bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and usability evaluation of a culturally adapted stroke prevention educational programme on WeChat apps
Authors: Liu Cui , Lee Wan Ling , Teo Chin Hai , Zhang Jin Hua , Chong Mei Chan
Published: July 2024

Background

The persistently high incidence of stroke in many nations is suggestive of an area for further improvement on existing strategies of primary stroke prevention. Although the era of digitalisation has led to the increasing use of mobile applications (apps) in healthcare, more studies are needed to determine the efficacy of apps in producing the desired health outcomes across different nations and cultures.

Objective

To describe the development and evaluate the usability of a mobile app in delivering a culturally adapted stroke prevention educational programme for middle-aged adults in the Republic of China.

Methods

The educational programme was developed in three phases. In Phase 1, the process involved analysing requirements and designing structured modules. Phase 2 concentrated on expert consultation and technical development to deliver the educational programme. Phase 3 included a usability trial and refinement of the educational program based on trial results.

Results

Educational content was derived from the Chinese Guidelines for the Prevention and Treatment of Stroke and the Dietary Guidelines for Residents. The WeChat platform was used to deliver the educational programme. Participants expressed satisfaction with the content, interface, and functions of the apps, indicating that the apps have good usability.

Conclusions

The development process of the Educational Programme was designed to maximise the culturally appropriate, and impact of lifestyle changes and stroke prevention. An app-based educational programme that has demonstrated good usability is a vital factor prior to deploying it in an intervention to evaluate its effects on health outcomes.
Exploring the Relative Impacts of Mindfulness Meditation and Medication Use on Changes in Teachers’ Internalizing Symptoms Over Time
Authors: Van Doren Natalia , Roeser Robert W.
Published: July 2024

Purpose

School teachers show higher levels of internalized distress compared to those in many other professions. In two exploratory studies, we examine the relative and interactive impacts of mindfulness training (MT) and medication use on reductions in depressive and anxious symptoms in teachers over time.

Design/Approach/Methods

These questions are explored using data from two randomized, waitlist-controlled trials of an 8-week teacher MT program. Data on medication use for anxiety or depression were assessed at baseline and revealed that 20% of the study samples reported such use. In addition, symptoms of anxiety and depression were assessed at baseline, post-program, and 3-month follow-up.

Findings

Results showed that MT significantly reduced depressive symptoms at post-program and at 3-month follow-up even after accounting for medication use. A similar pattern was found for anxious symptoms in Study 2 (but not Study 1). Comparative effects analysis indicated that MT resulted in stronger declines in depressive and anxious symptoms over time, while the effects of medication remained relatively stable.

Originality/Value

Results suggest that MT is an effective tool for reducing internalized distress in public school teachers, adds benefits above and beyond the use of medication for such symptoms in this population, and may result in greater long-term symptom reduction.
Writing Groups for Healthcare Professionals in Academic Medicine
Authors: Croghan Ivana T. , Kumar Shaji , Dugani Sagar B. , Hurt Ryan T. , Raffals Laura E. , Schletty Anne A. , Schroeder Darrel R. , Gathje Shelby R. , Shah Vijay
Published: July 2024

Within the Department of Medicine (DOM) in a large tertiary academic health care facility in midwestern United States, we have developed an educational offering that incorporates an academic writing program (AWP) blending the approaches of a writing accountability work group, a writing workshop, and didactic writing courses. The purpose of this AWP was to assist healthcare professionals (HCP) with their manuscript writing skills to enhance academic productivity. We report our evolving journey and experiences with this AWP. To date, it has been offered 3 times to 25 HCP over the course of 3 years. Among those responding to a post program follow up survey (N = 11), 8 (73%) indicated that they completed the project that they were working on during the AWP and went on to publish the manuscript (N = 5) or were in the process of submission (N = 2). Some indicated they has also gone on to present posters (N = 2) or were in the process of presenting posters (N = 2) or had received grants (N = 1) or were awaiting grant notice (N = 1). A number of attendees have continued to use and share the tools presented during the AWP. Based on input from attendees and increased requests for this AWP, this educational program has been deemed a success and expansion of this program is currently underway.
The Tirzepatide Drop: Beware of Slimmer’s Paralysis
Authors: Tucker John M. , Ritchie Jordan
Published: July 2024

This case series explores the association between tirzepatide-assisted weight loss and the development of foot drop due to peroneal nerve neuropathy, a phenomenon known as slimmer’s paralysis. Two cases are presented of patients who experienced rapid weight loss after initiation of tirzepatide therapy and within 6 to 8 months developed bilateral foot drop. As providers, we have more medications than ever to assist patients in their weight loss journeys, but both of these cases are reminders of the risks of rapid weight loss and the need to monitor therapy closely for patients on tirzepatide and similar medications.
Perspectives and Satisfaction of Consumers with Hypertension and Diabetes on Services Provided by Community Pharmacy
Authors: Mozu Ivan Eduku , Marfo Afia Frimpomaa Asare , Opare-Addo Mercy , Adomako Nana Ofori , Boachie-Ansah Pauline , Attakorah Joseph , Graham-Bannerman John Abeeku
Published: July 2024

