bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural history and clinical outcomes in patients with Alzheimer's disease–related psychosis by antipsychotic treatment status in the United States
Authors: Rao Sapna , Forns Joan , Danysh Heather E , Calingaert Brian , Dempsey Colleen , Aquilina Thomas , Pathak Sanjeev , Anthony Mary S , Layton J Bradley
Published: November 2024

Background

While some literature on clinical outcomes in persons with dementia-related psychosis exists, little is known regarding Alzheimer's disease–related psychosis (ADP).

Objective

Describe demographic/clinical characteristics of adults with ADP and estimate incidence of clinical events by antipsychotic treatment status.

Methods

This cohort study identified adults ≥65 years with Alzheimer's disease and incident psychosis (US Medicare database [2013–2018]) and no prior exposure to antipsychotics. Two nonmutually exclusive ADP subcohorts included: patients who initiated treatment with antipsychotic medications (antipsychotic users) and those who remained untreated (antipsychotic nonusers). Baseline characteristics were evaluated before psychosis diagnosis in untreated patients and before antipsychotic initiation in treated patients. Incidence rates were estimated for falls and fractures (composite and separately), seizure/epilepsy (new onset and any), and mortality.

Results

145,333 ADP antipsychotic nonusers and 49,452 antipsychotic users were identified. Both cohorts had similar baseline demographics; however, antipsychotic users versus nonusers had higher baseline skilled nursing facility use (40.3% and 27.8%), mood (72.7% and 62.1%) and anxiety (70.9% and 57.3%) disorders, falls/fractures (39.5% and 33.8%), urinary tract infections (55.1% and 47.0%), and frailty index scores (76.0% and 69.7%). Crude incidence rates (95% confidence interval)/100 person-years in antipsychotic users and nonusers were 70.0 (68.9–71.2) and 55.8 (55.4–56.1) (falls/fractures composite), 69.0 (67.9–70.1) and 54.9 (54.5–55.2) (falls), 38.6 (38.1–39.0) and 33.0 (32.7–33.2) (mortality), and 45.8 (44.9–46.7) and 54.2 (53.9–54.6) (any seizure/epilepsy).

Conclusions

Antipsychotic initiators with ADP had a higher burden of some baseline comorbidities; experienced higher incidence of falls, fractures, and mortality; and had lower incidence of seizure/epilepsy than antipsychotic nonusers.
A novel hybrid strategy for damage detection of wind turbine yaw bearing
Authors: Wang Xiaolong , Jin Hanwei , Fu Zixiang , Xiong Jiangtao , Zhang Bowen , Shi Haichao , Han Huilong
Published: November 2024

Compared with the strong background noise, the impact characteristics of wind turbine yaw bearing are weak in the initial damage stage. In order to completely eliminate unnecessary noise and detect damage characteristics, the useful component should be extracted from the complex vibration signal. To solve the problem that existing methods cannot effectively extract the useful component, an innovative hybrid strategy fusing weighted dual tree complex wavelet packet transform (WDTCWPT) with optimized minimum noise amplitude deconvolution (OMNAD) is developed. First, the envelope variable Rényi entropy indicator is defined, which reflects the impact strength. Meanwhile, this indicator is used to determine the optimal number of WDTCWPT decomposition level, and the weighted wavelet coefficient reconstruction is executed to get the enhanced signal. Subsequently, a square envelope correlation L-Kurtosis (SECLK) indicator is further defined and SECLK spectrum is utilized for estimating the deconvolution period. Ulteriorly, the multiple grid search algorithm is designed to automatically determine the optimal filter length as well as the noise ratio. And the optimal deconvolution signal with obvious damage characteristics can be obtained by OMNAD. Finally, the damage type of yaw bearing can be judged by performing envelope spectrum analysis on the deconvolution signal. The detection results of simulation and experiment signals demonstrate this developed hybrid strategy can accurately detect the local damage of yaw bearing under strong interference environment, which has certain engineering application value.
Severe Asymptomatic Carotid Artery Stenosis Treatment During Coronary Artery Bypass Surgery
Authors: Sugiyama Kayo , Watanuki Hirotaka , Tochii Masato , Koiwa Daisuke , Miyachi Shigeru , Matsuyama Katsuhiko
Published: November 2024

Background:

Although the prevalence of severe carotid artery disease (CAD) in patients undergoing coronary artery bypass grafting (CABG) is high, no clear consensus on how to manage these patients exists, especially in asymptomatic cases. We aimed to determine the impact of asymptomatic severe CAD on in-hospital stroke and all-cause mortality rates in patients undergoing CABG.

Methods:

We retrospectively analyzed 235 patients with documented carotid duplex ultrasound before undergoing isolated CABG at our institution between August 2015 and December 2022. To assess the rates of stroke and mortality after CABG, patients with severe CAD were compared with those without. Staged or concomitant carotid revascularization was considered in patients with severe bilateral CAD or a poor collateral brain network.

Results:

Patients with severe CAD were significantly older with a higher prevalence of CAD treatment history. Although their intensive care unit stay was longer, other postoperative complications were not significant. Among all patients, only one occurrence of 30-day mortality was observed, and patients with severe CAD had similar rates of postoperative stroke and death to those without. Postoperative stroke was related to carotid artery lesions in 2 patients with severe CAD but not in 9 patients without. Carotid artery stenting (CAS) was successfully performed without cerebral complications.

