bluuebunny/crossref_metadata_2025 huggingface dataset:
Jiangzhi Paizhuo Decoction Combined with Silibinin Capsules Improve the Outcomes of Metabolic Associated Fatty Liver Disease
Authors: Hao Jianmei , Xie Yuanjing , Yang Zhiping , Dou Jianwei , Mao Minghua , Li Xiaofang
Published: August 2024

The study aimed to evaluate the impact of combining silibinin capsules with Jiangzhi Paizhuo Decoction (JZPZ) versus silibinin capsules alone in patients with MAFLD. The research was carried out at the Xi'an Hospital of Traditional Chinese Medicine using a case-control design following to STROBE guideline. Eligible participants meeting the inclusion criteria were randomly allocated into two groups. The participants in control group and intervention group were assigned to receive oral administration of 70 mg (3 times daily) silibinin capsules or 70 mg silibinin capsules (3 times daily) plus colon dialysis with 150 ml JZPZ decoction for 8 weeks. The primary outcome and secondary outcome on the effects of JZPZ decoction in MAFLD were detected. We found that liver function significantly improved in both groups after treatment (p < 0.05) compared with the baseline. Importantly, JZPZ decoction was associated with significant decrease in hepatic steatosis (CAP changes: −18.91 ± 11.50 vs −26.86 ± 16.62, P = 0.0305). The JZPZ decoction reduced significantly the TCM syndromes score compared to control (−5.74 ± 0.95 versus −7.17 ± 1.23, P < 0.0001). Meanwhile, the weight and BMI in JZPZ group increased significantly more than control group (P = 0.0003, P < 0.0001). In conclusion, the JZPZ decoction combined with silibinin capsules in the treatment of MAFLD patients with liver depression and heat syndrome has more advantages in decreasing hepatic steatosis and TCM syndromes scores. It is worthy of clinical recommendation.
Comprehensive management and outcomes in female patients with Fournier’s gangrene: A case report
Authors: El Hajjar Charlotte , Al Hassan Jihad , Siblini Mohamad , Madi Nour , Abou Hammin Saad , Nakib Hamza , Yared Georges , Ghazal Kariman
Published: August 2024

Fournier’s gangrene is a severe, life-threatening form of necrotizing fasciitis that predominantly affects the perineal, genital, and perianal areas. It is characterized by a rapid onset and progression, often developing from urogenital infections, diabetes, compromised immune function, or trauma. This report describes the case of a 64-year-old woman who presented with perianal pain and purulent discharge persisting for a week. Upon examination, a substantial necrotic wound was identified in her perineal region, necessitating urgent surgical debridement followed by aggressive postoperative management, including antibiotic therapy and meticulous blood sugar control. Despite initial signs of improvement, the patient’s condition deteriorated due to complications from diabetes, acidosis, and pneumonia, ultimately leading to a fatal outcome. This case highlights the critical need for prompt recognition and comprehensive management of Fournier’s gangrene, particularly in female patients exhibiting similar symptoms.
Non-syndromic phocomelia: A rare case report signifying prenatal screening
Authors: Abu Isneina Shadi , Karaki Mayar , Salah Rand , Rasheed Bayan , Atrash Manar
Published: August 2024

Phocomelia is a rare congenital condition characterized by severe limb malformation, where the limbs are either partly or completely underdeveloped. Phocomelia can occur as a syndrome or as a limb-specific abnormality. The frequency of phocomelia ranges from 0.6 to 4.2 per 100,000 live births; hence, there are not many reports of this deformity. Genetic inheritance and the use of thalidomide are the two main etiological factors of phocomelia. Several symptoms and visceral abnormalities are associated with this condition. Ultrasonography is crucial for the early detection of phocomelia during the intrauterine stage. Presented here is a case of phocomelia in a 6-year-old boy who was diagnosed after birth, with no maternal history of thalidomide usage or family history of the same condition. This case is unique in that it involves a child born with phocomelia but no additional congenital defects observed in related syndromes. Because of that, we suggest this case may be isolated.
Concomitant ulcerative colitis and Usher syndrome in a Pakistani patient: A novel case report
Authors: Siddiqui Fatima Zulfiqar , Ashkar Anusha , Aamir Saira Maryam
Published: August 2024