Non-communicable diseases are increasing, but detection and control are inadequate. Active involvement of community pharmacies in their management can improve the situation. This is an exploratory study to unearth the perceptions and expectations of customers of services offered by community pharmacies. A cross-sectional study was conducted in two regions of Ghana. A total of 535 clients participated. Counseling was the most patronized (71.0%) service with medication review (38.5%) being the least. The most readily available service was sale of prescription medications (63.7%). Proximity (72.1%) was the most influential factor for selecting a pharmacy to visit. Clients perceived the dispensing of medications (64.3%) as the principal role of the pharmacists. The presence of a pharmacist and good and quick customer service were of statistical significance to customer satisfaction. Customers visited facilities mostly for blood pressure monitoring and to refill their medications, and counseling was the most patronized service. These call for planning multifaceted approaches to improve the care of patients with chronic disease.
Artificial Intelligence and Objective Structured Clinical Examinations: Using ChatGPT to Revolutionize Clinical Skills Assessment in Medical Education
Authors: Misra Sanghamitra M. , Suresh Srinivasan
Published: July 2024

This article examines the integration of OpenAI's Chat Generative Pre-trained Transformer (ChatGPT) into Objective Structured Clinical Examinations (OSCEs) for medical education. OSCEs, essential in evaluating medical trainees, are time and resource-intensive for educators and medical colleges. ChatGPT emerges as a solution, aiding educators in efficient OSCE preparation, including case development, standardized patient training, assessment methods, and grading rubrics. We explore ChatGPT's role in reducing trainee stress through simulated interactions of realistic practice scenarios and real-time trainee feedback. We also discuss the importance of validating ChatGPT outputs for medical accuracy and address compliance concerns. While highlighting ChatGPT's potential in reducing time and cost burdens for educators, we underscore the need for careful and informed application of Artificial Intelligence in medical education. Through examples, we outline ChatGPT's promising future in augmenting medical training and assessment, balancing technological innovation with educational integrity.
Simulation of magneto-nano-bioconvective coating flow with blowing and multiple slip effects
Authors: Bég Osman Anwar , Kumar Debasis , Uddin Mohammed Jashim , Alim Md Abdul , Bég Tasveer A.
Published: July 2024

The phenomenon of bioconvecton due to motile microorganism swimming patterns has been found to be a beneficial mechanism in many biological processes and microdevices. Inducing convective transport in self-propelling microbes has been successfully used to enhance mixing, reaction propensity and concentration transport within a range of engineered devices. Doping materials with microorganisms can also be implemented to manipulate magnetohydrodynamic coating processes with smart functional liquids, in which the substrate may be planar, wedge-shaped, curved etc. Inspired by this application, the current article examines theoretically and numerically the external boundary layer Falkner-Skan flow of an electroconductive nanofluid containing gyrotactic micro-organisms on a two-dimensional wedge with Stefan blowing and different slip effects at the wedge boundary. The physico-mathematical model is formulated using a system of partial differential equations and appropriate boundary conditions which are then transformed to a system of ordinary differential equations with appropriate similarity variables. The non-dimensional boundary value problem is solved numerically with the aid of the Mathematica software solver package named “NDSolve.” The impacts of the Stefan blowing, velocity, thermal, nanoparticle concentration and microorganism slips, magnetic number, Lewis number, bioconvection Lewis number, the Falkner-Skan wedge parameter, bioconvection Péclet number, thermophoresis and Brownian motion on key transport characteristics that is, dimensionless velocity, temperature, nanoparticle concentration (volume fraction), microorganism concentration, skin friction coefficient, local heat transfer rate (local Nusselt number), local mass transfer rate (local Sherwood number), and the microorganism local density number gradient are computed and visualized graphically. Numerical solutions are validated with previous literature. The outcomes reported in this paper are relevant to the synthesis of functional bio-nanopolymers.
Challenging Case of Postoperative Nocardia Endophthalmitis
Authors: Sreenivasan Janani , Anand Appakkudal R. , Varma Shobit , Garima
Published: July 2024