Conclusions:

Coronary artery bypass grafting in selected patients with severe asymptomatic CAD is acceptable and favorable; however, stroke related to severe CAD can occur after CABG. The decision to perform prophylactic or subsequent revascularization must be personalized and based on clinical judgment; however, close follow-up is required for patients with severe asymptomatic CAD. Furthermore, to prevent perioperative cerebrovascular events, preoperative carotid evaluation with a duplex ultrasonography scanner appears important.
Relationships Between Cognitive Impairments and Motor Learning After Stroke: A Scoping Review
Authors: Rajda Caroline M. , Desabrais Katrina , Levin Mindy F.
Published: November 2024

Background

Stroke is one of the leading causes of chronic disability worldwide. Sensorimotor recovery relies on principles of motor learning for the improvement of movement and sensorimotor function after stroke. Motor learning engages several cognitive processes to effectively learn and retain new motor skills. However, cognitive impairments are common and often coexist with motor impairments after stroke. The specific relationships between poststroke cognitive impairments and motor learning have not been determined.

Objectives

To summarize the existing evidence related to cognitive impairments and motor learning after stroke. Specific goals were to determine: (1) how motor learning is studied in individuals with poststroke cognitive impairments; (2) how cognitive impairments are assessed; (3) which cognitive domains impact motor learning.

Results

Over 400 studies were screened for specific inclusion criteria and 19 studies that related poststroke cognitive impairments to motor learning were included. Studies used a wide variety of experimental designs, sample sizes, and measures for cognitive evaluation. Cognitive impairments impacting motor improvement and learning capacity after stroke were reported in all but 4 studies. The most common domains impacting motor learning were attention, executive function, and memory.

Conclusion

Detailed cognitive assessments, retention testing, and a combination of clinical and kinematic outcomes are recommended for future studies. The presence of specific cognitive impairments measured with sensitive instruments should be considered when designing effective training interventions for patients with stroke to maximize sensorimotor recovery.
Victimhood and “Compassionate” Exceptions as Patriarchal Social Control in Anti-abortion Legislation
Authors: Slater Luna J. , de Heer Brooke A. , Schneider Emily M.
Published: November 2024

This paper examines the unprecedented legislative changes currently sweeping the abortion landscape in the United States, and how such changes do not simply criminalize abortion but also uphold patriarchal social norms that extend beyond the issue of reproductive rights. Through a qualitative analysis of total and hyper-restrictive abortion bans from 2018 to 2022, we find that these bans typically involve seemingly “compassionate” exceptions and that they avoid criminalizing abortion seekers. While such elements are often framed as rooted in a concern for the well-being of pregnant persons, our analysis reveals the ways that this language ultimately reinforces patriarchal gender roles.
Excellent vibration isolation properties of a curved Euler beam QZS isolator: Simulation and experiment
Authors: Chong Xiaoqiang , Wu Zhijing
Published: November 2024

In this study, a novel curved Euler beam quasi-zero stiffness (CE-QZS) isolator is proposed by limiting the displacement of the curved Euler beam to change its deformation mode, and the excellent vibration isolation properties are presented. The static and dynamic properties and parameter influences are investigated to identify the isolation mechanism of the novel isolator through numerical simulation using the finite element analysis. These studies of the proposed structure show that compared to the curved Euler beam structure, the bearing capacity and quasi-zero stiffness (QZS) range of the CE-QZS isolator have been significantly improved, and the original negative stiffness of the curved Euler beam is eliminated. Moreover, by changing the position of the rails, the position of the QZS range can be altered, allowing for full utilization of the structural space. Furthermore, the bearing capacity, working range, and QZS range of the CE-QZS isolator can be designed by adjusting the spring stiffness and geometric dimensions of the curved Euler beam. The experimental prototype is machined to conduct vibration tests that confirm the accuracy of the simulation analysis and the superiority of the proposed structure.
“A little bit more challenging, but more rewarding”: Medical-surgical nurses’ perspectives on caring for adults with intellectual disabilities
Authors: Desroches Melissa L. , Fisher Kathleen , Daudelin Denise
Published: November 2024

Background: Despite their central role in hospital care, little research has explored medical-surgical nurses’ perspectives on the rewarding aspects of and significant influences on caring for adults with intellectual disabilities, even though they are key to understanding this population’s inequitable hospital outcomes. Methods: A qualitative descriptive design was used, and interviews were conducted with 13 medical-surgical nurses from the United States. Manifest content analysis was used to analyze the interview transcripts and categorize findings. Results: Five categories of significant influences: Preparedness to Care for People with Intellectual Disabilities, Communication, Caregiver Involvement, Ethical Concerns, and Context of Care, and four categories of rewards: Connecting, Making a Difference, Enjoyment, and Learning Opportunity, were revealed. Conclusion: Medical-surgical nurses derive meaning from connecting with and making a difference in the lives of hospitalized adults with intellectual disabilities, but face barriers to providing high-quality nursing care, resulting in dehumanized, delayed, or missed care.
The safety and efficacy of pRESET stent retriever for treatment of thrombo-embolic stroke; a systematic review and meta-analysis
Authors: Habibi Mohammad Amin , Ahmadvand Muhammad Hussain , Delbari Pouria , Sabet Saba , Zare Amir Hessam , Mirjani Mohammad Sina , Boskabadi Amir Reza , Kolur Zahra Aslani , Bozorgi Maryam
Published: November 2024

Background

The pRESET stent retriever is a self-expanding nitinol stent designed for mechanical thrombectomy in cases of large vessel occlusion during acute ischemic stroke. This systematic review and meta-analysis synthesize the available evidence on the safety and efficacy of the pRESET device.

