Volume Measurement of the Cavum Septi Pellucidi: Normative Values Between 20 and 40 Weeks of Gestation

BACKGROUND

The cavum septi pellucidi (CSP) is a brain-enclosed cavity located on the midline between the two leaflets of the septum pellucidum that separates the lateral ventricles. This structure develops in the fetus from week 18 and can be seen up to week 37 in almost all cases and then begins to disappear.

OBJECTIVES

To measure and determine the normative values of the CSP volume in fetuses between 20 to 40 weeks of gestation.

METHODS

The study comprised 161 consecutive pregnant women between 20 to 40 weeks of gestation with single viable fetuses. All patients had normal, disease-free pregnancies. Transvaginal or transabdominal ultrasound was used according to the fetal presentation. The fetal head was assessed in mid-sagittal sections. Once the CSP was visualized, its volume was measured using three-dimensional ultrasound with Virtual Organ Computer-aided Analysis software. The width of the CSP was also measured at the biparietal diameter (BPD) plane.

RESULTS

Of the 161 fetuses, the CSP volume was measured in 158. In three patients the CSP was not identified. The CSP volume correlated poorly with gestational age (r=0.229) and with the BPD (r=0.295). The mean CSP volume was 0.508 ± 0.372 ml (range: 0.03-1.78 ml). The simple measurement of the CSP width correlated better with gestational age (r=0.535) and the BPD (r=0.484).

CONCLUSIONS

The CSP volume had a poor correlation with gestational age; however, the volume did not exceed 2 ml regardless of gestational age. This information can be used to assess pathologies involving the CSP.

Diagnostic Yield of head Computed Tomography in Patients with Syncope: Sex Differences

BACKGROUND

Syncope is responsible for approximately 1-3% of all emergency department (ED) visits and up to 6% of all hospital admissions in the United States. Although often of no long-term consequence, syncope can be the first presentation of a range of serious conditions such as strokes, tumors, or subarachnoid hemorrhages. Head computed tomography (CT) scanning is therefore commonly ordered in the ED for patients presenting with syncope to rule out any of these conditions, which may present without other associated physical or neurological findings on initial examination. However, the diagnostic yield of head CTs in patients presenting with syncope is unclear.

OBJECTIVES

To determine the diagnostic yield of head CT in the ED in patients with syncope.

METHODS

We conducted an observational analytical retrospective cross-sectional study on 360 patients diagnosed with syncope who underwent a head CT to determine the diagnostic yield of syncope to determine whether head CT is necessary for every patient presenting with syncope to the ED.

RESULTS

The total of new CT findings was 11.4%. Percentages varied between men (12.8%) and women (9.7%), P = 0.353. There were no significant differences between sexes regarding the findings in head CT, yet the incidence increased, especially among elderly males.

CONCLUSIONS

Age had a more significant impact on diagnostic yield of syncope than head CT. The use of a head CT scan as a routine diagnosis tool in patients with syncope is unjustifiable unless there is an indication based on medical history or physical examination.

The role of the neutrophil-lymphocyte ratio in predicting poor outcomes in COVID-19 patients

BACKGROUND

This study examines how the neutrophil-lymphocyte ratio (NLR) predicts coronavirus disease 2019 (COVID-19) hospitalization, severity, length, and mortality in adult patients.

METHODS

A study was done using a retrospective, single-center, observational design. A total of 400 patients who were admitted to the Ziv Medical Center (Safed, Israel) from April 2020 to December 2021 with a confirmed diagnosis of COVID-19 through RT-PCR testing were included in the analysis. Two complete blood count laboratory tests were conducted for each patient. The first test was administered upon admission to the hospital, while the second test was conducted prior to the patient's discharge from the hospital or a few days before their death.

RESULTS

Four hundred patients were included in the study, 206 males (51.5%) and 194 females (48.5%). The mean age was 64.5 ± 17.1 years. In the group of cases, there were 102 deaths, and 296 survivors were recorded, with a fatality rate of 25.5%. The median NLR was 6.9 ± 5.8 at the beginning of hospitalization and 15.1 ± 32.9 at the end of hospitalization (p < 0.001). The median length of hospital stay was 9.4 ± 8.8 days. NLR in the fatality group was 34.0 ± 49.9 compared to 8.4 ± 20.4 in the survivor group (p < 0.001). Comparison between the NLR at the time of admission of the patient and before discharge/death was 6.9 ± 5.8 vs. 15.1 ± 32.9 (p < 0.001).

CONCLUSIONS

The analyses conducted revealed a statistically significant correlation between the NLR and the severity, mortality rates, and the duration of hospitalization. The consideration of NLR should commence during the initial phases of the disease when assessing individuals afflicted with COVID-19.

The Impact of Generative Conversational Artificial Intelligence on the Lesbian, Gay, Bisexual, Transgender, and Queer Community: Scoping Review

BACKGROUND

Despite recent significant strides toward acceptance, inclusion, and equality, members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community still face alarming mental health disparities, being almost 3 times more likely to experience depression, anxiety, and suicidal thoughts than their heterosexual counterparts. These unique psychological challenges are due to discrimination, stigmatization, and identity-related struggles and can potentially benefit from generative conversational artificial intelligence (AI). As the latest advancement in AI, conversational agents and chatbots can imitate human conversation and support mental health, fostering diversity and inclusivity, combating stigma, and countering discrimination. In contrast, if not properly designed, they can perpetuate exclusion and inequities.

OBJECTIVE

This study aims to examine the impact of generative conversational AI on the LGBTQ community.