Purpose: To describe a case of postoperative Nocardia endophthalmitis that proved to be challenging. Methods: A 64-year-old woman presented with a clinical picture of postoperative endophthalmitis, which was managed by vitrectomy with intraocular lens explantation. Nocardia puris, sensitive to amikacin, cotrimoxazole (trimethoprim–sulfamethoxazole), and ciprofloxacin, was isolated in culture. The patient received intracameral and intravenous amikacin. On the sixth postoperative day, the infection appeared controlled; however, a macular infarction developed. One month later, the patient presented with recurrent infection (iris nodule and vitritis). After consultation with an infectious disease specialist, oral trimethoprim–sulfamethoxazole and oral moxifloxacin were started. Treatment continued for 6 months. Results: At the 3-month and 6-month follow-ups, the iris nodules had regressed in size with no new visible lesions. The vitreous cavity was clear, and the retina was attached; however, the best-corrected visual acuity was poor because of the macular infarction. Conclusions: This case highlights the importance of obtaining a microbiological diagnosis with sensitivity in cases of Nocardia endophthalmitis and its use in the aggressive management of the infection, including frequent monitoring for recurrences.
Extracurricular One Day Competitions in Enterprise and Entrepreneurship Education – Theorising Effects
Authors: Brentnall Catherine
Published: July 2024

This paper takes the popular but under-researched extracurricular format in school-based Enterprise and Entrepreneurship Education - the one-day competition– as its focus. One-day competitions are frequently implemented in practice, with teachers’ surveys and national evaluations showing them to be the most common activity in schools. Yet one-day provision receives surprisingly little research attention in literature and implications of the competitive nature of activities are not meaningfully explored. More generally, current evaluation approaches in Enterprise and Entrepreneurship Education tend to be measurement-focused, which obscures crucial differences - between students, schools and program experiences - behind reports of average effect sizes. In this study, the perspective and resources of Realist Evaluation are used to provide a holistic and comprehensive theorisation of experiences and effects in one-day competitions in secondary schools. The contribution of this approach is twofold. First, it provides a much-needed elaboration of what can happen in one-day competitions, developing foresight with which to think through how effects are generated for different students in different contexts. Second, by applying Realist Evaluation to explore a familiar enterprise and entrepreneurship activity, with regards to impact evaluation approaches, this study shows the usefulness of complementing measuring with thinking.
Not So Rare: Diseases Based on Mutant Proteins Controlling Endoplasmic Reticulum-Mitochondria Contact (MERC) Tethering
Authors: Makio Tadashi , Simmen Thomas
Published: July 2024

Mitochondria-endoplasmic reticulum contacts (MERCs), also called endoplasmic reticulum (ER)-mitochondria contact sites (ERMCS), are the membrane domains, where these two organelles exchange lipids, Ca2+ ions, and reactive oxygen species. This crosstalk is a major determinant of cell metabolism, since it allows the ER to control mitochondrial oxidative phosphorylation and the Krebs cycle, while conversely, it allows the mitochondria to provide sufficient ATP to control ER proteostasis. MERC metabolic signaling is under the control of tethers and a multitude of regulatory proteins. Many of these proteins have recently been discovered to give rise to rare diseases if their genes are mutated. Surprisingly, these diseases share important hallmarks and cause neurological defects, sometimes paired with, or replaced by skeletal muscle deficiency. Typical symptoms include developmental delay, intellectual disability, facial dysmorphism and ophthalmologic defects. Seizures, epilepsy, deafness, ataxia, or peripheral neuropathy can also occur upon mutation of a MERC protein. Given that most MERC tethers and regulatory proteins have secondary functions, some MERC protein-based diseases do not fit into this categorization. Typically, however, the proteins affected in those diseases have dominant functions unrelated to their roles in MERCs tethering or their regulation. We are discussing avenues to pharmacologically target genetic diseases leading to MERC defects, based on our novel insight that MERC defects lead to common characteristics in rare diseases. These shared characteristics of MERCs disorders raise the hope that they may allow for similar treatment options.
Phytolacca Dodecandra (L’ Herit) (Phytolaccaceae) Methanol Root Extract Protects Liver from Acetaminophen-Induced Injury in Rats
Authors: Geresu Gudeta Duga , Abebe Tilahun Tesfaye , Gadisa Diriba Alemayehu , Taye Getu Melese , Bedada Dejene Hailu , Baressa Tamirat Bekele , Hussen Shemsu Umer , Chala Tesemma Sileshi
Published: July 2024

