bluuebunny/crossref_metadata_2025 huggingface dataset:
A model for individualized prediction of liver-related death in outpatients with alcohol-associated cirrhosis
Authors: Marot Astrid , Henrion Jean , Knebel Jean-François , Trépo Eric , Moreno Christophe , Deltenre Pierre
Published: September 2023

Introduction:

In alcohol-associated cirrhosis, an accurate estimate of the risk of death is essential for patient care. We developed individualized prediction charts for 5-year liver-related mortality among outpatients with alcohol-associated cirrhosis that take into account the impact of abstinence.

Methods:

We collected data on outpatients with alcohol-associated cirrhosis in a prospective registry. The model was derived, internally and externally validated, and compared with the Child-Pugh and the Model For End-Stage Liver Disease (MELD) scores.

Results:

A total of 527 and 127 patients were included in the derivation and validation data sets, respectively. A model was developed based on the 3 variables independently associated with liver-related mortality in multivariate analyses (age, Child-Pugh score, and abstinence). In the derivation data set, the model combining age, Child-Pugh score, and abstinence outperformed the Child-Pugh and the MELD scores. In the validation data set, the Brier score was lower for the model (0.166) compared with the Child-Pugh score (0.196, p = 0.008) and numerically lower compared with the MELD score (0.190) (p = 0.06). The model had the greatest AUC (0.77; 95% CI 0.68–0.85) compared with the Child-Pugh score (AUC = 0.66; 95% CI 0.56–0.76, p = 0.01) and was numerically higher than that of the MELD score (AUC = 0.66; 95% CI 0.56–0.78, p = 0.06). Also, the Akaike and Bayesian information criterion scores were lower for the model (2163; 2172) compared with the Child-Pugh (2213; 2216) or the MELD score (2205; 2208).

Conclusion:

A model combining age, Child-Pugh score, and abstinence accurately predicts liver-related death at 5 years among outpatients with alcohol-associated cirrhosis. In this study, the model outperformed the Child-Pugh and the MELD scores, although the AUC and the Brier score of the model were not statically different from the MELD score in the validation data set.
Suboptimal diagnostic accuracy of ultrasound and CT for compensated cirrhosis: Evidence from prospective cohort studies
Authors: Hetland Liv E. , Kronborg Thit M. , Thing Mira , Werge Mikkel P. , Junker Anders E. , Rashu Elias B. , O’Connell Malene B. , Olsen Beth H. , Jensen Anne-Sofie H. , Wewer Albrechtsen Nicolai J. , Møller Søren , Hobolth Lise , Mortensen Christian , Kimer Nina , Gluud Lise Lotte
Published: September 2023

Introduction:

Abdominal ultrasound (US) and CT are important tools for the initial evaluation of patients with liver disease. Our study aimed to determine the accuracy of these methods for diagnosing cirrhosis.

Methods:

In all, 377 participants from 4 prospective cohort studies evaluating patients with various liver diseases were included. All patients were included between 2017 and 2022 and had undergone a liver biopsy as well as US and/or CT. Using the histological assessment as the gold standard, we calculated diagnostic accuracy for US and CT. Liver biopsies were evaluated by expert histopathologists and diagnostic scans by experienced radiologists.

Results:

The mean age was 54 ± 14 years and 47% were female. Most patients had NAFLD (58.3%) or alcohol-associated liver disease (25.5%). The liver biopsy showed cirrhosis in 147 patients (39.0%). Eighty-three patients with cirrhosis had Child-Pugh A (56.4% of patients with cirrhosis) and 64 had Child-Pugh B/C (43.6%). Overall, the sensitivity for diagnosing cirrhosis by US was 0.71 (95% CI 0.62–0.79) and for CT 0.74 (95% CI 0.64–0.83). The specificity was high for US (0.94, 95% CI 0.90–0.97) and for CT (0.93, 95% CI 0.83–0.98). When evaluating patients with Child-Pugh A cirrhosis, sensitivity was only 0.62 (95% CI 0.49–0.74) for US and 0.60 (95% CI 0.43–0.75) for CT. For patients with Child-Pugh B/C, sensitivity was 0.83 (95% CI 0.70–0.92) for US and 0.87 (95% CI 0.74–0.95) for CT. When limiting our analysis to NAFLD (20% with cirrhosis), the sensitivity for US was 0.45 (95% CI 0.28–0.64) and specificity was 0.97 (95% CI 0.93–0.99).

Conclusion:

US and CT show moderate sensitivity and may potentially overlook compensated cirrhosis underlining the need for additional diagnostic testing.
Prerequisite Delivery Method and Academic Outcomes in a Physician Assistant Education Program
Authors: Chalupa Robyn L. , Nevels Torrance L. , Kucia Margaret M. , Jones James J.
Published: September 2023

Purpose

The Interservice Physician Assistant Program (IPAP) educates up to 169 matriculants per year. Each service branch sets the admission criteria, including all prerequisites, for their applicants. We hypothesized that prerequisites obtained online/virtual are less rigorous than coursework completed in-person. The purpose of this investigation was to evaluate whether online/virtual prerequisite courses were associated with academic deceleration or attrition at any point.

Methods

Student self-reported data were retrospectively analyzed to evaluate program scores of students who took prerequisites online/virtual or in-person.