METHODS

This study was designed as a scoping review. Four electronic scholarly databases (Scopus, Embase, Web of Science, and MEDLINE via PubMed) and gray literature (Google Scholar) were consulted from inception without any language restrictions. Original studies focusing on the LGBTQ community or counselors working with this community exposed to chatbots and AI-enhanced internet-based platforms and exploring the feasibility, acceptance, or effectiveness of AI-enhanced tools were deemed eligible. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

RESULTS

Seven applications (HIVST-Chatbot, TelePrEP Navigator, Amanda Selfie, Crisis Contact Simulator, REALbot, Tough Talks, and Queer AI) were included and reviewed. The chatbots and internet-based assistants identified served various purposes: (1) to identify LGBTQ individuals at risk of suicide or contracting HIV or other sexually transmitted infections, (2) to provide resources to LGBTQ youth from underserved areas, (3) facilitate HIV status disclosure to sex partners, and (4) develop training role-play personas encompassing the diverse experiences and intersecting identities of LGBTQ youth to educate counselors. The use of generative conversational AI for the LGBTQ community is still in its early stages. Initial studies have found that deploying chatbots is feasible and well received, with high ratings for usability and user satisfaction. However, there is room for improvement in terms of the content provided and making conversations more engaging and interactive. Many of these studies used small sample sizes and short-term interventions measuring limited outcomes.

CONCLUSIONS

Generative conversational AI holds promise, but further development and formal evaluation are needed, including studies with larger samples, longer interventions, and randomized trials to compare different content, delivery methods, and dissemination platforms. In addition, a focus on engagement with behavioral objectives is essential to advance this field. The findings have broad practical implications, highlighting that AI's impact spans various aspects of people's lives. Assessing AI's impact on diverse communities and adopting diversity-aware and intersectional approaches can help shape AI's positive impact on society as a whole.

Probing the genomic landscape of human sexuality: a critical systematic review of the literature

Whether human sexuality is the result of nature or nurture (or their complex interplay) represents a hot, often ideologically driven, and highly polarized debate with political and social ramifications, and with varying, conflicting findings reported in the literature. A number of heritability and behavioral genetics studies, including pedigree-based investigations, have hypothesized inheritance patterns of human sexual behaviors. On the other hand, in most twin, adoption, and nuclear family studies, it was not possible to disentangle between underlying genetic and shared environmental sources. Furthermore, these studies were not able to estimate the precise extent of genetic loading and to shed light both on the number and nature of the putative inherited factors, which remained largely unknown. Molecular genetic studies offer an unprecedented opportunity to overcome these drawbacks, by dissecting the molecular basis of human sexuality and allowing a better understanding of its biological roots if any. However, there exists no systematic review of the molecular genetics of human sexuality. Therefore, we undertook this critical systematic review and appraisal of the literature, with the ambitious aims of filling in these gaps of knowledge, especially from the methodological standpoint, and providing guidance to future studies. Sixteen studies were finally retained and overviewed in the present systematic review study. Seven studies were linkage studies, four studies utilized the candidate gene approach, and five studies were GWAS investigations. Limitations of these studies and implications for further research are discussed.

Knowledge of Human Papillomavirus (HPV), Attitudes, and Practices Towards Anti-HPV Vaccination Among Israeli Nurses

Human papillomavirus (HPV) is a small, non-enveloped, double-stranded DNA virus, belonging to the family of Papillomaviridae. It is a highly common infectious agent, which causes one of the most widespread sexually transmitted infections (STIs), involving approximately 20% of sexually active female adolescents and up to 80% of female adults aged 50 years. There exist two major preventative strategies: namely, anti-HPV vaccination and cervical screening. Healthcare providers, including nurses, can play a crucial role in HPV immunization campaigns, counteracting vaccine hesitancy and doing advocacy and counseling. To explore the overall knowledge of HPV and HPV-related issues, as well as the attitudes and practices of Israeli nurses, a modified and adapted, previously validated knowledge, attitudes, and practices (KAP) questionnaire was administered to a sample of 565 participants, 481 female (85.1%) and 84 male (14.9%). Most of them were married (n = 428, 75.8%), with more than 5 years of experience (n = 405, 71.7%), working in the general/internal medicine ward (n = 432, 76.5%), and Jewish (n = 352, 62.3%). Only 87 nurses (15.4%) got vaccinated against HPV. Forty-four (9.1%) of the female nurses never underwent a Pap smear. Higher percentages of right replies were reported only for the item related to available preventative strategies for cervical cancer (82.1% versus 17.9%). Higher percentages of wrong replies were reported for items related to body regions that can be infected by HPV (60.5% versus 39.5%), percentage of girls aged 15-18 years being sexually active (68.0% versus 32.0%). Similar percentages of right and wrong replies were reported for items related to whom the Pap test is recommended (52.7% versus 47.3%), Israeli Ministry of Health's guidelines for anti-HPV vaccination (50.4% versus 49.6%), and percentage of boys aged 15-18 years being sexually active (44.4% versus 55.6%). Concerning the reliability of the third section of the questionnaire, Cronbach's alpha was deemed to be acceptable (α = 0.64). Statistically significant determinants of reporting lower scores in HPV-related attitudes and practices were religion (OR 1.44 [95%CI 1.02-2.04]), and male offspring (OR 1.22 [1.03-1.44]). This study has important implications for policy- and decision-makers in that they should be aware of the overall poor and unsatisfactory level of HPV-related knowledge among Israeli nurses and implement multipronged HPV vaccine promotion programs, taking into account the challenges of a multicultural and diverse society like Israel.

Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review

An emerging outbreak of monkeypox infection is quickly spreading worldwide, being currently reported in more than 30 countries, with slightly less than 1000 cases. In the present preliminary report, we collected and synthesized early data concerning epidemiological trends and clinical features of the ongoing outbreak and we compared them with those of previous outbreaks. Data were pooled from six clusters in Italy, Australia, the Czech Republic, Portugal, and the United Kingdom, totaling 124 cases (for 35 of which it was possible to retrieve detailed information). The ongoing epidemic differs from previous outbreaks in terms of age (54.29% of individuals in their thirties), sex/gender (most cases being males), risk factors, and transmission route, with sexual transmission being highly likely. Also, the clinical presentation is atypical and unusual, being characterized by anogenital lesions and rashes that relatively spare the face and extremities. The most prevalent sign/symptom reported was fever (in 54.29% of cases) followed by inguinal lymphadenopathy (45.71%) and exanthema (40.00%). Asthenia, fatigue, and headache were described in 22.86% and 25.71% of the subjects, respectively. Myalgia was present in 17.14% of the cases. Both genital and anal lesions (ulcers and vesicles) were reported in 31.43% of the cases. Finally, cervical lymphadenopathy was described in 11.43% of the sample, while the least commonly reported symptoms were diarrhea and axillary lymphadenopathy (5.71% of the case series for both symptoms). Some preliminary risk factors can be identified (being a young male, having sex with other men, engaging in risky behaviors and activities, including condomless sex, human immunodeficiency virus positivity (54.29% of the sample analyzed), and a story of previous sexually transmitted infections, including syphilis). On the other hand, being fully virally suppressed and undetectable may protect against a more severe infectious course. However, further research in the field is urgently needed.

HIV Pre-exposure Prophylaxis and Its Impact on the Gut Microbiome in Men Having Sex With Men

HIV/AIDS still imposes a high epidemiological and societal burden. Together with antiretroviral therapy, pre-exposure prophylaxis (PrEP) represents a fundamental tool in the fight against HIV/AIDS. PrEP is considered effective and safe, even though it may affect organs like the kidney, bone, and liver, as shown by randomized clinical trials (RCTs). These side effects may be mediated by alterations of the gut microbiome. Whilst the impact of the human rectal and vaginal microbiome on HIV prevention has been highly investigated among women, less is known about its effect among men having sex with men (MSM), a vulnerable population at high risk for HIV and disproportionately affected by HIV/AIDS. In the present paper, we will overview the effects of PrEP on the gut microbiota in MSM. Mining PubMed/MEDLINE, we identified three studies that have found significant changes affecting the gut microbiota. However, these shifts in the gut microbiome composition are variable, probably due to methodological differences, even though all studies reviewed in the present overview consistently report aberrations at the level of the gut microbiota. More data are needed, especially concerning the long-term side effects of PrEP: despite the studies included being a high-quality RCT, and two well-designed cross-sectional studies, evidence related to the impact of HIV PrEP on the gut microbiome in MSM is scarce and based on small populations. A better understanding of the interactions between the gut microbiota, sexual orientation/identity, and HIV prevention is expected to improve PrEP adherence and devise strategies to counteract PrEP-related side effects.

Ensuring equitable, inclusive and meaningful gender identity- and sexual orientation-related data collection in the healthcare sector: insights from a critical, pragmatic systematic review of the literature

In several countries, no gender identity- and sexual orientation-related data is routinely collected, if not for specific health or administrative/social purposes. Implementing and ensuring equitable and inclusive socio-demographic data collection is of paramount importance, given that the LGBTI community suffers from a disproportionate burden in terms of both communicable and non-communicable diseases. To the best of the authors' knowledge, there exists no systematic review addressing the methods that can be implemented in capturing gender identity- and sexual orientation-related data in the healthcare sector. A systematic literature review was conducted for filling in this gap of knowledge. Twenty-three articles were retained and analysed: two focussed on self-reported data, two on structured/semi-structured data, seven on text-mining, natural language processing, and other emerging artificial intelligence-based techniques, two on challenges in capturing sexual and gender-diverse populations, eight on the willingness to disclose gender identity and sexual orientation, and, finally, two on integrating structured and unstructured data. Our systematic literature review found that, despite the importance of collecting gender identity- and sexual orientation-related data and its increasing societal acceptance from the LGBTI community, several issues have to be addressed yet. Transgender, non-binary identities, and also intersex individuals remain often invisible and marginalized. In the last decades, there has been an increasing adoption of structured data. However, exploiting unstructured data seems to overperform in identifying LGBTI members, especially integrating structured and unstructured data. Self-declared/self-perceived/self-disclosed definitions, while being respectful of one's perception, may not completely be aligned with sexual behaviours and activities. Incorporating different levels of information (biological, socio-demographic, behavioural, and clinical) would enable overcoming this pitfall. A shift from a rigid/static nomenclature towards a more nuanced, dynamic, 'fuzzy' concept of a 'computable phenotype' has been proposed in the literature to capture the complexity of sexual identities and trajectories. On the other hand, excessive fragmentation has to be avoided considering that: (i) a full list of options including all gender identities and sexual orientations will never be available; (ii) these options should be easily understood by the general population, and (iii) these options should be consistent in such a way that can be compared among various studies and surveys. Only in this way, data collection can be clinically meaningful: that is to say, to impact clinical outcomes at the individual and population level, and to promote further research in the field.

Inflammatory Markers in the Diagnosis of Fibromyalgia

BACKGROUND

Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain accompanied by various additional symptoms. The prevalence of FMS ranges between 2-8% of the population. The exact pathophysiology of the disease remains unknown, and under certain circumstances it is difficult for the physician to diagnose. Previous studies have shown a correlation between inflammatory biomarkers such as C-reactive protein (CRP) and FMS activity, suggesting that an inflammatory component may play a role in this disease pathogenesis.

