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Carter S, Lin JC, Chow T, Martinez MP, Qiu C, Feldman RK, McConnell R, Xiang AH. Preeclampsia Onset, Days to Delivery, and Autism Spectrum Disorders in Offspring: Clinical Birth Cohort Study. JMIR Public Health Surveill 2024; 10:e47396. [PMID: 38630528 DOI: 10.2196/47396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 12/08/2023] [Accepted: 03/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Maternal preeclampsia is associated with a risk of autism spectrum disorders (ASD) in offspring. However, it is unknown whether the increased ASD risk associated with preeclampsia is due to preeclampsia onset or clinical management of preeclampsia after onset, as clinical expectant management of preeclampsia allows pregnant women with this complication to remain pregnant for potentially weeks depending on the onset and severity. Identifying the risk associated with preeclampsia onset and exposure provides evidence to support the care of high-risk pregnancies and reduce adverse effects on offspring. OBJECTIVE This study aimed to fill the knowledge gap by assessing the ASD risk in children associated with the gestational age of preeclampsia onset and the number of days from preeclampsia onset to delivery. METHODS This retrospective population-based clinical cohort study included 364,588 mother-child pairs of singleton births between 2001 and 2014 in a large integrated health care system in Southern California. Maternal social demographic and pregnancy health data, as well as ASD diagnosis in children by the age of 5 years, were extracted from electronic medical records. Cox regression models were used to assess hazard ratios (HRs) of ASD risk in children associated with gestational age of the first occurrence of preeclampsia and the number of days from first occurrence to delivery. RESULTS Preeclampsia occurred in 16,205 (4.4%) out of 364,588 pregnancies; among the 16,205 pregnancies, 2727 (16.8%) first occurred at <34 weeks gestation, 4466 (27.6%) first occurred between 34 and 37 weeks, and 9012 (55.6%) first occurred at ≥37 weeks. Median days from preeclampsia onset to delivery were 4 (IQR 2,16) days, 1 (IQR 1,3) day, and 1 (IQR 0,1) day for those first occurring at <34, 34-37, and ≥37 weeks, respectively. Early preeclampsia onset was associated with greater ASD risk (P=.003); HRs were 1.62 (95% CI 1.33-1.98), 1.43 (95% CI 1.20-1.69), and 1.23 (95% CI 1.08-1.41), respectively, for onset at <34, 34-37, and ≥37 weeks, relative to the unexposed group. Within the preeclampsia group, the number of days from preeclampsia onset to delivery was not associated with ASD risk in children; the HR was 0.995 (95% CI 0.986-1.004) after adjusting for gestational age of preeclampsia onset. CONCLUSIONS Preeclampsia during pregnancy was associated with ASD risk in children, and the risk was greater with earlier onset. However, the number of days from first preeclampsia onset to delivery was not associated with ASD risk in children. Our study suggests that ASD risk in children associated with preeclampsia is not increased by expectant management of preeclampsia in standard clinical practice. Our results emphasize the need to identify effective approaches to preventing the onset of preeclampsia, especially during early pregnancy. Further research is needed to confirm if this finding applies across different populations and clinical settings.
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Affiliation(s)
- Sarah Carter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jane C Lin
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Mayra P Martinez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Chunyuan Qiu
- Department of Anesthesiology and Perioperative Medicine, Baldwin Park Medical Center, Kaiser Permanente Southern California, Baldwin Park, CA, United States
| | - R Klara Feldman
- Department of Obstetrics and Gynecology, Baldwin Park Medical Center, Kaiser Permanente Southern California, Baldwin Park, CA, United States
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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Cates J, Mattison CP, Groom H, Donald J, Hall RP, Schmidt MA, Hall AJ, Naleway AL, Mirza SA. Health Care Utilization and Clinical Management of All-Cause and Norovirus-Associated Acute Gastroenteritis Within a US Integrated Health Care System. Open Forum Infect Dis 2024; 11:ofae151. [PMID: 38628950 PMCID: PMC11020278 DOI: 10.1093/ofid/ofae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Norovirus-associated acute gastroenteritis (AGE) exacts a substantial disease burden, yet the health care utilization for and clinical management of norovirus-associated AGE are not well characterized. Methods We describe the health care encounters and therapeutics used for patients with all-cause and norovirus-associated AGE in the Kaiser Permanente Northwest health system from 1 April 2014 through 30 September 2016. Medical encounters for patients with AGE were extracted from electronic health records, and encounters within 30 days of one another were grouped into single episodes. An age-stratified random sample of patients completed surveys and provided stool samples for norovirus testing. Results In total, 40 348 individuals had 52 509 AGE episodes; 460 (14%) of 3310 participants in the substudy tested positive for norovirus. An overall 35% of all-cause AGE episodes and 29% of norovirus-associated AGE episodes had ≥2 encounters. While 80% of norovirus-associated AGE episodes had at least 1 encounter in the outpatient setting, all levels of the health care system were affected: 10%, 22%, 10%, and 2% of norovirus-associated AGE episodes had at least 1 encounter in virtual, urgent care, emergency department, and inpatient settings, respectively. Corresponding proportions of therapeutic use between norovirus-positive and norovirus-negative episodes were 13% and 10% for intravenous hydration (P = .07), 65% and 50% for oral rehydration (P < .001), 7% and 14% for empiric antibiotic therapy (P < .001), and 33% and 18% for antiemetics (P < .001). Conclusions Increased health care utilization and therapeutics are likely needed for norovirus-associated AGE episodes during peak norovirus winter seasons, and these data illustrate that effective norovirus vaccines will likely result in less health care utilization.
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Affiliation(s)
- Jordan Cates
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, USA
| | - Holly Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Judy Donald
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Rebecca P Hall
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zhang X, Liu X, Liu C, Hua C. Clinical considerations of emergent oral manifestations during pregnancy. Hua Xi Kou Qiang Yi Xue Za Zhi 2024; 42:142-153. [PMID: 38597074 PMCID: PMC11034408 DOI: 10.7518/hxkq.2024.2023367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Indexed: 04/11/2024]
Abstract
Pregnancy is a special period for developing and treating oral diseases. Oral emergencies during pregnancy need to be handled appropriately. Changes in the physiological environments and personal habits of pregnant women increase susceptibility to some oral diseases. However, clinical treatment strategies are limited due to the need to ensure the safety of pregnant women and fetuses. Pregnant women should obtain oral health knowledge and enhance their awareness. Dentists should adhere to the principle of "prevention before pregnancy, controlling symptoms during pregnancy, and treating diseases after pregnancy" for different pregnancy periods. They should also formulate appropriate treatment plans to control emergencies, prevent disease progression, and avoid harmful effects on pregnant women by using the safest, simplest, and most effective strategies that avoid adverse effects on fetuses. Pregnant women and dentists should combine prevention and treatment while collaborating in maintaining oral health during pregnancy. This article focuses on the principles of treatment during pregnancy, and the treatment timing, clinical management, and treatment strategies of different diseases causing oral emergencies during pregnancy are reviewed.
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Affiliation(s)
- Xuefeng Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xian Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chang Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chengge Hua
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Rofes P, Dueñas N, del Valle J, Navarro M, Balmaña J, Ramón y Cajal T, Tuset N, Castillo C, González S, Brunet J, Capellá G, Lázaro C, Pineda M. Tumor analysis of MMR genes in Lynch-like syndrome: Challenges associated with results interpretation. Cancer Med 2024; 13:e7041. [PMID: 38558366 PMCID: PMC10983805 DOI: 10.1002/cam4.7041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/24/2024] [Accepted: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Up to 70% of suspected Lynch syndrome patients harboring MMR deficient tumors lack identifiable germline pathogenic variants in MMR genes, being referred to as Lynch-like syndrome (LLS). Previous studies have reported biallelic somatic MMR inactivation in a variable range of LLS-associated tumors. Moreover, translating tumor testing results into patient management remains controversial. Our aim is to assess the challenges associated with the implementation of tumoral MMR gene testing in routine workflows. METHODS Here, we present the clinical characterization of 229 LLS patients. MMR gene testing was performed in 39 available tumors, and results were analyzed using two variant allele frequency (VAF) thresholds (≥5% and ≥10%). RESULTS AND DISCUSSION More biallelic somatic events were identified at VAF ≥ 5% than ≥10% (35.9% vs. 25.6%), although the rate of nonconcordant results regarding immunohistochemical pattern increased (30.8% vs. 20.5%). Interpretation difficulties question the current utility of the identification of MMR somatic hits in the diagnostic algorithm of suspected LS cases.
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Affiliation(s)
- Paula Rofes
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Núria Dueñas
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Jesús del Valle
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Matilde Navarro
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO)Vall d'Hebron HospitalBarcelonaSpain
| | | | - Noemí Tuset
- Medical Oncology DepartmentArnau de Vilanova University HospitalLleidaSpain
| | - Carmen Castillo
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
| | - Sara González
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Joan Brunet
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
- Hereditary Cancer ProgramCatalan Institute of Oncology – IDIBGiGironaSpain
| | - Gabriel Capellá
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Conxi Lázaro
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Marta Pineda
- Hereditary Cancer ProgramCatalan Institute of Oncology, Molecular Mechanisms and Experimental Therapy in Oncology Program, Institut d'Investigació Biomèdica de Bellvitge – IDIBELLL'Hospitalet de LlobregatSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
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Costa B, Vale N. Virus-Induced Epilepsy vs. Epilepsy Patients Acquiring Viral Infection: Unravelling the Complex Relationship for Precision Treatment. Int J Mol Sci 2024; 25:3730. [PMID: 38612542 PMCID: PMC11011490 DOI: 10.3390/ijms25073730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The intricate relationship between viruses and epilepsy involves a bidirectional interaction. Certain viruses can induce epilepsy by infecting the brain, leading to inflammation, damage, or abnormal electrical activity. Conversely, epilepsy patients may be more susceptible to viral infections due to factors, such as compromised immune systems, anticonvulsant drugs, or surgical interventions. Neuroinflammation, a common factor in both scenarios, exhibits onset, duration, intensity, and consequence variations. It can modulate epileptogenesis, increase seizure susceptibility, and impact anticonvulsant drug pharmacokinetics, immune system function, and brain physiology. Viral infections significantly impact the clinical management of epilepsy patients, necessitating a multidisciplinary approach encompassing diagnosis, prevention, and treatment of both conditions. We delved into the dual dynamics of viruses inducing epilepsy and epilepsy patients acquiring viruses, examining the unique features of each case. For virus-induced epilepsy, we specify virus types, elucidate mechanisms of epilepsy induction, emphasize neuroinflammation's impact, and analyze its effects on anticonvulsant drug pharmacokinetics. Conversely, in epilepsy patients acquiring viruses, we detail the acquired virus, its interaction with existing epilepsy, neuroinflammation effects, and changes in anticonvulsant drug pharmacokinetics. Understanding this interplay advances precision therapies for epilepsy during viral infections, providing mechanistic insights, identifying biomarkers and therapeutic targets, and supporting optimized dosing regimens. However, further studies are crucial to validate tools, discover new biomarkers and therapeutic targets, and evaluate targeted therapy safety and efficacy in diverse epilepsy and viral infection scenarios.
