle A. , Wongtanasarasin Wachira , Ghali William A.
Published: September 2024

The International Classification of Diseases, 11th Revision (ICD-11) has significantly improved the ability to navigate coding challenges beyond prior iterations of the ICD. Commonly encountered sources of complexity in clinical documentation include coding of uncertain and “ruled out” diagnoses. Assessing official international guidelines and rules, this paper documents extensive variation across countries in existing practices for coding and reporting unconfirmed and “ruled out” clinical concepts in ICD-10 (and modifications thereof). The design of ICD-11 is intended to mitigate these coding challenges by introducing postcoordination, expanding the range of codable clinical concepts, and offering clearer guidance in the ICD-11 Reference Guide. ICD-11 offers substantial progress towards more precise capture of uncertain and “ruled out” diagnoses, including international consensus on coding rules for these historically challenging clinical concepts. However, we identify the need for further clarification of the concepts of “provisional diagnosis” and “differential diagnosis.”
Seeking the aim – perspectives of asylum seekers, nurses, and authorities on the objectives of the asylum seekers’ initial health assessment: a qualitative study
Authors: Mustonen K-L , Ismail M. , Mäki-Opas T. , Castaneda A.E. , Kauhanen J. , Atkins S. , Skogberg N.
Published: September 2024

Background

A voluntary and free initial health assessment is offered to all asylum seekers upon arrival in Finland. The central aim of this initial health assessment is early identification of service needs. There is, however, limited information on how effective the initial assessment is in fulfilling its aims. This study explores the viewpoints of asylum seekers, reception centre nurses, and health authorities regarding the objectives of the initial health assessment. It serves as a starting point for effectiveness research, where effectiveness is defined as the achievement of intended aims.

Methods

This qualitative descriptive study is based on 31 semi-structured individual interviews (13 asylum seekers, 14 nurses, and four asylum health authorities) conducted in January and February 2019. Reflective thematic analysis was employed for data analysis, involving initial separate analyses for each group, followed by an assessment of differences and similarities between the groups.

Results

The importance of a comprehensive initial health assessment and preventing infections was emphasized by all groups. The main differences were views on service needs assessment in relation to persons in vulnerable situation and information provision. All groups described both individual and public health perspectives.

Conclusions

This study provides valuable insights for developing a more effective assessment. Asylum seekers require comprehensive health assessment and details about their rights. To address these needs, it is crucial to update reception centre nurses’ practices. Additionally, authorities responsible for planning and guiding services should refine their instructions concerning the information provided to asylum seekers and persons in vulnerable situations. The findings of this study can be used to enhance information provision and develop targeted training programs for nurses, as well as to evaluate the achievement of established aims.
What influences the use of HR analytics in Human Resource management in Norwegian municipal health care services?
Authors: Anthun Kirsti Sarheim , Anthun Kjartan Sarheim , Håland Erna , Lillefjell Monica
Published: September 2024

Background

The centrality of human resources in the provision of healthcare suggests that Human Resource (HR) management and the use of Human Resource analytics – use of digital data to better understand, assess, plan and organize the workforce - can play an important role in this. However, data driven decision making in the field of human resource management is lagging, and the appropriation of HR analytics in the healthcare sector is limited.

Aim

The current study explores the role of HR departments and the adoption of Human Resource analytics in four municipalities in Norway to obtain insights into what influences the use or lack of use of HR analytics.

Methods

Empirical data were generated through qualitative interviews with fourteen individuals working in HR departments, the municipal administration, and the healthcare services. Structurational theory guided the analysis. The findings show that none of the municipalities made extensive use of data to inform decision making related to human resource management or workforce planning.

Results and conclusion

Three conditions hampered or made irrelevant the use of HR analytics: a decoupling between the services and HR, a weak data-culture, and HR and decision-making processes involving a plurality of stakeholders. However, there were changes underway in all municipalities related to the role of HR and HR analytics.
Qualitative perspectives of Medicaid-insured patients on ambulatory care at an academic medical center: challenges and opportunities
Authors: Blegen Mariah B. , Faiz Jessica , Gonzalez Daniel , Nuñez Vanessa , Harawa Nina , Briggs-Malonson Medell , Ryan Gery , Kahn Katherine L.
Published: September 2024

Background

Ambulatory access to academic medical centers (AMCs) for patients insured with Medi-Cal (i.e., Medicaid in California) is understudied, particularly among the 85% of beneficiaries enrolled in managed care plans. As more AMCs develop partnerships with these plans, data on patient experiences of access to care and quality are needed to guide patient-centered improvements in care delivery.