Methods

This is a systematic review and meta-analysis study conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The electronic databases of PubMed, Embase, WoS, and Scopus were systematically reviewed from inception to 8 July 2024.

Results

A total of eight studies involving 1163 patients were included. The pooled mortality rate was 18% with a 95% CI of [12%, 25%]. The rates of any hemorrhagic complication, parenchymal hemorrhage, and subarachnoid hemorrhage were 22% with a 95% CI of [12%, 36%], 7% with a 95% CI of [4%, 13%], and 10% with a 95% CI of [5%, 17%], respectively. The rate of favorable functional outcome (modified Rankin Scale 0-2) at 90 days was 43% with a 95% CI of [34%, 52%]. Successful recanalization rates were 60% with a 95% CI of [52%, 67%] after the first pass and 90% with a 95% CI of [83%, 95%] after the final pass. Rescue devices were used in 13% with a 95% CI of [7%, 24%] of cases.

Conclusions

The pRESET stent retriever demonstrates high recanalization rates and reasonable safety outcomes in patients undergoing mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion. Further randomized trials directly comparing pRESET to other stent retrievers are warranted.
Latest update on the use of recombinant growth factors for periodontal regeneration: existing evidence and clinical applications
Authors: Khehra Anahat , Shiba Takahiko , Chen Chia-Yu , Kim David M.
Published: November 2024

Growth factors were introduced to increase predictability in periodontal regeneration and have since been widely applied in dentistry. This narrative review article highlights histological and latest findings of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human fibroblast growth factor-2 (rhFGF-2) for periodontal regeneration. rhPDGF-BB enhances the proliferation and chemotaxis of periodontal ligament and alveolar bone cells. The optimal dose for rhPDGF-BB, in combination with beta-tricalcium phosphate, is 0.3 mg/ml. It is approved in the United States, Canada, and Taiwan for use in periodontal regeneration and treatment of gingival recession. rhFGF-2 promotes periodontal wound healing through mitogenic and angiogenic effects on mesenchymal cells in the periodontal ligament. It is approved in Japan at an optimal dose of 0.3% for periodontal regeneration in intrabony defects. Both recombinant growth factors show histological evidence of new bone, cementum, and periodontal ligament. Clinical studies demonstrate improved clinical attachment levels and defect resolution for treating intrabony and furcation periodontal defects. Presented clinical cases and consensus reports may serve as a reference for clinicians. rhPDGF-BB and rhFGF-2 are safe and effective biologics that can be applied to improve the outcomes of periodontal regeneration.
A case of probable drug-induced psoriasis to dapagliflozin
Authors: Qureshi Simal A , Finch Sarah E , Pratt Michelle E
Published: November 2024

Exposure to certain drugs can trigger new-onset psoriasis or flaring of existing psoriatic disease. The clinical presentation of drug-induced psoriasis can vary, and although there are features suggestive of drug-induced psoriasis, there are currently no standardized criteria to differentiate it from conventional psoriasis. Patients may present with localized psoriasiform plaques, or variants such as palmoplantar, nail disease, or widespread erythroderma. Histopathology of drug-induced psoriasis can also be indistinguishable from conventional psoriasis but features suggestive of drug-induced include lack of suprapapillary epidermal thinning, a limited number of Munro microabscesses, and the presence of eosinophils and/or a lichenoid reaction pattern. We report a case of suspected drug-induced psoriasis due to dapagliflozin (Farxiga) in a 76-year-old man. Evidence indicating this to be a probable drug-induced reaction includes the sudden onset of symptoms; atypical pathology with the presence of eosinophils; and clearance of the lesions upon discontinuation of the suspected causative drug.
The Relationship Between Self-Stigma, Basic and Instrumental Activities of Daily Living, and Communication Participation Among Individuals With Parkinson’s Disease
Authors: Ong Ying Qian , Zakaria Nur Zahirah , Lee Jaehoon , Gan Chun Hong , Chai Siaw Chui , Veronica Fierro , Hassan Fatimah Hani , Chu Shin Ying
Published: November 2024

The Malaysian healthcare system for individuals with Parkinson’s disease is still underdeveloped. Self-stigma has a significant influence on how successfully individuals with Parkinson’s disease handle their condition. Therefore, this study aimed to explore the association between self-stigma, basic and instrumental activities of daily living, and communication participation among individuals with Parkinson’s disease. In Study 1, 25 individuals with Parkinson’s disease from the Malaysian Parkinson’s Disease Association completed the Stigma Scale for Chronic Illness-8 Items, Katz Index of Independence in Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, and Communicative Participation Item Bank. Survey responses were analyzed using descriptive statistics and correlation/regression. In Study 2, semi-structured interviews were conducted with nine individuals with Parkinson’s disease. Interview data were transcribed verbatim and analyzed using thematic analysis. Survey results indicated that a higher level of self-stigma was associated with lower levels of basic ( r = −.47) and instrumental ( r = −.21) activities of daily living and communication participation ( r = −.41) among individuals with Parkinson’s disease. Furthermore, five main themes emerged from the in-person interviews: “challenges in performing activities of daily living due to Parkinson’s disease,” “speech and communication adaptations due to Parkinson’s disease,” “psychological responses toward one’s own Parkinson’s disease symptoms,” “self-stigmatization with impacts on self-concept,” and “perception formation of Parkinson’s disease resulting from self-stigmatization.” In conclusion, the self-stigma of individuals with Parkinson’s disease was considerably related to their activities of daily living and communication participation. Therefore, healthcare providers should address these factors collectively in their care of individuals with Parkinson’s disease. Moreover, health-related organizations and Parkinson’s disease associations must play a crucial role in educating and raising awareness of Parkinson’s disease in our society, considering that self-stigma is related to both how an individual perceives their condition and the public’s attitudes and perceptions toward it.
Internet-delivered Acceptance and Commitment Therapy for Cancer Patients and Survivors: A Systematic Review
Authors: García-Torres Francisco , García-Carmona Margarita , Moreno Eliana , Jurado-González Francisco , Aguilera-Martín Ángel
Published: November 2024