Ulcerative colitis (UC) and Usher syndrome (USH) are debilitating diseases, compromising quality of life. Globally, half a million cases of UC have been reported, whereas USH is the leading cause of genetic deaf-blindness worldwide. The combined occurrence of both these diseases together is extremely rare. In this one-of-a-kind case report, we discuss the implication of a limited resource-setting on the diagnosis of those diseases. A 33-year-old Southeast Asian male, a known case of hepatitis C presented with a chronic reduction of vision and hearing loss and an acute presentation of loose stools, abdominal pain, and weight loss for 4–7 months. Raised inflammatory markers were reported with a C-Reactive Protein (CRP) level of 64.8 mg/dL. Ultrasound of the abdomen revealed mild abdominopelvic ascites. Colonoscopy showed multiple polyps and was biopsied to have fragments of colonic mucosa with moderate active colitis along with ulcer slough. A Computed Tomography (CT) scan with contrast of the abdomen and pelvis suggested thickened bowel, findings all suggestive of UC. For hearing and sight loss, fundoscopy showed retinitis pigmentosa (RP), and pure tone audiometry suggested bilateral sensorineural hearing loss. A probable diagnosis of mild UC and type II USH was made on clinical examination, radiological imaging, and histopathological sampling. UC and USH have genetic mutations that contribute to the disease manifestations; however, none occur mutually. UC has ophthalmic extraintestinal manifestations, but RP, which is the main reported manifestation in USH, is rarely reported in UC. Maximum efforts were exercised in diagnosing and managing the patient effectively despite the limited resources available. The coexisting USH and UC diagnosis in this patient presents as a rare case. More research is needed to further determine a shared immunological basis of the two disease etiologies and therapeutic advancement.
Limb body wall complex in a 28-week fetus and impact of cultural beliefs on maternal outcomes: A case report
Authors: Ilyas Erum , Affan Muhammad , Dar Marrium S , Jobran Afnan WM
Published: August 2024

The limb body wall complex is a rare congenital disorder that is marked by various anomalies such as thoracoschisis, gastroschisis, limb defects and exencephaly. These defects are not compatible with life and result in spontaneous abortion or stillbirth. It is important to diagnose the anomalies on time and counsel the patients extensively to make the right decision. In this case report, we present a woman in her early twenties pregnant with a fetus with multiple anomalies including ectopia cordis, gastroschisis, meningomyelocele, kyphoscoliosis and congenital talipes equinovarus diagnosed as limb body wall complex at 18 weeks of gestation. Despite extensive counselling by the consultant, the couple decided to continue the pregnancy due to cultural beliefs which ultimately affected the maternal health. The fetus was spontaneously delivered at 28 weeks when the mother came to the hospital with ruptured membranes and the fetus was pronounced dead at birth. The co-occurrence of all these anomalies poses a challenge in diagnosis and management. Extensive counselling is required for the patient to make the appropriate decision for better outcomes. Cultural beliefs can play a major role in the decision-making of the patients and their families which can have a significant effect on maternal outcomes.
Connected health services: Health professionals’ role as seen by parents of a child with inflammatory bowel disease
Authors: Christen Aline , Benedetti Franzisca Domeisen , Händler-Schuster Daniela
Published: August 2024

Objective

Connected health services will change the scope of health professionals’ roles. It is unclear how parents of a child with inflammatory bowel disease perceive the role of health professionals in relation to these services and what their experiences and needs are. The purpose of this study is to highlight parents’ experiences with this role. Furthermore, it aims to outline the fundamental needs that parents have regarding this role, in order to promote audience-specific access to these services and derive overarching action measures.

Methods

Fourteen parents of children with inflammatory bowel disease from seven different clinics in Switzerland were recruited. Between August 2022 and February 2023, these parents were interviewed in semi-structured interviews. The interviews were analyzed using a structured qualitative content analysis.

Results

Five main categories were identified, with few parents having prior experience with the role of health professionals in this area. Parents saw health professionals in the role of gatekeepers, transferers of knowledge and in a supporting function for these services. From the parents’ perspective, health professionals should recognize the limitations of these services and use them as a complement to standard treatment.

Conclusion

The role of health professionals in relation to connected health services needs to be adapted from the parents’ perspective. To meet the needs of parents, health professionals must have access to these services. In addition to health professionals’ personal engagement with these services, institutional and policy changes, as well as research on role development from the perspective of other stakeholders are needed.
Exploring the Motivations of Female Sports Spectators in Taiwan: Implications of Measuring the Motives of Female Consumers at Sporting Events
Authors: Lee Yu-Lin , Wang Fong-Jia , Chen I-Cheng , Chung I-Wei
Published: August 2024

This study aimed to develop a Female Sports Spectator Motivation Scale to assess the factors that influence female consumer behavior at sports events. In Study 1, the Delphi method was employed to identify key factors and develop scale items. Participants ( n = 410) were selected from the regular Chinese Professional Baseball League season in Taiwan. Study 2 involved participants ( n = 413) from the same season, and a multiple linear regression analysis was conducted to assess the predictive validity. Descriptive statistics, exploratory factor analysis, and confirmatory factor analysis were utilized to validate the scale. The results identified stress reduction, emotional connection, game content, aesthetics, self-realization, economics, and social facilitation as influential factors in female sports spectator behavior. This research contributes to a more comprehensive understanding of female sports fans and lays the groundwork for tailored approaches to engage and cater to this important and growing market segment.
Resilience in Crisis: Ristorante Trattoria’s COVID-19 Dilemma
Authors: LeBlanc Brian , Daniell Ripp , Lam Miranda
Published: August 2024

This case study presents an actual scenario in which Ristorante Trattoria, a full-service Italian restaurant located in Boston’s North Shore, must make several difficult decisions related to the COVID-19 Pandemic. This case study introduces students to the realities of business ownership decision-making in times of financial and public health crises, starting with the early spread of coronavirus, business closures, health mandates, laying off employees, utilizing Federal PPP and restaurant funds, eventual reopening, and the difficulty of finding new employees. This case will allow students to examine and critique the restaurant owners’ decisions using qualitative and quantitative data and offer their own strategies.
Treatment of the Hypertrophic Nipple in Breast Augmentation
Authors: Olivera Whyte Lucila M. , Ahualli Patricia E. , Prezzavento Gustavo E.
Published: August 2024