OBJECTIVES

To investigate the role of certain new inflammatory biomarkers in the diagnosis of patients with FMS.

METHODS

In this study data were collected from FMS patients who were admitted to Ziv Medical Center during the period 2013 to 2019 in an attempt to find a connection between inflammatory markers detectable by a traditional complete blood count (CBC) tests such as neutrophil-lymphocytes ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet value (MPV), red cell distribution width (RDW), and C-reactive protein (CRP) and FMS.

RESULTS

We found significantly higher CRP levels, MPV, and PLR and lower lymphocyte count in the FMS group compared to the control group.

CONCLUSIONS

FMS has certain inflammatory components that may be useful in disease diagnosis.

Fertility-Sparing Treatment of Patients with Endometrial Cancer: A Review of the Literature

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3–5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.

Higher rates of COVID-19 but less severe infections reported for patients on Dupilumab: a Big Data analysis of the World Health Organization VigiBase

OBJECTIVE

Dupilumab (Dupixent®) is a monoclonal antibody that inhibits IL-4 and IL-13 signaling used for the treatment of allergic diseases. Whilst biologic therapy is traditionally regarded as immunosuppressive and capable to increase the infectious risk, Dupilumab does not display these characteristics and may be even protective in certain cases. We investigated the link between Dupilumab therapy and SARS-CoV-2 infection.

MATERIALS AND METHODS

We carried out a comprehensive data mining and disproportionality analysis of the WHO global pharmacovigilance database. One asymptomatic COVID-19 case, 106 cases of symptomatic COVID-19, and 2 cases of severe COVID-19 pneumonia were found.

RESULTS

Dupilumab treated patients were at higher risk of COVID-19 (with an IC0.25 of 3.05), even though infections were less severe (IC0.25 of -1.71). The risk of developing COVID-19 was significant both among males and females (with an IC0.25 of 0.24 and 0.58, respectively). The risk of developing COVID-19 was significant in the age-group of 45-64 years (with an IC0.25 of 0.17).

CONCLUSIONS

Dupilumab use seems to reduce COVID-19 related severity. Further studies are needed to better understand the immunological mechanisms and clinical implications of these findings. Remarkably, the heterogenous nature of the reports and the database structure did not allow to establish a cause-effect link, but only an epidemiologically decreased risk in the patients subset treated with dupilumab.

Safety profile of Dupilumab during pregnancy: a data mining and disproportionality analysis of over 37,000 reports from the WHO individual case safety reporting database (VigiBase™)

Atopic dermatitis, known also as atopic eczema, represents a commonly diagnosed, chronic or recurrent/relapsing inflammatory disorder. From a clinical point of view, it is characterized by acute flare-ups of intense itching, eczematous pruritic lesions involving dry skin. Dupilumab is the only biologic agent approved to treat moderate to severe course of atopic dermatitis, which can be particularly severe during pregnancy causing distress and impacting on maternal and fetal health. However, there is a dearth of data concerning the safety profile of Dupilumab during gestation. Therefore, we took advantage of a large global pharmacovigilance database. From inception up to March 9, 2021, 94,065 adverse drug reactions (ADRs) from 37,848 unique reports were retrieved. Of these, 36 reports related to pregnancy, puerperium and perinatal ADR could be extracted from the pharmacovigilance database. More than half of reports (n = 21; 58.3%) were spontaneous abortion, followed by other events, including exposure to the drug during the pregnancy (n = 8; 22.2%). Two cases of abortion were reported. No studied pregnancy, puerperium and perinatal ADR was found to be associated with the use of Dupilumab. The only OR significantly greater than 1 was the OR associated with the risk of developing heterotopic pregnancy (21.66 [95% CrI 2.95-159.02]) even if the IC was highly imprecise (1.45 [95% CrI from -2.34 to 3.09]), probably because of the single case of heterotopic pregnancy reported. In conclusion, Dupilumab use appears safe during gestation. Further studies are needed, especially to better understand the mechanisms underlying the pharmacological actions and ADR of Dupilumab.

Systematic Review and Meta-Analysis of Tocilizumab Therapy versus Standard of Care in over 15,000 COVID-19 Pneumonia Patients during the First Eight Months of the Pandemic

BACKGROUND

Tocilizumab is an anti-IL-6 therapy widely adopted in the management of the so-called "cytokine storm" related to SARS-CoV-2 virus infection, but its effectiveness, use in relation to concomitant corticosteroid therapy and safety were unproven despite widespread use in numerous studies, mostly open label at the start of the pandemic.

METHODS

We performed a systematic review and meta-analysis of case-control studies utilising tocilizumab in COVID-19 on different databases (PubMed/MEDLINE/Scopus) and preprint servers (medRxiv and SSRN) from inception until 20 July 2020 (PROSPERO CRD42020195690). Subgroup analyses and meta-regressions were performed. The impact of tocilizumab and concomitant corticosteroid therapy or tocilizumab alone versus standard of care (SOC) on the death rate, need for mechanical ventilation, ICU admission and bacterial infections were assessed.