Results

There were no statistically significant differences in foundational course performance between online/virtual and in-person coursework. In addition, students who took anatomy online performed better than students who completed the coursework in-person (140.6 ± 15.6 vs. 145.6 ± 14.7, P = .05).

Conclusions

This analysis indicates that using the prerequisite source to predict academic difficulty may not be possible in IPAP students. Faculty will need to continue to search for other predictors of academic difficulty.
Preceptor Tools for Success: Student Review on Creating an Effective Clinical Rotation
Authors: Bogenschutz Kevin
Published: September 2023

Purpose

The purpose of this article was to explore student perspectives regarding effective preceptors with the intention to improve development of supervised clinical practice experiences.

Methods

In total, 136 clinical year physician assistant (PA) students, representing 9 accredited PA programs, participated in a mixed-methods survey, including a 5-point Likert scale to identify characteristics of an effective preceptor. The survey achieved a 36.2% response rate. Quantitative data were analyzed based on mean and standard deviation (SD) with the analysis of variance to promote generalizability. Thematic analysis was performed on qualitative responses.

Results

Students reported the highest level of agreement that an effective preceptor welcomes questions from the student (mean 4.88, SD 0.54), are enthusiastic about having a student (4.84, 0.52), and provide a welcoming support staff who encourages student education (4.71, 0.66). Students also highlighted the positive effect of preceptor engagement during clinical rotations.

Conclusion

A preceptor who actively engages their student has the greatest positive impact on clinical education. Preceptors can implement clinical teaching strategies from this article to improve student-perceived effectiveness of their rotation.
Effect of ciprofol on swallowing function in patients undergoing painless gastrointestinal endoscopy
Authors: Liao Jinsong , Lv Shun , Wang Xiong , Ye Yu , Zhang Qiuyu , Zeng Lin , Dong Shuhua
Published: September 2023

Background:

Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. This study compared the effect of ciprofol and propofol on swallowing function during painless gastroenteroscopy.

Methods:

This was a single-center, placebo-controlled randomized trial. Three hundred sixty-eight patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups: the propofol group (PRO group, n = 183) and the ciprofol group (CIP group, n = 185). Sufentanil, ciprofol, and propofol are used to anesthetize the patients, and the effects of different solutions on these patients are compared and analyzed. The patient’s general condition, vocal cord adduction reflex, dysphagia severity score, penetration and aspiration scale score, vital signs at different times, complications, recovery time (minutes), residence time in the resuscitation room (minutes), and adverse reactions were recorded.

Results:

During the examination, the incidence of severe swallowing dysfunction in CIP group was lower than that in PRO group (P < .05). The BP in CIP group was higher than that in PRO Group (P < .05). The HR of CIP group was lower than that of PRO Group (P < .05). SpO2 in CIP group was higher than that in PRO Group (P < .05). The recovery time of CIP group was longer than that of PRO Group, and the postanesthesia care unit stay time of PRO group was longer than that of CIP group(P < .05). The incidence of respiratory depression, hypotension and cough in CIP group was lower than that in PRO Group (P < .05). The incidence of injection pain in CIP group was lower than that in PRO Group (P < .05).

Conclusion:

Compared with propofol, ciprofol has less inhibition on swallowing function, less impact on hemodynamics, less respiratory depression, and less injection pain, which is more suitable for painless gastroscopy.
A comparative study of using linear anastomosis with circular anastomosis in digestive tract reconstruction after laparoscopic radical total gastrectomy: A retrospective study
Authors: Huang Hai , Guo Zhiyuan , Li Wen , Zhang Mingkai , Li Yanbin
Published: September 2023

The purpose of this study is to compare the incidence of anastomotic leakage or stenosis, anastomotic bleeding, anastomosis time, postoperative exhaust time, pneumonia, gastroesophageal reflux, hospitalization and mental state after laparoscopic radical gastrectomy, so as to provide a reliable basis for the safety selection of the 2 clinical anastomosis methods and postoperative care. This study retrospectively analyzed the clinical data of 160 gastric cancer patients treated by our medical team from February 2021 to December 2021. We divided them into side-to-side anastomosis with linear stapler (linear stapler) and end-to-side anastomosis with circular stapler (circular stapler), analyzed the incidence and clinical efficacy of anastomotic complications after laparoscopic radical total gastrectomy. There was a statistically significant difference between linear stapler and the circular stapler in the incidence of anastomotic complications such as the incidence of anastomotic stenosis; The incidence of anastomotic leakage, incidence of anastomotic bleeding, without statistical significant; At the anastomosis time, time of first postoperative discharge, incidence of pneumonia, length of hospital stay, without statistical significant; The incidence of gastroesophageal reflux without statistical significant; The Anxiety Self-rating Scale score, depression self-rating scale score points, the linear stapler was significantly lower than the postoperative circular stapler. The study showed that the anastomotic complications (absolute odds ratio of 1.08; 95% CI 1.02–1.15). This 2 protocol can be used safely and effectively common methods for gastric cancer. The linear stapler after laparoscopic radical total gastrectomy was better than the circular stapler, and was better than the circular stapler in terms of postoperative exhaust time, the incidence of pneumonia and the hospital time. However, the anastomosis time was longer than that of the circular stapler, and fees are also relatively expensive.
The effect of acupuncture on recovery after colorectal cancer resection: A systematic review meta-analysis of randomized controlled trials
Authors: Qi Lin , Shi Hongshuo , Zhang Yunsong , Zhang Xuecheng , Jia Hongling , Tian Hu
Published: September 2023

Background:

To evaluate the efficacy and safety of acupuncture by systematically reviewing the literature on colorectal cancer resection.