Acceptance and commitment therapy (ACT) has proven effective in cancer patients, reducing common psychological symptoms and improving wellbeing. Moreover, the use of eHealth technologies makes support cheaper and easier to provide. The aim of this systematic review was to collect results on the effectiveness of internet-delivered ACT for common symptoms in cancer patients and survivors. The review follows PRISMA guidance and was registered in PROSPERO (CRD42022326543). Searches were conducted using PubMed, Web of Science, Scopus, EBSCOhost, and different web platforms of grey literature. Interventional studies were selected which focused on cancer patients and survivors, were published in English or Spanish, included at least two of the six main ACT components, and were partially or fully delivered through the Internet. The risk of bias was assessed following Cochrane’s recommendations. Eleven records from seven studies met the inclusion criteria. Only one study showed significant reductions in anxiety (reliable change index, RCI∈ [2.32, 3.47]) and depression ( RCI∈ [2.00, 4.00]). As regards quality of life, significant improvements were observed in certain domains such as cancer-related quality of life ( RCI = 2.43), fatigue ( d = −0.33), sleep problems ( d = −0.53), physical and functional wellbeing (η2 p = .06), and participation in social activities ( d = 0.18). ACT processes resulted in significant post-intervention improvements with regard to mindfulness ability and psychological flexibility. Results look promising; however, we believe that limitations such as blinding issues, the heterogeneity of designs and measurement tools, or the use of monetary incentives should be taken into account in future research.
Investigation of Preknowledge Cheating via Joint Hierarchical Modeling Patterns of Response Accuracy and Response Time
Authors: Balta Ebru , Dogan Celal Deha
Published: November 2024

As computer-based testing becomes more prevalent, the attention paid to response time (RT) in assessment practice and psychometric research correspondingly increases. This study explores the rate of Type I error in detecting preknowledge cheating behaviors, the power of the Kullback-Leibler (KL) divergence measure, and the L person fit statistic under various conditions by modeling patterns of response accuracy (RA) and RT using a joint hierarchical model. Four design factors were manipulated: test length, the difficulty level of compromised items, the ratio of compromised items, and variations in the RTs for these compromised items. The results indicate that the KL measure consistently exhibits higher power and Type I error rates than the person fit statistics [Formula: see text] and [Formula: see text] across all RA and RT patterns and under all conditions. Furthermore, the KL measure demonstrates the greatest power at a medium test length.
Artificial intelligence-based echocardiography assessment to detect pulmonary hypertension
Authors: Salehi Mahan , Alabed Samer , Sharkey Michael , Maiter Ahmed , Dwivedi Krit , Yardibi Tarik , Selej Mona , Hameed Abdul , Charalampopoulos Athanasios , Kiely David G , Swift Andrew J
Published: November 2024

Background

Tricuspid regurgitation jet velocity (TRJV) on echocardiography is used for screening patients with suspected pulmonary hypertension (PH). Artificial intelligence (AI) tools, such as the US2.AI, have been developed for automated evaluation of echocardiograms and can yield measurements that aid PH detection. This study evaluated the performance and utility of the US2.AI in a consecutive cohort of patients with suspected PH.

Methods

1031 patients who had been investigated for suspected PH between 2009–2021 were retrospectively identified from the ASPIRE registry. All patients had undergone echocardiography and right heart catheterisation (RHC). Based on RHC results, 771 (75%) patients with a mean pulmonary arterial pressure >20 mmHg were classified as having a diagnosis of PH (as per the 2022 European guidelines). Echocardiograms were evaluated manually and by the US2.AI tool to yield TRJV measurements.

Results

The AI tool demonstrated high interpretation yield, successfully measuring TRJV in 87% of echocardiograms. Manually- and automatically-derived TRJV values showed excellent agreement (intraclass correlation coefficient: 0.94; 95% CI 0.94–0.95) with minimal bias (Bland-Altman analysis). Automated TRJV measurements showed equally high diagnostic accuracy for PH as manual measurements (AUC: 0.88 [95% CI 0.84, 0.90]versus0.88 [95% CI 0.86, 0.91]).