RESULTS

Thirty-nine studies with 15,531 patients (3657 cases versus 11,874 controls) were identified. Unadjusted estimates (n = 28) failed to demonstrate a protective effect of tocilizumab on survival (OR 0.74 ([95%CI 0.55-1.01], p = 0.057), mechanical ventilation prevention (OR 2.21 [95%CI 0.53-9.23], p = 0.277) or prevention of ICU admission (OR 3.79 [95%CI 0.38-37.34], p = 0.254). Considering studies with adjusted, estimated, tocilizumab use was associated with mortality rate reduction (HR 0.50 ([95%CI 0.38-0.64], p < 0.001) and prevention of ICU admission (OR 0.16 ([95%CI 0.06-0.43], p < 0.001). Tocilizumab with concomitant steroid use versus SOC was protective with an OR of 0.49 ([95%CI 0.36-0.65], p < 0.05) as was tocilizumab alone versus SOC with an OR of 0.59 ([95%CI 0.34-1.00], p < 0.001). Risk of infection increased (2.36 [95%CI 1.001-5.54], p = 0.050; based on unadjusted estimates).

CONCLUSION

Despite the heterogeneity of included studies and large number of preprint articles, our findings from the first eight of the pandemic in over 15,000 COVID-19 cases suggested an incremental efficacy of tocilizumab in severe COVID-19 that were confirmed by subsequent meta-analyses of large randomized trials of tocilizumab. This suggests that analysis of case-control studies and pre-print server data in the early stages of a pandemic appeared robust for supporting incremental benefits and lack of major therapeutic toxicity of tocilizumab for severe COVID-19.

Vaccines are underused in pregnancy: what about knowledge, attitudes and practices of providers?

Introduction.

To investigate actual knowledge of official recommendations towards seasonal influenza (SID), and Tetanus-diphtheria acellular-pertussis (Tdap) vaccines in obstetrics/gynecologists (OBGYN).

Methods.

PubMed and EMBASE databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based.

Results.

A total of 6 studies met inclusion criteria, including 1323 OBGYN from 5 different countries. Overall, around 99% of sampled professionals were aware that official recommendations towards SID in pregnancy do exist, compared to 92% for Tdap, with significant heterogeneity (I² > 95%, p < 0.001). Concerns about vaccine safety was reported by 10% of respondents for Tdap, and by 6.0% for SID, but again available studies were substantially heterogenous (I² = 86.7% and 86.0%, p < 0.001). Eventually, 93% of respondents actively recommended SID in pregnancy, compared to 88% for Tdap (I² 98.8% and I² 95.9%, respectively p < 0.001). The evidence of significant publication bias was initially subjectively identified from the funnel plot, and then objectively confirmed through the regression test for all analyses.

Conclusions.

These results suggest an appropriated understanding of official recommendation among sampled OBGYN, with high shares of professionals actively promoting vaccination practices among their patients. Despite the high heterogeneity and the significant publication bias we identified, our results also hint towards extensive knowledge gaps of OBGYN, and particularly regarding unmotivated concerns about vaccine safety. As a consequence, appropriate information and formation campaigns should be appropriately tailored. (www.actabiomedica.it)

Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes

BACKGROUND AND AIM

Chronic inflammation has an important role in the development and progression of type 2 diabetes through immunologic inflammatory mechanisms. Simple new inexpensive inflammatory markers may contribute to the detection of microalbuminuria. Aim of our study is to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and red blood cell distribution width (RDW) for microalbuminuria in type 2 diabetic patients for possible application as prognostic factors for the prediction of microalbuminuria and the progression of disease in patients with diabetes.

METHODS

A total of 168 patients with type 2 diabetes mellitus were classified into gender- and BMI-matched three groups according to hemoglobin A1c and microalbuminuria: Group A: 53 patients with controlled diabetes, Group B: 57 patients with uncontrolled diabetes, both without microalbuminuria, and Group C: 58 patients with uncontrolled diabetes with microalbuminuria. Levels of NLR, MPV, and RDW between the study groups were examined and compared.

RESULTS

A significant difference in NLR was found between Group C and groups A and B (P < .001, P = .005, respectively). A statistically significant difference in RDW was found between groups B and C (P = .014). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction showed an area under curve (AUC) of 0.675 for NLR (CI 0.58-0.76, P < .001) and 0.614 for RDW (CI 0.52-0.70, P = .013). NLR value of 2.54 has 39.7% sensitivity, 78.8% specificity, and 45% positive predictive value (PPV). RDW value of 14.44 has 37.9% sensitivity, 76% specificity, and 41.5% PPV.

CONCLUSIONS

Neutrophil-to-lymphocyte ratio and RDW have PPV for microalbuminuria in diabetic patients.

The Prognostic Value of Inflammatory Markers in Clostridium difficile-associated Diarrhea

BACKGROUND

The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing and is associated with significant morbidity and mortality. Therefore, there is a need to find new tools to determine the severity of the disease.

OBJECTIVES

To investigate the prognostic values of inflammatory markers such as mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), and C-reactive protein (CRP) in patients with CDAD.

METHODS

The study comprised of 100 patients diagnosed with CDAD. The study included an additional control group of 69 patients with diarrhea who were negative for C. difficile toxin. The control group was age- and sex-matched and hospitalized at the same time period. NLR and MPV were obtained from complete blood count results. Serum CRP levels were measured by the latex particle enhanced immunoturbidimetric assay. Blood samples for all inflammatory markers were collected at time of diagnosis and prior to initiating the antibiotic therapy. Demographic, clinical, laboratory, and prognostic data were collected from medical records for a period of 90 days from the initial diagnosis of CDAD.

RESULTS

The mean age of the CDAD group was 68.6 ± 21.5 years compared to 65.6 ± 24.5 in the control group (P = 0.29). Our findings show that patients with CDAD had significantly higher NLR, MPV and serum CRP levels compared to the control group (P < 0.001)). Moreover, significantly higher levels were observed when CDAD was fatal (P < 0.001).

CONCLUSIONS

Elevated NLR, MPV, and serum CRP levels may serve as biomarkers for prediction of recurrence and mortality in patients with CDAD.