Methods:

Seven electronic databases were searched from inception to February 28, 2023. Randomized controlled trials on acupuncture in patients after CRC resection were included. Two reviewers independently selected relevant trials, extracted data, and assessed the risk of bias. A random-effects meta-analysis model was used to obtain summary effect estimates. The data were pooled and analyzed using RevMan 5.3. The heterogeneity of selected studies was evaluated by evaluating the I-squared (I
2) statistics.

Results:

Twenty-two studies with 1878 patients were included. Results of the meta-analysis showed there was a low level evidence that acupuncture may improve early postoperative symptoms, such as time to first flatus (n = 876, MD −0.77h, 95% CI −1.22 to −0.33 h, I
2 = 89%), time to first bowel movement (n = 671, MD −1.41h, 95% CI −2.20 to −0.63 h, I
2 = 95%), time to first defecation (n = 556, MD −1.03h, 95% CI −1.88 to −0.18 h, I
2 = 95%), and nausea/vomiting (n = 1488, RR 0.72, 95% CI 0.59–0.89, I
2 = 49%) compared with usual care and sham acupuncture. However, there were no statistically significant differences in postoperative pain (n = 1188, MD-0.21, 95% CI −0.59 to 0.17, I
2 = 74%). And there was no sufficient evidence of improving long-term functional outcomes. There was substantial heterogeneity across trials. The adverse events associated with acupuncture stimulation were minor in include studies.

Conclusion subsections:

There is currently low-level evidence supporting the use of acupuncture on postoperative symptoms for patients after colorectal cancer resection. More investigations should be established based on the STRICTA statement strictly.
Relationship between knee osteophytes and calcitonin gene-related peptide concentrations of serum and synovial fluid in knee of osteoarthritis
Authors: Liu Fan , Su Fan , Zhang Tao , Liu Rui , Liu Na , Dong Tianhua
Published: September 2023

To explore the relationship between knee osteophytes of osteoarthritic knee and calcitonin gene-related peptide (CGRP) concentrations of serum and synovial fluid (SF). 65 patients with knee medial compartment osteoarthritis (OA) were recruited and examined with weight-bearing radiographs of the entire lower limb. The concentrations of CGRP in serum/SF were also detected in surgery. The relationship between the concentrations of CGRP in serum/SF and osteophyte scores were detected with Spearman rank correlation coefficient. CGRP concentrations in serum and SF were significantly correlated with osteophyte score of overall knee respectively (R = 0.462, P < .001; R = 0.435, P < .001). In addition, a correlation tended to be observed about the relationship between CGRP concentrations in serum and SF and osteophyte scores of medial compartment (R = 0.426, P < .001; R = 0.363, P = .003), and osteophyte scores of lateral compartment (R = 0.429, P < .001; R = 0.444, P < .001). In this study, the relationship between CGRP in serum/SF and knee osteophyte scores in different subregions were explored, which showed significant positive correlations, that possibly reflecting the contribution of CGRP influencing osteophyte formation. Positive correlations between osteophyte scores and CGRP suggest that CGRP promote the growth of osteophyte formation. It has the potential to be selected as a biomarker for the assessment of severity in knee OA patients and predict the progression of knee OA. It also provides a potential therapeutic target to delay the progression and relieve the symptom of OA.
Association between chromosome abnormities and prenatal diagnosis indicators screening in the second trimester of pregnancy
Authors: Pan Ci , Li Zilong , Cheng Guomei , Luo Xiaohua , Nie Fufang , Gao Jing , Yang Peifeng
Published: September 2023

This study aimed to explore the prenatal indicators in the second trimester of pregnancy and their association with chromosome abnormities (CA) to guide decisions toward invasive diagnostic procedures. Pregnant women who underwent prenatal screening and underwent amniocentesis in the second trimester in our Hospital between June 2017 and February 2019 were included in this retrospective cohort study. The reason for amniocentesis in prenatal screening and diagnoses was extracted from the charts. Finally, 3449 pregnant women were included. Of them, 181 were with CA confirmed by amniocentesis (i.e., the CA group), while 3268 were without CA (i.e., the non-CA group). Compared with the women in the non-CA group, those in the CA group were more likely to be older (30 [27,32] vs 29 [26,31], P < .001), had higher gestational weeks (20 [19,23] vs 19 [18,23], P = .008), an increased risk of advanced maternal age (AMA) (9.4% vs 2.2%, P < .001), had an increased risk of NIPT (IRN) (5.1% vs 1.9%, P < .001), had higher rates of a parental chromosome abnormality (PCA) (1.8% vs 0.9%, P = .002), and had increased risk of trisomy 21 (IRT21) (63.0% vs 45.3%, P < .001). AMA (OR = 4.22, 95% CI: 2.35–7.58, P < .001; AUC = 0.536), IRN (OR = 10.62, 95% CI: 6.66–16.94, P < .001; AUC = 0.589), PCA (OR = 4.77, 95% CI: 2.01–11.32, P < .001; AUC = 0.584), and IRT21 (OR = 0.67, 95% CI: 0.47–0.89, P = .008; AUC = 0.515) were independently associated with CA. AMA, IRN, IRT21, and PCA during the second trimester were independently associated with CA, but their predictive values for CA were relatively low. Combining those indicators may improve the predictive value.
Association between post-stroke cognitive impairment and gut microbiota: A PRISMA-compliant systematic review and meta-analysis
Authors: Hu Xiaozhen , Mao Yajun , Luo Fang , Wang Xijun
Published: September 2023