Conclusion

Automated TRJV measurements on echocardiography were similar to manual measurements, with similarly high and non-inferior diagnostic accuracy for PH. These findings demonstrate that automated measurement of TRJV on echocardiography is feasible, accurate and reliable and support the implementation of AI-based approaches to echocardiogram evaluation and diagnostic imaging for PH.
Prevalence and determinants of smoke-free homes in 12 European countries: the TackSHS Survey
Authors: Tigova Olena , Stival Chiara , Castellano Yolanda , Lugo Alessandra , Fu Marcela , Mar López Anna , Martínez Cristina , Soriano Joan B. , O'Donnell Rachel , Semple Sean , López Maria J. , Fernández Esteve , Gallus Silvano , Investigators TackSHS
Published: November 2024

Background

Homes are one of the primary locations where people are exposed to second-hand smoke (SHS) in Europe. We describe the prevalence and identify the main determinants of having home-smoking restrictions in 12 European countries.

Methods

Cross-sectional survey in 12 European countries conducted in 2017–2018 (TackSHS Project). Approximately 1000 participants representing the general population aged ≥15 years of each country were interviewed face-to-face. Individual and country-level characteristics were explored through adjusted prevalence ratios (PR) obtained from multilevel Poisson models with random effects.

Results

Among 11 734 participants, 70.2% (95%CI: 69.4–71.0%) had smoke-free homes and 17.5% (95%CI: 16.8–18.2%) had partial home-smoking restrictions in place. Prevalence of smoke-free homes ranged from 44.4% in Greece to 84.5% in England. Having a smoke-free home was significantly inversely associated with current (PR=0.60) or former (PR=0.95) smoking and living in a household with one (PR=0.70) and two or more (PR=0.58) people who smoke. It was also significantly associated with being ≥65 years old (PR=1.05), being female (PR=1.07), having a high educational level (PR=1.09), and living with children (PR=1.09). Having a smoke-free home was associated with living in Northern Europe, while partial home-smoking restrictions were more likely among respondents from Eastern Europe and countries with lower per capita gross domestic product.

Conclusions

The prevalence of smoke-free homes in Europe is relatively high, but with large variability across countries. European countries with a lower prevalence of smoke-free homes should implement tailored interventions targeting identified determinants and incorporate the success of other countries.
The burden of headache disorders among adults in Peru: national estimates and a health-care needs assessment from a population-based door-to-door survey
Authors: Quispe Guiovanna , Loza Cesar , Limaco Luis , Gallegos Ruth , Palomino-Diaz Carlos , Cruz Ivett , Miranda Jacqueline , Rodriguez Liliana , Husøy Andreas , Steiner Timothy J.
Published: November 2024

Background

We have previously found that almost two thirds (64.6%) of adults in Peru have an active headache disorder. Here, using data from the same sample, we present attributed burden at individual and population levels. We use these data to assess need for headache-related health care among this population.

Methods

We used the standard methodology of the Global Campaign against Headache. Cluster-sampling from five geographical regions of Peru (Cajamarca, Lima, Piura, Puno, San Martín) generated a sample representative of the population aged 18–65 years. At unannounced visits to households, we interviewed one adult from each using the HARDSHIP questionnaire. We assessed symptom burden in terms of headache frequency and usual duration and intensity, and impaired participation in paid work, household work and social or leisure activities using the HALT index. To assess need for health care, we counted all those with headache on ≥ 15 days/month (H15+), those with migraine on ≥ 3 days/month, and those with migraine or tension-type headache meeting either of two criteria: a) proportion of time in ictal state (pTIS) > 3.3% and intensity ≥ 2 (moderate-to-severe); b) ≥ 3 lost days from paid and/or household work during the preceding 3 months. We derived population-level estimates by factoring in prevalences.

Results

The sample size was N = 2,149. From individual data, we estimated population-level pTIS at 1.9–2.5%, this proportion of all time among adults in Peru being spent with headache, with migraine the greatest contributor (1.2%). At population level, headache was responsible for 0.5 days lost from paid work and 1.0 days from household work per person per 3 months, with migraine again the biggest contributor (0.2 and 0.5 days). However, at individual level, H15 + was associated with greatest burden (pTIS 14.9–24.9%; 2.3–4.5 lost workdays/3 months). A quarter of the sample (n = 590; 27.5%) fulfilled one or more of our health-care need criteria.

Conclusion

Headache disorders are responsible for high levels of ill health and economic burden in Peru, with a substantial requirement for health care. Health and economic policies balancing health benefits against the cost of providing care should take account of the productivity losses that might be recovered, and the expected cost-offset.
Volume assessment comparing femoral vein and inferior vena cava among chest pain patients presenting to the emergency department
Authors: Nair Neeraja A , Sirur Freston Marc , Krishnan S Vimal
Published: November 2024

Background

Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary depending on the cardiac function, respiratory efforts, intraabdominal pressure, and mechanical ventilation. Due to these factors, IVC measurement cannot be considered a stand-alone technique appropriate for every patient. The femoral vein (FV), a more superficial vein than IVC, can be considered an alternative method for assessing fluid responsiveness in patients presenting to the Emergency department. It is easily accessible and can be used in scenarios where IVC cannot be visualized or reliable.

Methods

This was a single-center diagnostic study where 85 patients who presented to the ED with chest pain were enrolled prospectively. IVC and femoral vein collapsibility indices, stroke volume, and cardiac output are measured using an ultrasound machine. The measurements were repeated after a passive leg-raising test. These values were compared with each other to assess an intra-class correlation between IVC and femoral vein collapsibility indices. We have also evaluated the relationship between the collapsibility indices of both veins and cardiac output.