Background: Disproportionately large nipples with respect to the areola and the breast can result in physical and psychological problems for the patient. When a breast augmentation is performed, the nipple is projected forward by the implant, creating an optical appearance of being more projected and bigger in size with respect to the areola. A successful nipple reduction should be able to reduce its diameter and projection to achieve a good esthetic result, preserving its sensitive and lactation functions simultaneously. Objectives: The purpose of this study is to describe our technique and results of nipple reduction in context of breast augmentation. Methods: We carried out a retrospective cohort of patients in which a simultaneous breast augmentation and nipple reduction was performed by the Plastic and Reconstructive surgery Department of the German Hospital (Deutsches Hospital), in Buenos Aires, Argentina, between January 2016 and June 2022. Our technique consisted of a circumferential resection of skin at the base of the nipple followed by a wedge resection of the inferior portion of the nipple. The results were evaluated by comparing preoperative and postoperative photographs. Results: We included 17 patients. No patient presented nipple necrosis, wound dehiscence, hypertrophic scarring or permanent loss of sensation. Lactation could not be evaluated in the postoperative follow-up. Esthetic results were satisfactory in all patients. Conclusions: We described our surgical technique, which allows the treatment of the hypertrophic nipple addressing the anteroposterior projection and diameter independently. In turn, it preserves the sensory. The implantation of the scars at the base of the nipple and its inferior surface achieved discreet scars and a good esthetic result with high satisfaction rates in our patients. Level of evidence: Level IV, retrospective cohort.
A Perspective on Auditory Wellness: What It Is, Why It Is Important, and How It Can Be Managed
Authors: Humes Larry E. , Dhar Sumitrajit , Manchaiah Vinaya , Sharma Anu , Chisolm Theresa H. , Arnold Michelle L. , Sanchez Victoria A.
Published: August 2024

During the last decade, there has been a move towards consumer-centric hearing healthcare. This is a direct result of technological advancements (e.g., merger of consumer grade hearing aids with consumer grade earphones creating a wide range of hearing devices) as well as policy changes (e.g., the U.S. Food and Drug Administration creating a new over-the-counter [OTC] hearing aid category). In addition to various direct-to-consumer (DTC) hearing devices available on the market, there are also several validated tools for the self-assessment of auditory function and the detection of ear disease, as well as tools for education about hearing loss, hearing devices, and communication strategies. Further, all can be made easily available to a wide range of people. This perspective provides a framework and identifies tools to improve and maintain optimal auditory wellness across the adult life course. A broadly available and accessible set of tools that can be made available on a digital platform to aid adults in the assessment and as needed, the improvement, of auditory wellness is discussed.
A Rare Case of Infantile Myofibromatosis With Intra Cranial Involvement
Authors: El Mansoury Fatima Zahrae , El Yousfi Zakia , El Farouki Ayman , El Haddad Siham , Allali Nazik , Chat Latifa
Published: August 2024

Infantile myofibromatosis is a proliferative disorder occurring during infancy and early childhood, marked by the development of nodular or diffuse lesions consisting of various mesenchymal elements. Intracranial involvement is infrequently reported. Here, we present the case of a 3-year-old girl exhibiting a rare manifestation of IM with intracranial parenchymal involvement, displaying a histological pattern documented in existing literature on patients with infantile myofibromatosis. Subsequent MRI follow-up revealed no signs of recurrence.
Kinship Care Disruptions and Child Institutionalisation in Bali, Indonesia: A Qualitative Study
Authors: Westerlaken Rodney
Published: August 2024

This qualitative study explores the factors contributing to the disruption of kinship care and the subsequent institutionalisation of children in Bali, Indonesia. Through in-depth interviews with 50 children residing in child welfare institutions and 16 parents or familial caretakers, the study examines the changing social and cultural perceptions of child institutionalisation and its impact on traditional Balinese kinship systems. The findings reveal that economic hardship, family circumstances and the perceived benefits of institutional care for education are the primary drivers of child institutionalisation. The study highlights the need for strengthening family support systems, adhering to national standards of care and promoting community-based alternatives to institutional care, particularly kinship care and foster care, as part of a continuum of care. Recommendations are provided for policymakers, practitioners and researchers to address the challenges faced by children and families in Bali and to promote family-based care.
How to Support Kinship Care: Lessons Learnt Across the World
Authors: Delap Emily , Gilham Gemma , Clulow Suzanne , Mutama Blessing
Published: August 2024