Background:

Accumulating evidence has indicated a possible connection between post-stroke cognitive impairment (PSCI) and gut microbiota imbalance. To further investigate this association, the present work was designed to systematically assess the dissimilarity of gut microbiota between PSCI and healthy individuals or stroke patients.

Methods:

A meta-analysis and systematic review was conducted by searching various databases including PubMed, Web of Science, Embase, VIP, CNKI, and Wangfang for relevant studies. The pooled outcomes were used to estimate the combined dissimilarity of gut microbiota composition between PSCI and healthy individuals or patients with stroke.

Results:

Nine eligible studies were included in this meta-analysis. The results showed that there were no significant changes in observed richness indexes (Chao1 and ACE) and Shannon index. Notably, a significant decrease in Simpson index was observed in PSCI patients in comparison to the healthy individuals (–0.31, 95% CI: –0.62 to –0.01, P = 0.04). Moreover, the microbiota composition at the phylum level (increased abundance of Proteobacteria), family level (increased abundance of Bacteroidaceae, Lachnospiraceae, and Veillonellaceae; decreased abundance of Enterobacteriaceae), and genus level (increased abundance of Bacteroides, Clostridium XIVa, and Parabacteroides; decreased abundance of Prevotella and Ruminococcus) was found to be significantly different between PSCI and controls.

Conclusion:

This meta-analysis suggests a significant shift of observed species and microbiota composition in PSCI compared to healthy individuals or patients with stroke.
Novel heterozygous mutations of SLC12A3 gene in a Chinese pedigree with Gitelman syndrome: A care-compliant case report
Authors: Bi Ye , Kuang Ming-Yang , Li Ming-Long
Published: September 2023

Rationale:

The diagnosis of Gentleman syndrome (GS) is usually delayed because the clinical symptoms are easily mistaken.

Patient concerns:

A 19-year-old male patient was referred to endocrinology due to intermittent twitch of extremities for approximately 7 years.

Diagnoses:

The diagnosis of GS was made based on the laboratory and gene detection results. We identified 2 new variants in the SLC12A3 gene [c.857 A > C (exon7) and c.2089_2095del (exon17)] in his Asian family.

Interventions:

The patient received the treatment of potassium chloride sustained release tablets, potassium magnesium aspartate and spironolactone. After given potassium supplement through enema, his serum potassium level was corrected to normal.

Outcomes:

The electrolyte imbalance including hypokalemia and hypomagnesemia were improved with a remission of the clinical manifestations. But the patient’s condition still could not remain stable for his irregular oral potassium supplementation during the follow-up of nearly 3 months.

Lessons:

Our finding broadens the variant spectrum of SLC12A3 and contributes to a more quickly genetic counseling. As a result, when a patient presents with persistent, unspecified, and inadequately treated hypokalemia, tests for GS should indeed be considered. For suspected cases of GS, genetic testing should always be considered in the diagnosis.
GLP-1 receptor agonists modulate blood glucose levels in T2DM by affecting Faecalibacterium prausnitzii abundance in the intestine
Authors: Liang Lei , Rao Elizabeth , Zhang Xuxiang , Wu Bin , Su Xiaoyun , Chen Lin , Nie Rong , Nian Xin
Published: September 2023

Background:

Glucagon-like peptide 1 (GLP-1) receptor agonists are a class of medications used to treat type 2 diabetes, including metformin, which is considered first-line therapy for type 2 diabetes. In recent years, GLP-1 receptor agonists (GLP-1 RAs) have been found to alter the composition and structure of gut flora and also promote the production of gut probiotics. However, there have been few clinical studies regarding the effects of GLP-1 RAs on gut flora. In this study, we investigated changes in the abundance of Lactobacillus delbrueckii (L delbrueckii) and Faecalibacterium prausnitzii (F prausnitzii) 1 week after administration of a GLP-1 RA in the clinical treatment of type 2 diabetes. The association with glycemic and body mass index (BMI) correlations was also explored.

Methods:

Twelve newly diagnosed patients with type 2 diabetes were examined for changes in the abundance of L delbrueckii and F prausnitzii by Fluorescence in Situ Hybridization 1 week after administration of GLP-1 RAs. Subjects BMI was measured and fasting glucose changes were detected using the glucose oxidase method, and Spearman correlation analysis was performed to explore their relevance.

Results:

There was no significant change in the abundance of L delbrueckii in the intestine (P = .695) and no significant correlation with BMI and fasting glucose levels (R = 0.134, P = .534) after the use of GLP-1 RA (R = −0.098, P = .647); F prausnitzii on the other hand had a significantly higher abundance (P = .002) and a significant negative correlation with fasting glucose level (R = −0.689, P < .001), but no significant correlation with BMI (R = −0.056, P = .796).

