Impact of Race, Socioeconomic Status, and Geography on Healthcare Outcomes for Children With Sickle Cell Disease in the United States: A Scoping Review

A large proportion of patients with sickle cell disease (SCD) identify as Black or African American (AA). Social bias and stigma in healthcare outcomes for children with SCD are impossible to explore without considering the impact of racial/cultural identity, socioeconomic status (SES), and geography. It is important to understand the current influences of social movements, expanded health insurance coverage, and telehealth on these variables when considering healthcare outcomes for patients with SCD. The objective of this study was to determine the roles of racial identity, SES, and geography in healthcare outcomes for the pediatric population of children with SCD in the United States (US). This study is a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases utilized included Cochrane, CINHAL, Medline, and Nursing and Allied Health Collection, all accessed through the EBSCO Information Services. Studies met the following inclusion criteria: published in English, pediatric patients residing in the US, and published between 2017 and 2022. Search terms included "sickle cell" AND "pediatric", which were then combined with "minority" OR "racial" OR "rural" OR "urban" OR "poverty" OR "income" OR "socioeconomic status". The initial search yielded 635 unique articles, with 17 articles meeting full inclusion criteria. Overall, it was clear that there are examples of positive effects of race, low SES, and rural geographic location on positive health outcomes, though a large number of studies oscillated between showing negative associations or no association at all. Barriers to care for patients with SCD are multifaceted, making it difficult to isolate and analyze the impact of individual variables. Many studies demonstrated the significance of family, community, and institutional relationships as positive support for patients with SCD. This review highlights the need for additional research on the healthcare outcome benefits of patient/familial support groups aiming to bring together patients who share racial experience and SCD diagnosis regardless of SES and geography.

Exogenous Ca/Mg quotient reduces the inhibitory effects of PEG induced osmotic stress on Avena sativa L

Abstract Drought is one of the most damaging abiotic stress that hinder plant growth and development. The present study aimed to determine the effects of various Ca/Mg quotients under polyethylene glycol (PEG)–induced osmotic stress on growth, uptake and translocation of Ca and Mg in Avena sativa (L). Plants were grown in nutrient solution supplemented with three different Ca/Mg molar quotients (0.18, 2, and 4). After 30 days plants were exposed to two different PEG (Polyethylene glycol) concentrations (0.6 MPa & 0.2 MPa) for 8 days, and solutions were renewed after 4 days. A solution containing Ca and Mg nutrients has mitigated the negative impact caused via osmotic stress on relative growth rate (RGR), absolute growth rate (AGR), crop growth rate (CGR), leaf area ratio (LAR), Leaf index ratio (LAI), root-shoot ratio (RSR), water use efficiency (WUE) and net assimilation rate (NAR). In addition, it adversely affected germination parameters, including final emergence percentage (FEP), mean germination time (MGT), Timson germination Index (TGI), germination rate index (GRI) and percent field capacity (%FC), of oat (Avena sativa L.). Mg and Ca in shoot and root and Ca translocation factor decreased with increasing Ca in solution, while Mg translocation factor increased with increasing Ca in nutrient solution. In this work, the combined effects of various Ca/Mg quotients and osmotic stress produced by polyethylene glycol (PEG) in different concentrations (0.6 MPa, 0.2 MPa) on the growth and element uptake of Avena sativa L. are examined. As a result, the Ca/Mg Quotient may naturally combat the moderate drought stress experienced by field crops.

Knowledge, attitudes and practices with regard to prophetic medicine during the COVID-19 pandemic in Saudi Arabia

OBJECTIVE

The current study explores the impact of Prophetic medicine's knowledge, attitudes, and practices on the Saudi population during the COVID-19 pandemic.

SUBJECTS AND METHODS

This study used a web-based cross-sectional design. A self-selected nonprobability sampling technique was utilized to recruit social media users in Saudi Arabia aged ≥18.

