bluuebunny/crossref_metadata_2025 huggingface dataset:
Interstitial lung diseases: an epidemiological overview
Authors: Demedts M. , Wells A.U. , Antó J.M. , Costabel U. , Hubbard R. , Cullinan P. , Slabbynck H. , Rizzato G. , Poletti V. , Verbeken E.K. , Thomeer M.J. , Kokkarinen J. , Dalphin J.C. , Newman Taylor A.
Published: October 2024

Epidemiological studies on interstitial lung diseases (ILDs) may be schematically subdivided into the following major types: 1) quantifications of disease, broken down into incidence, prevalence and mortality data; 2) identification of aetiological factors; and 3) clinical epidemiological studies. Epidemiological data may be obtained from different sources or population groups, using different study designs such as systematic national statistics, population-based data and registries, and large case series of specific diseases.

Differences in results between epidemiological studies may be due to real differences in incidence, but may also be due to changes in disease definitions and classifications, differences in the epidemiological design of the studies, or even registration bias.

Comparative epidemiological data of different ILDs are almost limited to the general population study in Bernalillo County and to national mortality statistics, which should be interpreted with great caution. Also, some, mostly national registries of the different ILDs have been carried out by specific medical profession groups (especially pulmonologists), which clearly underestimate the real incidence of ILDs, but in which the comparison of the relative frequencies is probably accurate. Based on all these comparative studies, sarcoidosis and idiopathic pulmonary fibrosis appear to be the most frequent ILDs, followed by hypersensitivity pneumonitis and ILD in collagen vascular disease, when classical pneumoconioses are not included. There is also a relatively large group of nonspecific fibrosis.

Much more data have been published on the epidemiology of specific forms of interstitial lung disease. Most information is available on the epidemiology of sarcoidosis, and those data are probably the most accurate. Data on idiopathic pulmonary fibrosis have the disadvantage of the recent changes in definition and classification of this disease. Hypersensitivity pneumonitis has been studied epidemiologically, especially in some exposure groups such as farmers and pigeon breeders, and in some regions in North America, UK, France and Scandinavia. Estimates of frequencies of interstitial lung disease in collagen vascular disease or of drug-induced interstitial lung disease are less accurate and more variable, depending on diagnostic criteria. Notwithstanding the aforementioned problems, this report tries to provide a balanced overview of the epidemiology of different interstitial lung diseases.
Cryptogenic fibrosing alveolitis/idiopathic pulmonary fibrosis
Authors: du Bois R.M. , Wells A.U.
Published: October 2024

Cryptogenic fibrosing alveolitis (CFA), synonymous with idiopathic pulmonary fibrosis (IPF), remains a life-threatening disease: 50% of patients die within 5 yrs. Historically, many diseases that are now considered to be quite distinct have been “labelled” as CFA. More recently, high-resolution computed tomography and new appreciation of the histopathological patterns of idiopathic interstitial pneumonias have enabled disease variants to be defined according to their different responses to therapy and survival.

CFA is believed to be induced by an external agent, although it is not clear whether CFA represents the final common outcome of numerous pathogenetic mechanisms or has a single cause. In addition, there are currently no prospective double-blind, placebo-controlled trials of treatment showing superiority of one drug regimen over another.

This review attempts to dissect the different patterns of cryptogenic fibrosing alveolitis, illustrate the major features of each, and refine the clinico-radiological-pathological descriptors that together define cryptogenic fibrosing alveolitis as it is understood today.
Sarcoidosis: clinical update
Authors: Costabel U.
Published: October 2024

Many advances have been made regarding sarcoidosis in the past 2 decades. As a result, sarcoidosis is now defined as a multisystem disorder with a heightened cellular immune response at sites of disease activity in patients with a predisposition for sarcoidosis and a presumed exposure to as yet unknown transmissible environmental agents.

Recent International Consensus Statement recommendations regarding diagnosis and therapy have been published. The diagnosis of sarcoidosis is based on a compatible clinical and/or radiological picture, histological evidence of noncaseating granulomas and exclusion of other diseases capable of producing a similar histological or clinical picture.

Therapy is based on corticosteroids, although there are indications of valuable alternatives. Except for life- and sight-threatening organ involvement, it should be carefully considered whether the patient might benefit from treatment. For asymptomatic pulmonary sarcoidosis, a watch and wait approach is appropriate; treatment should mainly be considered if symptoms develop or lung function deteriorates.
Drug-induced infiltrative lung disease
Authors: Camus Ph. , Foucher P. , Bonniaud Ph. , Ask K.
Published: October 2024

An increasing number of drugs are recognized to induce distinctive patterns of infiltrative lung disease (ILD), ranging from benign infiltrates to life-threatening adult respiratory distress syndromes. In addition to drugs, biomolecules such as proteins and cytokines, and medicinal plants are also capable of inducing respiratory disease, some being severe and/or irreversible.