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Affiliation(s)
- Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Satarvandi D, van der Werff SD, Nauclér P, Hildenwall H, Sondén K. Scoring systems for prediction of malaria and dengue fever in non-endemic areas among travellers arriving from tropical and subtropical areas. Emerg Med J 2024; 41:242-248. [PMID: 38355290 PMCID: PMC10982626 DOI: 10.1136/emermed-2023-213296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Fever is a common symptom among travellers returning from tropical/subtropical areas to Europe, and promptly distinguishing severe illnesses from self-limiting febrile syndromes is important but can be challenging due to non-specific clinical presentation. METHODS A cross-sectional study enrolled adults and children who sought care during 2015-2020 at Karolinska University Hospital, Stockholm, Sweden with fever within 2 months after returning from travel to a tropical/subtropical area. Data on symptoms and laboratory parameters were prospectively and retrospectively collected. Two separate scoring systems for malaria and dengue were developed based on backward elimination regressions. RESULTS In total, 2113 adults (18-94 years) and 202 children (1-17 years) were included, with 112 (4.8%) confirmed malaria by blood thick smear and 90 (3.9%) PCR/serology dengue-positive cases. Malaria was more likely in a patient who had visited sub-Saharan Africa and presented with combination of thrombocytopenia, anaemia and fever ≥39.5°C. Leucopenia, muscle pain and rash after travelling to Asia or South/Latin America indicated high probability of dengue. Two scoring systems with points between 0 and 7 for prediction of malaria or dengue were created based on the above predictors. Scores ≥3 indicated >80% sensitivity and specificity for malaria and >90% specificity for dengue in children and adults (area under the curve (AUC) for dengue: 0.92 in adults (95% CI 0.90 to 0.95) and 0.95 in children (95% CI 0.88 to 1.0); AUC for malaria: 0.93 in adults (95% CI 0.91 to 0.96) and 0.88 in children (95% CI 0.78 to 0.99)). Internal validation of optimism and overfitting was managed with bootstrap. CONCLUSION The presented scoring systems provide novel tools for structured assessment of patients with tropical fever in a non-endemic area and highlight clinical signs associated with a potential severe aetiology to direct the need for microbial investigation.
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Affiliation(s)
- Donya Satarvandi
- Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Suzanne Desirée van der Werff
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Hildenwall
- Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Klara Sondén
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
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7
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Oyelese Y, Javinani A, Gudanowski B, Krispin E, Rebarber A, Akolekar R, Catanzarite V, D'Souza R, Bronsteen R, Odibo A, Scheier MA, Hasegawa J, Jauniaux E, Lees C, Srinivasan D, Daly-Jones E, Duncombe G, Melcer Y, Maymon R, Silver R, Prefumo F, Tachibana D, Henrich W, Cincotta R, Shainker SA, Ranzini AC, Roman AS, Chmait R, Hernandez-Andrade EA, Rolnik DL, Sepulveda W, Shamshirsaz AA. Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus. Am J Obstet Gynecol 2024:S0002-9378(24)00442-3. [PMID: 38494071 DOI: 10.1016/j.ajog.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/01/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies. OBJECTIVE This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique. STUDY DESIGN A 4-round focus group discussion and a 3-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a focus group discussion panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A 3-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa, which the experts were asked to rate on a 5-point Likert scale (from "strongly disagree"=1 to "strongly agree"=5). Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of ≤3 were deemed to have had no consensus and were excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and nonconsensus statements were then aggregated. RESULTS A total of 68 international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on 5 continents and have contributed to >80% of published cohort studies on vasa previa, as well as national and international society guidelines. Completion rates were 84%, 93%, and 91% for the first, second, and third rounds, respectively, and 71% completed all 3 rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including the following: (1) although there is no agreement on the distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2-cm distance; (2) all pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; (3) when a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at approximately 32 weeks to rule out vasa previa; (4) outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; (5) asymptomatic patients with vasa previa should be delivered by scheduled cesarean delivery between 35 and 37 weeks of gestation; and (6) there was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa. CONCLUSION Through focus group discussion and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical guidelines.
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Affiliation(s)
- Yinka Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA.
| | - Ali Javinani
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA
| | - Brittany Gudanowski
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Eyal Krispin
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Andrei Rebarber
- Division of Maternal Fetal Medicine, Mount Sinai West, New York, NY; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY; Carnegie Imaging for Women, PLLC, New York, NY
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, United Kingdom
| | - Val Catanzarite
- Maternal-Fetal Medicine, Rady Children's Specialists of San Diego, San Diego, CA
| | - Rohan D'Souza
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Richard Bronsteen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - Anthony Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO
| | | | - Junichi Hasegawa
- Department of Perinatal Development Pathophysiology, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Christoph Lees
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Deepa Srinivasan
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elizabeth Daly-Jones
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gregory Duncombe
- Department of Obstetrics and Gynaecology, Logan Hospital, Metro South Health, Meadowbrook, Australia
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, Shamir Medical Center, Tzrifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Shamir Medical Center, Tzrifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Silver
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Federico Prefumo
- Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daisuke Tachibana
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Wolfgang Henrich
- Department of Obstetrics, Campus Virchow-Klinikum, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany; Department of Obstetrics, Charité - University Medical Center, Berlin, Germany
| | - Robert Cincotta
- Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Australia
| | - Scott A Shainker
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA
| | - Angela C Ranzini
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth System, Case Western Reserve University, Cleveland, OH
| | - Ashley S Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY
| | - Ramen Chmait
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Edgar A Hernandez-Andrade
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Waldo Sepulveda
- Fetal Imaging Unit, FETALMED Maternal-Fetal Diagnostic Center, Santiago, Chile
| | - Alireza A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA.
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8
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Petersen Williams P, Prinsloo M, Peden MM, Neethling I, Mhlongo S, Maqungo S, Parry C, Matzopoulos R. Identifying and Validating Alcohol Diagnostics for Injury-Related Trauma in South Africa: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e52949. [PMID: 38466974 DOI: 10.2196/52949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma. OBJECTIVE This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy. METHODS The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools. RESULTS Pilot data are being collected, and the protocol will be modified based on the results. CONCLUSIONS Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries-policy makers and senior health clinicians-to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52949.
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Affiliation(s)
- Petal Petersen Williams
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Lifecourse Development, Faculty of Education, Health & Human Sciences, University of Greenwich, London, United Kingdom
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Margaret M Peden
- George Institute for Global Health UK, Imperial College London, London, United Kingdom
- WHO Collaborating Centre on Injury Prevention and Trauma Care, London, United Kingdom
| | - Ian Neethling
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Lifecourse Development, Faculty of Education, Health & Human Sciences, University of Greenwich, London, United Kingdom
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Sithombo Maqungo
- Orthopaedic Trauma Service, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Charles Parry
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of Cape Town, Cape Town, South Africa
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9
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Shi J, Ying G, Zheng R, Zhang Z. Clinical significance and management of low-level HIV viremia in the era of integrase strand transfer inhibitors. HIV Med 2024; 25:361-369. [PMID: 37990782 DOI: 10.1111/hiv.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND People living with HIV (PLWH) and receiving antiretroviral therapy (ART) have a goal of achieving and maintaining viral suppression; however, the existence of PLWH that show events of low-level viremia (LLV) between 50 and 1000 copies/mL and with different virological consequences have been observed. Moreover, some reports indicate that LLV status can lead to residual immune activation and inflammation, leading to a higher occurrence of non-AIDS-defining events (nADEs) and other adverse clinical outcomes. Until now, however, published data have shown controversial results that hinder understanding of this phenomenon's actual cause(s) and origin(s). Integrase strand transfer inhibitors (INSTIs)-based therapies could lead to lower LLV over time and, therefore, more effective virological control. OBJECTIVES This review aims to assess recent findings to provide a view of the clinical significance and management of low-level HIV viremia in the era of INSTIs.
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Affiliation(s)
- Jinchuan Shi
- Affiliated Hangzhou Xixi Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Gaoxiang Ying
- Affiliated Hangzhou Xixi Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Rongrong Zheng
- Affiliated Hangzhou Xixi Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Zhongdong Zhang
- Affiliated Hangzhou Xixi Hospital Zhejiang University School of Medicine, Hangzhou, PR China
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10
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Yan N, Guo S, Zhang Z, Shen S, Li X. Efficacy of immune checkpoint inhibitors in advanced large cell neuroendocrine carcinoma of the lung: A single‑institution experience. Oncol Lett 2024; 27:135. [PMID: 38357477 PMCID: PMC10865179 DOI: 10.3892/ol.2024.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Large cell neuroendocrine carcinoma (LCNEC) is a rare and highly invasive lung cancer subtype with an overall poor prognosis. Due to its low incidence rate and unusual pathological features, the clinical management of LCNEC remains controversial. The present study aimed to assess the effect of immune checkpoint inhibitors (ICIs) on treatment response and survival outcomes in patients with advanced LCNEC. The clinical data from 148 patients with LCNEC treated with ICIs at The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) between January 2019 and September 2021 were retrospectively analyzed. Kaplan-Meier and multivariable Cox regression analyses were used to evaluate associations between clinicopathological variables and patient outcomes. Patients treated with ICIs demonstrated extended median overall survival (mOS) times [23.5 months; 95% confidence interval (CI), 18.524-28.476] compared with patients who did not receive ICIs (11.2 months; 95% CI, 4.530-18.930) (P<0.001). Univariate analysis revealed that histological subtype (P=0.043), lymph node metastases (P=0.032) and number of metastatic organs (P=0.009) were associated with a poor prognosis. The heterogeneity of pathological components was associated with prognosis, and the mOS time was shorter for mixed LCNEC than that for pure LCNEC (P=0.043). The median progression-free survival (mPFS) (9.78 vs. 9.37 months; P=0.82) and mOS (20.70 vs. 25.79 months; P=0.181) times showed no significant association with regard to different regimens of immuno-based combination therapy (chemotherapy combined with ICIs vs. anti-angiogenic agents combined with ICIs). Poor Eastern Cooperative Oncology Group performance status score (P=0.04), multiple organ metastases (P=0.02) and high cancer antigen 125 levels (P=0.01) were independent risk factors of a poor prognosis. The present findings offer valuable insights into potential prognostic markers and highlight the favorable impact of ICIs on OS in advanced LCNEC. Prospective clinical studies are required to validate the therapeutic value of ICIs in LCNEC.
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Affiliation(s)
- Ningning Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Sanxing Guo
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Ziheng Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Shujing Shen
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
| | - Xingya Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China
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11
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Romero R, Sabo Romero V, Kalache KD, Stone J. Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture. Am J Obstet Gynecol 2024; 230:S653-S661. [PMID: 38462251 DOI: 10.1016/j.ajog.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.
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Affiliation(s)
- Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| | | | - Karim D Kalache
- Department of Clinical Obstetrics and Gynecology, Weill Cornell Medical College-Qatar Division, Doha, Qatar; Division of Maternal-Fetal Medicine, Women's Services, Sidra Medicine, Doha, Qatar
| | - Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
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12
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Saab R, Assali S, Angelides M, Idler J. Surviving Postpartum Group A Streptococcus Sepsis Complicated by Multiorgan System Failure: A Complex Case Presentation. Cureus 2024; 16:e56167. [PMID: 38618427 PMCID: PMC11015903 DOI: 10.7759/cureus.56167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Postpartum group A streptococcal (GAS) sepsis is a rare obstetric complication with severe clinical implications and high morbidity and mortality, presenting diagnostic and management challenges. This report analyzes a complex case of postpartum GAS sepsis, highlighting the importance of understanding the pathophysiology and clinical trajectories of this often fatal pathogen. A comprehensive analysis was conducted on a patient with postpartum GAS sepsis. Literature review and case comparisons informed the study's context. Medical history, clinical presentation, diagnostic procedures, interventions, and outcomes were reviewed and documented. The patient presented on postpartum day 5 with abdominal pain and vaginal bleeding. Her condition rapidly deteriorated, requiring aggressive interventions and systemic support. Blood cultures confirmed GAS bacteremia. She developed toxic shock syndrome, cardiomyopathy with acute cardiac failure, and seizures secondary to subdural empyema. Multidisciplinary care facilitated eventual clinical recovery. Obstacles in achieving treatment balance were evident, underscoring the systemic nature of GAS infection and the significance of interdisciplinary collaboration. This case underscores the complex pathophysiology of postpartum GAS sepsis and the importance of prompt treatment initiation, aggressive intervention, and a multidisciplinary approach to management. The study contributes to the understanding of disease progression and clinical management in severe peripartum infections, reaffirming the need for further research to improve outcomes.