The role of neutrophil-lymphocyte ratio, and mean platelet volume in detecting patients with acute venous thromboembolism

Background

Acute venous thromboembolism (VTE) refers to deep venous thrombosis (DVT) of the extremities or pulmonary embolism (PE), or to both. Reliable imaging is not always available making a serologic diagnosis, or biomarker, highly desirable.

Objective

This study aimed to examine the role of neutrophil‐lymphocyte ratio (NLR), platelet‐lymphocyte ratio (PLR), and mean platelet volume (MPV) in detection patients with acute VTE.

Methods

A total of 327 patients with initial diagnosis of acute VTE who were admitted to Ziv hospital were evaluated. Of them, 272 patients with definitive diagnosis of VTE, and 55 patients without VTE were used as control group. Complete blood count (CBC), measurements of NLR, MPV, and PLR were determined at admission.

Results

Patients with VTE were older than controls (62 ± 18.9 vs 55.4 ± 15.1 years, respectively, P = .03). Female gender was predominant in the two groups. In the study group, 178/272 (66%) had DVT, 84/272 (31%) had pulmonary embolism (PE), and the rest had DVT and PE. NLR, MPV, and PLR were found to be significantly elevated in acute VTE compared to control (P < .001, P = .008, P = .014, respectively). A ROC curve analysis of NLR and MPV for predicting acute VTE was performed which found a cut‐off value of 5.3 for NLR, an area under curve of (0.67 (0.60‐0.75), P < .001, with a sensitivity of 69% and specificity of 57%. and a cut‐off value of 8.6 for MPV, an area under curve of (0.61 [0.53‐0.68], P = .014, with a sensitivity of 52% and specificity of 67%. Multivariate logistic regression model found that NLR (OR 1.2, 95% CI [1.01‐1.4], P = .041) and MPV (OR 1.5, 95%CI [1.07‐2.12], P = .5) were associated with acute VTE.

Conclusions

Neutrophil‐lymphocyte ratio and MPV could be beneficial predictors for the early detection of potential acute VTE.

Consecutive Measures of CRP Correlate with Length of Hospital Stay in Patients with Community-Acquired Pneumonia

BACKGROUND

Accurate diagnosis of community acquired pneumonia (CAP) is crucial to its proper management and to combating antibiotic resistance. Levels of C-reactive protein (CRP) have been shown to distinguish pneumonia from other pathological conditions and can be used to control the severity of infection during admission.

OBJECTIVES

To investigate an association between consecutive measurements of CRP and the severity of CAP in hospitalized patients.

METHODS

A total of 500 patients with CAP were admitted to the hospital. Traditional markers of inflammation including CRP, leukocyte count, body temperature, were measured on the first, second, and fifth days of hospitalization. Correlations between these measures and the length of the hospital stay were calculated.

RESULTS

Mean levels of CRP, body temperature, and leukocyte count were significantly lower on the second day after hospital admission and even lower on the fifth day. A positive correlation of medium strength was found between the level of CRP on the second day of hospitalization and the length of hospital stay (P < 0.001, rs = 0.447), and a negative correlation was noted between the decrease in CRP level from the first to second day and the length of hospital stay.

CONCLUSIONS

CRP levels correlated with body temperature and leukocyte count, traditional markers of inflammation. A greater decrease in CRP level between the first and second day of hospitalization was associated with shorter hospital stay and rapid improvement. These findings support the use of CRP as a marker for the severity and complication of CAP.

Tetrahydrobiopterin (BH4 ): Targeting endothelial nitric oxide synthase as a potential therapy for pulmonary hypertension

PURPOSE

Pulmonary Hypertension (PH) is complex disease which is associated with endothelial and cardiac dysfunction. Tetrahydrobiopterin (BH4 ) regulates endothelial nitric oxide synthase (eNOS) to produce nitric oxide rather than superoxide which maintains normal endothelial and cardiac function. This study explores the therapeutic potential of BH4 in experimental PH.

METHODS

Monocrotaline-induced PH in rats and Hph-1 deficiency in mice were used for animal experiments. Hemodynamic measurements using pressure transducers were conducted for pulmonary and cardiac pressures, and Langendorff apparatus was used for isolated heart experiments; preventive as well as rescue treatment protocols were conducted; tissues were collected for histological and biochemical studies.

RESULTS

In vivo acute BH4 administration reduced pulmonary artery pressure (PAP) only in the MCT rat. In a Langendorff preparation, BH4 increased right ventricular systolic pressure (RVSP) in right ventricular hypertrophy (RVH) but not in control. In "prevention" therapy, BH4 (10 and 100 mg/kg) attenuated the development of PH in rat MCT model. eNOS protein levels in lung homogenates were maintained and cGMP levels were increased. In "rescue" therapy, BH4 (10 and 100 mg/kg) ameliorated pulmonary vascular muscularization in a dose-dependent manner. RVSP was reduced in RVH and pulmonary vascular muscularization was attenuated. BH4 at 10 mg/kg reduced RV myocyte diameter while BH4 at 100 mg/kg reversed it to control level. BH4 restored normal levels of eNOS protein and in a dose of 100 mg/kg enhanced lung tissue levels of BH4 , cGMP, and NO compared to placebo.

CONCLUSION

The current study provides scientific evidence for a therapeutic potential of BH4 in PH and invites further investigation.

A link between platelet to lymphocyte ratio and Helicobacter pylori infection

PURPOSE

Chronic Helicobacter pylori gastritis affects two-thirds of the world's population and is one of the most common chronic inflammatory disorders of humans, the infection clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. Some studies showed that there was a correlation between low-grade inflammation as CRP and HP infection. The purpose of this study was to investigate the relationship between the presence of HP infection and platelet/lymphocyte ratio (PLR).