Phytolacca dodecandra (L’ Herit), or ‘Endod’, is one of the widely known medicinal plants in Ethiopia. Berries of the endod have been used as a detergent for centuries. The present study was aimed to test the hepatoprotective effects of the plant against acetaminophen (APAP)-induced liver injury in rats. Mice of either sex were used for oral acute toxicity tests and APAP-induced lethality tests. Hepatoprotective experiments were done on male rats using 2 g/kg of APAP to induce liver damage. Liver enzymes, total bilirubin (TB), and lipid profile were determined. Liver tissues were also examined histopathologically to see a morphologic change in the control and experiment groups. The protective effect of the plant extract was also tested through sodium pentobarbital (SPB)-induced sleeping time. A significant increase in serum levels of liver enzymes, TB, low-density lipoprotein (LDL), and triglycerides (TGs) was seen from oral administration of 2 g/kg APAP. Total cholesterol (TC) and high-density lipoprotein (HDL) levels were decreased. Serum levels of all parameters were reversed to normal after administration of silymarin 100 mg/kg and, 100, 200, and 400 mg/kg doses of the extract. A significant dose-dependent hepatoprotective effect of Phytolacca dodecandra Methanol Root Extract (PDME) was seen in terms of LDL. Histopathological investigations and SPB-induced sleeping time confirmed the findings of biochemical analysis. The findings of the present study indicate that PDME protected the liver from APAP injury.
Making a Case for Incorporating Victim–Offender Mediation into the Criminal Justice System of Trinidad and Tobago
Authors: Scotland Gillian
Published: July 2024

The Criminal Procedure Rules were implemented in 2016 by virtue of Legal Notice No. 55/2016 with an emphasis on the disposition of and dealing with matters ‘justly’. This ambitious objective cannot be accomplished by solely adhering to the legal framework that currently governs the criminal justice system. Restorative justice has been seen as an opportunity and an approach for victims and other stakeholders of crime to deal with the same. At the forefront of such approaches is victim–offender mediation, which can be utilized for both juvenile and adult offenders. Inclusion of such a process as part of the criminal justice system of Trinidad and Tobago would assist in realizing the objectives envisioned by the Criminal Procedure Rules.
Gallium distribution between slag and metal phases during the carbothermal reduction of bauxite
Authors: Nakamura Tomofumi , Yasuda Kouji , Uda Tetsuya
Published: July 2024

This article investigated the recoverability of the Ga in bauxite by carbothermal reduction. Currently, Ga is mostly manufactured from bauxite through the Bayer process as a by-product of alumina, but it is worthwhile to consider alternative processes under stricter environmental regulations and a shortage of high-quality bauxite. This study focused on the Pedersen process, which is the alumina production process consisting of carbothermal reduction and alkaline leaching. The metal and slag phases were prepared by carbothermal reduction of bauxite at 1873 K, and then aluminium in the slag was leached with (Na2CO3 + NaOH) solution at 348 K. Evaluation by inductively coupled plasma atomic emission spectroscopy and inductively coupled plasma mass spectrometry revealed that almost all Ga in bauxite was transferred to the metal phase, and the distribution to the slag phase was negligible in carbothermal reduction, which agrees with the thermodynamic consideration. These results suggest that the gallium recovery from pig iron is necessary to produce Ga in the Pedersen process.
Fluid land values in petro-geographies: Temporality and human–nonhuman relations in Ghana and Tanzania
Authors: Otchere-Darko William
Published: July 2024

Land plays a central role in the explorations of value, embodying notions of use, exchange, common property and deeply held beliefs. However, with the discovery of natural resources, land values become even more dynamic and imbricated beyond pre-existing notions. What can be learnt about land values from resource extraction? Focusing on petro-geographies in Southwest Ghana and Tanzania’s Lindi-Mtwara, the current study calls attention to temporality and human–nonhuman relations within notions of land values and valuation processes. The research utilises a multi-method approach, grounding analysis in key expert interviews, policy documents, secondary research and empirical data on land use and development statistics. It shows that, in Southwest Ghana, calls for subsistence and food security highlight the deepening linkages between land’s caloric use values and nature’s intrinsic values. Here, food security is not easily subsumed within instrumental use values but rather interlinked within the complex ecology of (un)polluted nature. In Lindi-Mtwara, calls for intergenerational sustenance re-valuate land’s exchange value as a flow of resources rather than a stock to be paid off. Here, social histories and future capabilities become key considerations in deliberations over the market value of lands. The research thus highlights the interdependencies, social relations and temporalities of value triggered by resource extraction, the neglect of which often leads to conflict and loss.
Healthcare interpreting as relational practice: Understanding the interpreter’s role in facilitating rapport in health interactions
Authors: Major George
Published: July 2024

This article explores the extent to which healthcare interpreting can be considered “relational practice.” It describes an interactional sociolinguistic study conducted in Australia, based on video recordings of two naturally occurring interpreted general practice consultations. Participants were hearing Australian Sign Language (Auslan)/English interpreters, deaf patients, and hearing doctors. Analysis of these recordings was supplemented by reflective interviews with participants. The study examines the ways in which interpreters facilitate good working relationships between participants, and to explore the extent to which their decision-making is driven by relational considerations. The analyses presented in this article provide evidence that relational work is an important aspect of the healthcare interpreter’s role. Some of the ways in which it is achieved, however, may challenge our ideas about “appropriate” interpreter behaviour. Thus, the skilled and experienced interpreters in the study were seen to modify face threats, directly influence the flow of interaction, and actively facilitate social talk and humour, occasionally even engaging in it themselves. It is argued that interpreters’ decisions can only be understood within the discursive context in which they occur, and such behaviour can highlight interpreters’ attentiveness to the maintenance of good rapport.
Remapping trans-Himalayan studies in the digital domain during the COVID-19 pandemic: Constraint-based innovation, multimodality and the way of knowing
Authors: Yang Zezhou
Published: July 2024