Methods

The authors conducted semi-structured, qualitative interviews with Medi-Cal-insured patients with initial visits at a large, urban AMC during 2022. Participant recruitment was informed by a database of ambulatory Medi-Cal encounters. The interview guide covered Medi-Cal enrollment, scheduling, and visit experience. Interviews were transcribed and inductively coded, then organized into themes across four domains: access, affordability, patient-provider interactions, and continuity.

Results

Twenty participant interviews were completed (55% female, 85% English speaking, 80% self-identified minority or “other” race, and 30% Hispanic or Latino) with primary and/or specialty care visits. Within the access domain, participants reported delays with Medi-Cal enrollment and access to specialist care or testing, though appointment scheduling was reported to be easy. Affordability concerns included out-of-pocket medical and parking costs, and missed income when patients or families skipped work to facilitate care coordination. Participants considered clear, bilateral communication with providers fundamental to positive patient-provider interactions. Some participants perceived discrimination by providers based on their insurance status. Participants valued continuity, but experienced frustration arising from frequent and unexpected health plan changes that disrupted care with their established AMC providers.

Conclusions

The missions of AMCs typically focus on clinical care, education, research, and equity. However, reports from Medi-Cal insured patients receiving care at AMCs highlight their stress and confusion related to inconsistent provider access, uncompensated costs, variability in perceptions of quality, and fragmented care. Recommendations based upon patient-reported concerns suggest opportunities for AMC health system-level improvements that are compatible with AMC missions.
Blood-based DNA methylation and exposure risk scores predict PTSD with high accuracy in military and civilian cohorts
Authors: Wani Agaz H. , Katrinli Seyma , Zhao Xiang , Daskalakis Nikolaos P. , Zannas Anthony S. , Aiello Allison E. , Baker Dewleen G. , Boks Marco P. , Brick Leslie A. , Chen Chia-Yen , Dalvie Shareefa , Fortier Catherine , Geuze Elbert , Hayes Jasmeet P. , Kessler Ronald C. , King Anthony P. , Koen Nastassja , Liberzon Israel , Lori Adriana , Luykx Jurjen J. , Maihofer Adam X. , Milberg William , Miller Mark W. , Mufford Mary S. , Nugent Nicole R. , Rauch Sheila , Ressler Kerry J. , Risbrough Victoria B. , Rutten Bart P. F. , Stein Dan J. , Stein Murray B. , Ursano Robert J. , Verfaellie Mieke H. , Vermetten Eric , Vinkers Christiaan H. , Ware Erin B. , Wildman Derek E. , Wolf Erika J. , Nievergelt Caroline M. , Logue Mark W. , Smith Alicia K. , Uddin Monica
Published: September 2024

Background

Incorporating genomic data into risk prediction has become an increasingly popular approach for rapid identification of individuals most at risk for complex disorders such as PTSD. Our goal was to develop and validate Methylation Risk Scores (MRS) using machine learning to distinguish individuals who have PTSD from those who do not.

Methods

Elastic Net was used to develop three risk score models using a discovery dataset (n = 1226; 314 cases, 912 controls) comprised of 5 diverse cohorts with available blood-derived DNA methylation (DNAm) measured on the Illumina Epic BeadChip. The first risk score, exposure and methylation risk score (eMRS) used cumulative and childhood trauma exposure and DNAm variables; the second, methylation-only risk score (MoRS) was based solely on DNAm data; the third, methylation-only risk scores with adjusted exposure variables (MoRSAE) utilized DNAm data adjusted for the two exposure variables. The potential of these risk scores to predict future PTSD based on pre-deployment data was also assessed. External validation of risk scores was conducted in four independent cohorts.

Results

The eMRS model showed the highest accuracy (92%), precision (91%), recall (87%), and f1-score (89%) in classifying PTSD using 3730 features. While still highly accurate, the MoRS (accuracy = 89%) using 3728 features and MoRSAE (accuracy = 84%) using 4150 features showed a decline in classification power. eMRS significantly predicted PTSD in one of the four independent cohorts, the BEAR cohort (beta = 0.6839, p=0.006), but not in the remaining three cohorts. Pre-deployment risk scores from all models (eMRS, beta = 1.92; MoRS, beta = 1.99 and MoRSAE, beta = 1.77) displayed a significant (p < 0.001) predictive power for post-deployment PTSD.