For several reasons it is difficult to estimate the exact frequency of drug-induced infiltrative lung disease (DI‐ILD). The risk for DI‐ILD and the clinical patterns vary depending on a variety of host and drug factors.

Although establishing the diagnosis is often difficult, systematic evaluation of the possible role of almost any kind of drugs in ILD is warranted, as stopping a drug may favourably influence prognosis. However, prognosis depends on the drug and the type of DI‐ILD. Corticosteroids may suppress the inflammatory reaction, but for many drugs, proof of the effect of corticosteroids is lacking.

Advances in prevention and prediction are needed. A user-friendly database of respiratory adverse drug reactions was made available on the web, to provide quick information in this area.
Comparison of registries of interstitial lung diseases in three European countries
Authors: Thomeer M.J. , Costabel U. , Rizzato G. , Poletti V. , Demedts M.
Published: October 2024

Few published studies have compared epidemiological data on the prevalence, incidence or relative frequency of the different interstitial lung diseases. In this review, the data of such registries from three countries in Europe (Belgium, Germany and Italy) are compared with those in the USA (Bernalillo County, NM).

These registries show some striking similarities, but also discrepancies, which in part may be real, but may also be due to selection bias. Indeed, the registries in the European countries encompass the patients seen by pulmonologists, while the registry in Bernalillo County is based on a general population study in a limited area. In addition, in some studies, prevalences and incidences were registered, while in others, only prevalences or incidences were registered. Finally, most, but not all studies were prospective.

Nonetheless, the different studies showed that sarcoidosis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, interstitial lung diseases due to collagen vascular diseases and not-defined (or postinflammatory) fibrosis were most frequent. In the majority of disease entities a male predominance was found. Surprisingly large differences in the use of diagnostic techniques, such as high-resolution computed tomography, bronchoalveolar lavage, open lung biopsy and transbronchial lung biopsy, were noted between the different studies.
Occupational dust exposure and the aetiology of cryptogenic fibrosing alveolitis
Authors: Hubbard R.
Published: October 2024

Cryptogenic fibrosing alveolitis (CFA), synonymous with idiopathic pulmonary fibrosis, is probably a disease entity of increasing frequency.

Epidemiological investigations into the aetiology of CFA are at an early age; yet there are several indications that exposures associated with traditionally male manufacturing occupations may be a cause of CFA.

Specifically, metal exposure, and to a lesser extent wood dust exposure, was increased in patients with CFA and may explain some cases of CFA. Indeed, the four case-control studies in the literature, to date, have all found an identical occupational exposure to metal or working with metal as a risk factor for CFA and there is now further evidence confirming this association from a case-control study nested within an occupational cohort. There is also evidence from three of the case-control studies that working with wood may be a risk factor for CFA.

However, these exposures clearly only explain a minority of cases of cryptogenic fibrosing alveolitis. Further studies amongst different populations with different occupational demographics are required to fully assess the impact of several exposures on the occurrence of cryptogenic fibrosing alveolitis.
Antibody-targeted T cells and natural killer cells for cancer immunotherapy
Authors: Sutherland Ashley R. , Parlekar Brijesh , Livingstone David W. , Medina Andrés X. , Bernhard Wendy , García Tays Hernández , DeCoteau John , Geyer C. Ronald
Published: October 2024

Background

Adoptive cell cancer therapies aim to re-engineer a patient’s immune cells to mount an anti-cancer response. Chimeric antigen receptor T and natural killer cells have been engineered and proved successful in treating some cancers; however, the genetic methods for engineering are laborious, expensive, and inefficient and can cause severe toxicities when they over-proliferate.

Results

We examined whether the cell-killing capacity of activated T and NK cells could be targeted to cancer cells by anchoring antibodies to their cell surface. Using metabolic glycoengineering to introduce azide moieties to the cellular surface, we covalently attached a dibenzocyclooctyne-modified antibody using the strain-promoted alkyne azide cycloaddition reaction, creating antibody-conjugated T and NK cells. We targeted the immune cells to tumors possessing the xenoantigen, N-glycolyl neuraminic acid GM3 ganglioside, using the 14F7hT antibody. These activated T and NK cells are “armed” with tumour-homing capabilities that specifically lyses antigen-positive cancer cells without off-target toxicities. Moreover, when exposed to target cells, 14F7hT-conjugated T cells that are not preactivated exhibit increased perforin, granzyme, CD69, and CD25 expression and specific cell killing.

Conclusions

This research shows the potential for a non-genetic method for redirecting cytotoxic immune cells as a feasible and effective approach for tumor-targeted cell immunotherapy.