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Affiliation(s)
- Rim Saab
- Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, USA
| | - Sarah Assali
- General Surgery, Allegheny Health Network, Pittsburgh, USA
| | - Mary Angelides
- Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh, USA
| | - Jay Idler
- Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh, USA
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13
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Chen H, Jia M, Yang S, Zou J, Xiao X. Umbilical cord cysts: Classification, diagnosis, prognosis, and pregnancy recommendations. Int J Gynaecol Obstet 2024; 164:823-829. [PMID: 37489030 DOI: 10.1002/ijgo.15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
Umbilical cord cysts (UCCs)-cysts located in the umbilical cord that are derived from an abnormal embryonic development process-are typically an incidental discovery during prenatal ultrasound. It can be described as either a pseudocyst or a true UCC, which results from focal edema or degeneration of Wharton jelly or the remnants of embryonic development, respectively. Due to the relative rarity of the UCC, the clinical guidance of UCCs is not yet available. Herein, the aim of this paper is to discuss the classification, diagnosis, prognosis, and clinical management of UCCs through a literature review, in order to improve the understanding of UCCs among clinical obstetricians and pediatricians.
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Affiliation(s)
- Huiling Chen
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Mingzhu Jia
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Shuqi Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Juan Zou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xue Xiao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
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14
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Pham S, Churruca K, Ellis LA, Braithwaite J. Help-Seeking, Support, and Engagement in Gestational Diabetes Mellitus Online Communities on Facebook: Content Analysis. JMIR Form Res 2024; 8:e49494. [PMID: 38407949 DOI: 10.2196/49494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) has drastically risen in recent years. For some, self-management includes the use of GDM online communities on Facebook. Such communities can fill gaps in information and support that participants are not able to access elsewhere to address unmet needs. Given the popularity of sharing information about pregnancy on Facebook and the documented benefits of diabetes online communities, the same may be true of GDM online communities. OBJECTIVE This study aimed to categorize and quantify what is being discussed in GDM Facebook groups, including informational and emotional help-seeking behavior, and how this support and engagement may be demonstrated by peers through comments and reactions. METHODS We sourced the data from the 2 largest Facebook groups focused on GDM in Australia. A summative content analysis was conducted on original posts across the 2 groups and coded for topics as well as help-seeking types. The coding scheme was based on the previous work of Liang and Scammon. Visible indicators of engagement, including the number of comments and "reactions," were tabled and manually evaluated. RESULTS There were 388 original posts, and the analysis produced 6 topics: GDM self-management (199/388, 51.3%), GDM clinical management (120/388, 30.9%), preparing for birth (40/388, 10.3%), mental distress (35/388, 9%), birth announcement (29/388, 7.5%), and GDM journey reflections (21/388, 5.4%). Secondary coding of help-seeking type revealed more than half of the posts were informational help-seeking (224/388, 57.7%), while a small proportion were both informational and emotional help-seeking (44/388, 11.3%), and some (12/388, 3.1%) were emotional help-seeking only. Self-disclosure was identified as a fourth category, comprising almost a quarter of all posts (90/388, 23.2%). A total of 6022 comments were posted in response to the original posts, and there were 4452 reactions across all posts. Emotional help-seeking attracted the most comments per thread (mean 21.5, SD 19.8), followed by informational and emotional help-seeking (mean 20.2, SD 14.7), informational help-seeking (mean 15.6, SD 14.6), and self-disclosure (mean 14.3, SD 21.8). Across all help-seeking categories, few reactions occurred compared to comments; in contrast, self-disclosure attracted a large number of reactions (mean 9.4, SD 45.3). CONCLUSIONS This is one of the first studies to examine peer support in a GDM online community on Facebook. Our findings suggest that active participants' needs around information and support in relation to GDM are being somewhat met by peer-led online communities. Given the practical limitations of formal health care, including the provision of ongoing social support, it is important to recognize how GDM online communities can complement formal health care and help address unmet needs.
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Affiliation(s)
- Sheila Pham
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Sydney, Australia
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15
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Tang L, Zhang T, Hur GM, Li Y. Editorial: Pharmaceutical strategies to prevent, treat, and recover: advances and challenges in ischemic stroke and hemorrhagic stroke. Front Neurosci 2024; 18:1383941. [PMID: 38449741 PMCID: PMC10915073 DOI: 10.3389/fnins.2024.1383941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Linqiao Tang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Tiejun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gang-Min Hur
- Department of Pharmacology, Research Institute for Medical Science, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
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Damgaard RK, Jenkins D, Stoler MH, de Koning M, van de Sandt M, Lycke KD, Kahlert J, Gravitt PE, Quint WGV, Steiniche T, Petersen LK, Hammer A. Human papillomavirus genotypes and risk of persistence and progression in women undergoing active surveillance for cervical intraepithelial neoplasia grade 2. Am J Obstet Gynecol 2024:S0002-9378(24)00072-3. [PMID: 38336125 DOI: 10.1016/j.ajog.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In recent years, active surveillance has been introduced as an alternative to excisional treatment in younger women with cervical intraepithelial neoplasia grade 2 because regression rates are high and excisional treatment is associated with increased risk of preterm birth. However, early identification of women at increased risk of persistence/progression is important to ensure timely treatment. Evidence is limited on biomarkers that may be used to identify women at increased risk of persistence/progression. OBJECTIVE This study aimed to describe human papillomavirus HPV type-specific persistence/progression in women undergoing active surveillance for cervical intraepithelial neoplasia grade 2. STUDY DESIGN We conducted a historical cohort study of women aged 23 to 40 years diagnosed with cervical intraepithelial neoplasia grade 2 at Aarhus University Hospital from 2000 to 2010. Women were identified through the Danish Pathology Data Bank (DPDB) and were considered as undergoing active surveillance if they had a first record of a cervical biopsy within 2 years after index diagnosis and no loop electrosurgical excision procedure before this. Human papillomavirus genotyping was performed on archived tissue samples using the HPV SPF10-DEIA-LiPA25 system (DNA ELISA [enzyme-linked immunosorbent assay] HPV SPF10 kit and RHA HPV SPF10-LiPA25 kit). Persistence/progression was defined as having a record of cervical intraepithelial neoplasia grade ≥2 in the DPDB determined on the last and worst diagnosis on a biopsy or loop electrosurgical excision procedure specimen during follow-up. We estimated the relative risk (95% confidence interval) of persistence/progression using a modified Poisson model. RESULTS A total of 455 women were included. Two-thirds were aged ≤30 years (73.8%) at index diagnosis, and nearly half had a high-grade index cytology (48.8%). Overall, 52.2% of all women had cervical intraepithelial neoplasia grade ≥2 during follow-up; 70.5% were human papillomavirus-16-positive and 29.5% were positive for other human papillomavirus types. Human papillomavirus-16 was associated with a significantly higher risk of persistence/progression (relative risk, 1.64; 95% confidence interval, 1.37-1.95) compared with non-human papillomavirus-16. The risk of persistence/progression was highest in human papillomavirus-16-positive women with a high-grade index cytology compared with human papillomavirus-16-positive women with a low-grade cytology (relative risk, 1.29; 95% confidence interval, 1.03-1.61), whereas no differences were observed across age groups. CONCLUSION The highest risk of persistence/progression was observed among human papillomavirus-16-positive women, particularly those with associated high-grade cytology. These findings suggest that early excisional treatment should be considered in this group of women.
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Affiliation(s)
- Rikke Kamp Damgaard
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark; NIDO, Center for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - David Jenkins
- Viroclinics-DDL, Cerba Research, Rijswijk, the Netherlands
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, VA
| | | | | | - Kathrine Dyhr Lycke
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark; NIDO, Center for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Wim G V Quint
- Viroclinics-DDL, Cerba Research, Rijswijk, the Netherlands
| | - Torben Steiniche
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark; NIDO, Center for Research and Education, Gødstrup Hospital, Herning, Denmark.
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17
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Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
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Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
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18
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Raggi P. Coronary Artery Calcium Score: A 2 for 1 Deal. JACC Cardiovasc Imaging 2024:S1936-878X(24)00028-7. [PMID: 38363262 DOI: 10.1016/j.jcmg.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Paolo Raggi
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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19
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Yan JW, Slim A, Van Aarsen K, Choi YH, Byrne C, Poonai N, Collins H, Clemens KK. Balanced crystalloids (RInger's lactate) versus normal Saline in adults with diabetic Ketoacidosis in the Emergency Department (BRISK-ED): a pilot randomised controlled trial. Emerg Med J 2024; 41:103-111. [PMID: 38050056 PMCID: PMC10850620 DOI: 10.1136/emermed-2023-213290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Current diabetic ketoacidosis (DKA) treatment guidelines recommend using normal saline (NS); however, NS may delay DKA resolution by causing more hyperchloremic metabolic acidosis compared with balanced crystalloids. This study's objective was to determine the feasibility of a future multicentred randomised controlled trial (RCT) comparing intravenous Ringer's lactate (RL) with NS in managing ED patients with DKA. METHODS We conducted a parallel-arm, triple-blind, pilot RCT of adults (≥18 years) with DKA at a Canadian academic tertiary care ED. The primary feasibility outcome was recruitment rate (target ≥41.3% of eligible participants over the 1-year study period); the primary efficacy outcome was time elapsed from ED presentation to DKA resolution. The superiority margin for a clinically significant difference was chosen to be a 40% time reduction to DKA resolution. We also assessed the need to break allocation concealment and loss to follow-up. Patients with clinical suspicion for DKA were screened for inclusion and enrolled patients were randomised 1:1 to receive RL or NS. Patients, clinicians and outcome assessors were blinded to allocation. RESULTS We enrolled 52 (25 RL, 27 NS) of 60 eligible patients (86.7%), exceeding our target recruitment rate. There were more patients in the NS group with type 1 diabetes, and more patients in the RL group had an admission co-diagnosis in addition to DKA. For the 44 participants with confirmed laboratory evidence of resolution, median (IQR) time to DKA resolution for RL versus NS was 15.7 (10.4-18.8) and 12.7 (7.9-19.2) hours, respectively. There were no cases where blinding was broken, and there was no loss to follow-up. CONCLUSIONS This pilot trial demonstrated our protocol's feasibility by exceeding our target recruitment rate. Our results may be used to inform future multicentre trials to compare the safety and efficacy of RL and NS in managing DKA in the ED. TRIAL REGISTRATION NUMBER NCT04926740.
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Affiliation(s)
- Justin W Yan
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Ahmed Slim
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Kristine Van Aarsen
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Byrne
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Naveen Poonai
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Departments of Paediatrics, Internal Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Kristin K Clemens
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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20
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Lim MS, Mohamed M. Retrospective study of clinical settings, indications and consequences of measurement of direct oral anticoagulant plasma levels in Northern Tasmania, Australia. Intern Med J 2024. [PMID: 38213182 DOI: 10.1111/imj.16329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Routine monitoring of direct oral anticoagulant (DOAC) levels is not recommended but may be useful in certain clinical situations. There is a knowledge gap regarding the clinical use of DOAC levels in Australian hospitals. AIMS To evaluate the clinical settings, indications and changes to anticoagulant management associated with DOAC levels in a tertiary hospital in Northern Tasmania, Australia. METHODS Patients with one or more DOAC levels (dabigatran, rivaroxaban or apixaban) requested between January 2017 and December 2022 were identified. Retrospective chart review was performed to evaluate the clinical settings, indications, adequacy of request information and changes to clinical management associated with the measurement of DOAC levels. RESULTS One hundred and twenty-nine DOAC measurements (54 rivaroxaban, 66 apixaban and nine dabigatran) were performed in 98 patients between January 2017 and December 2022. Annual requests for DOAC levels increased significantly between 2017 and 2019 and remained stable between 2020 and 2021 but declined in 2022. Overall, the most common indication for a DOAC level was renal impairment, followed by bleeding and recurrent thrombosis. Approximately 25% of requests were for acute bleeding with a reversal/haemostatic agent given in 45% of patients, while 10% were prior to urgent surgery. Measurement of DOAC levels was associated with a change in management in 50% of cases. 10% of requests did not specify anticoagulant history. CONCLUSION Trends in requests for DOAC levels have changed over time. Clinician education regarding the importance of providing specific anticoagulant history is essential. Future prospective studies investigating the clinical utility of DOAC levels in different clinical settings are needed.