Kinship care is acknowledged in global guidance as the first form of care that should be explored for children outside of parental care. It is widely used across the world. However, it is poorly supported in many countries. A global review of the literature, key informant interviews and consultations with 411 kinship carers and children in kinship care provide lessons learnt on how to effectively support kinship care. Principles of good practice include enabling the active participation of children and caregivers, taking a kin-first approach, building on the strengths in kinship care families and acknowledging diversity within kinship care. Effective support to kinship care requires an enabling environment, which includes a strong evidence base, policies, strategies and guidance on kinship care, properly financed services across sectors and supportive social norms. In some instances, it is appropriate to formalise kinship care either through registering these arrangements or through the involvement of courts or social services in arranging and monitoring placements. However, this formalisation is neither necessary nor advisable in all instances, and support should never be contingent on formalisation. Kinship care families need access to a range of services and support, including child protection and social services, information about available services, social protection, support accessing health care and education and caregiving supports.
Tell Me More® As A Tool for Provider Connectedness With Hospitalized Patients: A Mixed-Methods Study
Authors: Belin Bryana , Aron Ishi , Bhagat Shyam , Fornari Alice , Ahuja Taranjeet K
Published: August 2024

Rates of burnout and compassion fatigue in healthcare professionals have remained high since the beginning of the pandemic with adverse implications for patient care. Tell Me More® (TMM) is a tool licensed by the Gold Foundation, which was created with the purpose of helping patients, caregivers, and hospital staff to connect with each other on a humanistic level. Research has shown the benefits of the TMM with students and anecdotally with patients. This mixed-method study, which consisted of surveys and semistructured interviews with healthcare professionals (n = 72), sought out to understand the impact of implementation of TMM on a hospital floor. Surveys were distributed before and after the occurrence of TMM with interviews only occurring afterward. Three out of 8 survey items were found to be significant. Content analysis from interviews generated 4 themes from participants which included “Connectedness to Patient,” “Separation of Person and Illness,” “Communication with Patient's Support Network,” and “Connectedness with Non-Verbal Patients.” TMM is a useful tool for strengthening provider–patient relationships in hospital settings and may therefore lessen compassion fatigue and burnout.
Clinical Services, Barriers, and Public Perspectives of Community Pharmacies in Saudi Arabia: A Cross-Sectional Study
Authors: Khayyat Sarah M. , Haseeb Abdul , Alkaabi Ziyad H. , Bahaziq Abdullah M. , Alhomayani Abdulaziz M. , Alhifany Abdullah A. , Alrammaal Hanadi H. , Jaha Athar Y.
Published: August 2024

In the Kingdom of Saudi Arabia, there is an increasing demand for community pharmacists to provide the highest level of clinical knowledge and services. However, evidence regarding Saudi public awareness of the clinical services offered by community pharmacies (CPs) and the barriers to using them is limited. In this cross-sectional study, we used an online questionnaire developed by adapting the Consolidated Framework for Implementation Research. A total of 273 participants completed the survey. Half the participants were generally aware of the availability of some CP services but were not informed about the full range on offer, eg, medication reviews (84%) and online counseling (89%). Most of the participants (69.6%) did not identify differences in the care provided by community pharmacists versus hospital pharmacists ( P = 0.02). A commonly reported barrier to using CP services was a general preference for other healthcare professionals to seek pharmaceutical help (85.7%). Many other barriers were also reported, impacting the participants’ use of these services. The decision-making authorities should consider improvements to increase patients’ awareness and utilization of clinical services and enhance community pharmacists’ performance in clinical-oriented pharmaceutical care.
Knowledge and Practice of Intestinal Ostomy Care Among Nurses in Bahir Dar City, Ethiopia: A Cross-Sectional Study
Authors: Endeshaw Destaw , Tesfaye Tadesse Dagget , Afewerk Sahileslassie , Adal Ousman , Belayneh Asnake Gashaw , Bogale Eyob Ketema , Yohannes Senay
Published: August 2024

Background

Globally, ostomy creation rates are rising. Stomas, while life-saving, pose significant challenges. Nurses are vital in providing care and support to stoma patients. However, ostomy care practice and knowledge among Ethiopian nurses remain understudied. This study aimed to assess these aspects among nurses in Bahir Dar City, Ethiopia, in 2022.

Methods

An institutional-based cross-sectional study was conducted in three public hospitals in Bahir Dar City from September 19 to September 30, 2022. A simple random sampling technique was used to select 423 nurses. Binary logistic regression analysis was employed to identify associated factors toward dependent variables by considering p-value <0.05 to be statistically significant.

Result

From the total samples, 382(90.3%) responded to the questionnaire. The overall good knowledge and practice level of nurses regarding ostomy care was 55.2% and 52.1%, respectively. Taking ostomy care training {AOR = 2.44; 95% CI (1.29, 4.61)} and high level of a monthly income of study participants {AOR = 2.90; 95% CI (1.72, 4.91)} had a significant association with knowledge of ostomy care. On the other hand, taking courses on ostomy care {AOR = 1.76; 95% CI (1.06, 2.93)}, receiving training on ostomy care {AOR = 4.15; 95% CI (2.12, 8.09)} and good knowledge level on ostomy care {AOR = 2.13; 95% CI (1.32, 3.45)} were significantly associated with expressed practice of ostomy care.