This article offers a critical reflection on the adaptive reconfiguration of my South Asian Studies-based PhD project into a multimodal and collaborative endeavour in response to the challenges posed by the COVID-19 pandemic. Challenging the binary narrative that constraint-based methodological innovations are merely reactive measures to restore research projects to their pre-pandemic state, this paper posits that such innovations are integral, yet often overlooked, elements of social dynamics and relationships in Asian contexts. These innovations call for heightened attention, action and emotion that are typically marginalised in what is perceived as normalcy. The paper begins by contextualising my positionality, PhD project and fieldwork within the broader discourse on remapping Asian Studies, multimodal research and constraint-based innovation. Following this, I explore my interactions with Jade and her transnational charity group, describing how I conducted remote, virtual ethnography within this virtual community. This methodological shift is then discussed, with a focus on how it contributes to alternative, decolonial approaches to knowledge production in Asian Studies. The paper concludes by advocating for constraint-based innovation as a vital method of knowing diverse social and cultural experiences at the grassroots level.
Low salinity stress increases the risk of Vibrio parahaemolyticus infection and gut microbiota dysbiosis in Pacific white shrimp
Authors: Chang Yi-Ting , Huang Wan-Ting , Wu Ping-Lun , Kumar Ramya , Wang Han-Ching , Lu Hsiao-Pei
Published: July 2024

Background

Extreme precipitation events often cause sudden drops in salinity, leading to disease outbreaks in shrimp aquaculture. Evidence suggests that environmental stress increases animal host susceptibility to pathogens. However, the mechanisms of how low salinity stress induces disease susceptibility remain poorly understood.

Methods

We investigated the acute response of shrimp gut microbiota exposed to pathogens under low salinity stress. For comparison, shrimp were exposed to Vibrio infection under two salinity conditions: optimal salinity (Control group) and low salinity stress (Stress group). High throughput 16S rRNA sequencing and real-time PCR were employed to characterize the shrimp gut microbiota and quantify the severity level of Vibrio infection.

Results

The results showed that low salinity stress increased Vibrio infection levels, reduced gut microbiota species richness, and perturbed microbial functions in the shrimp gut, leading to significant changes in lipopolysaccharide biosynthesis that promoted the growth of pathogens. Gut microbiota of the bacterial genera Candidatus Bacilliplasma, Cellvibrio, and Photobacterium were identified as biomarkers of the Stress group. The functions of the gut microbiota in the Stress group were primarily associated with cellular processes and the metabolism of lipid-related compounds.

Conclusions

Our findings reveal how environmental stress, particularly low salinity, increases shrimp susceptibility to Vibrio infection by affecting the gut microbiota. This highlights the importance of avoiding low salinity stress and promoting gut microbiota resilience to maintain the health of shrimp.
Frequency of side effects experienced in two different NIM-EMG tubes used in thyroid and parathyroid surgery; a prospective observational study
Authors: Kale Oya , Akaslan Filiz , Keskin Gülsen , Toptaş Gökhan
Published: July 2024

Background

In this study, we observed the frequency of side effects encountered when the neural integrity monitor electromyogram endotracheal tube (NIM-EMG-ETT) was used in thyroidectomy and parathyroidectomy surgeries.

Methods

After obtaining hospital ethics committee approval, 239 cases affiliated with the American Society of Anesthesiologists (ASA II-IV) who used NIM EMG tubes in thyroid and parathyroid surgery were included in the prospective observational study. Tube and patient-related complications encountered with two different NIM EMG-ETT (silicone and polyvinyl chloride-PVC) were recorded.

Results

The average age of the patients is 49.50 ± 13.44 years, the average BMI is 28.25 ± 4.91 kg/m2, the median surgery time is 115 (32–475) minutes, 75.7% are women, 97.5% are ASA II. Additional diseases other than thyroid and parathyroid problems were present in 77.3%. Thyroidectomy was performed in 73.2% of the patients. In our study, only 0.8% of patients with transient recurrent laryngeal nerve RLN paralysis were observed in thyroid and parathyroid surgeries performed using NIM-EMG tubes, 3 patient already had nerve involvement in the preoperative period. The most common complication was loss of stimulation response related to tubes and patient-related ventilation failure. There was no difference between the complications of silicone and PVC tubes except for irregular EMG response.