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Affiliation(s)
- Ming S Lim
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Muhajir Mohamed
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
- Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
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21
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Brix GS, Rasmussen LD, Rohde PD, Schmidt SE, Nyegaard M, Douglas PS, Newby DE, Williams MC, Foldyna B, Knuuti J, Bøttcher M, Winther S. Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease. JACC Cardiovasc Imaging 2024:S1936-878X(23)00527-2. [PMID: 38180413 DOI: 10.1016/j.jcmg.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Coronary artery calcium scoring (CACS) improves management of chest pain patients. However, it is unknown whether the benefit of CACS is dependent on the clinical likelihood (CL). OBJECTIVES This study aims to investigate for which patients CACS has the greatest benefit when added to a CL model. METHODS Based on data from a clinical database, the CL of obstructive coronary artery disease (CAD) was calculated for 39,837 patients referred for cardiac imaging due to symptoms suggestive of obstructive CAD. Patients were categorized according to the risk factor-weighted (RF-CL) model (very low, ≤5%; low, >5 to ≤15%; moderate >15 to ≤50%; high, >50%). CL was then recalculated incorporating the CACS result (CACS-CL). Reclassification rates and the number needed to test with CACS to reclassify patients were calculated and validated in 3 independent cohorts (n = 9,635). RESULTS In total, 15,358 (39%) patients were down- or upclassified after including CACS. Reclassification rates were 8%, 75%, 53%, and 30% in the very low, low, moderate, and high RF-CL categories, respectively. Reclassification to very low CACS-CL occurred in 48% of reclassified patients. The number needed to test to reclassify 1 patient from low RF-CL to very low CACS-CL was 2.1 with consistency across age, sex, and cohorts. CACS-CL correlated better to obstructive CAD prevalence than RF-CL. CONCLUSIONS Added to an RF-CL model for obstructive CAD, CACS identifies more patients unlikely to benefit from further testing. The number needed to test with CACS to reclassify patients depends on the pretest RF-CL and is lowest in patients with low (>5% to ≤15%) likelihood of CAD.
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Affiliation(s)
- Gitte S Brix
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Laust D Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Palle D Rohde
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Samuel E Schmidt
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Borek Foldyna
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu, Turku, Finland
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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22
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van Dijk SPJ, Coerts HI, Lončar I, van Kinschot CMJ, von Meyenfeldt EM, Edward Visser W, van Noord C, Zengerink HF, Ten Broek MRJ, Verhoef C, Peeters RP, van Ginhoven TM. Regional Collaboration and Trends in Clinical Management of Thyroid Cancer. Otolaryngol Head Neck Surg 2024; 170:159-168. [PMID: 37595096 DOI: 10.1002/ohn.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE This study examines the trends in the management of thyroid cancer and clinical outcomes in the Southwestern region of The Netherlands from 2010 to 2021, where a regional collaborative network has been implemented in January 2016. STUDY DESIGN Retrospective cohort study. SETTING This study encompasses all patients diagnosed with thyroid cancer of any subtype between January 2010 and June 2021 in 10 collaborating hospitals in the Southwestern region of The Netherlands. METHODS The primary outcome of this study was the occurrence of postoperative complications. Secondary outcomes were trends in surgical management, centralization, and waiting times of patients with thyroid cancer. RESULTS This study included 1186 patients with thyroid cancer. Median follow-up was 58 [interquartile range: 24-95] months. Surgery was performed in 1027 (86.6%) patients. No differences in postoperative complications, such as long-term hypoparathyroidism, permanent recurrent nerve paresis, or reoperation due to bleeding were seen over time. The percentage of patients with low-risk papillary thyroid carcinoma referred to the academic hospital decreased from 85% (n = 120/142) in 2010 to 2013 to 70% (n = 120/171) in 2014 to 2017 and 62% (n = 100/162) in 2018 to 2021 (P < .01). The percentage of patients undergoing a hemithyroidectomy alone was 9% (n = 28/323) in 2010 to 2013 and increased to 20% (n = 63/317; P < .01) in 2018 to 2021. CONCLUSION The establishment of a regional oncological network coincided with a de-escalation of thyroid cancer treatment and centralization of complex patients and interventions. However, no differences in postoperative complications over time were observed. Determining the impact of regional oncological networks on quality of care is challenging in the absence of uniform quality indicators.
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Affiliation(s)
- Sam P J van Dijk
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hannelore I Coerts
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ivona Lončar
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Caroline M J van Kinschot
- Department of Internal Medicine, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - Erik M von Meyenfeldt
- Department of Surgical Oncology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - Hans F Zengerink
- Department of Surgery, Franciscus Gasthuis & Vlietland Rotterdam, Rotterdam, The Netherlands
| | - Marc R J Ten Broek
- Department of Nuclear Medicine, Reinier de Graaf Hospital Delft, Delft, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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23
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Giltmier AJ, Higano NS, Woods JC, Kingma PS. Evaluation of regional lung mass and growth in neonates with bronchopulmonary dysplasia using ultrashort echo time magnetic resonance imaging. Pediatr Pulmonol 2024; 59:55-62. [PMID: 37787390 PMCID: PMC10841165 DOI: 10.1002/ppul.26705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
RATIONALE Bronchopulmonary dysplasia (BPD) is the most common long term pulmonary morbidity in premature infants and is characterized by impaired lung growth and development. We hypothesized that lung mass growth is a critical factor in determining outcomes in infants with BPD. OBJECTIVES To measure regional lung density and mass in infants with BPD and compare to clinical variables. METHODS We conducted a retrospective cohort study of neonates (n = 5 controls, n = 46 with BPD). Lung mass and lung density were calculated using ultrashort echo time (UTE) magnetic resonance imaging (MRI). MEASUREMENTS AND MAIN RESULTS Lung mass increased with increasing corrected gestational age at the time of MRI in all patients. Total, right, and left lung mass in infants with BPD trended higher than control infants (65.7 vs. 49.9 g, 36.2 vs. 26.8 g, 29.5 vs. 23.1 g, respectively). Babies with BPD who survived to discharge had higher relative lung mass than control infants and infants with BPD that did not survive to discharge (21.6 vs. 15.7 g/kg, p = .01). There was a significant association between the rate of lung mass growth and linear growth at the time of MRI (p = .034). CONCLUSIONS Infants with BPD are capable of building lung mass over time. While this lung mass growth in infants with BPD may not represent fully functional lung tissue, higher lung mass growth is associated with increased linear growth.
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Affiliation(s)
- Andrew J Giltmier
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, The Perinatal Institute, Cincinnati, Ohio, USA
| | - Nara S Higano
- Cincinnati Bronchopulmonary Dysplasia Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jason C Woods
- Cincinnati Bronchopulmonary Dysplasia Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Paul S Kingma
- Cincinnati Children's Hospital Medical Center, The Perinatal Institute, Cincinnati, Ohio, USA
- Cincinnati Bronchopulmonary Dysplasia Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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24
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Noor MA, Al-Ashqar M, Abul A, Grayston J, Nisar S, Loughenbury PR, Radcliffe G. The Clinical Utility of Repeating Magnetic Resonance Imaging (MRI) Scans Within 12 Months in the Management of Lumbosacral Degenerative Disc Disease. Cureus 2024; 16:e53100. [PMID: 38414690 PMCID: PMC10897750 DOI: 10.7759/cureus.53100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) is the gold standard investigation for lumbosacral degenerative disc disease. However, there is controversy regarding the clinical value of repeating an MRI scan within 12 months when a patient presents with recurring or changing symptoms. This study measures rates of radiological change in a real-world cohort to guide clinicians when deciding to repeat a scan. METHODS All patients over a 10-year window in one general hospital who underwent two lumbosacral MRI scans for degenerative disc disease within 12 months of each other were included in the study. All MRI reports were manually reviewed. The level of main vertebral pathology was recorded, along with the location of a disc prolapse. Time intervals between the two scans were calculated, and these were collated into 30-day intervals for analysis. The repeat scans were categorized into three groups: no change, radiological improvement, and radiological deterioration. Patients who had clinically significant deterioration in the form of cauda equina compression on MRI scans were recorded. FINDINGS Four hundred and eighty-one patients were included for analysis. Three hundred and ninety (81%) showed no change in MRI findings, 18 (3.7%) had improvements in their repeat scans, and 73 (15.3%) demonstrated deterioration in their repeat scans. Of the 73 patients with radiological deterioration, three patients (0.62% of the total) required urgent surgical intervention for cauda equina syndrome (CES). CONCLUSIONS Though there is no alternative to detailed clinical assessment in determining whether a repeat MRI scan is indicated, the findings demonstrate that repeating MRI within 12 months for patients with lumbosacral degenerative disc disease has a low chance of altering the management plan. Over the 10-year period, only three patients required an urgent change to their clinical management. We believe this data can help guide clinical decision-making when considering a repeat scan.
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Affiliation(s)
- Muhammad Ashhad Noor
- Department of Medicine and Surgery, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
| | - Mohammad Al-Ashqar
- Department of Trauma and Orthopaedics, Yorkshire and Humber Deanery, Leeds, GBR
| | - Ahmad Abul
- College of Medicine, University of Leeds, Leeds, GBR
| | - James Grayston
- Department of Trauma and Orthopaedics, University Hospital Crosshouse, Kilmarnock, GBR
| | - Sohail Nisar
- Department of Trauma and Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | - Peter R Loughenbury
- Department of Spinal Surgery, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, GBR
| | - Graham Radcliffe
- Department of Trauma and Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
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25
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Liu J, Li Y, Zhang X, Bu P, Du X, Fang L, Feng Y, Guo Y, Han F, Jiang Y, Li Y, Lin J, Liu M, Liu W, Long M, Mu J, Sun N, Wu H, Xie J, Xie J, Xie L, Yu J, Yuan H, Zha Y, Zhang Y, Zhu S, Wang J. Management of nocturnal hypertension: An expert consensus document from Chinese Hypertension League. J Clin Hypertens (Greenwich) 2024; 26:71-83. [PMID: 38126623 PMCID: PMC10795100 DOI: 10.1111/jch.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Nocturnal hypertension is highly prevalent among Chinese and Asian populations, which is mainly attributed to high salt intake and high salt sensitivity. Nocturnal hypertension increases the risk of cardiovascular and all-cause mortality, independent of daytime blood pressure (BP). However, it can usually be detected by 24-h ambulatory BP monitoring, rather than routine office or home BP measurement, thus is often underdiagnosed in clinical practice. Currently, no specific guidance is available for the management of nocturnal hypertension in China or worldwide. Experts from the Chinese Hypertension League summarized the epidemiologic and pathophysiologic characteristics and clinical phenotype of nocturnal hypertension and provided consensus recommendations on optimal management of nocturnal hypertension, with the goal of maximally reducing the cardiovascular disease risks. In this consensus document, 24-h ABPM is recommended for screening and diagnosis of nocturnal hypertension, especially in the elderly, patients with diabetes, chronic kidney diseases, obstructive sleep apnea and other conditions prone to high nocturnal BP. Lifestyle modifications including salt intake restriction, exercise, weight loss, sleep improvement, and mental stress relief are recommended. Long-acting antihypertensive medications are preferred for nocturnal and 24-h BP control. Some newly developed agents, renal denervation, and other device-based therapy on nocturnal BP reduction are evaluated.