Discussion & limitations

Our findings show an insufficient correlation between IVC and FV collapsibility indices. However, both vein diameters significantly increased after passive leg raising (PLR), indicating a response to fluid challenge. Post-PLR reduced IVC, and FV collapsibility index (CI) suggests intravascular volume expansion after a fluid challenge, also reflected in the hemodynamic parameters. Our study was conducted only in a subset of relatively stable patients. The applicability of the study in different subsets of patients presenting to ED is still questionable.

Conclusion

We conclude that femoral vein indices may not be an accurate alternative for volume assessment in the chosen cohort of patients. IVC and FV metrics do not correlate and may not be accurate for volume responsiveness. We may need to explore the utility of FV and its indices in a larger population in multiple settings for a better understanding of its role in volume assessment and responsiveness.

Trial registration

(EC/NEW/INST/2021/1707). Registered 03 January 2023.
The impact of the COVID-19 pandemic on hospital-acquired infections and multi-drug resistant organisms, in comparison to seasonal influenza
Authors: Dabaja-Younis Halima , Silman Zmira , Tarabeia Jalal , Hussein Khetam
Published: November 2024

Background

While effective preventive measures reduce hospital-acquired infections (HAIs) and the spread of multi-drug resistant organisms (MDROs), studies on the impact of the COVID-19 pandemic and its associated preventive measures remain inconclusive.

Objective

To assess the impact of COVID-19 on HAIs and MDROs and to compare it with the effect of seasonal influenza.

Methods

A retrospective cohort study analyzed prospectively collected data from a tertiary hospital in Haifa, northern Israel, from 2016 to 2021. It compared pre/during COVID-19 and influenza (Dec-Feb)/non-influenza (Mar-Nov) seasons. Studied parameters: hospital-acquired bloodstream infections (HA-BSI), MDROs, nosocomial Clostridioides difficile infections (CDI) per 10,000 hospital days (HD), central line-associated BSI (CLABSI) per 1000 catheter days (CD) and hand hygiene compliance (HHC).

Results

During the COVID-19 period, rates of HAIs and MDROs decreased compared to the pre-COVID era for methicillin-resistant Staphylococcus aureus (MRSA) (4.2 vs. 6.9/10,000 HD; p < 0.001), carbapenem-resistant Acinetobacter baumani (CRAB) (2.2 vs. 3.1/10,000 HD; p = 0.02), and nosocomial CDI (3 vs. 4.6/10,000 HD; p < 0.001). However, there was a higher rate of carbapenem-resistant Enterobacteriaceae (CRE) (4.6 vs. 2.7/10,000 HD; p < 0.001) and HA-BSI (29.7 vs. 27.3/10,000 HD; p = 0.006) during the COVID-19 era. CLABSI rates showed no significant difference (2.3 vs. 2.7/1000 CD; p = 0.910). HHC rate remained at 70% in both eras (p = 0.151). No significant differences were observed in MDROs, CDI, HA-BSI, or CLABSI rates (p = 0.233, 0.675, 0.267, and 0.563, respectively) between influenza and non-influenza seasons.

Conclusions

In the COVID-19 era, HAIs and MDROs rates significantly declined, while CRE rates increased, possibly due to a national trend in Israel since 2016. Steady HHC rates suggest additional factors like enhanced environmental cleaning, personal protective equipment usage, and increased infection prevention awareness contributed to this decline. Influenza had no noticeable impact, likely due to healthcare workers’ varying perceptions and the brevity of the influenza season, making it challenging to assess impact.
Evaluation of high school-based dengue solution model in Southern Thailand: a community participatory action research
Authors: Suwanbamrung Charuai , Mehraj Sandeep Kumar , Kercho Melkamu Worku , Stanikzai Muhammad Haroon , Ageru Temesgen Anjulo , Jaroenpool Jiraporn , Pibul Panatda , Shohaimi Shamarina , Israel Eskinder
Published: November 2024

Introduction

By the time the globe started to tackle the COVID-19 pandemic, Southeast Asian countries had faced an increased dengue incidence, which has eventually become an important public health problem. However, effective and sustainable disease control measures in the area are still lacking. Therefore, the current study is aimed to evaluate the development and implementation of high school-based dengue solution model in Southern Thailand.

Methods

Integrated community participatory action research (CPAR) was employed using preparation, planning, implementation, and evaluation. Data was collected using quantitative and qualitative methods from high school students. Descriptive statistics such as frequency and percentage, chi-square and fisher’s exact test were used to summarize and compare quantitative data before and after intervention. Similarly, qualitative data was collected through interviews and focus group discussion (FGD) and then analyzed through thematic analysis.

Results

Two hundred and thirty-nine (96.3%, n = 239/248) and 232 (93.5, n = 232/248) participants were included in the interventions before and after, respectively. School-based dengue prevention was developed with input from a variety of stakeholders, including students, community leaders, health educators, district officials, and community health volunteers. As demonstrated by pre- to post-test results, students understanding of dengue and the larval indices surveillance system has increased. Students who received the training were not only inspired but created a sense of community responsibility with a high commitment to teaching and sharing information in their circle to enhance overall community wellbeing. Being female and higher educational attainment was associated with students understanding of dengue and larval indices surveillance.