Graphical Abstract
Impact of chronic ankle instability on gait loading strategy in individuals with chronic ankle instability: a comparative study
Authors: Elabd Omar M. , Elabd Aliaa M. , El-Azez Mona S. Abd , Taha Mohamed M. , Mohammed Amira H.
Published: October 2024

Background

Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied.

Purpose

The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control.

Methods

A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy.

Results

The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly.

Conclusions

The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.
The effects of neighborhood perceptions on response to a technology-assisted parenting intervention for adolescent substance use: protocol of a diversity supplement to parent SMART (Substance Misuse in Adolescents in Residential Treatment)
Authors: Patel-Syed Zabin , Helseth Sarah A. , Rosales Robert , Janssen Tim , Scott Kelli , Becker Sara J.
Published: October 2024

Background

It is well established that an adolescent’s neighborhood is associated with their likelihood of developing a substance use disorder. The availability of drugs, lack of access to resources, and exposure to violence are all associated with greater substance use among young people, leading to more pronounced health inequities. Technology assisted interventions (TAIs) have been touted to enhance the reach of substance use treatment and improve outcomes for high-need families living in underserved neighborhoods. A key question is whether neighborhood characteristics impact the effectiveness of TAIs, given these interventions are embedded within an adolescent’s natural environment. This National Institute on Drug Abuse-funded Diversity Supplement will examine the role of perceived neighborhood characteristics on response to Parent SMART, a TAI for parents of adolescents in residential substance use treatment (R37DA052918; PI: Becker). Aim 1 will use both adolescent and parent self-report of multiple neighborhood dimensions (e.g., physical environment, social disorder, satisfaction with community resources) to identify indicators predictive of treatment response. Aim 2 will then explore the indirect relationship between neighborhood context and response to Parent SMART, via engagement.

Methods

Participants include adolescent and parent dyads enrolled in an effectiveness trial evaluating Parent SMART, a TAI for parents of adolescents in residential substance youth treatment. Participants will complete self-report measures of neighborhood physical environment, social disorder, and satisfaction with community resources at baseline to predict parenting and youth substance outcomes at 6-, 12-, and 24-weeks post discharge.

Discussion

To date, few studies have explicitly tested how neighborhood affects response to TAIs for adolescent substance use. Assessing adolescent and parent perceptions of neighborhood characteristics holds potential to pinpoint key contextual factors that affect TAI response and to promote consideration of multi-level health equity determinants in substance use research. Understanding neighborhood influences can advance public health by helping tailor TAIs to address the unique needs of adolescents living in underserved communities.

Trial registration

This study extends the measurement and analysis plan of a pragmatic effectiveness trial. The pragmatic effectiveness trial is registered at ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385
Deciphering LAG-3: unveiling molecular mechanisms and clinical advancements
Authors: Martínez-Pérez Alejandra , Granda-Díaz Rocío , Aguilar-García Candelaria , Sordo-Bahamonde Christian , Gonzalez Segundo
Published: October 2024

Treatment based on immune checkpoint blockade has revolutionized cancer therapy. Despite the remarkable success achieved and the preclinical development of multiple checkpoint inhibitors targeting other checkpoints, only antibodies targeting the PD-1/PD-L1 axis and CTLA-4 have been approved for patient treatment, especially in solid tumors. Currently, with the approval of relatlimab, a LAG-3 blocking antibody, a third player, has been used in the fight against cancer. The endorsement of relatlimab marks a significant milestone in cancer immunotherapy, opening new avenues for combination therapies and enhancing treatment outcomes. However, the complex biology of LAG-3 may hinder its full development as a therapeutic alternative. In this review, we provide in-depth insight into the biology of LAG-3 and its current and future development in cancer treatment.
Experimental study evaluating the performance of thermal conductivity prediction models for air–water saturated weathered sandstone heritage
Authors: Hu Jinshuai , Huang Jizhong , Cheng Yuan
Published: October 2024