Conclusion

The inclusion of exposure variables adds to the predictive power of MRS. Classification-based MRS may be useful in predicting risk of future PTSD in populations with anticipated trauma exposure. As more data become available, including additional molecular, environmental, and psychosocial factors in these scores may enhance their accuracy in predicting PTSD and, relatedly, improve their performance in independent cohorts.
Cardiac thrombus in acute ischemic stroke: impact on endovascular thrombectomy utilization
Authors: Ali Zafar , Khan Abdul Wali , Shatla Islam , Mufarrih Sayyeda Aleena , Talluri Rithvik , Asif Talal
Published: September 2024

Cardiac embolism plays a very significant role in acute ischemic strokes (AIS), constituting approximately one-third of cases. The origin of these emboli often stems from intracardiac thrombi in the left atrium or left ventricle. Utilizing the National Readmission Database from 2016 to 2019, we investigate the prevalence of cardiac thrombi in AIS patients and explore their potential correlation with endovascular thrombectomy (EVT) utilization, and mortality rates. Among 1,272,456 AIS patients, 0.6% had concurrent cardiac thrombus, with an increasing trend observed over the study period (P value < 0.001). The cardiac thrombus cohort showed a higher prevalence of comorbidities such as congestive heart failure and atrial fibrillation. After propensity-score matching, groups were well-balanced in terms of baseline characteristics. Patients within the cardiac thrombus cohort experienced a longer hospital stay (median 5 days vs. 3 days), but no significant difference in mortality was noted. Importantly, the cardiac thrombus cohort demonstrated a higher frequency of EVT utilization, suggesting a link to larger vessel occlusions. Despite matching based on atrial fibrillation, the EVT utilization in the cardiac thrombus cohort remained high, highlighting a significant association. While 30-day readmission rates were comparable, cardiac thrombus patients faced a higher risk of gastrointestinal bleeding and hemorrhagic stroke, likely attributed to anticoagulation use. Limitations include potential miscoding in the administrative database and a lack of detailed imaging findings. In conclusion, this study highlights the increased likelihood of EVT in AIS patients with cardiac thrombus, possibly indicative of larger vessel occlusion associated with cardiac thrombus.
Shank3 deficiency alters midbrain GABAergic neuron morphology, GABAergic markers and synaptic activity in primary striatal neurons
Authors: Bačová Zuzana , Jurkovičová-Tarabová Bohumila , Havránek Tomáš , Mihalj Denisa , Borbélyová Veronika , Pirnik Zdenko , Mravec Boris , Ostatníková Daniela , Bakoš Ján
Published: September 2024

Abnormalities in gamma-aminobutyric acid (GABA)ergic neurotransmission play a role in the pathogenesis of autism, although the mechanisms responsible for alterations in specific brain regions remain unclear. Deficits in social motivation and interactions are core symptoms of autism, likely due to defects in dopaminergic neural pathways. Therefore, investigating the morphology and functional roles of GABAergic neurons within dopaminergic projection areas could elucidate the underlying etiology of autism. The aim of this study was to (1) compare the morphology and arborization of glutamate decarboxylase (GAD)-positive neurons from the midbrain tegmentum; (2) evaluate synaptic activity in primary neurons from the striatum; and (3) assess GABAergic postsynaptic puncta in the ventral striatum of wild-type (WT) and Shank3-deficient mice. We found a significant decrease in the number of short neurites in GAD positive primary neurons from the midbrain tegmentum in Shank3-deficient mice. The application of a specific blocker of GABAA receptors (GABAAR) revealed significantly increased frequency of spontaneous postsynaptic currents (sPSCs) in Shank3-deficient striatal neurons compared to their WT counterparts. The mean absolute amplitude of the events was significantly higher in striatal neurons from Shank3-deficient compared to WT mice. We also observed a significant reduction in gephyrin/GABAAR γ2 colocalization in the striatum of adult male Shank3-deficient mice. The gene expression of collybistin was significantly lower in the nucleus accumbens while gephyrin and GABAAR γ2 were lower in the ventral tegmental area (VTA) in male Shank3-deficient compared to WT mice. In conclusion, Shank3 deficiency leads to alterations in GABAergic neurons and impaired GABAergic function in dopaminergic brain areas. These changes may underlie autistic symptoms, and potential interventions modulating GABAergic activity in dopaminergic pathways may represent new treatment modality.
The feasibility and safety of ultrasound-guided puncture for treatment of septic arthritis in children
Authors: Michaud Jeffrey , Dutron Sarah , Pico Julien , Jeandel Clément , Joly-Monrigal Pauline , Neagoe Petre , Alkar Fanny , Sarradin Thomas , Domitien Léa , Prodhomme Olivier , Jeziorski Eric , Delpont Marion
Published: September 2024