Conclusion

The study found that only half of nurses exhibit good knowledge and practice in ostomy care. Training and monthly income significantly influence nurses’ knowledge, while practice level is associated with training, course attendance, and knowledge. These findings highlight the importance of targeted training programs and education initiatives to enhance nurses’ competence in ostomy care. It is also crucial to address factors like nurses’ income levels to ensure equitable access to educational resources and opportunities for professional development, thus enhancing their knowledge.
Nursing Leaders’ Knowledge and Awareness of Bullying and Lateral Violence: A Qualitative Study
Authors: Luca Corina Elena , Pezzoli Giovanna , Kunz Stefan , Bianchi Monica
Published: August 2024

Introduction

Bullying and lateral violence are prevalent phenomena within the nursing profession, exerting significant impacts on patient safety, the nursing profession and the organisation. The pivotal role of nurse leaders is paramount in both the prevention and resolution of these issues.

Aim

The aim is to explore the level of awareness and knowledge of bullying and lateral violence of nurse leaders in a public hospital in Switzerland.

Methods

A qualitative descriptive study has been conducted. Data were collected from February to August 2020 using semi-structured interviews and focus groups that were recorded and transcribed verbatim. Two researchers independently utilised Braun and Clarke's thematic analysis to code, categorise and synthesise the data. The sample of nursing middle-management leaders was purposive.

Results

The study involved 35 nurse leaders as participants. Through data analysis, 15 themes were identified, which were further grouped into five major themes: characteristics of the phenomena, facilitating and hindering factors, emotions/experiences, strategies and supports. The results highlighted that nurse leaders may have a lack of knowledge about these phenomena, leading to challenges in their identification. The awareness achieved by the nurse leaders highlighted their need to understand what they were ‘fighting against’.

Conclusion

It is essential to consider the impact of these phenomena on employees’ well-being and their potential consequences for patient safety, quality of care and financial performance. A preventive approach by increasing nurse leaders’ competence in observing everyday working realities and identifying strategies for addressing bullying is required. Further research on the construction and implementation of specific interventions is essential, aimed at preventing and addressing these phenomena comprehensively.
Has Immigration Slowed Down Secularization in Germany? Empirical Evidence From 2014 to 2021
Authors: Steinmann Jan-Philip
Published: August 2024

The aim of this data visualization is to answer the question of whether immigration has acted as a counter-secularization force in Germany in recent years. The hypothesis is based on the tendency of first- and second-generation immigrants to exhibit higher levels of religiosity compared with the host populations. Simulation analysis involving more than 15,000 respondents of data from the 2014 to 2021 German General Social Survey indicates that the increase in the immigrant population during this period does not emerge as a substantial counterforce to religious decline in both eastern and western Germany. An effective slowdown of secularization in Germany would have required a more substantial increase in immigration, a notably higher level of religious engagement among new arrivals and their descendants than was observed, and a reduced pace of secularization among them.
A Future Uniform Regime of International Commercial Mediator Immunity: Limited, Party-Agreed and Statute-Required
Authors: Lin Meng
Published: August 2024

Mediator immunity refers to the privilege of mediators’ to be partially or completely immune from civil liability. There are ongoing debates on whether to grant this immunity and both sides provide their arguments. However, mediator immunity is better supported based on mediators’ identity as experts rather than as judicial or quasi-judicial figures. So far, there are three degrees of mediator immunity: absolute, limited and differentiated. Among these, limited immunity is more effective in balancing the conflicting interests involved. Furthermore, mediator immunity may find its source in exemption agreements, case law or statute law. For the sake of certainty and predictability, parties should be entitled to provide mediators with immunity within limits by agreement, and the validity and effects of such agreements should be clearly recognised by statute.
Response to Portugali: Seeing the forest for the trees
Authors: DeVerteuil Geoffrey
Published: August 2024

This commentary provides several critiques to Portugali's admirably ambitious paper on the utility of applying Bohm's scientific approach to unify the current disarray in urban studies. The critiques focus on incommensurability between science and social science, conceptual over-reach, and the value of diversity versus unity.
Theorizing epidemiology, the stories bodies tell, and embodied truths: a status update on contending 21st c CE epidemiological theories of disease distribution
Authors: Krieger Nancy
Published: August 2024

This critical review considers the status of 21st-century epidemiological theories of disease distribution, updating to 2024 prior analyses published up through 2014, and discusses the implications of these theories for research, practice, and pedagogy. Three key trends stand out: ( a) the continued dominance of individualistic biomedical and lifestyle theories; ( b) growth and elaboration of social epidemiological alternatives; and ( c) the ongoing inattention to epidemiologic theories of disease distribution in the training of epidemiologists and public health professionals and in current efforts to improve the rigor of epidemiological research and causal inference. In a context of growing global political polarization, climate crisis, broader environmental and ecological crises, and stubbornly persistent health inequities within and between nations, producing actionable knowledge relevant to improving the people’s health and advancing health justice will require much greater engagement with social epidemiologic theories of disease distribution in research, pedagogy, and practice. At issue is critically engaging with the embodied truths manifested in the stories bodies tell in population patterns of health, disease, and well-being.
Endogenous endophthalmitis secondary to Lemierre’s Syndrome originating from pharyngotonsillitis
Authors: Gangoitia Gorrotxategi Nerea , Garmendia Iñigo Salmeron , Heras-Mulero Henar , Arbués Santiago López , Silva Esther Compains
Published: August 2024

Purpose

The purpose of this article is to report a case of Lemierre’s Syndrome producing unilateral endogenous endophthalmitis in a healthy, young woman with a history of tonsillitis.