As a critical parameter, thermal conductivity directly determines the heat transfer and temperature variation within rocks, which can lead to mechanical damage and chemical corrosion. Consequently, understanding the thermal conductivity of stone heritage is vital for assessing their deterioration mechanisms and developing effective conservation strategies. This study obtained sandstone samples from the Yungang Grottoes and subjected them to freeze–thaw cycle experiments to generate weathered sandstone samples. Subsequently, the thermal conductivity of these samples was measured under both dry and water-saturated state using the transient plane source method. To analyze the relationship between air–water saturation, porosity, and thermal conductivity, a saturation influence coefficient was introduced. Thereafter, the effectiveness and applicability of 13 commonly used thermal conductivity mixing law prediction models were evaluated based on experimental data. The results suggested that the influence of water saturation on the thermal conductivity of rocks varies with porosity, and water saturation significantly enhances the thermal conductivity of weathered sandstone. Among the 13 common models, the Geometric mean model was found to be more accurate than other models, with superior performance in both dry (MAE, RMSE, MAPE are 0.148, 0.214, 5.59% respectively) and water-saturated (MAE, RMSE, MAPE are 0.244, 0.170, 8.4% respectively) state. The Albert model demonstrates a good fit in the dry state, whereas the Walsh model (with maximum effect), Ribaud model, and Huang model also exhibit good fitting efficacy in the water-saturated state. This study provides a solid foundation for better predicting the thermal conductivity of weathered stone heritage and developing effective preventive conservation strategies.
Effective multi-biocatalyst system with reusable NADH for transformation of glycerol to value-added dihydroxyacetone
Authors: Wee Youngho , Kumar Gudi Satheesh , Kim Seongbeen , Zhao Xueyan Sarah , Wang Ping , Lee Jinwoo , Hwang Ee Taek , Kim Jungbae
Published: October 2024

Glycerol-based biorefinery can be a highly profitable process by producing highly value-added products such as dihydroxyacetone via combined catalytic strategies. Here, two-enzyme system is adopted for the transformation of glycerol into highly valuable dihydroxyacetone as well as cofactor regeneration at the same time. Glycerol dehydrogenase (GDH) and alcohol dehydrogenase (ADH) are co-immobilized within magnetically separable and spherical mesocellular silica foam (Mag-S-MCF), to prepare NER-(GDH/ADH). In details, GDH and ADH are adsorbed into the mesopores of Mag-S-MCF, and further crosslinked within the mesopores of Mag-S-MCF. The resulting nanoscale enzyme reactors (NER) of crosslinked GDH and ADH molecules within the bottle-neck structured mesopores can effectively prevent larger sized crosslinked enzyme aggregates from being leached out of smaller mesopores, due to the bottle-neck mesopore structure of Mag-S-MCF, as well as stabilize the activity of GDH and ADH upon chemical crosslinking, effectively preventing the denaturation of enzyme molecules. More importantly, the proximity of GDH and ADH molecules within mesopores of NER improves the efficiency of cofactor-mediated dual-enzymatic reactions by relieving mass-transfer limitations and improving cofactor recycling in an effective way, expediting both glycerol oxidation and dihydroxyacetone generation at the same time. As a result, the DHA concentration of NER-(GDH/ADH) and the simple mixture of NER-GDH and NER-ADH were 410 μM and 336 μM, respectively. To the best of our knowledge, this report is the first demonstration of stabilized nanoscale multi-enzyme reactor system, equipped with efficient cofactor regeneration within confined mesopores, for efficient glycerol transformation to high-valued dihydroxyacetone.

Graphical Abstract
Engineering a high-sugar tolerant strain of Saccharomyces cerevisiae for efficient trehalose production using a cell surface display approach
Authors: Tulsook Kan , Bussadee Piyada , Arnthong Jantima , Mhuantong Wuttichai , U-thai Panida , Trakarnpaiboon Srisakul , Champreda Verawat , Suwannarangsee Surisa
Published: October 2024

Trehalose production via a one-step enzymatic route using trehalose synthase (TreS) holds significant promise for industrial-scale applications due to its simplicity and utilization of low-cost substrates. However, the development of a robust whole-cell biocatalyst expressing TreS remains crucial for enabling practical and economically viable production. In this study, a high-sugar tolerant strain of S. cerevisiae was screened and employed as a host cell for the cell surface display of TreS from Acidiplasma aeolicum. The resultant strain, S. cerevisiae I3A, exhibited remarkable surface displayed TreS activity of 3358 U/g CDW and achieved approximately 64% trehalose yield (10.8 g/L/h productivity) from maltose. Interestingly, no glucose by-product was observed during trehalose production. The S. cerevisiae I3A cells exhibited reusability for up to 12 cycles leading to potential cost reduction of trehalose products. Therefore, our study demonstrated the development of a high-sugar tolerant S. cerevisiae strain expressing TreS on its surface as a whole-cell biocatalyst for efficient and economical trehalose production with potential applications in the food and pharmaceutical industries.
Challenges associated with the implementation of institutional quarantine and isolation strategies during major multicountry viral outbreaks in Africa (2000–2023): a scoping review
Authors: Amzat Jimoh , Oduwole Ebunoluwa , Lawal Saheed Akinmayowa , Aluko-Arowolo Olusola , Afolabi Rotimi , Adedeji Isaac Akinkunmi , Temisan Ige Angela , Oludiran Ayoyinka , Aminu Kafayat , Salami Afeez Abolarinwa , Kanmodi Kehinde Kazeem
Published: October 2024

Background

Quarantine and isolation (Q&I) are interrelated but not mutually exclusive public health practices for disease control, which may face public resistance in the context of health emergencies due to associated challenges. Hence, it is often tough for most countries to implement Q&I even in the context of health emergencies. Therefore, this scoping review examines the challenges associated with the implementation of institutional Q&I strategies during major multicountry viral outbreaks (Ebola, Lassa and COVID-19) in Africa between 2000 and 2023.