Conclusion

This participatory action research not only improved students' understanding of dengue but also empowered them to be proactive in various community health initiatives. The positive correlation between educational attainment and students understanding of dengue solution and larval indices surveillance underscores the need for tailored educational interventions that address diverse learning needs within the community. Collaborative efforts to establish dengue health information center based at primary schools and above can better improve reduction of dengue incidence.
Validating anti-inflammatory and cytotoxic properties of Fagonia cretica L. through metabolic, in vitro, and in silico profiling
Authors: Mohamed Enas I. A. , Elwekeel Ahlam H. , Mohamed Dalia El Amir , Zaki Mohamed A. , Hassan Marwa H. A.
Published: November 2024

Background

Fagonia cretica L. (Family: Zygophyllaceae), is a wild shrub mostly found in Mediterranean districts and extensively used in folk medicine for a vast array of purposes such as antidiabetic and anticancer during the early stages. The goal of the current study was to validate the antioxidant, anti-inflammatory, and cytotoxic properties of Egyptian F. cretica using in vitro studies, metabolic profiling, and in silico approaches.

Methods

The plant was collected from the Egyptian desert and the alcoholic extract was prepared from its aerial parts, total phenolic and total flavonoid contents were evaluated spectrophotometrically. Antioxidant potential was assessed via 1,1 diphenyl-2-picrylhydrazyl (DPPH) scavenging activity. Anti-inflammatory activity was validated through in vitro COX-2, COX-1, and nitric oxide inhibition. Cytotoxicity was tested against liver (HepG2), breast (MCF-7), and intestinal (CACO2) carcinoma cell lines followed by assessment of its impact on the levels of apoptotic markers namely topoisomerase I and caspase 9 enzymes. Chemical profiling of the extract was performed using LC-HRMS technique. Saponin rich extract was prepared and tested for affecting topo I and caspase 9 enzymes. In silico studies were conducted on anti-inflammatory (COX-2 and COX-1) and cytotoxicity (topoisomerases I, IIα, and IIβ) targets using Autodock vina in PyRx platform.

Results

Total phenolic and total flavonoid content of the extract were 2.4 ± 0.12 mg GAE/g and 0.18 ± 0.01 mg RE/g, respectively. In vitro results revealed antioxidant activity calculated as 1.4 ± 0.1 mg AEAC/g. In vitro anti-inflammatory assays unveiled inhibition of COX-2 and COX-1 enzymes with IC50 values of 13.02 ± 0.61 and 26.51 ± 0.83 µg/ml, respectively and nitric oxide with IC50 of 147.05 ± 9.61 µg/ml. Cytotoxicity on MCF-7, HepG2, and CACO2 cell line with IC50 values of 6.9 ± 0.53, 7.6 ± 0.42, and 9.2 ± 0.35 µg/ml, respectively, in addition to in vitro topoisomerase I inhibition (IC50 = 13.57 ± 0.71 µg/ml) and caspase 9 induction by 5.66 folds. Metabolic profiling using LC-HRMS technique resulted in dereplication of 21 compounds including triterpenoid saponins, flavonoids, diterpenoids, etc. Interestingly, saponin rich fraction and non-saponin fraction exhibited similar effects on topoisomerase I and caspase 9. In silico investigation unveiled high binding affinities of almost all the detected metabolites to the active sites of COX-2, COX-1, topo I, IIα, and IIβ enzymes.

Conclusion

Collectively, we can conclude that F. cretica is a new source of many phytochemicals, and a significant natural source as cytotoxic and anti-inflammatory agent.
Factors influencing the intention of doctors to emigrate: a cross-sectional study of Ghanaian doctors
Authors: Wutor Baleng Mahama , Sarfo Francisca Nyarko , Nkrumah Louisa Afia , Bakuoru Luki Daniel , Amanze Chinenye Nneoma , Osei Isaac
Published: November 2024

Background

The migration of healthcare professionals from developing countries to more developed nations poses a significant challenge to healthcare systems in low- and middle-income countries. This study aimed to determine the proportion of doctors in Ghana who intend to migrate abroad and to identify the sociodemographic and "pull and push" factors that influence their intention.

Methodology

A cross-sectional survey was conducted among doctors in Ghana between March 1, 2024, and March 15, 2024, via an online-based semi-structured questionnaire. Doctors working in Ghana, regardless of nationality, were included. Descriptive statistics and logistic regression analyses were conducted to identify factors associated with the intention to emigrate. Statistical significance was set at a p-value of < 0.05.

Results

Almost all the doctors who responded to the questionnaire consented to participate (99.4%, 641/645). More than half (53.8%, n = 345) of the respondents were medical officers. Most respondents intended to migrate to practice abroad (71.8%, n = 460). The United States (59.7%), the United Kingdom (39.1%), and Canada (34.8%) were the most preferred destinations. After adjusting for covariates, young doctors between 20–29 years [(Adjusted Odd Ratios) AOR = 2.69, 95% CI = 1.13—6.39)], male doctors (AOR = 1.53, 95% CI = 1.04—2.25), doctors in lower professional ranks, and doctors in the field of diagnostics (AOR = 5.70, 95% CI = 1.16 – 28.03) had significantly higher odds of intending to migrate. In descending order of magnitude, the respondents strongly agreed that better remuneration (1.22 ± 0.63), better quality of life (1.22 ± 0.67), better working conditions (1.26 ± 0.69), and better postgraduate training (1.41 ± 0.80) were pull factors. The push factors were economic challenges (1.17 ± 0.49), a lack of a conducive working environment (1.56 ± 0.86), slow career progression (1.95 ± 1.07), excessive workload (2.07 ± 0.12), personal circumstances (2.26 ± 1.19), and poor postgraduate training (2.48 ± 1.22).