Case report/observations

A 17-year-old healthy woman developed fever after a few days of sore throat. She later developed pneumonia with septic signs, leading to admission to the Intensive Care Unit. Lemierre Syndrome was diagnosed due to multiple septic pulmonary emboli and signs of sepsis following a recent episode of tonsillitis. During hospitalization, the patient complained of decreased visual acuity and floaters in her left eye. Ophthalmological examination revealed papillary edema, vitritis, foci of chorioretinitis in the macula and Roth’s spots, confirming the diagnosis of endogenous endophthalmitis. Subsequently, she underwent appropriate treatment, progressing satisfactorily.

Conclusion and importance

Although ophthalmological manifestations are rare, due to the pathophysiological characteristics of Lemierre’s Syndrome, all patients should underwent standard ophthalmologic assessment, even in the absence of ophthalmic symptoms or visible findings, as part of a multidisciplinary management approach.
Visualizing and diagnosing spillover within randomized concurrent controlled trials through the application of diagnostic test assessment methods
Authors: Hurley James C.
Published: August 2024

Background

Spillover of effect, whether positive or negative, from intervention to control group patients invalidates the Stable Unit Treatment Variable Assumption (SUTVA). SUTVA is critical to valid causal inference from randomized concurrent controlled trials (RCCT). Spillover of infection prevention is an important population level effect mediating herd immunity. This herd effect, being additional to any individual level effect, is subsumed within the overall effect size (ES) estimate derived by contrast-based techniques from RCCT’s. This herd effect would manifest only as increased dispersion among the control group infection incidence rates above background.

Methods and results

The objective here is to explore aspects of spillover and how this might be visualized and diagnosed. I use, for illustration, data from 190 RCCT’s abstracted in 13 Cochrane reviews of various antimicrobial versus non-antimicrobial based interventions to prevent pneumonia in ICU patients. Spillover has long been postulated in this context. Arm-based techniques enable three approaches to identify increased dispersion, not available from contrast-based techniques, which enable the diagnosis of spillover within antimicrobial versus non-antimicrobial based infection prevention RCCT’s. These three approaches are benchmarking the pneumonia incidence rates versus a clinically relevant range, comparing the dispersion in pneumonia incidence among the control versus the intervention groups and thirdly, visualizing the incidence dispersion within summary receiver operator characteristic (SROC) plots. By these criteria there is harmful spillover effects to concurrent control group patients.

Conclusions

Arm-based versus contrast-based techniques lead to contrary inferences from the aggregated RCCT’s of antimicrobial based interventions despite similar summary ES estimates. Moreover, the inferred relationship between underlying control group risk and ES is ‘flipped’.
Gender-based differences in the representation and experiences of academic leaders in medicine and dentistry: a mixed method study from Pakistan
Authors: Shahzad Muhammad , Jamil Brekhna , Bushra Mehboob , Mahboob Usman , Elmigdadi Fayig
Published: August 2024

Background

Research evidence suggests gender-based differences in the extent and experiences of academic leaders across the globe even in developed countries like USA, UK, and Canada. The under-representation is particularly common in higher education organizations, including medical and dental schools. The current study aimed to investigate gender-based distribution and explore leaders’ experiences in the medical and dental institutes in a developing country, Pakistan.

Methods

A mixed-method approach was used. Gender-based distribution data of academic leaders in 28 colleges including 18 medical and 10 dental colleges of Khyber Pakhtunkhwa, Pakistan were collected. Qualitative data regarding the experiences of academic leaders (n = 10) was collected through semi-structured interviews followed by transcription and thematic analysis using standard procedures.

Results

Gender-based disparities exist across all institutes with the greatest differences among the top-rank leadership level (principals/deans) where 84.5% of the positions were occupied by males. The gender gap was relatively narrow at mid-level leadership positions reaching up to as high as > 40% of female leaders in medical/dental education. The qualitative analysis found gender-based differences in the experiences under four themes: leadership attributes, leadership journey, challenges, and support.

Conclusions

The study showed that women are not only significantly under-represented in leadership positions in medical and dental colleges in Pakistan, they also face gender-based discrimination and struggling to maintain a decent work life balance. These findings are critical and can have important implications for government, organizations, human resource managers, and policymakers in terms of enacting laws, proposing regulations, and establishing support mechanisms to improve gender-based balance and help current and aspiring leaders in their leadership journey.
Prediction of sepsis mortality in ICU patients using machine learning methods
Authors: Gao Jiayi , Lu Yuying , Ashrafi Negin , Domingo Ian , Alaei Kamiar , Pishgar Maryam
Published: August 2024

Problem

Sepsis, a life-threatening condition, accounts for the deaths of millions of people worldwide. Accurate prediction of sepsis outcomes is crucial for effective treatment and management. Previous studies have utilized machine learning for prognosis, but have limitations in feature sets and model interpretability.

Aim

This study aims to develop a machine learning model that enhances prediction accuracy for sepsis outcomes using a reduced set of features, thereby addressing the limitations of previous studies and enhancing model interpretability.