Conclusion:

F prausnitzii may be one of the pathways through which glucose is regulated in the treatment of type 2 diabetes by GLP-1 RAs.
Assessment of drug prescription practises in chronic hemodialysis patients: case series
Authors: Boukabous Sara , Meftah Hicham , Frikal Kaoutar , Bentata Yassamine , Haddiya Intissar
Published: September 2023

Introduction:

The aim of the study was to assess the quality of drugs prescriptions in chronic haemodialysis patients.

Material and methods:

The authors conducted a prospective study in chronic haemodialysis patients of two haemodialysis centres in the city of Oujda eastern Morocco, during the year of 2020. The authors identified the drugs prescribed in this population with regards to the product characteristics, in terms of indications, contraindications, dosage and drug interactions. Our data were analyzed by SPSS version 27 software.

Results:

The mean number of drugs taken per patient was 8.15±6. Ninety-three percent of patients received treatment for anaemia. Phosphocalcic disorders and hypertension were treated in 89% and 72% of patients, respectively. In 77.6% of the cases, these drugs were taken orally. According to Vidal, the majority of prescriptions met the criteria of good prescription, in 81.54% of the cases, versus 18.46% of the patients with at least one of non-compliant prescription. On the other hand, 6.15% of the patients had at least one inadvisable combination. No contraindicated association was noted in our patients.

Conclusion:

Patients undergoing haemodialysis have a higher risk of developing side effects and drug interactions than patients with normal kidney function. Given the paucity of pharmacokinetic studies in this population, nephrologists refer to their own experience to treat his patients effectively.

Therapeutic education and regular monitoring of chronic haemodialysis patients can improve clinical outcomes, quality of life and reduce the cost of care.
Anterior Nutcracker syndrome in a young male patient: a case report and review of literature
Authors: Hamdan Alaa , Homsy Sleman , Rashid Gowhar , Rehman Andleeb , Al-Jamal Mohammad
Published: September 2023

Introduction and importance:

The left renal vein (LRV) is affected by a venous compression syndrome called Nutcracker syndrome (NCS). This syndrome is characterized by extrinsic compression of the LRV, which usually occurs between aorta and superior mesenteric artery. It is a rare and under-diagnosed condition, more prevalent in females and that, if left untreated, can lead to severe problems. There are no clear guidelines regarding management. Therefore, the authors report this rare case and its symptoms in male patient and they display current management options.

Case presentation:

NCS was observed during computer tomography in a male patient presented with persistent left flank pain and associated haematuria. Ultrasound for left scrotum demonstrated left moderate-sized varicocele. The left varicocele testis unit was 1.6 mm and during the Valsalva manoeuvre in the supine position the testis unit was 2 mm. LRV compression between abdominal aorta and superior mesenteric artery was identified by computer tomography imaging and therefore, diagnosis of NCS was confirmed.

Clinical discussion:

The actual prevalence is unclear, and incidence rates have been observed to fluctuate among age group and more prevalent in women. Main symptoms include haematuria, left flank discomfort, varicocele in men, proteinuria and anaemia. Depending on severity of symptoms, management might range from conservative care to surgery.

Conclusion:

This treatment strategy was effective in reducing the symptoms of the patients. In young patients, conservative treatment is advised for a fair amount of time. However, more studies on how much the authors should wait before considering surgery is important.
The complexities of treating brain and spinal cord tumors: a review of current approaches
Authors: Mansour Abdallah , Trefi Abdullah , Mansour Majd , Shekho Abdullah , Salloum Shadi
Published: September 2023

This article provides an overview of brain and spinal cord tumours, including their types, diagnosis, and treatment approaches. Brain and spinal cord tumours are complex and can be caused by various factors. They can be divided into two main categories, primary and metastatic tumours, which present their own unique challenges and complexities when it comes to treatment. Diagnosing brain and spinal cord tumours requires a careful evaluation of the patient’s medical history and symptoms, as well as a variety of diagnostic tools and techniques. Treatment approaches include surgery, radiation therapy, and chemotherapy, each with its own benefits and drawbacks. The choice of treatment depends on the type and location of the tumour, as well as the patient’s individual needs and preferences. Despite advances in treatment, there is a pressing need for further research to improve the effectiveness and safety of these treatments.
The pandemic’s unseen wounds: COVID-19’s profound effects on mental health
Authors: Chaudhary Rishabh , Rohilla Manni , Chauhan Samrat , Saini Monika , Aman Shahbaz , Singla Hrithik , bibi Ayesha , Ahmed Sohel , Shriwastav Shalini , Kaur Narinder , Dev Jai , Chalotra Rishabh , Singh Thakur Gurjeet , Mehta Sachin
Published: September 2023

Objective:

This review aims to explore the impact of the COVID-19 pandemic on mental health, with a focus on the physiological and psychological consequences, including comorbidities. The goal is to understand the direct and indirect populations affected by mental distress and identify potential interventions.

Methodology:

A comprehensive literature search was conducted using various databases, including Google Scholar, ResearchGate, ScienceDirect, PubMed, PLoS One, and Web of Science. The search utilized relevant keywords to investigate the direct and indirect impacts of COVID-19 on mental health. The selected articles were critically evaluated and analyzed to identify key findings and insights.