Methods

This scoping review was designed based on Arksey and O’Malley’s guidelines. A systematic literature search, using nine online research databases, was conducted with the aid of relevant search terms, Boolean operators and truncations. All articles obtained from the literature search were electronically imported into Rayyan web application for deduplication based on specific inclusion and exclusion criteria. From the included literature, relevant data were charted, summarized, collated, and presented.

Results

This review included 24 of the 787 retrieved articles. Sixteen of the 24 selected articles investigated issues related to COVID-19 prevention and control in Africa. Two assessed precautionary practices for Lassa fever, while five were on Ebola virus disease. However, one article explored knowledge, preventive practices, and general isolation precautions. The review identified various challenges that hindered the implementation of successful Q&I practices during viral infection outbreaks in Africa. Essential healthcare infrastructure, equipment (medical supplies including personal protective equipment and testing kits) and facilities that are essential for Q&I were deficient. Q&I implementation was often threatened by low human resource capacity and inefficiencies in the healthcare system which portray Africa as unprepared to handle complex public health crises.

Conclusions

This review shows that Q&I implementation in Africa is often threatened by low human resource capacity and inefficiencies in the healthcare system and also portrays Africa as unprepared to handle complex public health crises. Hence, Q&I for major multicountry outbreaks in Africa is very challenging. Therefore, continuous efforts to address these identified challenges are crucial to enhancing health emergency preparedness in Africa.
Cluster randomized trial of a team communication training implementation strategy for depression screening in a pediatric healthcare system: a study protocol
Authors: Stadnick Nicole A. , Aarons Gregory A. , Edwards Hannah N. , Bryl Amy W. , Kuelbs Cynthia L. , Helm Jonathan L. , Brookman-Frazee Lauren
Published: October 2024

Background

Pediatric depression is a global concern that has fueled efforts for enhanced detection and treatment engagement. As one example, the US Preventive Services Task Force recommends depression screening for adolescents ages 12–18 years. While many health systems have implemented components of depression screening protocols, there is limited evidence of effective follow-up for pediatric depression. A key barrier is timely team communication and coordination across clinicians and staff within and across service areas for prompt service linkage. However, team effectiveness interventions have been shown to improve team processes and outcomes and can be applied in healthcare settings.

Methods

This project aims to refine and test a team communication training implementation strategy to improve implementation of an existing pediatric depression screening protocol in a large pediatric healthcare system. The team will be defined as part of the study but is expected to include medical assistants, nurses, physicians, and behavioral health clinicians within and across departments. The implementation strategy will target team mechanisms at the team-level (i.e., intra-organizational alignment and implementation climate) and team member-level (i.e., communication, coordination, psychological safety, and shared cognition). First, the project will use mixed methods to refine the team training strategy to fit the organizational context and workflows. Next, a hybrid type 3 implementation-effectiveness pilot trial will assess the initial effectiveness of the team communication training (implementation strategy) paired with the current universal depression screening protocol (clinical intervention) on implementation outcomes (i.e., feasibility, acceptability, appropriateness, workflow efficiency) and clinical/services outcomes (increased frequency of needed screening and reduced time to service linkage). Finally, the study will assess mechanisms at the team and team member levels that may affect implementation outcomes.

Discussion

Team communication training is hypothesized to lead to improved, efficient, and effective decision-making to increase the compliance with depression screening and timely service linkage. Findings are expected to yield better understanding and examples of how to optimize team communication to improve efficiency and effectiveness in the pediatric depression screening-to-treatment cascade. This should also culminate in improved implementation outcomes including patient engagement critical to address the youth mental health crisis.

Trial registration

NCT06527196.

Trial Sponsor: University of California San Diego.
“It's been a Process”: A Multiple Case Study of Biology Instructor Efforts to Reform their Sex and Gender Curriculum to be More Inclusive of Students with Queer Genders and Intersex Students
Authors: Driessen Emily P. , Walker Keenan E. , Hallman Tess , Casper Aramati , Eddy Sarah L. , Schneider Joel R. , Lane A. Kelly
Published: October 2024

We interviewed four undergraduate biology instructors who reformed their curriculum to include queer gender and intersex inclusive strategies. We found that instructors focused on changing language, often removing sexed or gendered language, and used a variety of inclusive activities in their undergraduate biology classroom.
Why regulation hurts: balancing the need to maintain standards with the mental health impact on public sector professionals
Authors: Mannion Hester , Minshall Darren , Tarn Mark , Tracy Derek K. , Brooks Samantha K. , Greenberg Neil
Published: October 2024