Conclusions

There was no significant difference in side effects other than irregular EMG response in the two different tubes we used in our study. It was observed that prolonging the surgical time increased the risk of irregular EMG response. It should not be forgotten that no matter which NIM-EMG tube is used, additional risks are encountered during the intubation and extubation process. In order to avoid negative consequences, it is necessary to follow the usage rules recommended by the manufacturer when using NIM-EMG tubes.
Tipping point analysis for the between-arm correlation in an arm-based evidence synthesis
Authors: Han Wenshan , Wang Zheng , Xiao Mengli , He Zhe , Chu Haitao , Lin Lifeng
Published: July 2024

Systematic reviews and meta-analyses are essential tools in contemporary evidence-based medicine, synthesizing evidence from various sources to better inform clinical decision-making. However, the conclusions from different meta-analyses on the same topic can be discrepant, which has raised concerns about their reliability. One reason is that the result of a meta-analysis is sensitive to factors such as study inclusion/exclusion criteria and model assumptions. The arm-based meta-analysis model is growing in importance due to its advantage of including single-arm studies and historical controls with estimation efficiency and its flexibility in drawing conclusions with both marginal and conditional effect measures. Despite its benefits, the inference may heavily depend on the heterogeneity parameters that reflect design and model assumptions. This article aims to evaluate the robustness of meta-analyses using the arm-based model within a Bayesian framework. Specifically, we develop a tipping point analysis of the between-arm correlation parameter to assess the robustness of meta-analysis results. Additionally, we introduce some visualization tools to intuitively display its impact on meta-analysis results. We demonstrate the application of these tools in three real-world meta-analyses, one of which includes single-arm studies.
Efficacy and tolerability of a 4-month ofloxacin-containing regimen compared to a 6-month regimen in the treatment of patients with superficial lymph node tuberculosis: a randomized trial
Authors: Hissar Syed , Velayutham Banurekha , Tamizhselvan Manoharan , Rathinam Sridhar , Arunbabu Chinnadurai , Vidhya Jayanthi Bharathi , Vargunapandian Gurusamy , Sundararajaperumal Anandakrishnan , Sivaramakrishnan Gomathi Narayan , Chelvi Silambu , Ramesh Paranchi Murugesan , Arun Damodharan , Reddy Sirasanambati Devarajulu , Kumaran Paramasivam Paul , Kumar Marimuthu Makesh , Kalaiselvi Dharuman , Hanna Luke Elizabeth , Kumar Hemanth , Gowrisankar Alagarsamy , Rajavelu Ramasamy , Jayabal Lavanya , Ponnuraja Chinnayan , Baskaran Dhanaraj
Published: July 2024

Background

Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients.

Methods

New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment.

Results

Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction.

Conclusion

The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen.
Helicobacter pylori infection increases the risk of dyslipidemia in Chinese diabetic Population: a retrospective cross-sectional study
Authors: Yang Chaoyu , You Ningning , Chen Yi , Zhang Jinshun
Published: July 2024

Background

In contemporary times, increased prevalence of Helicobacter pylori (H. pylori) infection and elevated dyslipidemia levels present substantial public health challenges. However, the relationship between H. pylori and dyslipidemia remains inconclusive. No studies have yet conducted a population-based classification to investigate the impact of H. pylori infection on dyslipidemia in individuals with diabetes.

Methods

A retrospective cohort study was carried out on a total of 60,535 individuals who underwent health check-ups at the Health Examination Center in Taizhou Hospital from 2017 to 2022. Physical measurements, hematological markers and detection of H. pylori were gathered from all patients. The study population was further stratified into diabetic and non-diabetic groups for analysis.

Results

H. pylori infection was found to be an autonomous risk factor for dyslipidemia based on the results of multivariate logistic regression analysis (OR = 1.13, 95% CI: 1.03–1.24). However, no notable effect on dyslipidemia in the non-diabetic group was observed. Furthermore, at the follow-up, the group with persistent negative showed a significantly lower incidence ratio of dyslipidemia compared to the group with persistent infection (P = 0.006). The persistent negative group exhibited a significantly higher rate of improvement in dyslipidemia compared to the new infection group (P = 0.038).