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Affiliation(s)
- Jing Liu
- Peking University People's HospitalBeijingChina
| | - Yan Li
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xinjun Zhang
- West China Hospital of Sichuan UniversityChengduSichuanChina
| | - Peili Bu
- Qilu Hospital of Shandong UniversityJinanShandongChina
| | - Xueping Du
- Yuetan Community Health Service CenterFuxing HospitalCapital Medical UniversityBeijingChina
| | - Lizheng Fang
- Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Yingqing Feng
- Guangdong Provincial People's HospitalGuangzhouGuangdongChina
| | - Yifang Guo
- Hebei General HospitalShijiazhuangHebeiChina
| | - Fei Han
- The First Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Yinong Jiang
- The First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yuming Li
- T International Cardiovascular HospitalTianjinChina
| | - Jinxiu Lin
- The First Affiliated Hospital of Fujian Medical UniversityFuzhouFujianChina
| | - Min Liu
- Henan Province People's HospitalZhengzhouHenanChina
| | - Wei Liu
- Beijing HospitalBeijingChina
| | - Mingzhi Long
- The Second Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Jianjun Mu
- The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | | | - Hao Wu
- School of General Practice and Continuing Education, Capital Medical UniversityBeijingChina
| | - Jianhong Xie
- Zhejiang Provincial People's HospitalHangzhouZhejiangChina
| | - Jingyuan Xie
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Liangdi Xie
- The First Affiliated Hospital of Fujian Medical UniversityFuzhouFujianChina
| | - Jing Yu
- Lanzhou University Second HospitalLanzhouGansuChina
| | - Hong Yuan
- The Third Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Yan Zha
- Guizhou Provincial People's HospitalGuiyangGuizhouChina
| | - Yuqing Zhang
- Fuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Shanzhu Zhu
- Zhongshan HospitalFudan UniversityShanghaiChina
| | - Jiguang Wang
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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26
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Markovic N, Stojanovic B, Jovanovic I, Milosevic B, Spasic M, Radosavljevic I, Zdravkovic N, Radovanovic D, Stojanovic BS, Spasojevic M, Jovanovic M, Todorovic Z, Pavlovic M, Sretenovic S, Milosavljevic MZ, Dimitrijevic Stojanovic M. Metastatic Breast Cancer Presenting as Acute Appendicitis: A Rare Case Study and Review of Current Knowledge. Diagnostics (Basel) 2023; 13:3657. [PMID: 38132241 PMCID: PMC10743293 DOI: 10.3390/diagnostics13243657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
This manuscript discusses a rare case of acute appendicitis caused by metastasis from invasive breast carcinoma of no special type in a 70-year-old female previously diagnosed with breast cancer. It delves into the diagnostic challenges and management complexities of such unusual clinical presentations. The paper includes an analysis of 19 documented cases, enriching the understanding of metastatic patterns and treatment strategies in breast cancer. It underlines the importance of considering a history of malignancy when diagnosing acute abdominal conditions and emphasizes a comprehensive approach in interpreting diagnostic imaging in patients with past oncological issues to effectively manage metastatic breast cancer exhibiting atypical manifestations.
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Affiliation(s)
- Nenad Markovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Ivan Radosavljevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Natasa Zdravkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Dragce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Bojana S. Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Marija Spasojevic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (M.Z.M.); (M.D.S.)
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Zeljko Todorovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Mladen Pavlovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.M.); (B.S.); (B.M.); (M.S.); (D.R.); (M.P.)
| | - Snezana Sretenovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (N.Z.); (M.J.); (S.S.)
| | - Milos Z. Milosavljevic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (M.Z.M.); (M.D.S.)
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (M.Z.M.); (M.D.S.)
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Carmody LC, Gargano MA, Toro S, Vasilevsky NA, Adam MP, Blau H, Chan LE, Gomez-Andres D, Horvath R, Kraus ML, Ladewig MS, Lewis-Smith D, Lochmüller H, Matentzoglu NA, Munoz-Torres MC, Schuetz C, Seitz B, Similuk MN, Sparks TN, Strauss T, Swietlik EM, Thompson R, Zhang XA, Mungall CJ, Haendel MA, Robinson PN. The Medical Action Ontology: A tool for annotating and analyzing treatments and clinical management of human disease. Med 2023; 4:913-927.e3. [PMID: 37963467 PMCID: PMC10842845 DOI: 10.1016/j.medj.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Navigating the clinical literature to determine the optimal clinical management for rare diseases presents significant challenges. We introduce the Medical Action Ontology (MAxO), an ontology specifically designed to organize medical procedures, therapies, and interventions. METHODS MAxO incorporates logical structures that link MAxO terms to numerous other ontologies within the OBO Foundry. Term development involves a blend of manual and semi-automated processes. Additionally, we have generated annotations detailing diagnostic modalities for specific phenotypic abnormalities defined by the Human Phenotype Ontology (HPO). We introduce a web application, POET, that facilitates MAxO annotations for specific medical actions for diseases using the Mondo Disease Ontology. FINDINGS MAxO encompasses 1,757 terms spanning a wide range of biomedical domains, from human anatomy and investigations to the chemical and protein entities involved in biological processes. These terms annotate phenotypic features associated with specific disease (using HPO and Mondo). Presently, there are over 16,000 MAxO diagnostic annotations that target HPO terms. Through POET, we have created 413 MAxO annotations specifying treatments for 189 rare diseases. CONCLUSIONS MAxO offers a computational representation of treatments and other actions taken for the clinical management of patients. Its development is closely coupled to Mondo and HPO, broadening the scope of our computational modeling of diseases and phenotypic features. We invite the community to contribute disease annotations using POET (https://poet.jax.org/). MAxO is available under the open-source CC-BY 4.0 license (https://github.com/monarch-initiative/MAxO). FUNDING NHGRI 1U24HG011449-01A1 and NHGRI 5RM1HG010860-04.
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Affiliation(s)
- Leigh C Carmody
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | | | - Sabrina Toro
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Margaret P Adam
- University of Washington School of Medicine, Seattle, WA, USA
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | | | - David Gomez-Andres
- Pediatric Neurology, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Robinson Way, Cambridge CB2 0PY, UK
| | - Megan L Kraus
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Markus S Ladewig
- Department of Ophthalmology, Klinikum Saarbrücken, Saarbrücken, Germany
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, Ottowa, Canada; Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada; Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada; Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Centro Nacional de Análisis Genómico, Barcelona, Spain
| | | | | | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Saar, Germany
| | - Morgan N Similuk
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Teresa N Sparks
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Timmy Strauss
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Emilia M Swietlik
- Department of Medicine, University of Cambridge, Heart and Lung Research Institute, Cambridge CB2 0BB, UK
| | - Rachel Thompson
- Children's Hospital of Eastern Ontario Research Institute, Ottowa, Canada
| | | | | | | | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.
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Doszhanova G, Colpani A, Duisenova A, De Vito A, Zholdybay Z, Juszkiewicz K, Brunetti E, Katarbayev A, Kaniyev S, Zhakenova Z, Manciulli T, Mustapayeva A. The high burden of pediatric cystic echinococcosis in Kazakhstan: epidemiological and clinical consequences. Trans R Soc Trop Med Hyg 2023; 117:875-877. [PMID: 37721185 DOI: 10.1093/trstmh/trad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/10/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Cystic echinococcosis (CE) is attributable to Echinococcus granulosus metacestodes. Ultrasound examinations enable a stage-specific approach to CE management. However, this approach is not often applied in endemic areas, which include Kazakhstan. METHODS We collected clinical and ultrasound data on CE pediatric patients seen at a national referral surgical center in Almaty, Kazakhstan, during 2015-2020. RESULTS We included 49 patients, and 79 cysts that were all surgically treated. All but one patient carried active cysts (CE1-CE3 stages). Twenty-six (53.2%) did not receive albendazole postsurgery. Children with CE1 and CE3a cysts underwent surgery, while the use of albendazole and percutaneous drainage were advised upon by experts. CONCLUSIONS A stage-specific approach to CE management in Kazakhstan is urgent, especially in the pediatric population. The rate of active cysts suggests continuing transmission of CE.
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Affiliation(s)
- Gaukhar Doszhanova
- Department of Infectious and Tropical Diseases, Asfendyiarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
| | - Agnese Colpani
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari 07100, Italy
| | - Amangul Duisenova
- Department of Infectious and Tropical Diseases, Asfendyiarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari 07100, Italy
| | - Zhamilya Zholdybay
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
| | - Konrad Juszkiewicz
- Department of Infectious and Tropical Diseases, Asfendyiarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
| | - Enrico Brunetti
- WHO-Collaborating Center for the Clinical Management of Cystic Echinoccocosis, San Matteo Hospital Foundation, Pavia 27100, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia 27100, Italy
| | - Adyl Katarbayev
- Department of Children Infectious Diseases, Asfendiyarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
| | - Shokan Kaniyev
- Syzganov National Institute of Surgery, 62 Zheltoksan Street, Almaty 050004, Kazakhstan
| | - Zhanar Zhakenova
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
| | - Tommaso Manciulli
- WHO-Collaborating Center for the Clinical Management of Cystic Echinoccocosis, San Matteo Hospital Foundation, Pavia 27100, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence 50121, Italy
| | - Aigerim Mustapayeva
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, 94 Tole Bi Street, Almaty 050012, Kazakhstan
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Wada S, Watanabe T, Ishii T, Ichinose Y, Rikitake R, Ogata D, Nakano E, Namikawa K, Yamazaki N, Higashi T. A retrospective study of sentinel lymph node biopsy for skin cancer in Japan: Comparison with breast cancer and evaluation of factors related to its use. Cancer Med 2023; 12:21364-21372. [PMID: 37902245 PMCID: PMC10726788 DOI: 10.1002/cam4.6677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/24/2023] [Accepted: 09/30/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) underuse has been reported for skin cancers; however, actual performance rates have not been compared. The objective of this study was to investigate the SLNB performance rate in skin cancers covered by health insurance in Japan and compare it with that in breast cancer. METHODS This was a retrospective study of the SLNB performance rate in SLNB-eligible patients with breast or skin cancer from 2018 to 2019, utilizing a database linked to the Hospital-Based Cancer Registry and Diagnosis Procedure Combination survey. Demographic and tumor characteristics were analyzed using logistic regression. RESULTS A total of 71,652 patients were included in this study. SLNB was performed in 86.4% (57,904/67,036) of the patients with breast cancer, 44.7% (694/1552) with melanomas, 3.1% (89/2849) with squamous cell carcinomas (SCCs), and 13.5% (29/215) with Merkel cell carcinomas (MCCs). The performance rate of SLNB was significantly lower for skin cancers than for breast cancers (odds ratio [OR], 0.03; p < 0.001). In addition, the performance rates of SLNB were significantly lower for SCCs and MCCs than for melanomas (SCC: OR, 0.04; p < 0.001; MCC: OR, 0.19; p < 0.001). Factors associated with SLNB performance included age, sex, year of incidence, primary tumor site, T stage, and number of hospital beds. CONCLUSIONS SLNB is underutilized for skin cancer. Further investigation is required to explore the reasons for its underutilization so that it may be implemented more universally.
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Affiliation(s)
- Shogo Wada
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
| | - Tomone Watanabe
- Division of Health Services Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
- Department of Public Health and Health Policy, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Taisuke Ishii
- Division of Health Services Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | - Yuichi Ichinose
- Division of Health Services Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | - Ryoko Rikitake
- Division of Health Services Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | - Dai Ogata
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
| | - Eiji Nakano
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
| | - Kenjiro Namikawa
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
| | - Naoya Yamazaki
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
- Department of Public Health and Health Policy, Graduate School of MedicineThe University of TokyoTokyoJapan
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Pradelli L, Massaia M, Todisco E, Gherlinzoni F, Furlan A, La Targia M, Grande E, Tripoli IE, Occhipinti F, Comello F, Iannello F, Bellucci S. Improved efficiency of daratumumab treatment of multiple myeloma adopting the subcutaneous route: A micro-costing analysis in three Italian hematology centers. Cancer Med 2023; 12:21480-21489. [PMID: 37942566 PMCID: PMC10726826 DOI: 10.1002/cam4.6699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Daratumumab is a humanized monoclonal antibody approved for the treatment of adult patients with newly diagnosed or relapsed/refractory multiple myeloma (RRMM). Subcutaneous (SC) formulation proved to be non-inferior in comparison with intravenous (IV) administration route. This study aimed at assessing the economic and time impact associated with the use of SC versus IV daratumumab in patients with RRMM from the perspective of the hematology center. METHODS This was a 5-month multicenter time-and-motion cross-sectional micro-costing study conducted in three Italian hematology centers among adult patients diagnosed with RRMM with ongoing treatment with IV or SC daratumumab. Measurements were performed by an ad hoc App. RESULTS Nineteen (20%) IV and 76 (80%) SC administration procedures were measured. Patients spent a mean of 4.85 ± 0.91 or 1.08 ± 0.56 h in the hematology center to receive IV or SC daratumumab, respectively. Healthcare professionals (HCPs) spent a mean of 49.38 ± 16.13 and 20.37 ± 7.88 min of active working time to manage IV and SC administrations, respectively. The infusion chair was occupied for a mean of 4.85 ± 0.91 and 0.99 ± 0.55 h during IV or SC administration, respectively. On average, considering the costs due to HCP and chair time, materials, and overhead costs, every IV and SC administration costed €80.33 and 34.90, respectively. CONCLUSIONS In conclusion, as compared with IV administration, SC daratumumab was associated with 78%, 59%, 80% savings in terms of patient time, HCP active working time, and infusion chair, respectively, and 56.6% budget savings.