Main findings:

Mental health, being an intrinsic component of overall well-being, plays a vital role in physiological functioning. The COVID-19 pandemic, caused by the emergence of the novel SARS-CoV-2 virus, has had a devastating global impact. Beyond the respiratory symptoms, individuals recovering from COVID-19 commonly experience additional ailments, such as arrhythmia, depression, anxiety, and fatigue. Healthcare professionals on the frontlines face an elevated risk of mental illness. However, it is crucial to recognize that the general population also grapples with comparable levels of mental distress.

Conclusion:

The COVID-19 pandemic has underscored the significance of addressing mental health concerns. Various strategies can help mitigate the impact, including counselling, fostering open lines of communication, providing mental support, ensuring comprehensive patient care, and administering appropriate medications. In severe cases, treatment may involve the supplementation of essential vitamins and antidepressant therapy. By understanding the direct and indirect impacts of COVID-19 on mental health, healthcare providers and policymakers can develop targeted interventions to support individuals and communities affected by the pandemic. Continued research and collaborative efforts are essential to address this pervasive issue effectively.
Distinct non-contrast computerized tomography head findings in a patient with secondary polycythemia in rural Nepal: a captivating case report highlighting diagnostic challenges
Authors: Ghimire Aastha , Katwal Shailendra , Shrestha Kusum , Baniya Sunil
Published: September 2023

Introduction:

Tetralogy of Fallot is a cyanotic congenital heart disease which if untreated leads to death by adulthood. In rare cases who survive this can lead to secondary polycythemia due to chronic hypoxia who can present with multiple indistinct symptoms leading to diagnostic dilemma.

Case presentation:

The authors present a rare case of secondary polycythemia diagnosed in early fifties with the unique non-contrast computerized tomography head findings who presented with a spectrum of long standing symptoms and a history of neurological manifestations.

Clinical discussion:

Patients diagnosed with polycythemia in adulthood can have a background of an untreated congenital heart disease, which can be complemented further by appropriate radiological investigations in a resource poor setting.

Conclusion:

Polycythemia secondary to an untreated congenital heart disease in the age beyond 50 is a rare occurrence. The presentation of these patients might present clinicians with a diagnostic challenge which can be mitigated with an appropriate knowledge of the peculiar non-contrast computerized tomography head findings.
Myiasis of open great toe fracture wound: a rare case report
Authors: Khadka Sabir K. , Banmala Sabin , Dhakal Sujan B. , Pandey Ashmita , Jha Sudhanshu
Published: September 2023

Introduction and importance:

Myiasis of an open fracture wound is very rare but can occur due to neglect of wound care.

Case presentation:

A 12-year-old boy from a low socio-economic background, following an impact injury in his right great toe 10 days back presented with complaints of pain, swelling, and a foul-smelling odor from his right great toe. On examination, a swollen, tender puncture wound was noted over the dorsal aspect of the great toe revealing part of live larvae and serosanguinous discharge. Management was done with the complete removal of maggots, wound debridement, wound lavage, administration of systemic antibiotics, and toe guard slab application.

Clinical discussion:

Wound myiasis results from a facultative or obligatory parasite that is initiated when flies oviposit in hemorrhagic, necrotic, or pus-filled lesions. The possible complications of myiasis include local destruction, invasion into deep tissues, and secondary infection, which could result in amputation of the affected area, especially where obligatory parasites are concerned.

Conclusion:

Myiasis commonly occurs due to poor hygiene and neglect of wound care along with many other risk factors. Early proper wound care prevents the development of wound myiasis and early diagnosis and treatment of myiasis prevent complication of local tissue destruction and amputation of affected parts.
Diplopia in the Younger Adult (≤65 Years Old) Compared With Older Adult (>65 Years Old) Population—Presentation, Progression, and Outcome
Authors: Gindelskhi Sagiv Rotem , Levy Niv , Huna-Baron Ruth , Leiba Hana , Paz Tal , Rappoport Daniel
Published: September 2023

Background:

Despite the impact of new-onset diplopia on the quality of life, there are few studies concerning new-onset diplopia in seniors. This study aimed to describe the epidemiology, etiology, prognosis, and outcome of different treatments in the older adults compared with younger adult patients presenting with new-onset binocular diplopia.

Methods:

A retrospective chart review of patients ≥18 YO with new-onset binocular diplopia presenting between 2010 and 2021. Data collected included age at presentation, gender, duration of time since diplopia onset, imaging results, known trigger, etiology, treatment, and follow-up.

Results:

Two hundred ten patients were included. Of them, 75 patients were ≤65 YO (35.7%, the “younger adult group”) and 135 > 65 YO (64.3%, the “older adults group”). The common etiology in both groups was neurogenic (54.7% ≤ 65 vs 62.2% >65, P = 0.29). Cranial nerve palsies were more commonly microvascular in the older adults (96.0% vs 74.1%, P = 0.005), whereas tumor-related cranial nerve palsies were more frequent in younger adults (14.81% vs 2.04%, P = 0.03). A restrictive etiology was observed in 20% of younger adult compared with 11.1% of older adults group (P = 0.08). Sagging eye syndrome (SES) was the second most common etiology in the older adults group at 11.9%, compared with 1.3% in the younger adult group (P = 0.01). Decompensated phoria/tropia appeared in 16% of younger adult group compared with 11.9% of older adults (P = 0.4), with an obvious trigger (mostly cataract surgery) in the latter (80% older adults vs 20% younger adults, P = 0.019). Positive imaging findings were found in 46.7% of patients ≤65 compared with 25.3% of >65 (P = 0.01) and complete spontaneous resolution of diplopia was noted in 32.1% of the older adults compared with 11.8% of younger adults (P = 0.003).