Methods

This study analyzes intensive care patient outcomes using the MIMIC-IV database, focusing on adult sepsis cases. Employing the latest data extraction tools, such as Google BigQuery, and following stringent selection criteria, we selected 38 features in this study. This selection is also informed by a comprehensive literature review and clinical expertise. Data preprocessing included handling missing values, regrouping categorical variables, and using the Synthetic Minority Over-sampling Technique (SMOTE) to balance the data. We evaluated several machine learning models: Decision Trees, Gradient Boosting, XGBoost, LightGBM, Multilayer Perceptrons (MLP), Support Vector Machines (SVM), and Random Forest. The Sequential Halving and Classification (SHAC) algorithm was used for hyperparameter tuning, and both train-test split and cross-validation methodologies were employed for performance and computational efficiency.

Results

The Random Forest model was the most effective, achieving an area under the receiver operating characteristic curve (AUROC) of 0.94 with a confidence interval of ±0.01. This significantly outperformed other models and set a new benchmark in the literature. The model also provided detailed insights into the importance of various clinical features, with the Sequential Organ Failure Assessment (SOFA) score and average urine output being highly predictive. SHAP (Shapley Additive Explanations) analysis further enhanced the model’s interpretability, offering a clearer understanding of feature impacts.

Conclusion

This study demonstrates significant improvements in predicting sepsis outcomes using a Random Forest model, supported by advanced machine learning techniques and thorough data preprocessing. Our approach provided detailed insights into the key clinical features impacting sepsis mortality, making the model both highly accurate and interpretable. By enhancing the model’s practical utility in clinical settings, we offer a valuable tool for healthcare professionals to make data-driven decisions, ultimately aiming to minimize sepsis-induced fatalities.
Assessing hypertension care quality in Brazil: gender, race, and socioeconomic intersection in public and private services, 2013 and 2019 national health surveys
Authors: de Albuquerque Paulo Victor Cesar , Tomasi Elaine
Published: August 2024

We conducted a cross-sectional study of hypertension care in public and private services, analyzing gender, color, and socioeconomic status. Using data from the 2013 (n = 60,202) and 2019 (n = 90,846) national health surveys, hypertension prevalence increased from 21.4 to 23.9%. Quality of care declined from 41.7 to 35.4%, particularly in public services, disproportionately affecting low-income Black women. Poisson regression estimated prevalence ratios (PRs), with the lowest adjusted PR for high-quality care among low-income Black women. These findings highlight persistent health inequalities and the urgent need for intersectoral policies to promote health equity.
Contamination of a drug consumption room with drugs and potential risks for social health care workers
Authors: Cuffaro Flore , Dahm Georges , Marson Claude , Berlemont Patrick , Yegles Michel , Allar Claudia , Fauchet Lionel , Creta Matteo , Schneider Serge
Published: August 2024

Background

Studies have shown that contamination of surfaces by illicit drugs frequently occurs in forensic laboratories when manipulating seized samples as well as in pharmacies and hospitals when preparing medicinal drugs. In this project, we extended these studies to a Drug Consumption Room to investigate drug levels and possible exposure of the staff members.

Methods

We investigated pre and post cleaning contamination by heroin and cocaine and their degradation products 6-monoacetylmorphine and benzoylecgonine on different surfaces (tables, counters, computers and door handles) and in the ambient air. We also collected urine and hair samples from staff members to check for potential short and long term contaminations.

Results

Medium to heavy contamination has been detected on most surfaces and door handles; as expected, air contamination was particularly high in the smoking room. Drug levels were < LOD to very low in the urine and the hair samples of staff members tested.

Conclusion

The cleaning efficiency of the surfaces, carried out by staff and drug users after drug consumption, was often not satisfactory. The very low drug levels in hair indicate that acute health risks for staff members are low.
7p22.3 microdeletion: a case study of a patient with congenital heart defect, neurodevelopmental delay and epilepsy
Authors: Skvortsova Liliya , Perfilyeva Anastassiya , Bespalova Kira , Kuzovleva Yelena , Kabysheva Nailya , Khamdiyeva Ozada
Published: August 2024

Background

Chromosome 7 has regions enriched with low copy repeats (LCRs), which increase the likelihood of chromosomal microdeletion disorders. Documented microdeletion disorders on chromosome 7 include both well-known Williams syndrome and more rare cases. It is noteworthy that most cases of various microdeletions are characterized by phenotypic signs of neuropsychological developmental disorders, which, however, have a different genetic origin. The localization of the microdeletions, the genes included in the region, as well as the structural features of the sequences of these genes have a cumulative influence on the phenotypic characteristics of the individuals for each specific case and the severity of the manifestations of disorders. The consideration of these features and their detailed analysis is important for a correct and comprehensive assessment of the disease.

Results

The article describes a clinical case of 7p22.3 microdeletion in a patient with congenital heart defect and neurological abnormalities - epilepsy, combined with moderate mental and motor developmental delay.