Robust regulatory scrutiny is an unavoidable and necessary part of professional life for public sector professionals. Inspection and investigation can lead to poor mental health for individuals already working under pressure owing to increased workload and anticipation of poor outcomes. Although good regulation maintains standards and provides accountability to government and the public, regulators must face their obligation to understand the wider impact of their practices on the mental health of those they evaluate. This article discusses how regulation affects public sector culture and the potential risks and negative impact of regulatory practices and highlights how clinicians, working in occupational practice, are well placed to recognise ‘regulatory stress’ among public sector workers and offer vital support, guidance and advocacy.
Is too much insight bad for you?
Authors: Lopez-Morinigo Javier-David , David Anthony S.
Published: October 2024

Insight in psychosis is associated with reduced psychotic symptom severity, less coercive treatment and better functioning. Controversially, it has been suggested that insight may lead to depression, higher suicide risk and worse self-perceived quality of life. Future clinical trials are warranted to address this ‘insight paradox’, particularly the direction of causality.
Primary Paraganglioma Arising From the Maxillary Bone
Authors: Chuki Elias , Saleh Anaraki Kimia , Jha Abhishek , Patel Mayank , Ling Alexander , Pacak Karel
Published: October 2024

We present a unique case of primary intraosseous paraganglioma (PGL) originating from maxillary bone. PGL is a neurosecretory neoplasm that arises from cells believed to originate from the neural crest. A 30-year-old woman presented with right facial pain and swelling, along with palpitations. Computed tomography (CT) imaging revealed a 3.3 × 3.1 × 2.3 cm mass in the anterior maxilla, and biochemical results showed elevated plasma dopamine, 3-methoxytyramine, and chromogranin A levels. Biopsy confirmed a PGL, with positive expression of synaptophysin, chromogranin A, and GATA-3. Whole-body positron emission tomography/computed tomography (PET/CT) scans showed avidity on 18F-fluorodopa (18F-FDOPA), 68Ga-DOTA(0)-Tyr(3)-octreotate ​​ (68Ga-DOTATATE), and 18F-fluorodeoxyglucose (18F-FDG). No other lesions (primary or metastatic) were found. Proton beam therapy was chosen over surgery due to potential complications and patient's preference. Following radiotherapy, she experienced symptom relief, with dopamine levels decreasing and chromogranin A normalizing, with the lesion remaining stable on 11-month follow-up imaging. This case highlights the rarity of primary bone PGLs and underscores the importance of comprehensive diagnostic approaches combining physical examinations, biochemical testing, functional imaging, and histopathological analysis properly guiding personalized treatment strategies. Additionally, proton beam therapy emerges as a highly suitable treatment option for head and neck paragangliomas (HNPGLs), offering effective tumor control with minimal complications.
Clandestine Issues
Authors: Alemu Amsale
Published: October 2024

To this day, materials surrounding the 1974 Ethiopian Revolution that live in the archives of Addis Ababa University are designated as “clandestine literature.” Their publication was a clandestine affair; critiquing the emperor of the then-oldest Christian kingdom in the world and eventually professing Marxist thinking, they amounted to blasphemy. However, building an argument for Ethiopian revolution was premised on another heretical proposition: that Ethiopia, world-famous for having eluded European colonial rule, was a client state of US imperialism during the mid-century age of decolonization. This article employs a selection of Ethiopian revolutionary papers—including magazines, newspapers, and journals produced and distributed across Ethiopia, North America, and Europe—to provide a genealogy of “US Imperialism in Ethiopia,” a composite, hand-transcribed document of the late 1960s that has since been destroyed. Assembling materials marked by both their refutation of and proximity to US empire, this article argues that building the case for US imperialism in Ethiopia was a necessary step to clarify and link Ethiopian revolutionary struggle to anticolonialism. In the process, the article thinks with and extends the archival designation “clandestine” as both the conspiracy of alleging US imperialism in Ethiopia and an analytic for reading other transnational networks of revolutionary papers.
“Critical Realisms” in Savera
Authors: Akhtar Areej , Ahmad Javaria , Khan Sana Farrukh
Published: October 2024

This teaching tool is based on Savera (Dawn), a left-wing literary periodical published quarterly on the Indian subcontinent from 1946 onward under the leadership of the Progressive Writers’ Movement. The tool foregrounds the genealogy of “critical realism,” a revolutionary form of Urdu realism that perpetuated the movement’s aim of bringing about social transformation in a former colony by critiquing India’s indigenous conceptions of class, gender, nationalism, language, and religion.
Key predictors of fertility: Exploring the role of Vitamin-D
Authors: Salahuddin Huma , Zaki Samar , Ashraf Mussarat , Rehman Rehana
Published: October 2024