Conclusions:

Neurogenic diplopia was the most common etiology for both groups, but is more prominent in the older adults. Noticeable findings in the older adults were SES diagnosis, identification of triggers for impaired fusion/diplopia, and a paucity of positive findings in imaging results. It is important to know these differences not only for managing seniors better, but also to minimize symptoms of binocular diplopia after lens-related procedures.
A mixed-methods evaluation of patients’ views on primary care multi-disciplinary teams in Scotland
Authors: Sweeney KD , Donaghy E , Henderson D , Wang HHX , Mercer SW
Published: September 2023

Background

Expanding the primary care multi-disciplinary team (MDT) is a key aim of the 2018 Scottish GP contract, and over 3,000 new MDT-staff have been appointed since then.

Aim

To explore patients’ views on MDT expansion in primary care in Scotland.

Design and methods

Survey of patients aged 18 years and over who had consulted a GP in the previous four weeks, in three population settings (deprived urban (DU), affluent urban (AU) and remote and rural (RR)), followed by 30 semi-structured individual interviews. The survey assessed awareness of five key new MDT roles, and attitudes towards reception signposting. Interviews explored views regarding MDT-care generally.

Results

Of the 1,053 survey respondents, most were unaware of the possibility of being offered MDT, rather than GP, consultations, for three out of five roles (69% unaware of link worker appointments; 68% mental health nurse; 58% pharmacist). Reception signposting to MDT was viewed significantly more negatively in DU areas than elsewhere (34% quite or very unhappy vs 21% AU vs 29% RR; p<0.001).

Most of the 30 patients interviewed were accepting of MDT-care, and many reported positive first-hand experiences. Improved access and added expertise were perceived benefits. However, many had reservations about MDT expansion and an overriding preference for holistic, relationship-based GP-care.

Conclusion

Four years since the introduction of the new Scottish GP contract, patient awareness of MDT expansion is limited, views on reception signposting mixed, though experiences of MDT-care generally positive. However, patients still want to see a known GP when they feel it is important, and report this as being challenging especially in deprived areas.
How will COVID-19 persist in the future? Simulating future dynamics of COVID-19 using an agent-based network model
Authors: Roubenoff Ethan
Published: September 2023

Despite the United States Center for Disease Control (CDC)’s May 2023 expiration of the declared public health emergency pertaining to the COVID-19 pandemic (Silk 2023), approximately 3 years after the first cases of SARS-CoV-2 appeared in the United Sates, thousands of new cases persist daily. Many questions persist about the future dynamics of SARS-CoV-2’s in the United States, including: will COVID continue to circulate as a seasonal disease like influenza, and will annual vaccinations be required to prevent outbreaks? In response, we present an Agent Based Networked Simulation of COVID-19 transmission to evaluate recurrent future outbreaks of the disease, accounting for contact heterogeneity and waning vaccine-derived and natural immunity. Our model is parameterized with data collected as part of the Berkeley Interpersonal Contact Survey (BICS; Feehan and Mahmud 2021) and is used to simulate time series of confirmed cases of and deaths due to SARS-CoV-2, paying special attention to seasonal forces and waning immunity (Kronfeld-Schor et al. 2021; X. Liu et al. 2021; Nichols et al. 2021). From the BICS ABM model we simulate SARS-CoV-2 dynamics over the 10-year period beginning in 2021 with waning immunity and inclusion of annual booster doses under a variety of transmission scenarios. We find that SARS-CoV-2 outbreaks are likely to occur frequently, and that distribution of booster doses during certain times of the year—notably in the late winter/early spring—may reduce the severity of a wintertime outbreak depending on the seasonal epidemiology of the pathogen.
Treatment of thoracic outlet syndrome to alleviate chronic migraine headache
Authors: Randall L , Ahn S. , Weber J. , Cha Y.H.
Published: September 2023

Background

Prior case reports have indicated that treating thoracic outlet syndrome (TOS) may relieve intractable migraine headaches, but the reported experience has been limited. We report in a large case series how a strategy of treating concurrent TOS can help relieve intractable migraine headaches in patients with these dual diagnoses.

Methods

Retrospective chart review for diagnostic and interventional data on patients with migraine and TOS followed by a questionnaire to investigate specific migraine features and changes in headache burden before and after treatment of TOS.