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Affiliation(s)
| | | | | | | | - Anna Furlan
- Divisione di EmatologiaOspedale Cà Foncello di Treviso–ASL 2TrevisoItaly
| | - Maria La Targia
- U.O. Ematologia ASST Valle Olona Busto ArsizioBusto ArsizioItaly
| | | | | | | | - Francesco Comello
- Divisione di EmatologiaOspedale Cà Foncello di Treviso–ASL 2TrevisoItaly
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Hu Z, Ding L, Yao Y. Atrial fibrillation: mechanism and clinical management. Chin Med J (Engl) 2023; 136:2668-2676. [PMID: 37914663 PMCID: PMC10684204 DOI: 10.1097/cm9.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 11/03/2023] Open
Abstract
ABSTRACT Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with a range of symptoms, including palpitations, cognitive impairment, systemic embolism, and increased mortality. It places a significant burden on healthcare systems worldwide. Despite decades of research, the precise mechanisms underlying AF remain elusive. Current understanding suggests that factors like stretch-induced fibrosis, epicardial adipose tissue (EAT), chronic inflammation, autonomic nervous system (ANS) imbalances, and genetic mutations all play significant roles in its development. In recent years, the advent of wearable devices has revolutionized AF diagnosis, enabling timely detection and monitoring. However, balancing early diagnosis with efficient resource utilization presents new challenges for healthcare providers. AF management primarily focuses on stroke prevention and symptom alleviation. Patients at high risk of thromboembolism require anticoagulation therapy, and emerging pipeline drugs, particularly factor XI inhibitors, hold promise for achieving effective anticoagulation with reduced bleeding risks. The scope of indications for catheter ablation in AF has expanded significantly. Pulsed field ablation, as a novel energy source, shows potential for improving success rates while ensuring safety. This review integrates existing knowledge and ongoing research on AF pathophysiology and clinical management, with emphasis on diagnostic devices, next-generation anticoagulants, drugs targeting underlying mechanisms, and interventional therapies. It offers a comprehensive mosaic of AF, providing insights into its complexities.
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Affiliation(s)
| | | | - Yan Yao
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Sinibaldi L, Garone G, Mandarino A, Iarossi G, Chioma L, Dentici ML, Merla G, Agolini E, Micalizzi A, Mancini C, Niceta M, Macchiaiolo M, Diodato D, Onesimo R, Blandino R, Delogu AB, De Rosa G, Trevisan V, Iademarco M, Zampino G, Tartaglia M, Novelli A, Bartuli A, Digilio MC, Calcagni G. Congenital heart defects in CTNNB1 syndrome: Raising clinical awareness. Clin Genet 2023; 104:528-541. [PMID: 37455656 DOI: 10.1111/cge.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/23/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
CTNNB1 [OMIM *116806] encodes β-catenin, an integral part of the cadherin/catenin complex, which functions as effector of Wnt signaling. CTNNB1 is highly expressed in brain as well as in other tissues, including heart. Heterozygous CTNNB1 pathogenic variations are associated with a neurodevelopmental disorder characterized by spastic diplegia and visual defects (NEDSDV) [OMIM #615075], featuring psychomotor delay, intellectual disability, behavioral disturbances, movement disorders, visual defects and subtle facial and somatic features. We report on a new series of 19 NEDSDV patients (mean age 10.3 years), nine of whom bearing novel CTNNB1 variants. Notably, five patients showed congenital heart anomalies including absent pulmonary valve with intact ventricular septum, atrioventricular canal with hypoplastic aortic arch, tetralogy of Fallot, and mitral valve prolapse. We focused on the cardiac phenotype characterizing such cases and reviewed the congenital heart defects in previously reported NEDSDV patients. While congenital heart defects had occasionally been reported so far, the present findings configure a higher rate of cardiac anomalies, suggesting dedicated heart examination to NEDSDV clinical management.
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Affiliation(s)
- Lorenzo Sinibaldi
- Medical Genetics Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Giacomo Garone
- Clinical and Experimental Neurology, IRCCS Bambino Gesù Children Hospital, Rome, Italy
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Mandarino
- Child and Adolescent Neuropsychiatry Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giancarlo Iarossi
- Department of Ophthalmology, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Chioma
- Endocrinology and Diabetology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Lisa Dentici
- Medical Genetics Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Giuseppe Merla
- Laboratory of Regulatory & Functional Genomics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
- Department of Molecular Medicine & Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Alessia Micalizzi
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Cecilia Mancini
- Molecular Genetics and Functional Genomics, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Marcello Niceta
- Molecular Genetics and Functional Genomics, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Marina Macchiaiolo
- Rare Diseases and Medical Genetics Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Daria Diodato
- Neuromuscular and Neurodegenerative Disorders Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Roberta Onesimo
- Rare Diseases Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Pediatric Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Rita Blandino
- Pediatric Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | - Gabriella De Rosa
- Pediatric Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Valentina Trevisan
- Rare Diseases Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Mariella Iademarco
- Rare Diseases Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Giuseppe Zampino
- Rare Diseases Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Pediatric Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica Sacro Cuore, Rome, Italy
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetics Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | | | - Giulio Calcagni
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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Chouhan AS, Kaple M, Hingway S. A Brief Review of Diagnostic Techniques and Clinical Management in Chronic Kidney Disease. Cureus 2023; 15:e49030. [PMID: 38116359 PMCID: PMC10728575 DOI: 10.7759/cureus.49030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Given its increasing incidence and detrimental effects on life expectancy and quality of life, chronic kidney disease (CKD) is a significant worldwide health concern. This review article provides a complete summary of current information on the diagnosis and management of CKD, focusing on recent advances and innovative approaches. The article discusses the most current findings on CKD risk assessment, emphasizing the need for early diagnosis utilizing better biomarkers and predictive models. A rigorous examination of diagnostic tools such as albumin-to-creatinine ratio (ACR) in urine and glomerular filtration rate (GFR) highlights their importance in determining CKD phases and etiologies. In terms of therapy, the study explores evidence-based techniques to reduce the development of CKD, such as enhanced blood pressure control, glycemic management in diabetic patients, dietary changes, and renin-angiotensin-aldosterone system (RAAS) blocking. Novel therapeutic approaches, including antifibrotic and precision medicine, are evaluated regarding their potential to revolutionize CKD treatment. The study also underlines the need for multidisciplinary therapy and patient education to achieve the best possible CKD patient outcomes. It also highlights the financial and social effects of CKD, highlighting the importance of early treatment to lower medical expenses and enhance the patient's standard of living. Finally, this review article provides a comprehensive update on CKD diagnosis and treatment, highlighting present successes alongside future potential. It is a valuable resource for healthcare professionals, academics, and policymakers who want to improve CKD treatment methods and patient outcomes.
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Affiliation(s)
- Anant Shourya Chouhan
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Meghali Kaple
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Snehlata Hingway
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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López RM, Bovaird I, Olmo González B, Abu-Eid R. Dental student readiness to treat special care patients upon graduation. Spec Care Dentist 2023; 43:869-882. [PMID: 37186085 DOI: 10.1111/scd.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION There has been a global increase in patients with special needs. Undergraduate dental curricula need to adjust to meet the needs of these patients. This study aimed to identify how confident final year dental students felt about treating patients with special needs upon graduation and evaluate the influence that the curriculum had on their preparedness based on competencies outlined by the International Association for Disability and Oral Health (iADH). METHODS A questionnaire was administered to final year dental students at two different Universities in Scotland and in Spain to: (1) evaluate how prepared students felt when treating patients with special needs and (2) assess the competencies outlined by iADH. RESULTS The response rate was 18.4% (30/163 students). Overall, 83.3% of the students (n = 25) perceived they would benefit from more practical sessions with patients with learning and physical disabilities to improve their clinical management of these patients. 53.3% (n = 16) didn't feel that had the knowledge to properly treat all special care dentistry (SCD) patients upon graduation (scored 5 or 6 on the IADH competency framework). 83.3% of the students (n = 25) felt that the mode of teaching should be problem-based complemented with small group seminars. CONCLUSION Students from both Universities agreed that more clinical practice might be required for them to further their skills to treat special needs patients upon graduation, which correlates with the need to have more practical sessions to consolidate competency 4 (communication skills with SCD) and competency 6 (clinical management of patients requiring SCD).
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Affiliation(s)
| | - Iain Bovaird
- Institute of Dentistry, University of Aberdeen, Aberdeen, UK
| | - Belisa Olmo González
- Special Care and Oral Medicine Department, Dental School. Universitat Internacional de Catalunya, Sant Cugat del Valles, Spain
| | - Rasha Abu-Eid
- Institute of Dentistry, University of Aberdeen, Aberdeen, UK
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Prinsloo C, Smith S, Law M, Hanson J. The Epidemiological, Clinical, and Microbiological Features of Patients with Burkholderia pseudomallei Bacteraemia-Implications for Clinical Management. Trop Med Infect Dis 2023; 8:481. [PMID: 37999600 PMCID: PMC10675116 DOI: 10.3390/tropicalmed8110481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Patients with melioidosis are commonly bacteraemic. However, the epidemiological characteristics, the microbiological findings, and the clinical associations of Burkholderia pseudomallei bacteraemia are incompletely defined. All cases of culture-confirmed melioidosis at Cairns Hospital in tropical Australia between January 1998 and June 2023 were reviewed. The presence of bacteraemia was determined and correlated with patient characteristics and outcomes; 332/477 (70%) individuals in the cohort were bacteraemic. In multivariable analysis, immunosuppression (odds ratio (OR) (95% confidence interval (CI)): (2.76 (1.21-6.27), p = 0.02), a wet season presentation (2.27 (1.44-3.59), p < 0.0001) and male sex (1.69 (1.08-2.63), p = 0.02), increased the likelihood of bacteraemia. Patients with a skin or soft tissue infection (0.32 (0.19-0.57), p < 0.0001) or without predisposing factors for melioidosis (0.53 (0.30-0.93), p = 0.03) were less likely to be bacteraemic. Bacteraemia was associated with intensive care unit admission (OR (95%CI): 4.27 (2.35-7.76), p < 0.0001), and death (2.12 (1.04-4.33), p = 0.04). The median (interquartile range) time to blood culture positivity was 31 (26-39) hours. Patients with positive blood cultures within 24 h were more likely to die than patients whose blood culture flagged positive after this time (OR (95%CI): 11.05 (3.96-30.83), p < 0.0001). Bacteraemia portends a worse outcome in patients with melioidosis. Its presence or absence might be used to help predict outcomes in cases of melioidosis and to inform optimal clinical management.