Conclusions

Through detailed genetic analyses, we are improving the clinical description of the rare 7p22.3 microdeletion and thus creating a basis for future genetic counseling and research into targeted therapies.
Whole-genome sequencing analysis reveals new susceptibility loci and structural variants associated with progressive supranuclear palsy
Authors: Wang Hui , Chang Timothy S. , Dombroski Beth A. , Cheng Po-Liang , Patil Vishakha , Valiente-Banuet Leopoldo , Farrell Kurt , Mclean Catriona , Molina-Porcel Laura , Rajput Alex , De Deyn Peter Paul , Le Bastard Nathalie , Gearing Marla , Kaat Laura Donker , Van Swieten John C. , Dopper Elise , Ghetti Bernardino F. , Newell Kathy L. , Troakes Claire , de Yébenes Justo G. , Rábano-Gutierrez Alberto , Meller Tina , Oertel Wolfgang H. , Respondek Gesine , Stamelou Maria , Arzberger Thomas , Roeber Sigrun , Müller Ulrich , Hopfner Franziska , Pastor Pau , Brice Alexis , Durr Alexandra , Le Ber Isabelle , Beach Thomas G. , Serrano Geidy E. , Hazrati Lili-Naz , Litvan Irene , Rademakers Rosa , Ross Owen A. , Galasko Douglas , Boxer Adam L. , Miller Bruce L. , Seeley Willian W. , Van Deerlin Vivanna M. , Lee Edward B. , White Charles L. , Morris Huw , de Silva Rohan , Crary John F. , Goate Alison M. , Friedman Jeffrey S. , Leung Yuk Yee , Coppola Giovanni , Naj Adam C. , Wang Li-San ,   P. S. P. genetics study group, Dalgard Clifton , Dickson Dennis W. , Höglinger Günter U. , Schellenberg Gerard D. , Geschwind Daniel H. , Lee Wan-Ping
Published: August 2024

Background

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease characterized by the accumulation of aggregated tau proteins in astrocytes, neurons, and oligodendrocytes. Previous genome-wide association studies for PSP were based on genotype array, therefore, were inadequate for the analysis of rare variants as well as larger mutations, such as small insertions/deletions (indels) and structural variants (SVs).

Method

In this study, we performed whole genome sequencing (WGS) and conducted association analysis for single nucleotide variants (SNVs), indels, and SVs, in a cohort of 1,718 cases and 2,944 controls of European ancestry. Of the 1,718 PSP individuals, 1,441 were autopsy-confirmed and 277 were clinically diagnosed.

Results

Our analysis of common SNVs and indels confirmed known genetic loci at MAPT, MOBP, STX6, SLCO1A2, DUSP10, and SP1, and further uncovered novel signals in APOE, FCHO1/MAP1S, KIF13A, TRIM24, TNXB, and ELOVL1. Notably, in contrast to Alzheimer’s disease (AD), we observed the APOE ε2 allele to be the risk allele in PSP. Analysis of rare SNVs and indels identified significant association in ZNF592 and further gene network analysis identified a module of neuronal genes dysregulated in PSP. Moreover, seven common SVs associated with PSP were observed in the H1/H2 haplotype region (17q21.31) and other loci, including IGH, PCMT1, CYP2A13, and SMCP. In the H1/H2 haplotype region, there is a burden of rare deletions and duplications (P = 6.73 × 10–3) in PSP.

Conclusions

Through WGS, we significantly enhanced our understanding of the genetic basis of PSP, providing new targets for exploring disease mechanisms and therapeutic interventions.
A qualitative study on the experiences of family caregivers of children with End Stage Kidney Disease (ESKD)
Authors: Boateng Edward Appiah , Bisiw Mabel Baaba , Agyapomah Rosemary , Enyemadze Isaac , Kyei-Dompim Joana , Kumi Samuel Peprah , Boakye Dorothy Serwaa
Published: August 2024

Background

Family caregivers, mostly parents, are greatly involved in the care of their children with end stage kidney disease (ESKD) globally. Yet, the experiences of these caregivers and the demands placed on them by the caregiving role have not been explored or documented in Ghana. This study explored how caregiving affects the psychological, physical, social, and spiritual well-being of family caregivers of children with end stage kidney disease (ESKD) in Ghana.

Methods

A phenomenological approach with the purposive sampling technique was used to gather data from 12 family caregivers of children with ESKD at a pediatric renal unit in Ghana. A semi-structured interview guide was constructed based on the constructs of the City of Hope Quality of Life (QoL) Family Caregiver Model and the research objectives. Colaizzi’s thematic analysis approach was utilized to analyze data for this study. Themes were organized under the domains of the chosen model, and a new theme outside these domains was also generated.

Results

The majority of the family caregivers experienced anxiety, fear, uncertainty, and hopelessness in response to the children’s diagnosis and care. The thought of the possibility of the children dying was deeply traumatizing for our participants. Most participants reported bodily pains and physical ailments because of lifting and caring for the children. Financial constraint was also a key issue for all the family caregivers. Most of them received diverse support from their families and loved ones. Due to the demanding nature of the care, most family caregivers had to change or quit their jobs. They coped with the challenges through prayers, participating in religious activities, and being hopeful in God for healing.

Conclusion

All the family caregivers had their psychological well-being compromised as a result of the challenges they encountered physically, socially, and spiritually. Continuous psychosocial support, funding support, and review of policies on leave for civil workers with children diagnosed with ESKD are urgently required.