Conclusions

In the diabetic population, the presence of H. pylori infection heightens the propensity for developing dyslipidemia. Therefore, the implementation of efficient eradication strategies for H. pylori infection could potentially lead to a decrease in the occurrence of dyslipidemia among individuals with diabetes.
Risk of arboviral transmission and insecticide resistance status of Aedes mosquitoes during a yellow fever outbreak in Ghana
Authors: Owusu-Akyaw Margaret , Owusu-Asenso Christopher Mfum , Abdulai Anisa , Mohammed Abdul Rahim , Sraku Isaac Kwame , Boadu Emmanuel Nana , Aduhene Evans , Attah Simon Kwaku , Afrane Yaw Asare
Published: July 2024

Background

In late 2021, Ghana was hit by a Yellow Fever outbreak that started in two districts in the Savannah region and spread to several other Districts in three regions. Yellow fever is endemic in Ghana. However, there is currently no structured vector control programme for Aedes the arboviral vector in Ghana. Knowledge of Aedes bionomics and insecticide susceptibility status is important to control the vectors. This study therefore sought to determine Aedes vector bionomics and their insecticide resistance status during a yellow fever outbreak.

Methods

The study was performed in two yellow fever outbreak sites (Wenchi, Larabanga) and two non-outbreak sites (Kpalsogu, Pagaza) in Ghana. Immature Aedes mosquitoes were sampled from water-holding containers in and around human habitations. The risk of disease transmission was determined in each site using stegomyia indices. Adult Aedes mosquitoes were sampled using Biogents Sentinel (BG) traps, Human Landing Catch (HLC), and Prokopack (PPK) aspirators. Phenotypic resistance to permethrin, deltamethrin and pirimiphos-methyl was determined with WHO susceptibility tests using Aedes mosquitoes collected as larvae and reared into adults. Knockdown resistance (kdr) mutations were detected using allele-specific multiplex PCR.

Results

Among the 2,664 immature Aedes sampled, more than 60% were found in car tyres. Larabanga, an outbreak site, was classified as a high-risk zone for the Yellow Fever outbreak (BI: 84%, CI: 26.4%). Out of 1,507 adult Aedes mosquitoes collected, Aedes aegypti was the predominant vector species (92%). A significantly high abundance of Aedes mosquitoes was observed during the dry season (61.2%) and outdoors (60.6%) (P < 0.001). Moderate to high resistance to deltamethrin was observed in all sites (33.75% to 70%). Moderate resistance to pirimiphos-methyl (65%) was observed in Kpalsogu. Aedes mosquitoes from Larabanga were susceptible (98%) to permethrin. The F1534C kdr, V1016I kdr and V410 kdr alleles were present in all the sites with frequencies between (0.05–0.92). The outbreak sites had significantly higher allele frequencies of F1534C and V1016I respectively compared to non-outbreak sites (P < 0.001).

Conclusion

This study indicates that Aedes mosquitoes in Ghana pose a significant risk to public health. Hence there is a need to continue monitoring these vectors to develop an effective control strategy.
Pembrolizumab with platinum-based chemotherapy with or without epacadostat as first-line treatment for metastatic non-small cell lung cancer: a randomized, partially double-blind, placebo-controlled phase II study
Authors: Boyer Michael , Hui Rina , Urban Damien , Clingan Philip , Su Wu-Chou , Devaux Celine , Gadgeel Shirish , Garassino Marina , Leopold Lance , Daniel Jeannie , Munteanu Mihaela C. , Samkari Ayman , Luo Yiwen , Abreu Delvys Rodriguez
Published: July 2024

Background

The combination of the checkpoint inhibitor (CPI) pembrolizumab and platinum-based chemotherapy is effective frontline therapy for advanced non-small cell lung cancer (NSCLC) lacking targetable mutations. Indoleamine 2,3- dioxygenase 1 (IDO1), an enzyme involved in kynurenine production, inhibits immune responses. Inhibition of IDO1 may restore antitumor immunity and augment CPI activity. This trial evaluated addition of epacadostat, a potent and highly selective IDO1 inhibitor, to pembrolizumab and chemotherapy for metastatic NSCLC.

Methods

ECHO-306/KEYNOTE-715 was a partial double-blind, randomized phase II study of adults with treatment-naïve stage IV NSCLC not indicated for EGFR-, ALK-, or ROS1-directed therapy. Patients were randomized to one of three treatment arms: epacadostat-pembrolizumab-chemotherapy (E + P + C; blinded), epacadostat-pembrolizumab (E + P; open-label) or placebo-pembrolizumab-chemotherapy (PBO + P + C; blinded). Stratification was by PD-L1 tumor proportion score (< 50% vs. ≥ 50%) and tumor histology (non-squamous vs. squamous). A protocol amendment closed enrollment in the open-label E + P group, excluding it from efficacy analyses. Intravenous pembrolizumab (200 mg) was administered every 21 days and epacadostat 100 mg or matching placebo (oral) twice daily (BID) for ≤ 35 3-week cycles. The primary objective was objective response rate (ORR) for E + P + C vs. PBO + P + C.