RESULTS

Four statements were used to evaluate participants' knowledge of the role of prophetic medicine in preventing and treating COVID-19. The participants had significant levels of knowledge, with an average of 90.3% correct answers. They strongly agreed with prophetic advice, including quarantine, travel bans and hand washing to prevent COVID-19 infection, with a mean of 4.3. In addition, the participants followed prophetic advice, including walking for half an hour, keeping social distance, wearing masks, and taking vaccines to prevent COVID-19 infection, with a mean of 4.2.

CONCLUSIONS

The current study was conducted to evaluate the knowledge, attitudes, and practices of Muslim residents of Saudi Arabia concerning prophetic medicine during the COVID-19 pandemic. The study revealed that participants had good knowledge of prophetic medicine, including the use of natural products such as honey, ginger, garlic, and olive oil, as well as herbal products such as black seeds, and practices such as cupping. The study also showed that participants strongly believed that COVID-19 preventative measures - including quarantine, travel bans, and handwashing - were introduced by prophetic medicine. Practices including self-isolation, hand washing, and travel bans help prevent, treat and control diseases. They assist in maintaining good health and developing resistance to diseases.

Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

Introduction

Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke.

Purpose

The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS.

Methods

28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test.

Results

Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01).

Discussion

According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population.

Measurement of electromechanical delay

Funding Acknowledgement

Type of funding source: None

Functional Precision Medicine Identifies New Therapeutic Candidates for Medulloblastoma

Medulloblastoma is among the most common malignant brain tumors in children. Recent studies have identified at least four subgroups of the disease that differ in terms of molecular characteristics and patient outcomes. Despite this heterogeneity, most patients with medulloblastoma receive similar therapies, including surgery, radiation, and intensive chemotherapy. Although these treatments prolong survival, many patients still die from the disease and survivors suffer severe long-term side effects from therapy. We hypothesize that each patient with medulloblastoma is sensitive to different therapies and that tailoring therapy based on the molecular and cellular characteristics of patients' tumors will improve outcomes. To test this, we assembled a panel of orthotopic patient-derived xenografts (PDX) and subjected them to DNA sequencing, gene expression profiling, and high-throughput drug screening. Analysis of DNA sequencing revealed that most medulloblastomas do not have actionable mutations that point to effective therapies. In contrast, gene expression and drug response data provided valuable information about potential therapies for every tumor. For example, drug screening demonstrated that actinomycin D, which is used for treatment of sarcoma but rarely for medulloblastoma, was active against PDXs representing Group 3 medulloblastoma, the most aggressive form of the disease. Functional analysis of tumor cells was successfully used in a clinical setting to identify more treatment options than sequencing alone. These studies suggest that it should be possible to move away from a one-size-fits-all approach and begin to treat each patient with therapies that are effective against their specific tumor. SIGNIFICANCE: These findings show that high-throughput drug screening identifies therapies for medulloblastoma that cannot be predicted by genomic or transcriptomic analysis.

Sexually dimorphic behavioral and neural responses to a predator scent

Male and female C57BL/6 J mice were tested on the predator odor response task, where they needed to cross through a chamber of scented bedding to reach a sucrose reward. Following the behavioral testing, mouse brains were immunohistochemically labeled for expression of the immediate early gene c-fos. In the presence of the novel odorant methyl valerate (MV), both males and females exhibited increased exploration behaviors and delayed rewards compared to control bedding. However, in the presence of the predator odor phenylethylamine (PEA), males exhibited increased exploration that strongly resembled their behavior in MV (a non-predator odor) while females behaved very similarly to the clean bedding controls, quickly traversing the chamber to achieve the reward. Expression of c-fos exhibited significant sex by odor condition interactions overall across brain regions and in the anterior piriform cortex, cingulate cortex, and dorsomedial hypothalamus specifically. In all three regions we observed the general pattern that PEA exposure evoked elevated c-fos expression in females but suppressed c-fos expression in males. Taken together these data suggest that males and females may adopt different behavioral strategies in the presence of predator threat.

Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study

BACKGROUND

Ambulatory surgery has recently gain popularity, as it is a good method of optimizinghospital resources utilization. To support ambulatory surgery, anaesthetic goals nowrevolve around patients' early recovery with minimal pain and nausea, expedientdischarge home and prompt resumption of activities of daily living. In this study, weevaluated the effect of a single pre-induction dose of dexmedetomidine on anaestheticrequirements, postoperative pain and clinical recovery after ambulatory ureteroscopy andureteric stenting under general anaesthesia.

METHODS

Sixty patients were randomised to receive IV dexmedetomidine 0.5 μg.kg-¹ (Group DEX, n = 30) or IV saline (Group P, n = 30). General anaesthesia was maintained with Sevoflurane: oxygen: air, titrated to BIS 40-60. Pain intensity, sedation, rescue analgesics, nausea/vomiting and resumption of daily activities were recorded at 1 h, and postoperative day (POD) 1-5.

RESULTS

Group DEX patients had significant reduction in sevoflurane minimum alveolar concentration (MAC), mean (SD) DEX vs. Placebo 0.6 (0.2) vs. 0.9 (0.1), p = 0.037; reduced postoperative resting pain at 1 h (VAS 0-10) (mean (SD) 1.00 (1.84) vs. 2.63 (2.78), p = 0.004), POD 1 (mean (SD) 1.50 (1.48) vs. 2.87 (2.72), p = 0.002), POD 2 (0.53 (0.97) vs. 1.73 (1.96), p = 0.001) and POD 3 (0.30 (0.75) vs. 0.89 (1.49), p = 0.001). DEX patients also had less pain on movement POD 1 (3.00 (2.12) vs. 4.30 (3.10), p = 0.043) and POD 2 (2.10 (1.98) vs. 3.10 (2.46), p = 0.040), with higher resumption of daily activities by 48 h compared to placebo, 87% vs. 63%, p = 0.04.

CONCLUSIONS

We conclude that a single dose of dexmedetomidine was a useful adjuvant in reducing MAC and postoperative pain (at 1 h and POD 1-3), facilitating faster return to daily activities by 48 h.

TRIAL REGISTRATION

The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001120369 , 31st July 2017, retrospectively registered.

Acute Aluminium Phosphide Poisoning: An Update

Acute aluminium phosphide poisoning is an extremely lethal poisoning. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. Unfortunately the absence of a specific antidote results in very high mortality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. This article aims to identify the salient features and mechanism of aluminium phosphide poisoning along with its management strategies and prognostic variables.

Changes in central retinal artery blood flow after ocular warming and cooling in healthy subjects

Context:

Retinal perfusion variability impacts ocular disease and physiology.

Aim:

To evaluate the response of central retinal artery (CRA) blood flow to temperature alterations in 20 healthy volunteers.

Setting and Design:

Non-interventional experimental human study.

Materials and Methods:

Baseline data recorded: Ocular surface temperature (OST) in °C (thermo-anemometer), CRA peak systolic velocity (PSV) and end diastolic velocity (EDV) in cm/s using Color Doppler. Ocular laterality and temperature alteration (warming by electric lamp/cooling by ice-gel pack) were randomly assigned. Primary outcomes recorded were: OST and intraocular pressure (IOP) immediately after warming or cooling and ten minutes later; CRA-PSV and EDV at three, six and nine minutes warming or cooling.

Statistical Analysis:

Repeated measures ANOVA.