METHOD

A total of 200 patients who met the HP criteria and 180 age- and gender-matched control subjects were included in this randomized controlled trial. Patients were diagnosed to have HP according stomach biopsy and urea breath test, PLR was calculated from complete blood count at time of diagnosis and before initiating the treatment.

RESULTS

Patients with HP infection had significantly higher PLR compared to those without HP. Moreover, the patients with symptomatic HP had higher PLR than those with asymptomatic HP. While PLR increased as the severity of HP symptoms increased (r=.452, P<.001).

CONCLUSION

Our study indicated, for the first time, a significant association between HP infection and symptoms based on PLR, a simple and reliable indicator of inflammation. Furthermore, there an increase in PLR as the severity of HP increases.

Antioxidant Enzyme Activity and Cognition in Obese Individuals with or without Metabolic Risk Factors

Background: The metabolic syndrome may be associated with cognitive impairment and increased oxidative stress. Aim: To document the association between metabolic syndrome, cognitive impairment and oxidative stress activity in metabolically healthy obese and in metabolically unhealthy obese individuals. Methods: 60 obese individuals aged (49±10 years, 52% male) were enrolled. Obesity was defined as BMI>30. Metabolic syndrome was defined according to ATP III guidelines. Obese individuals were divided into 2 groups: Group 1, metabolically healthy obese (≤2 components of metabolic syndrome), and Group 2, metabolically unhealthy obese (>2 components of metabolic syndrome). Cognitive dysfunction was determined by Montreal cognitive assessment score. Liver Fibro scan (Elastography), Inflammation (CRP), pro oxidants (MDA), antioxidant activity (SOD, PON, GSH, GPx) and insulin resistance (HOMA-IR) were measured. Results: Of the 30 metabolically unhealthy obese individuals, 13% developed dementia, 51% had mild cognitive impairment, and 36% had a normal cognitive score. In the metabolically healthy obese group, 3% developed dementia, 7% had mild cognitive impairment, and 90% had a normal cognitive score. There was a significant difference in liver stiffness (7±3 vs. 5.2±2.7 kpa, p<0.001), liver fat measurement (337±51 vs. 280±20 db/m, p<0.001), MDA (4.7±0.9 vs. 5.47±1.12 mM, P<0.003), Glutathione GSH (27.2±2.4 vs. 28.4±2.3, P<0.03), CRP (9±6 vs. 7±6 P<0.001) and insulin resistance (2.5±1 vs. 6±5.5 p<0.02) between the 2 groups. Correlations were significant between GPx activity and liver stiffness (r=0.37), GPx activity and abdominal girth (r=-0.22) and glucose concentration and SOD activity (r=0.4). Multivariate analysis showed that HOMA-IR, MDA and GSH were the most powerful predictors of metabolically unhealthy obesity. Conclusion: There is a significant mild cognitive impairment and increased oxidative stress activity in the metabolically unhealthy obese. Whether treatment with anti-oxidants improves cognitive dysfunction remains to be determined.

Common Laboratory Parameters for Differentiating Between Community-Acquired and Healthcare-Associated Pneumonia

BACKGROUND AND OBJECTIVES

The correct diagnosis of healthcare-associated pneumonia (HCAP) as opposed to community-acquired pneumonia is essential for the selection of a correct empirical antimicrobial approach, reserving the broad-spectrum or highly potent antimicrobial therapies for resistant strains most commonly present in HCAP, whereas treating the less resistant strains, most commonly associated with community and long-term care facility-acquired infections, with a more targeted empirical approach. The standard approach today is to differentiate between the two based on the medical history of the past 90 days prior to admission. Measurable, quantitative assessment may be able to assist in this decision. The objective of this study is to find a measurable method of differentiating between community-acquired and healthcare-associated pneumonias.

MATERIALS AND METHODS

The records of 126 patients admitted with a diagnosis of pneumonia were divided into two groups based on the probable cause of their disease, in accordance with common practice. The routine laboratory work taken upon admittance was analyzed using logistical regression and Student's t-test.

RESULTS

We have found that the red blood cell distribution width and the neutrophil-to-lymphocyte ratio, both routine parameters obtained in a simple blood count, can each assist in differentiating between community-acquired and healthcare-associated pneumonias.

CONCLUSION

We have found two statistically significant parameters that may be used as adjuncts to the medical history, chest radiography and other parameters in forming an immediate clinical impression of a patient presenting with pneumonia.

[SURVIVAL OF PATIENTS WITH WORSENING CHRONIC OBSTRUCTIVE PULMONARY DISEASE]

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD), a common disease worldwide, refers to two frequently coexisting lung diseases, chronic bronchitis and emphysema. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. A sharp worsening obstructive pulmonary disease with respiratory acidosis leads to repeated hospitalizations and high mortality rates.

OBJECTIVE

This study examined patients with COPD during hospitalization. Parameters included: the number of patients admitted for a defined period of time, the time of ventilation, the average length of hospitalization, the treatment modality, the mortality rate and the percentage of returning patients.

METHODS

We chose 260 admissions with worsening chronic obstructive pulmonary disease during a six month period in internal medicine departments and the intensive care unit. We selected patients who met the criteria and collected demographic data, complete blood tests including blood gases and checking the ventilator during hospitalization. We checked the relationship between the indices for hospitalization, and the mechanical ventilation.