Background

In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance.

Methods

We retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up.

Results

We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications.

Conclusions

US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery.

Level of evidence

IV (case series).

Trial registration

IRB-MTP_2021_05_202100781
Asymptomatic SARS-COV2 Infection or COVID-19 vaccination effect for severe multisystem inflammatory syndrome in a 6-year-old girl: case report and review of the literature
Authors: Manca Enrica , di Toma Michele , Esotico Marianna , Soldano Lucia , Polito Anna Nunzia , Mongelli Giuseppina , Guglielmi Leonardo , Scaltrito Francesca , Campanozzi Angelo
Published: September 2024

Background

Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication, which develops within 3–6 weeks after SARS-CoV2 infection. The coronavirus disease 2019 (COVID-19) vaccine was firstly introduced in adults and adolescents and later in patients aged 5–11 years old. Although a reduced incidence of MIS-C and with less severe symptoms has been reported in vaccinated adolescents, there is little knowledge in children younger than 12 years of age. In addition, it is not understood whether MIS-C in vaccinated patients can be triggered by Covid19 vaccination or be secondary to a recent asymptomatic Sars-Cov2 infection.

Case presentation

We describe the case of a Caucasian 6-year-old girl, one month after double COVID-19 vaccination, who presented fever, acute abdominal pain, rash, pharyngotonsillitis, cheilitis, cervical lymphadenopathy without a prior detected Sars-Cov2 infection. She also had lymphopenia, increase in inflammatory markers, cardiac and pulmonary involvement. Therefore, we dosed both anti Sars-Cov2 Spike and Nucleocapsid antibodies, which were positive and allowed us to confirm the diagnosis of MIS-C. We promptly administered intravenous immunoglobulins and methylprednisone, resulting in the initial regression of fever. During the hospitalization, the child also developed pancreatitis and severe neurological involvement, including irritability, drowsiness, distal tremor, dyskinesia and buccal asymmetry with complete resolution after 2 months. After 3 months from the onset of the symptoms, she reported a transient loss of hair compatible with telogen effluvium. After 12 months of follow-up, she did not show any symptomatic sequelae.

Conclusions

This case raises the question of whether COVID-19 vaccination may be involved in the pathogenesis of MIS-C in children between the ages of 5 and 11 years old.
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated encephalitis induced by Mycoplasma pneumoniae infections
Authors: Liu Yan-Ru , Zeng Xiang-Dong , Xiong Ying
Published: September 2024

Background

This study aims to report the phenomenon of Myelin oligodendrocyte glycoprotein antibody-associated encephalitis induced by Mycoplasma pneumoniae infections and promote the potential benefits of combining early immunotherapy and anti-M—pneumoniae therapy for these patients.

Methods

Three children with MOG-IgG-associated encephalitis due to M. pneumoniae infections who were treated at our hospital from September to November 2023 were included in the study. We investigated and analyzed the background and clinical features of these patients.

Results

Three patients developed headaches, seizures, and/or other neurological manifestations, elevated mononuclear cells in cerebrospinal fluid, intracranial lesions on cranial magnetic resonance imaging (MRI), and positive MOG-IgG in serum, within 10–14 days. They were diagnosed with MOG-IgG-associated encephalitis due to M. pneumoniae infections, the treatment consisted of intravenous immunoglobulin, glucocorticoid, and erythromycin, then they were completely recovered.