Results:

(n = 20; μ ± SD): Pre-warming values were; OST: 34.5 ± 1.02°C, CRA-PSV: 9.3 ± 2.33 cm/s, CRA-EDV: 4.6 ± 1.27 cm/s. OST significantly increased by 1.96°C (95% CI: 1.54 to 2.37) after warming, but returned to baseline ten minutes later. Only at three minutes, the PSV significantly rose by 1.21 cm/s (95% CI: 0.51to1.91). Pre-cooling values were: OST: 34.5 ± 0.96°C, CRA-PSV: 9.7 ± 2.45 cm/s, CRA-EDV: 4.7 ± 1.12 cm/s. OST significantly decreased by 2.81°C (95% CI: −2.30 to −3.37) after cooling, and returned to baseline at ten minutes. There was a significant drop in CRA-PSV by 1.10cm/s (95% CI: −2.05 to −0.15) and CRA-EDV by 0.81 (95% CI: −1.47 to −0.14) at three minutes. At six minutes both PSV (95% CI: −1.38 to −0.03) and EDV (95% CI: −1.26 to −0.02) were significantly lower. All values at ten minutes were comparable to baseline. The IOP showed insignificant alteration on warming (95% CI of difference: −0.17 to 1.57mmHg), but was significantly lower after cooling (95% CI: −2.95 to −4.30mmHg). After ten minutes, IOP had returned to baseline.

Conclusion:

This study confirms that CRA flow significantly increases on warming and decreases on cooling, the latter despite a significant lowering of IOP.

Clinics in diagnostic imaging (130). Congenital megalourethra

A 35-day-old boy presented with complaints of an enlarged deformed penis and a history of difficulty in micturition. Haematological and biochemical analyses as well as renal tract sonography were normal. Retrograde urethrography revealed congenital megalourethra which was confirmed on cystourethroscopy. The literature pertaining to the types, aetiology, associated abnormalities, differential diagnosis, imaging and management of megalourethra is discussed.

A study of heart rate variability and QT dispersion in patients of acute ST elevation myocardial infarction

AIMS AND OBJECTIVES

To study the effect of Heart Rate Variability (HRV) and QT dispersion (QTd) in patients presenting with acute ST elevation myocardial infarction (STEMI).

METHODS

100 patients of Acute myocardial infarction (AMI) were evaluated by history and examination. Electrocardiogram (ECG) and Holter monitoring was done in all patients. HRV, QTd, Standard Deviation of the mean RR interval (SDNN) and Standard Deviation of the average of RR interval measured every five minutes during 24 hr (SDANN) were calculated. Results were statistically analyzed using Student 't' test, Paired 't' test and Pearson's formula.

RESULTS

The most common presenting symptoms were chest pain (88%) and dyspnoea (50%). Tachycardia was seen in 565 while congestive heart failure was present in 29% patients. Mean SDNN was 61.4 +/- 24.4 ms and SDANN was 50 +/- 18.2 ms. HRV values were significantly decreased while QTd was higher in patients who died in comparison to patients who survived. A strong negative correlation was seen between HRV and QTd.

CONCLUSIONS

Markers of autonomic regulation of heart like HRV and QTd provide valuable information about the future course of events in a patient following acute STEMI which can be utilized to plan the future course of management in patients especially predisposed to adverse and catastrophic outcomes.

Congenital localized limb hypertrophy: macrodystrophia lipomatosa

Congenital localized gigantism in children is rare and may be caused by a gamut of disorders. Family history, cutaneous and systemic manifestations and imaging together with histopathology assist in reaching the diagnosis. Macrodystrophia lipomatosa is one such rare non-hereditary congenital developmental anomaly causing localized overgrowth of a digit(s) or limb. Herein we report an interesting case of macrodystrophia lipomatosa in a child.

Is MRI as safe as we think?

Magnetic resonance imaging (MRI) is nowadays widely used as a noninvasive imaging modality for a wide variety of diseases and disorders. A patient placed in the MR system for scanning remains under the influence of powerful static magnetic field, rapidly varying gradient magnetic field and radiofrequency field in addition to the risk factors associated with gadolinium based MR contrast agents. At present, there is no conclusive evidence for adverse biological effects in patients undergoing MRI. However, a clear understanding of the various bioeffects associated with MRI diagnostics is necessary in order to ensure the safety of the patient as well as to justify its clinical use.