RESULTS

A total of 255 admissions were enrolled in the study; 13 patients were excluded. Data was collected from 242 hospitalizations; 242 admissions included 71 patients hospitalized more than once. Patients' age ranged from 34 to 97 years with a median age of 66.6 years. During hospitalization, 194 patients (80%) were admitted to the internal medicine departments and 48 patients (19.8%) needed mechanical ventilation in intensive care. Most patients (60.7%) were hospitalized for 2 to 4 days, but 50% of the group of patients were hospitalized for almost one week.

CONCLUSION

Although the results were almost identical to those found in the literature we found other factors related to the aggravation of the disease e.g. smoking, ischemic heart disease and malignancy, which are more common in this group of diseases.

Association of neutrophil to lymphocyte ratio with presence and severity of gastritis due to Helicobacter pylori infection

OBJECTIVE

Infection with the bacterial pathogen Helicobacter pylori (HP) clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. Some studies have shown that there was a correlation between low-grade inflammation as C-reactive protein (CRP) and HP infection. The aim of this study was to investigate the relationship between the presence of gastritis due to HP infection and neutrophil/lymphocyte ratio (NLR), a simple and reliable indicator of inflammation.

DESIGN

Fifty patients met the HP criteria and half of them have had severe symptoms and upper endoscopy showed atrophic gastritis, and fifty age- and sex-matched control subjects with gastritis without HP infection were included in this randomized controlled trial. Patients were diagnosed to have HP according to the use of urea breath testing (UBT) and multiple biopsies. NLR was calculated from complete blood count at the time of diagnosis and before initiating the treatment to all groups.

RESULTS

Patients with HP infection had significantly higher NLR compared to those without HP. Moreover, the patients with symptomatic HP and grade 4 gastritis had higher NLR than those asymptomatic with past history of peptic disease (P 0.007 and P 0.068, respectively). Although NLR increased as the severity of gastritis and HP symptoms increased (r = 0.564, P < 0.001), Receiver operating characteristic (ROC) Curve analysis was performed. The cut-off level for NLR with optimal sensitivity and specificity was calculated as 1.82 (area under curve [AUC] = 0.825 [0.753-0.884], P < 0.001).

CONCLUSION

The present study indicated, for the first time, a significant correlation between HP infection and inflammation on the basis of NLR, a simple and reliable indicator of inflammation. Furthermore, there is an increase in NLR as the severity of gastritis with HP increases. This elevated ratio gets normalized with treatment.

Calcium channel blocker effect on insulin resistance and inflammatory markers in essential hypertension patients

AIM

Insulin resistance, inflammation and oxidative stress (OS), are among the mechanisms that have been implicated in pathogenesis of essential hypertension (EH). Peripheral polymorphonuclear leukocytes (PMNLs) are primed in EH patients, releasing uncontrolled superoxide anion contributing to OS in these patients. PMNL priming correlates with insulin resistance and with PMNL intracellular calcium ([Ca2+]i). Recent studies have attributed to the anti-hypertensive drug lercanidipine, a third generation calcium-channel blocker, and additional anti-ischemic and anti-oxidative characteristics. Aim of the study was to evaluate the possible non-traditional effect of two months of lercanidipine treatment on insulin resistance and on PMNL-related inflammation in EH patients.

METHODS

Non-smoking EH patients with untreated mild to moderate high blood pressure (BP) were included. Low-graded inflammation was reflected by WBC and PMNL counts and by PMNL apoptosis. Systemic inflammation was measured by plasma fibrinogen, CRP and albumin levels. Fasting serum insulin levels served as a marker of insulin resistance.

RESULTS

Two months of lercanidipine treatment showed significant decrease in BP, in WBC and PMNL counts, in PMNL apoptosis, in CRP and serum insulin levels and significant increase in serum albumin levels. Rates of superoxide release from PMNLs, WBC and PMNL counts and insulin levels positively correlated with mean arterial blood pressure values.

CONCLUSION

We imply that use of this CCB lercanidipine can be favored in EH patients due to its combined anti-PMNL priming and anti-inflammatory effects, in addition to its anti-hypertensive characteristics.

Lercanidipine effect on polymorphonuclear leukocyte-related inflammation and insulin resistance in essential hypertension patients

INTRODUCTION

Inflammation, insulin resistance, and oxidative stress (OS) are among the mechanisms that have been implicated in the pathogenesis of essential hypertension (EH). Peripheral polymorphonuclear leukocytes (PMNLs) are primed in EH patients, releasing uncontrolled superoxide anions contributing to OS in these patients. PMNL priming correlates with insulin resistance and PMNL intracellular calcium ([Ca(2+)]i). Recent studies have attributed additional anti-ischemic and antioxidative characteristics to the antihypertensive drug, lercanidipine, a third-generation calcium-channel blocker. The purpose of this study was to evaluate the possible nontraditional effect of 2 months of lercanidipine treatment on insulin resistance and on PMNL-related inflammation in EH patients.

METHODS

Non-smoking EH patients with untreated mild-to-moderate high blood pressure (BP) were included. Low-grade inflammation was reflected by PMNL apoptosis and by white blood cell (WBC) and PMNL counts. Systemic inflammation was measured by plasma fibrinogen, C-reactive protein (CRP), and transferrin and albumin levels. Fasting serum insulin levels served as a marker of insulin resistance.

RESULTS

Two months of lercanidipine treatment showed a significant decrease in BP, WBC, and PMNL counts, PMNL apoptosis, CRP, and serum insulin levels, and a significant increase in serum albumin levels. Rates of superoxide release from PMNLs, WBC and PMNL counts, and insulin levels positively correlated with mean arterial BP values.

CONCLUSION

The use of lercanidipine can be favorable in EH patients due to its combined anti-PMNL priming and anti-inflammatory effects, in addition to its antihypertensive characteristics.