Conclusion

Mycoplasma pneumoniae (M. pneumoniae) infections can cause oligodendrocyte glycoprotein (MOG) antibody-associated encephalitis. The recognition of this condition will promote the potential benefits of combining early immunotherapy and anti-M. pneumoniae therapy for patients with MOG-IgG-associated encephalitis.
Effect of a prolonged slow expiration technique on 24-h food intake in children hospitalized for moderate bronchiolitis: a randomized controlled trial
Authors: Combret Yann , Machefert Margaux , Couet Mélody , Bonnevie Tristan , Gravier Francis-Edouard , Gillot Timothée , Le Roux Pascal , Hilfiker Roger , Medrinal Clément , Prieur Guillaume
Published: September 2024

Background

Chest physiotherapy for airway clearance is not recommended in children hospitalized with bronchiolitis. The updated Cochrane meta-analysis suggests that slow expiratory techniques could slightly improve clinical severity, but the evidence certainty is low and the clinical significance of this change is unknown. We investigated whether the prolonged slow expiration technique (PSET) would impact the 24-h food intake of these children.

Methods

We conducted a two-arm double-blind randomized controlled trial. Hospitalized children aged from 1 to 12 months, bottle-fed or diversified and referred for airway clearance were included. Both groups received upper airway clearance at inclusion and standard treatments. The experimental group received PSET including rhinopharyngeal unclogging and targeted unprovoked cough. The primary outcome was the 24-h food intake. Clinical severity, vomit episodes and sleep quality were also recorded. An ordinary least squares linear regression for quantitative variables was modelled for between-group comparisons.

Results

From January 9, 2019, to December 1, 2022, 42 children were randomized with a 1:1 ratio (mean age: 5.0 (± 2.9) months). The 24-h food intake did not differ between groups (estimate: 1.8% (95%CI -7.0 to 10.6); p = 0.68). PSET had no effect on SpO2, clinical severity, RR and HR at the follow-up assessments (5 min, 30 min and 24 h after intervention), nor on the number of vomit episodes, total sleep time and SpO2 during sleep.

Conclusions

PSET did not affect food intake or the 24-h course of bronchiolitis more than standard treatment in children hospitalized for moderate bronchiolitis.

Trial registration

NCT03738501 registered on 13/11/2018, Slow Expiratory Technique to Improve Alimentation in Children With Bronchiolitis (BRONCHIOL-EAT); https://classic.clinicaltrials.gov/ct2/show/NCT03738501.
Antigenic reactivity of Leishmania (Viannia) lainsoni axenic amastigote proved to be a suitable alternative for optimizing Montenegro skin test
Authors: de Melo Leonardo Viana , Vasconcelos dos Santos Thiago , Ramos Patrícia Karla , Lima Luciana Vieira , Campos Marliane Batista , Silveira Fernando Tobias
Published: September 2024

Background

Laboratory diagnosis of American cutaneous leishmaniasis (ACL) requires a tool amenable to the epidemiological status of ACL in Brazil. Montenegro skin test (MST), an efficient immunological tool used for laboratory diagnosis of ACL, induces delayed-type hypersensitivity (DTH) response to the promastigote antigens of Leishmania; however, human immune responses against infection are modulated by the amastigote of the parasite. Leishmania (V.) lainsoni induces strong cellular immunity in humans; therefore, the antigenic reactivity of its axenic amastigote (AMA antigen) to MST was evaluated for the laboratory diagnosis of ACL.

Methods

Among 70 individuals examined, 60 had a laboratory-confirmed diagnosis of ACL; 53 had localized cutaneous leishmaniasis (LCL), and 7 had mucosal leishmaniasis (ML). Patients were treated at the Evandro Chagas Institute’s leishmaniasis clinic, Pará State, Brazil. Ten healthy individuals with no history of ACL (control group) were also examined. Leishmania (V.) braziliensis promastigote antigen (PRO) was used to compare the reactivity with that of AMA antigen. Paired Student’s t-test, kappa agreement, and Spearman test were used to evaluate the reactivity of AMA and PRO.

Results

The mean reactivity of AMA in ACL patients was 19.4 mm ± 13.3, which was higher (P < 0.001) than that of PRO: 12.1 mm ± 8.1. MST reactivity according to the clinical forms revealed that AMA reactivity in LCL and ML, 18.8 mm ± 13.3 and 24.3 mm ± 13.7, was higher (P < 0.001) than that of PRO, 11.8 mm ± 8.2 and 14.6 mm ± 8.4, respectively.

Conclusion

AMA reactivity was higher than that of PRO, indicating that AMA is a promising alternative for optimizing MST in the laboratory diagnosis of ACL.

Graphical abstract