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Affiliation(s)
- Carmen Prinsloo
- College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, QLD 4870, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia;
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, NSW 2042, Australia;
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia;
- The Kirby Institute, University of New South Wales, Sydney, NSW 2042, Australia;
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
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36
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Nelson EE, Rousseau MA, Black TA, George MN, Rashid RM. Smartwatch Technology in Medicine: A Call for Future Dermatologic Research. JMIR Dermatol 2023; 6:e47252. [PMID: 37843896 PMCID: PMC10616727 DOI: 10.2196/47252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Emelie E Nelson
- McGovern Medical School at UTHealth Houston, Houston, TX, United States
| | - Morgan A Rousseau
- McGovern Medical School at UTHealth Houston, Houston, TX, United States
| | - T Austin Black
- McGovern Medical School at UTHealth Houston, Houston, TX, United States
| | - Mariya N George
- McGovern Medical School at UTHealth Houston, Houston, TX, United States
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Tawfiq E, Pylypchuk R, Elwood JM, McKeage M, Wells S, Selak V. Risk of cardiovascular disease in cancer survivors: A cohort study of 446,384 New Zealand primary care patients. Cancer Med 2023; 12:20081-20093. [PMID: 37746882 PMCID: PMC10587917 DOI: 10.1002/cam4.6580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/11/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Given advances in the management of cancer, it is increasingly important for clinicians to appropriately manage the risk of cardiovascular disease (CVD) among cancer survivors. It is unclear whether CVD risk is increased among cancer survivors overall, and there is inconsistency in evidence to date about CVD incidence and mortality by cancer type. METHODS Patients aged 30-74 years entered an open cohort study at the time of first CVD risk assessment, between 2004 and 2018, in primary care in New Zealand. Patients with established CVD or cancer within 2 years prior to study entry were excluded. Cancer diagnosis (1995-2016) was determined from a national cancer registry. Cause-specific hazard models were used to examine the association between history of cancer and two outcomes: (1) CVD-related hospitalization and/or death and (2) CVD death. RESULTS The study included 446,384 patients, of whom 14,263 (3.2%) were cancer survivors. Risk of CVD hospitalization and/or death was increased among cancer survivors compared with patients without cancer at cohort entry (multivariable-adjusted hazard ratio, mHR, 1.11, 95% CI 1.05-1.18), more so for CVD death (1.31, 1.14-1.52). Risk of CVD hospitalization and/or death was increased in patients with myeloma (2.66, 1.60-4.42), lung cancer (2.19, 1.48-3.24) and non-Hodgkin lymphoma (1.90, 1.42-2.54), but not for some cancers (e.g., colorectal, 0.87, 0.71-1.06). Risk of CVD death was increased in several cancer types including melanoma (1.73, 1.25-2.38) and breast cancer (1.56, 1.16-2.11). CONCLUSION CVD risk management needs to be prioritized among cancer survivors overall, and particularly in those with myeloma, lung cancer and non-Hodgkin lymphoma given consistent evidence of increased risk.
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Affiliation(s)
- Essa Tawfiq
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Romana Pylypchuk
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - J. Mark Elwood
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Mark McKeage
- School of Medical SciencesUniversity of AucklandAucklandNew Zealand
| | - Sue Wells
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Vanessa Selak
- School of Population HealthUniversity of AucklandAucklandNew Zealand
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38
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Lilly E, Bunick CG. Congenital Ichthyosis: A Practical Clinical Guide on Current Treatments and Future Perspectives. Clin Cosmet Investig Dermatol 2023; 16:2473-2479. [PMID: 37719935 PMCID: PMC10503504 DOI: 10.2147/ccid.s388608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Congenital ichthyoses are a group of hereditary disorders of keratinization that are challenging to treat. Affected individuals suffer not only from thickening of the skin but also associated complications such as growth restriction, hearing and eye complications, infections, and thermodysregulation. This clinical review provides a practical roadmap to the longitudinal care of patients with ichthyosis with both general and age- and disease-specific recommendations. The allure of pathogenesis-based and targeted treatments for these monogenetic severe but orphan conditions shines bright as dermatological therapies enter a new era.
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Affiliation(s)
- Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Christopher G Bunick
- Department of Dermatology and Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT, 06520, USA
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Paganin W. Viewpoint: Difficult-to-treat depression versus treatment-resistant depression: A new integrative perspective for managing depression. Eur Psychiatry 2023; 66:e73. [PMID: 37680180 PMCID: PMC10594272 DOI: 10.1192/j.eurpsy.2023.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
In the STAR*D study, the efficacy of treatments for major depression was examined. It was found that, while many responded to the initial antidepressant treatment, only 30% of participants achieved complete remission. Concerning treatment resistance in depression, there is a recent distinction emerging between treatment-resistant depression (TRD) and difficult-to-treat depression (DTD). Historically, TRD and DTD have been conflated, but it is essential to recognize them as separate entities. While TRD is characterized by a patient's inadequate response to two or more consecutive antidepressant treatments given for an adequate duration and dosage without achieving acceptable therapeutic effects, DTD describes a clinical category where patients do not achieve full symptom control despite various therapeutic approaches. The recent shift in perspective proposes a more integrated approach for DTD, encompassing psychosocial, biological, and interactive factors. This multifactorial model calls for a multidisciplinary therapeutic intervention, not restricted to pharmacological treatments but also including psychotherapy, neurostimulation, and social interventions. Informing professionals and the general public about the significance of this new approach could mitigate the stigma associated with depression and enhance the quality of care. The future challenge will involve a deeper clinical understanding of DTD and its optimal management by refining available treatments.
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Affiliation(s)
- Walter Paganin
- PhD Student in Neuroscience, University of Roma Tor Vergata, Rome, Italy
- Vocational Training in Advanced Clinical and Medical Research Methodologies, University of Bologna Alma Mater Studiorum, Bologna, Italy
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Metcalfe KA, Pal T, Narod SA, Armel S, Shickh S, Buckley K, Walters ST, Brennenstuhl S, Kinney AY. Theory-based behavior change intervention to increase uptake of risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 pathogenic variant: The PREVENT randomized controlled trial. Cancer Med 2023; 12:18246-18257. [PMID: 37602539 PMCID: PMC10524042 DOI: 10.1002/cam4.6417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate the effect of a theory-based behavioral intervention delivered by genetic counselors on the uptake of risk-reducing salpingo-oophorectomy (RRSO) at 12 and 24 months by women with a BRCA1 or BRCA2 pathogenic variant (PV) compared to women who received usual care. METHODS In this two-arm, multi-site randomized controlled trial participants were randomized to receive a theoretically-guided behavioral telephone intervention or usual care. Outcome data were collected at 12 and 24 months. Participants in the usual care arm were offered the intervention after 12 months. RESULTS Data on 107 participants were included in the analysis. There was no significant difference in the proportion of women who had a RRSO by 1 year (28.6%- intervention; 22.9%- usual care (p = 0.54)). At 1 year, women who received the intervention had significantly lower mean decisional conflict (pinteraction <0.001) and a higher mean knowledge score at one-year compared to usual care (pinteraction <0.001). At 2 years, 53.9% of participants in the intervention arm had RRSO compared to 32.6% in usual care (p = 0.05). CONCLUSIONS A theory-based behavioral intervention delivered by genetic counselors to women with a BRCA PV who chose not to have the recommended RRSO was effective at reducing decisional conflict and increasing knowledge in women with a BRCA1 or BRCA2 PV.
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Affiliation(s)
- Kelly A. Metcalfe
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
- Women's College Research InstituteTorontoOntarioCanada
| | - Tuya Pal
- Vanderbilt‐Ingram Cancer Center at the Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Susan Armel
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Salma Shickh
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | | | - Scott T. Walters
- University of North Texas Health Science CenterFort WorthTexasUSA
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Anita Y. Kinney
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
- Department of Biostatistics and Epidemiology, School of Public HealthRutgers UniversityPiscatawayNew JerseyUSA
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Momesso T, Gokpinar B, Ibrahim R, Boyle AA. Effect of removing the 4-hour access standard in the ED: a retrospective observational study. Emerg Med J 2023; 40:630-635. [PMID: 37369563 DOI: 10.1136/emermed-2023-213142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Time-based targets are used to improve patient flow and quality of care within EDs. While previous research often highlighted the benefits of these targets, some studies found negative consequences of their implementation. We study the consequences of removing the 4-hour access standard. METHODS We conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. The primary outcomes of interest were the proportion of admitted patients, that is, the admission rate, the length of stay in the ED and ambulance handover times. We used interrupted time series models to study and estimate the impact of removing the 4-hour access standard. RESULTS A total of 169 916 attendances were included in the analysis. The interrupted time series models for the average daily admission rate indicate a drop from an estimated 35% to an estimated 31% (95% CI -4.1 to -3.9). This drop is only statistically significant for Majors (Ambulant) patients (from an estimated 38.3% to an estimated 31.4%) and, particularly, for short-stay admissions (from an estimated 18.1% to an estimated 12.8%). The models also show an increase in the average daily length of stay for admitted patients from an estimated 316 min to an estimated 387 min (95% CI 33.5 to 108.9), and an increase in the average daily length of stay for discharged patients from an estimated 222 min to an estimated 262 min (95% CI 6.9 to 40.4). CONCLUSION Lifting the 4-hour access standard reporting was associated with a drop in short-stay admissions to the hospital. However, it was also associated with an increase in the average length of stay in the ED. Our study also suggests that the removal of the 4-hour standard does not impact all patients equally. While certain patient groups such as those Majors (Ambulant) patients with less severe issues might have benefited from the removal of the 4-hour access standard by avoiding short-stay hospital admissions, the average length of stay in the ED seemed to have increased across all groups, particularly for older and admitted patients.
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Affiliation(s)
- Tomas Momesso
- UCL School of Management, University College London, London, UK
| | - Bilal Gokpinar
- UCL School of Management, University College London, London, UK
| | - Rouba Ibrahim
- UCL School of Management, University College London, London, UK
| | - Adrian A Boyle
- Emergency Department, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ronde EM, Nolte JW, Kruisinga FH, Maas SM, Lapid O, Ebbens FA, Becking AG, Breugem CC. Evaluating International Diagnostic, Screening, and Monitoring Practices for Craniofacial Microsomia and Microtia: A Survey Study. Cleft Palate Craniofac J 2023; 60:1118-1127. [PMID: 35469463 PMCID: PMC10466995 DOI: 10.1177/10556656221093912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
To (1) appraise current international classification and clinical management strategies for craniofacial microsomia (CFM) and microtia, and (2) to assess agreement with the European Reference Network "European Guideline Craniofacial Microsomia" recommendations on screening and monitoring. This was a cross-sectional online survey study. The survey consisted of 44 questions on demographics, diagnostics and classification, obstructive sleep apnea, feeding difficulties, speech and language development, hearing, ocular abnormalities, visual development, orthodontic screening, genetic counselling, psychological wellbeing, and extracraniofacial anomalies. Respondents were participants of 3 international cleft and craniofacial conferences, members of the American Cleft Palate and Craniofacial Association and members of the International Society for Auricular Reconstruction. Respondents were requested to complete 1 questionnaire per multidisciplinary team. Fifty-seven responses were received from 30 countries (response rate ∼3%).The International Consortium for Health Outcomes Measurement diagnostic criteria were used by 86% of respondents, though 65% considered isolated microtia a mild form of CFM. The Orbit, Mandible, Ear, Facial Nerve and Soft Tissue classification system was used by 74% of respondents. Agreement with standardized screening and monitoring recommendations was between 61% and 97%. A majority of respondents agreed with screening for extracraniofacial anomalies (63%-68%) and with genetic counselling (81%). This survey did not reveal consistent agreement on the diagnostic criteria for CFM. Respondents mostly supported management recommendations, but frequently disagreed with the standardization of care. Future studies could focus on working towards international consensus on diagnostic criteria, and exploring internationally feasible management strategies.