Background & Objectives: The relationship of Vitamin-D (VD) with Luteinizing Hormone (LH), Follicle stimulating Hormone (FSH) and Anti Mullerian Hormone (AMH) is recognized. This study was conducted to determine whether VD is a predictor of fertility and investigate its relationship with female reproductive hormones and markers of ovarian reserve in female population of Karachi.
Methods: A cross-sectional study was performed from July 2020 to June 2022 at the Aga Khan University Hospital (AKUH) with recruitment of 135 fertile and infertile subjects. VD, AMH, FSH and LH levels were estimated by ‘Enzyme Linked Immunosorbent assay (ELISA)’. By applying binary logistic regression, variables with p-value < 0.25 in univariate analysis were used for multivariate regression model and adjusted odds ratios were computed. In multivariate analysis, significance was p-value ≤ 0.05.
Results: VD deficiency was observed in all infertile female subjects. In univariate regression analysis, FSH, LH, LH/FSH ratio and VD levels turned out to be significant. The Multivariate analysis represented that for every one ng/mL increase in VD level, the odds of fertility were expected to be 50.154 times higher with p-value < 0.001. The positive correlation of VD with FSH was significant.
Conclusion: VD deficiency was prevalent in all infertile female subjects. VD levels were strong predictor of fertility in the study population. The significant association of VD with FSH explained the indirect effect of VD on follicular development and ovarian functions however no relationship of VD with ovarian reserve was exhibited.
Note: AI assisted technologies were used in the preparation of the manuscripts, to improve readability and language.
doi: https://doi.org/10.12669/pjms.40.10.9774
How to cite this: Salahuddin H, Zaki S, Ashraf M, Rehana Rehman4. Key predictors of fertility: Exploring the role of Vitamin-D. Pak J Med Sci. 2024;40(10):2363-2367. doi: https://doi.org/10.12669/pjms.40.10.9774
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Assessment of serum protein profile in sickle cell disease
Authors: Ibrahim Munirudeen , Yakub Hafiz Abiodun , Garuba Wasiu O. , Ogunniyi Tolulope , Lawal Abubakar Z. , Adunmo Godwin O. , Ogunwale Kola A , Busari Akeem O. , Popoola AbdulGafar N , Eleha Suleiman I. , Nuhu Abdulrazak , Ibrahim Musbaudeen
Published: October 2024

Background: Sickle Cell disease (SCD) is known to be caused by a mutation in the beta-globin gene of the hemoglobin  that affects the red blood cells (RBCs) and is passed down through generations. This study was carried out to determine the effect of sickling of RBC on serum protein profile  in SCD individuals.
Methods: A case-controlled study was carried out among 80 patients. They were forty-five sickle cell disease individuals (HbSS) attending Children Specialist Hospital Ilorin and thirty-five  healthy controls (HbAA). The levels of total protein and albumin were determined spectrophotometrically and serum protein electrophoresis (SPE) was carried out using cellulose acetate electrophoresis.
Results: Significant hypoalbuminemia and hypergammaglobulinemia were observed in SCD groups compared with controls. A higher proportion of the SCD group, 11(25%) had hypergammaglobulinemia and 21(49%) had hypoalbuminemia (P<0.05). Plasma protein electrophoresis in SCD patients shows an intense colour at the gamma region which was not seen in control. There was a significant relationship between the patterns of serum protein electrophoresis and the frequency of crisis.
Conclusions: Sickle cell disease crisis and other associated underlying conditions may be prevented early through assessment of serum protein profile, especially SPE. Hypergammaglobulinemia and hypoalbuminemia may be associated with frequent episode of crisis.
The quality of life in Thai senior table tennis players
Authors: To-aj Oam , Krajangkantamatr Sornpravate , Saenkla Pennapa , Putthasri Weerasak , Chanbanchong Navaporn , Bumrungpanictarworn Apithai
Published: October 2024

Background Table tennis presented a unique and accessible sport for people of all ages, particularly seniors compared to other sports. Methods This study utilized a quantitative with 136 Table tennis players those who registered for attending in the Thailand Master Table tennis Championships 2024 which hosted in January 2024 at Chiangmai. The questionnaire based on the measurement quality of life, WHOQOL Thai version, and analyzed using Descriptive statistics, Pearson Correlation. Results Pearson correlation coefficients between the scores of the quality of life in four dimensions and the overall score revealed significant correlations (p < 0.01) with all dimensions, including physical health, psychological health, social relationships, and environmental health. Conclusions Playing Table tennis for senior in the tournament level helped to improve the quality of life in all domains.
Relationship between physical activity, body posture and morbidity risk in the elderly population
Authors: Arango Zuleta Sandra Marcela , Poblete-Valderrama Felipe , Monterrosa-Quintero Armando
Published: October 2024