Results

50 patients (48 women, 2 men, age = 43.9+/12.7years) with dual diagnoses of chronic migraine and TOS were included (20 migraine with aura, 28 migraine without aura, two hemiplegic migraines). Based on review of available data, headaches had become chronic within one year of onset in 21 patients (42%) and included these characteristics: side-locked or greater severity ipsilateral to limb paresthesia (38/50 patients), presence of limb swelling (32/48 patients), and worsened by recumbency (32/38 patients). Interventions included physical therapy, percutaneous transluminal venoplasty, 1st rib removal, scalenectomy, pectoralis minor tenotomy, and vein patching. Thirty-two patients needed surgery. Mean patient-reported improvement of headaches on the treated side was 72+/-26.7%; 12 patients experienced complete resolution of headaches after surgical treatment of TOS (follow-up 7.2+/-5.2 months). Questionnaire responders reported significant reductions in headache days (18.3+/-8.6 to 11.1+/-10.8 days/month, p<0.0016), severity (7.8+/2.5 to 5.4+/-2.9, p<0.00079), and need for emergency care (3.6+/-4.0 to 0.71+/-1.3 visits/year, p<0.0029) after having had their TOS treated with surgery. Questionnaire responders and non-responders were not significantly different in underlying clinical features.

Conclusion

Chronic migraines can be important manifestations of TOS. Early transition to a chronic state, headaches worsened by recumbency, and headaches with lateralized myofascial pain are clues to a contribution by TOS pathology. The TOS contribution to migraine has been under-recognized. Addressing it can significantly improve migraine headache burden.
Deep multiple-instance learning accurately predicts gene haploinsufficiency and deletion pathogenicity
Authors: Liu Zhihan , Huang Yi-Fei
Published: September 2023

Copy number losses (deletions) are a major contributor to the etiology of severe genetic disorders. Although haploinsufficient genes play a critical role in deletion pathogenicity, current methods for deletion pathogenicity prediction fail to integrate multiple lines of evidence for haploinsufficiency at the gene level, limiting their power to pinpoint deleterious deletions associated with genetic disorders. Here we introduce DosaCNV, a deep multiple-instance learning framework that, for the first time, models deletion pathogenicity jointly with gene haploinsufficiency. By integrating over 30 gene-level features potentially predictive of haploinsufficiency, DosaCNV shows unmatched performance in prioritizing pathogenic deletions associated with a broad spectrum of genetic disorders. Furthermore, DosaCNV outperforms existing methods in predicting gene haploinsufficiency even though it is not trained on known haploinsufficient genes. Finally, DosaCNV leverages a state-of-the-art technique to quantify the contributions of individual gene-level features to haploinsufficiency, allowing for human-understandable explanations of model predictions. Altogether, DosaCNV is a powerful computational tool for both fundamental and translational research.
PFAS assessment in fish – samples from Illinois waters
Authors: Sands Mia , Zhang Xing , Jensen Tor , Frano Michael La , Lin Mindy , Irudayaraj Joseph
Published: September 2023

Per- and Polyfluoroalkyl substances (PFAS) have been widely used in various industries, including pesticide production, electroplating, packaging, paper making, and the manufacturing of water-resistant clothes. This study investigates the levels of PFAS in fish tissues collected from four target waterways (15 sampling points) in the northwestern part of Illinois during 2021-2022. To assess accumulation, concentrations of 17 PFAS compounds were evaluated in nine fish species to potentially inform on exposure risks to local sport fishing population via fish consumption. At least four PFAS (PFHxA, PFHxS, PFOS, and PFBS) were detected at each sampling site. The highest concentrations of PFAS were consistently found in samples from the Rock River, particularly in areas near urban and industrial activities. PFHxA emerged as the most accumulated PFAS in the year 2022, while PFBS and PFOS dominated in 2021. Channel Catfish exhibited the highest PFAS content across different fish species, indicating its bioaccumulation potential across the food chain. Elevated levels of PFOS were observed in nearly all fish, indicating the need for careful consideration of fish consumption. Additional bioaccumulation data in the future years is needed to shed light on the sources and PFAS accumulation potential in aquatic wildlife in relation to exposures for potential health risk assessment.
Rapamycin mitigates Valproic Acid-induced teratogenicity in human and animal models by suppressing AP-1-mediated senescence
Authors: Pietrogrande Giovanni , Shaker Mohammed R. , Stednitz Sarah J. , Soheilmoghaddam Farhad , Aguado Julio , Morrison Sean , Zambrano Samuel , Tabassum Tahmina , Javed Ibrahim , Cooper-White Justin , Davis Thomas P. , O’Brien Terence J , Scott Ethan K. , Wolvetang Ernst J.
Published: September 2023

Valproic acid (VPA) is an effective and widely used anti-seizure medication but is teratogenic when used during pregnancy, affecting brain and spinal cord development for reasons that remain largely unclear. Here we designed a genetic recombinase-basedSOX10reporter system in human pluripotent stem cells that enables tracking and lineage tracing of Neural Crest cells (NCCs) in a human organoid model of the developing neural tube. We found that VPA induces extensive cellular senescence and promotes mesenchymal differentiation of human NCCs at the expense of neural lineages. We next show that the clinically-approved drug, Rapamycin, inhibits AP1-mediated senescence and restores aberrant NCC differentiation trajectory in human organoids exposed to VPA. Notably,in vivovalidation in developing zebrafish highlighted the therapeutic promise of this approach. Collectively our data identifies a novel mechanism for VPA-associated neurodevelopmental teratogenicity and a potential pharmacological preventative strategy. The results exemplify the power of genetically modified human stem cell-derived organoid models for drug discovery and safety testing.