Conclusion

A substantial proportion of doctors in Ghana are considering emigration, driven by a combination of attractive opportunities abroad and challenging conditions in Ghana. Addressing these issues through improved remuneration, better working environments, and enhanced career development and training opportunities is crucial to retaining healthcare professionals.
The association between neutrophil and lymphocyte to high-density lipoprotein cholesterol ratio and metabolic syndrome among Iranian population, finding from Bandare Kong cohort study
Authors: Hashemi Seyyed Mohammad , Kheirandish Masoumeh , Rafati Shideh , Ghazalgoo Arezoo , Amini-Salehi Ehsan , Keivanlou Mohammad-Hossein , Abbaszadeh Shahin , Saberian Parsa , Rahimi Arash
Published: November 2024

Background

Metabolic Syndrome (MetS) is characterized by the co-occurrence of various metabolic risk factors, significantly increasing the risk of cardiovascular diseases (CVD) and type 2 diabetes (T2DM). This study investigates the potential of hematological indices, specifically the neutrophil to high-density lipoprotein cholesterol ratio (NHR) and lymphocyte to high-density lipoprotein cholesterol ratio (LHR), as predictors of MetS in a population from southern Iran.

Methods

Utilizing baseline data from the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort, part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN), A total of 2,684 participants aged 35–70 years were analyzed. Participants were evaluated using the Iranian National Cholesterol Education Program (NCEP) criteria to diagnose MetS. Receiver operating characteristic (ROC) analysis was conducted to assess the predictive validity of NHR and LHR across different demographic categories.

Results

The mean LHR and NHR values were significantly higher in individuals diagnosed with MetS (P < 0.001). Specifically, the LHR was 0.85 ± 0.26 in MetS patients compared to 0.76 ± 0.23 in those without MetS, while the NHR was 1.33 ± 0.35 in MetS patients compared to 1.20 ± 0.32 in those without MetS. After adjusting for confounding factors, both LHR and NHR remained significantly associated with MetS, with odds ratios (OR) of 6.61 (95% CI: 4.43–9.83) for LHR and 4.76 (95% CI: 3.51–6.45) for NHR. Among MetS components, LHR was associated with low HDL cholesterol and elevated triglycerides, while NHR showed significant associations with central obesity, low HDL cholesterol, and elevated triglycerides. ROC analysis revealed moderate predictive capabilities for both indices, with areas under the curve of 0.60 for LHR and 0.61 for NHR.

Conclusion

The findings suggest that NHR and LHR are promising, easily obtainable hematological markers for predicting MetS. These indices could serve as valuable tools for early detection and ongoing monitoring in clinical settings, aiding in the prevention and management of MetS.
Monitoring circulating tumor DNA liquid biopsy in stage III BRAF-mutant melanoma patients undergoing adjuvant treatment
Authors: Marchisio Sara , Ricci Alessia Andrea , Roccuzzo Gabriele , Bongiovanni Eleonora , Ortolan Erika , Bertero Luca , Berrino Enrico , Pala Valentina , Ponti Renata , Fava Paolo , Osella-Abate Simona , Deaglio Silvia , Marchiò Caterina , Sapino Anna , Senetta Rebecca , Funaro Ada , Ribero Simone , Quaglino Pietro , Cassoni Paola
Published: November 2024

Background

The introduction of adjuvant therapies for patients with resected cutaneous melanoma (CM) has increased the need for sensitive biomarkers for risk stratification and disease monitoring. This study aims to investigate the utility of circulating tumor DNA (ctDNA) assessment in predicting and reflecting disease status during adjuvant therapy.

Methods

We enrolled 32 patients with resected BRAF-mutated stage III CM receiving adjuvant targeted therapy or immunotherapy. Plasma samples of patients were collected at the baseline (treatment initiation) and during the therapy, and BRAF-mutated ctDNA was quantified by droplet digital PCR (ddPCR).

Results

Baseline ctDNA was detected in 11/32 (34.4%) patients and predicted postoperative high risk of relapse [HR 3.79, 95% CI 1.20–12.00, p = 0.023]. The three-year overall survival (OS) rate was 54.6% (95% CI 22.9–77.9) versus 95% (95% CI 69.5–99.3) in ctDNA-positive and negative groups, respectively, with significantly worse OS for ctDNA-positive patients [HR 7.92, 95% CI 1.56–40.36, p = 0.013]. Among the baseline ctDNA-positive group (high-risk patients), longitudinal ctDNA detection during adjuvant therapy reflected the clinical outcomes. Only non-relapsing patients cleared their plasma ctDNA by the end of the treatment, while persistent ctDNA detection provided early evidence of disease recurrence.

Conclusions

ctDNA detection shows promising results in the post-operative setting for identifying cutaneous melanoma patients at the highest risk of relapse and for real-time monitoring of patients’ clinical status and treatment response.
Ixekizumab: an alternative for HIV-positive psoriasis patients
Authors: Liu Fanghua , Liu Zhou , Yang Rongming , Huang Dandan , Han Yongzhi
Published: November 2024

Psoriasis is a recurrent and protracted inflammatory disease. Generalized erythema, plaques, and silvery scales on the surface mainly characterize its skin lesions. Biologics bring new hope to psoriasis patients. However, HIV infection is a major concern before receiving biologics. Here, we present a case of the efficacy and safety of Ixekizumab, an interleukin 17 inhibitor, in the treatment of psoriasis patients living with HIV (PPLHIV).