Background Physical activity plays a crucial role in the health and well-being of older adults, positively influencing various aspects of their quality of life. This study aims to explore the relationship between physical activity and body segments, as well as the risk indices of non-communicable chronic diseases in healthy elderly individuals. Methods The analyzed variables include weekly physical activity, the Postural Correction Index (PCI), measured using the system developed by Portland State University (PSU), and predictors of non-communicable chronic diseases assessed through body mass index (BMI) and waist-to-hip ratio. Results The results reveal a moderate positive relationship between physical activity and the PCI (r=0.45; p≤0.05), with significant correlations in specific components of the PCI, such as thoracic depression (r=0.51; p<0.01), anteroposterior shoulder alignment (r=0.51; p<0.01), and upper back (r=0.53; p<0.001). Conclusions It is concluded that physical activity has a significant positive impact on the posture of older adults, particularly in the trunk, contributing 40% to the improvement of PCI components. The PCI values obtained, exceeding 82.67 in men and 84.67 in women according to the PSU evaluation, underscore the effectiveness of physical activity in postural correction and the prevention of issues associated with chronic diseases.
Development and Initial Implementation of a Clinical Monitoring Strategy in a Non-regulated Trial: a research note from the ReStOre II Trial
Authors: O'Neill Linda , Murphy Fiona , Reidy Derval , Poisson Camille , Hussey Juliette , Guinan Emer
Published: October 2024

Background Data and Safety Monitoring is integral to quality assurance of clinical trials. Although monitoring is a core legal component of regulated clinical trials, non-regulated trials are not mandated to incorporate monitoring. Consequently, the monitoring process has been underutilised and underreported in this setting. This research report outlines the development and plans for implementing a bespoke Clinical Monitoring Strategy within the ‘Rehabilitation Strategies Following Oesophagogastric and Hepatopancreaticobiliary Cancer (ReStOre II) Trial’, a non-regulated trial comparing a 12-week multidisciplinary programme of rehabilitation to standard care in a cohort of 120 cancer survivors. Methods This research note provides a detailed overview of the ReStOre II Clinical Monitoring Strategy and describes the development of the strategy pre and post awarding of the grant. The strategy consists of the establishment and implementation of a comprehensive trial governance structure, inclusive of a Trial Management Group, Trial Steering Committee Meeting, and Independent Data Monitoring Committee. In addition, external trial monitoring by the Clinical Research Facility at St James’s Hospital. Three monitoring visits will be conducted during the trial; i) site initiation visit, ii) interim monitoring visit, and iii) close our visit. Results The Clinical Monitoring Strategy has been finalised and is currently being implemented within the ReStOre II Trial. Two site initiation visits and one interim monitoring visit have been completed to date. Conclusion This research note provides a template for implementation of a Clinical Monitoring Strategy in a non-regulated clinical trial. Registration ReStOre II Trial: https://clinicaltrials.gov/ct2/show/NCT03958019
Redefining professionalism to improve health equity in competency based medical education (CBME): A qualitative study
Authors: Bakunda Linda , Crooks Rachel , Johnson Nicole , Osei-Tutu Kannin , Bharwani Aleem , Gye Emmanuel , Okoro Daniel , Hinz Heather , Nearing Shelley , Peer Leah , Kassam Aliya , Smyth Penelope , Chu Pamela , Ruzycki Shannon , Joneja Mala , Rabi Doreen , Barnabe Cheryl , Roach Pamela
Published: October 2024

Purpose There is a pressing need to address all forms of anti-oppression in medicine, given systemic harm and inequities in care and outcomes for patients and health care professionals from equity-deserving groups. Revising definitions of professionalism used in competency-based education can incorporate new professional competencies for physicians to identify and eliminate the root causes of these inequities. This study redefined the CanMEDS Professionalism definition to centre perspectives of equity-deserving groups. Methods In this qualitative study there were two phases. The authors conducted individual semi-structured interviews with participants representing equity-deserving population groups to understand their perspectives on and iteratively build a definition of medical professionalism. Then, the authors undertook a consensus-building process, a modified nominal group technique, using focus groups with community members from equity-deserving groups and healthcare providers to verify findings and arrive at an updated definition of medical professionalism. Results Four main themes were identified: 1) healthcare at the margins; 2) equity-oriented domains of professionalism; 3) structural professionalism; and 4) supporting improved professionalism. These themes were incorporated into a consensus-based definition of medical professionalism, with a focus on anti-oppression, anti-racism, accountability, safety, and equity. Conclusions The authors propose a new definition of medical professionalism that embeds anti-oppression, including anti-racism, as critical competencies in clinical practice and education.