Results

178 patients were randomized to E + P + C (n = 91) or PBO + P + C (n = 87); 55 were enrolled in the E + P group. The E + P + C group had a lower confirmed ORR (26.4%; 95% CI 17.7–36.7) than the PBO + P + C group (44.8%; 95% CI 34.1–55.9), with a difference of − 18.5% (95% CI − 32.0 – (− 4.3); one-sided P = 0.9948). The E + P + C group had a numerically higher percentage of confirmed responders with extended response ≥ 6 months (29.2% vs. 15.4%). Circulating kynurenine levels at C1D1 were similar to those at C2D1 in all treatment groups and were not reduced to normal levels with epacadostat 100 mg BID plus P + C. The safety profile of E + P + C was consistent with that for PBO + P + C.

Conclusions

Addition of epacadostat 100 mg BID to pembrolizumab and platinum-based chemotherapy was generally well tolerated but did not improve ORR in patients with treatment-naïve metastatic NSCLC. Evaluating epacadostat doses that normalize circulating kynurenine in combination with CPIs may help determine the clinical potential of this combination.

Trial registration

NCT03322566. Registered October 26, 2017.
Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for unilateral cervical radiculopathy or coexisting cervical myelopathy: a prospective, randomized, controlled, noninferiority trial
Authors: Peng Wei , Chu Rupeng , Cui Wei , Zhuang Yin , Chen Wenjin , Han Xiaofei , Sun Zhenzhong , Zhang Shujun
Published: July 2024

Background

Cervical spondylosis (CS), including myelopathy and radiculopathy, is the most common degenerative cervical spine disease. This study aims to evaluate the clinical outcomes of unilateral biportal endoscopy (UBE) compared to those of conventional anterior cervical decompression and fusion (ACDF) for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs.

Methods

A prospective, randomized, controlled, noninferiority trial was conducted. The sample consisted of 131 patients who underwent UBE or ACDF was conducted between September 2021 and September 2022. Patients with cervical nerve roots or coexisting spinal cord compression symptoms and imaging-defined unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs were randomized into two groups: a UBE group (n = 63) and an ACDF group (n = 68). The operative time, blood loss, length of hospital stay after surgery, and perioperative complications were recorded. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores, visual analog scale (VAS) scores, neck disability index (NDI) scores, and recovery rate (RR) of the mJOA were utilized to evaluate clinical outcomes.

Results

The hospital stay after surgery was significantly shorter in patients treated with UBE than in those treated with ACDF (p < 0.05). There were no significant differences in the neck or arm VAS score, NDI score, mJOA score, or mean RR of the mJOA between the two groups (p < 0.05). Only mild complications were observed in both groups, with no significant difference (p = 0.30).

Conclusion

UBE can significantly relieve pain and disability without severe complications, and most patients are satisfied with this technique. Consequently, this procedure can be used safely and effectively as an alternative to ACDF for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs.

Trial registration

This study was registered in the Chinese Clinical Trial Registry on 02/08/2023 (http://www.chictr.org.cn, #ChiCTR2300074273).
Incidental synchronous intrathyroidal parathyroid carcinomas and papillary thyroid microcarcinoma with compressive neck mass and primary hyperparathyroidism: case report and literature review
Authors: Xu Tianfeng , Zheng Xun , Wei Tao
Published: July 2024

Background

Parathyroid carcinoma (PC) is a rare malignancy, often diagnosed incidentally through postoperative pathological examination. The occurrence of nodular goiter, intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma (PA), and papillary thyroid microcarcinoma (PTMC) is extremely uncommon, which prompted us to report our case experience.

Case presentation

We describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter.

Conclusion

Parathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.
Orthognathic surgery improves quality of life: a survey clinical study
Authors: Sen Esengul , Duran Hatice , Sarı Merve , Akbulut Nihat , Demir Osman
Published: July 2024

Background

The aim of this study was to evaluate the quality of life (QoL) of patients with dentofacial deformity (n = 107) compared with that of healthy individuals (n = 108) from 2019 to 2020.

Methods

Oral Health Impact Profile 14 (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were administered to the individuals before surgery (T1) and 6 months after surgery (T2).

Results

Preoperative scores (T1) were greater in the surgical group than in the control group in all domains of both surveys (p ≤ 0.001). Postoperative scores (T2) in the surgery group decreased significantly after surgery in all domains in both surveys (p < 0.001). The OHIP-14 scores in the control group at T2 were significantly greater than those in the other domains except for functional limitation at T1. The type of surgery had no effect on quality of life. Class III patients had higher preoperative scores in certain domains. Postoperative physical disability (p = 0.037), physical pain (p = 0.047), and preoperative social disability (p = 0.030) scores of OHIP-14 awareness of dentofacial aesthetics of OQLQ (p = 0.019) were found to be higher in females than in males.

Conclusions

The results showed that orthognathic surgery positively affected quality of life. The control group showed differences in T1 and T2 scores, which can be attributed to their psychological status.