The design, implementation, and acceptance of a primary care-based intervention to prevent depression relapse

OBJECTIVE

This article describes the conceptual underpinnings, implementation, and participation rates of a twelve-month low-intensity primary care-based intervention to prevent depression relapse. The intervention was designed to address the inherent problems in delivery of effective maintenance treatment in a population based sample of primary care patients.

METHODS

Patients at high risk of relapse based on psychiatric history who recovered from depression six to eight weeks after initiation of pharmacotherapy by their primary care physician were eligible; 194 were randomized to receive the intervention. The intervention combined education about depression, motivation-enhancing shared decision-making regarding the use of maintenance pharmacotherapy, and cognitive-behavioral strategies. The program included two visits with a Depression Prevention Specialist working in tandem with the primary care physician at the primary care clinic, with supervision and back up from a consulting psychiatrist, proactive follow-up telephone calls and mailed personalized feedback.

RESULTS

Ninety-three percent of patients attended both in-person visits; 97 percent attended one visit. Eighty percent of patients completed all three follow-up telephone calls, and 85 percent returned at least one mailed feedback form; 48 percent returned all four forms. Offered a menu of options for self-management, most patients chose medication as well as a variety of behavioral strategies. At six months, 72 percent ofpatients and at twelve months 62 percent of patients remained on antidepressant medication.

CONCLUSIONS

We conclude that it is feasible to integrate a low intensity, twelve-month relapse prevention intervention for depression into a primary care clinic.

Performance characteristics of a rapid western blot assay system for antibody to human immunodeficiency virus type 1

One hundred and twenty reactive sera were selected from specimens studied by enzyme immunoassay (EIA, Abbott Laboratories, Abbott Park, North Chicago, IL) for antibodies against human immunodeficiency virus (HIV-1). Using these sera, the 'WesPage' system (American Bionetics, Inc., Haywood, CA), was compared to the Western blot evaluation performed by a commercial reference laboratory (Abbott Laboratories, Abbott Park, North Chicago, IL). Using criteria established by the Food and Drug Administration, all major bands representing specific antigens of HIV-1 and their corresponding antibodies were identified on the immunoblot membrane when the strongly reactive control serum was used in the assay. The weakly reactive control serum demonstrated antibodies to the p24 core antigen and the gp120/160 envelope antigen of the virus in addition to others. The non-reactive control serum did not react with any antigen on the immunoblot sheet. All results obtained by our evaluation agreed with the reference laboratory results. The WesPage assay offers a combination of advantages which include rapid turn around time, less direct contact with potentially infectious materials, good resolution of bands and high reproducibility of results.

Detection of human immunodeficiency virus antigen in vitreous humor

The vitreous humor from 11 patients with acquired immunodeficiency syndrome was obtained at postmortem examination and tested for human immunodeficiency virus antigen and antibody by using the Abbott enzyme-linked immunosorbent assay procedures. Five patients had detectable antigen, supporting the recent observation that the virus may directly infect the retina.

Orbital paecilomycosis due to Paecilomyces lilacinus (Thom) Samson

The first case of orbital paecilomycosis is described. Fungal hyphae were found in a KOH preparation of the granulomatous tissue, removed from the orbit, and also in histological sections. Culture of the tissue was positive for fungus which was resistant to cycloheximide (0.5 g/l). It was identified as Paecilomyces lilacinus (Thom) Samson (IMI 213487) and shown to be pathogenic for the rabbit cornea.

Studies on a strain of Fusarium solani (Mart.) Sacc. Isolated from a case of mycotic keratitis

A strain of Fusarium solani (Mart.) Sacc. (IMI-216517), isolated from a patient of mycotic keratitis, produced experimental keratomycosis in albino rabbit cornea and survived in internal tissues of albino mice for varying periods. Alantolactone, isolated from the plant - Inula racemosa Hook. f. exhibited marked in vitro fungistatic activity against this strain of F. solani at 100-200 microgram/ml concentrations. The strain was less sensitive to amphotericin B and showed more acid than alkaline proteinase and phosphatase activities.