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Affiliation(s)
- Elsa M. Ronde
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Oral and Maxillofacial Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Jitske W. Nolte
- Amsterdam UMC location University of Amsterdam, Oral and Maxillofacial Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Frea H. Kruisinga
- Amsterdam UMC location University of Amsterdam, Pediatrics, Amsterdam, the Netherlands
| | - Saskia M. Maas
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Clinical Genetics, Amsterdam, the Netherlands
| | - Oren Lapid
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Fenna A. Ebbens
- Amsterdam UMC location University of Amsterdam, Otorhinolaryngology, Amsterdam, the Netherlands
- Amsterdam Public Health, Ear and Hearing, Amsterdam, the Netherlands
| | - Alfred G. Becking
- Amsterdam UMC location University of Amsterdam, Oral and Maxillofacial Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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Mastrolonardo EV, Mann DS, Sethi HK, Yun BH, Sina EM, Armache M, Worster B, Fundakowski CE, Mady LJ. Perioperative opioids and survival outcomes in resectable head and neck cancer: A systematic review. Cancer Med 2023; 12:18882-18888. [PMID: 37706634 PMCID: PMC10557889 DOI: 10.1002/cam4.6524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC). METHODS A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included. RESULTS Three thousand three hundred seventy-eight studies met initial inclusion criteria, and three studies representing 562 patients (intraoperative opioids, n = 463; postoperative opioids, n = 99) met final exclusion criteria. One study identified that high intraoperative opioid requirement in oral cancer surgery was associated with decreased OS (HR = 1.77, 95% CI 0.995-3.149) but was not an independent predictor of decreased DFS. Another study found that increased intraoperative opioid requirements in treating laryngeal cancer was demonstrated to have a weak but statistically significant inverse relationship with DFS (HR = 1.001, p = 0.02) and OS (HR = 1.001, p = 0.02). The last study identified that patients with chronic opioid after resection of oral cavity cancer had decreased DFS (HR = 2.7, 95% CI 1.1-6.6) compared to those who were not chronically using opioids postoperatively. CONCLUSION An association may exist between perioperative opioid use and OS and DFS in patients with resectable HNC. Additional investigation is required to further delineate this relationship and promote appropriate stewardship of opioid use with adjunctive nonopioid analgesic regimens.
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Affiliation(s)
- Eric V. Mastrolonardo
- Department of Otolaryngology – Head and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Derek S. Mann
- Department of Otolaryngology – Head and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Harleen K. Sethi
- Department of Otolaryngology – Head and Neck SurgeryPhiladelphia College of Osteopathic MedicinePhiladelphiaPennsylvaniaUSA
| | - Bo H. Yun
- Department of Otolaryngology – Head and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Elliott M. Sina
- Department of Otolaryngology – Head and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Maria Armache
- Department of Otolaryngology – Head and Neck SurgeryThe Johns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Brooke Worster
- Department of Hospice and Palliative CareThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Christopher E. Fundakowski
- Department of Otolaryngology – Head and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Leila J. Mady
- Department of Otolaryngology – Head and Neck SurgeryThe Johns Hopkins School of MedicineBaltimoreMarylandUSA
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Price ME, Gordon S, Emmitt C, Ndugga N, Kabdiyeva A, Mull H, Pizer S, Garrido MM. Growth of community-based immunotherapy treatment in the Veterans Health Administration. Cancer Med 2023; 12:18110-18119. [PMID: 37519258 PMCID: PMC10524003 DOI: 10.1002/cam4.6372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The MISSION and CHOICE Acts expanded the Veterans Health Administration's (VA) capacity to purchase immunotherapy services for VA patients from community-based providers. Our objective was to identify predictors of community-based immunotherapy treatment, and assess differences in cost and utilization across community treatment settings METHODS: We examined claims for 21,257 patients who started immunotherapy treatment between 2015 and 2020. We assessed growth in VA community-based immunotherapy care, predictors of community-based immunotherapy treatment using multivariable logistic regression based on patients' sociodemographic and clinical characteristics. We compared utilization and costs among those who received community-based immunotherapy services in hospital outpatient departments (HOPDs) versus physician office settings (POs). RESULTS The proportion of community-based immunotherapy in the VA increased from 5.3% in 2015 to 32.1% in 2020, with total annual costs of immunotherapy growing from $6.1 million to $187 million. Older, married, and rural patients and those with more comorbidities were more likely than younger, single, or urban patients to be treated in the community. Black patients were more likely to be treated in the VA. Respiratory Cancer was the most common cancer type in both settings. Among community immunotherapy patients, we observed no meaningful differences in the number of units administered, the unit drug costs, or the cost per immunotherapy visit between POs and HOPDs. CONCLUSION Drug costs did not differ widely across HOPDs and POs among VA patients who receive community-based immunotherapy.
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Affiliation(s)
| | - Sarah Gordon
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Caroline Emmitt
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Nambi Ndugga
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | | | - Hillary Mull
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Steven Pizer
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Melissa M. Garrido
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
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Guha SK, Sadhukhan S, Niyogi S. COVID-19 cluster identification and support vector machine classifier model construction using global healthcare and socio-economic features. Epidemiol Infect 2023; 151:e159. [PMID: 37646158 PMCID: PMC10600736 DOI: 10.1017/s0950268823001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
Coronaviruses of the human variety have been the culprit of global epidemics of varying levels of lethality, including COVID-19, which has impacted more than 200 countries and resulted in 5.7 million fatalities as of May 2022. Effective clinical management necessitates the allocation of sufficient resources and the employment of appropriately skilled personnel. The elderly population and individuals with diabetes are at increased risk of more severe manifestations of COVID-19. Countries with a higher gross domestic product (GDP) typically exhibit superior health outcomes and reduced mortality rates. Here, we suggest a predictive model for the density of medical doctors and nursing personnel for 134 countries using a support vector machine (SVM). The model was trained in 107 countries and tested in 27, with promising results shown by the kappa statistics and ROC analysis. The SVM model used for predictions showed promising results with a high level of agreement between actual and predicted cluster values.
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Affiliation(s)
- Soumya Kanti Guha
- Department of Computer Application, Dinabandhu Andrews Institute of Technology and Management, Kolkata, India
| | - Sandip Sadhukhan
- Department of Computer Application, Dinabandhu Andrews Institute of Technology and Management, Kolkata, India
| | - Sougata Niyogi
- Department of Medical Lab Technology, Dinabandhu Andrews Institute of Technology and Management, Kolkata, India
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46
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Zhu Y, Sharma L, Chang D. Pathophysiology and clinical management of coronavirus disease (COVID-19): a mini-review. Front Immunol 2023; 14:1116131. [PMID: 37646038 PMCID: PMC10461092 DOI: 10.3389/fimmu.2023.1116131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
An unprecedented global pandemic caused by a novel coronavirus named SARS-CoV-2 has created a severe healthcare threat and become one of the biggest challenges to human health and the global economy. As of July 2023, over 767 million confirmed cases of COVID-19 have been diagnosed, including more than 6.95 million deaths. The S protein of this novel coronavirus binds to the ACE2 receptor to enter the host cells with the help of another transmembrane protease TMPRSS2. Infected subjects that can mount an appropriate host immune response can quickly inhibit the spread of infection into the lower respiratory system and the disease may remain asymptomatic or a mild infection. The inability to mount a strong initial response can allow the virus to replicate unchecked and manifest as severe acute pneumonia or prolonged disease that may manifest as systemic disease manifested as viremia, excessive inflammation, multiple organ failure, and secondary bacterial infection among others, leading to delayed recovery, hospitalization, and even life-threatening consequences. The clinical management should be targeted to specific pathogenic mechanisms present at the specific phase of the disease. Here we summarize distinct phases of COVID-19 pathogenesis and appropriate therapeutic paradigms associated with the specific phase of COVID-19.
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Affiliation(s)
- Ying Zhu
- College of Pulmonary and Critical Care Medicine, 8th Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, 7th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - De Chang
- College of Pulmonary and Critical Care Medicine, 8th Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, 7th Medical Center of Chinese PLA General Hospital, Beijing, China
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47
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Briasoulis A, Kourek C, Papamichail A, Loritis K, Bampatsias D, Repasos E, Xanthopoulos A, Tsougos E, Paraskevaidis I. Arrhythmias in Patients with Cardiac Amyloidosis: A Comprehensive Review on Clinical Management and Devices. J Cardiovasc Dev Dis 2023; 10:337. [PMID: 37623350 PMCID: PMC10455774 DOI: 10.3390/jcdd10080337] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Cardiac amyloidosis (CA) is a rare but potentially life-threatening disease in which misfolded proteins accumulate in the cardiac wall tissue. Heart rhythm disorders in CA, including supraventricular arrhythmias, conduction system disturbances, or ventricular arrhythmias, play a major role in CA morbidity and mortality, and thus require supplementary management. Among them, AF is the most frequent arrhythmia during CA hospitalizations and is associated with significantly higher mortality, while ventricular arrhythmias are also common and are usually associated with poor prognosis. Early diagnosis of potential arrythmias could be performed through ECG, Holter monitoring, and/or electrophysiology study. Clinical management of these patients is quite significant, and it usually includes initiation of amiodarone and/or digoxin in patients with AF, potential electrical cardioversion, or ablation in specific patients with indication, as well as initiation of anticoagulants in all patients, independent of AF and CHADS-VASc score, for potential intracardiac thrombus. Moreover, identification of patients with conduction disorders that could benefit from prophylactic pacemaker implantation and/or CRT as well as identification of patients with life-threatening ventricular arrythmias that could benefit from ICD could both increase the survival rates of these patients and improve their quality of life.
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Affiliation(s)
- Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
| | - Christos Kourek
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
| | - Adamantia Papamichail
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
| | - Konstantinos Loritis
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
| | - Dimitrios Bampatsias
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
| | - Evangelos Repasos
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece;
| | - Elias Tsougos
- Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece;
| | - Ioannis Paraskevaidis
- Medical School of Athens, National and Kapodistrian University of Athens, 15772 Athens, Greece; (C.K.); (A.P.); (K.L.); (D.B.); (E.R.); (I.P.)
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48
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Bele A, Wagh V, Munjewar PK. A Comprehensive Review on Cardiovascular Complications of COVID-19: Unraveling the Link to Bacterial Endocarditis. Cureus 2023; 15:e44019. [PMID: 37746510 PMCID: PMC10517725 DOI: 10.7759/cureus.44019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
The global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ushered in a new era of understanding the multifaceted nature of infectious diseases. Beyond its well-documented respiratory impact, COVID-19 has unveiled intricate interactions with the cardiovascular system, with potential implications that extend to bacterial endocarditis. This review explores the complex interplay between COVID-19 and bacterial endocarditis, elucidating shared risk factors, theoretical mechanisms, and clinical implications. We examine the diverse cardiovascular manifestations of COVID-19, ranging from myocarditis and thromboembolic events to arrhythmias, and delve into the pathogenesis, clinical features, and diagnostic challenges of bacterial endocarditis. By analyzing potential connections, such as viral-induced endothelial disruption and immune modulation, we shed light on the plausible relationship between COVID-19 and bacterial endocarditis. Our synthesis highlights the significance of accurate diagnosis, optimal management, and interdisciplinary collaboration in addressing the challenges posed by these intricate interactions. In addition, we underscore the importance of future research, emphasizing prospective studies on bacterial endocarditis incidence and investigations into the long-term cardiovascular effects of COVID-19. As the boundaries of infectious diseases and cardiovascular complications converge, this review calls for continued research, vigilance, and coordinated efforts to enhance patient care and public health strategies in a rapidly evolving landscape.
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Affiliation(s)
- Anurag Bele
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vasant Wagh
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratiksha K Munjewar
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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49
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Xu K, Gao B, Li J, Xiang Y, Cao L, Zhao M. Clinical features, diagnosis, and management of COVID-19 vaccine-associated Vogt-Koyanagi-Harada disease. Hum Vaccin Immunother 2023; 19:2220630. [PMID: 37282614 PMCID: PMC10305503 DOI: 10.1080/21645515.2023.2220630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a rare and serious ocular adverse reaction following COVID-19 vaccination. This study aimed to evaluate the clinical features, diagnosis and management of COVID-19 vaccine-associated VKH disease. Case reports of VKH disease after COVID-19 vaccination were collected up to February 11, 2023 for retrospective analysis. Twenty-one patients (9 males and 12 females) were included, with a median age of 45 years (range 19-78), from three main regions, Asia (12/21), the Mediterranean region (4/21), and South America (5/21). Fourteen patients developed symptoms after the first dose of the vaccine, and 8 after the second dose. Vaccines included mRNA vaccine (10 cases), virus vector vaccine (6 cases), and inactivated vaccine (5 cases). The average time interval from vaccination to onset of symptoms was 7.5 days (range 12 hours to 4 weeks). All 21 patients experienced visual impairment after vaccination, with 20 cases involving both eyes. Sixteen patients showed symptoms of meningitis. Serous retinal detachment was observed in 16 patients, choroidal thickening was observed in 14, aqueous cell in 9, and subretinal fluid in 6. CSF pleocytosis was detected in 7 patients and skin symptoms were found in 3 patients. All patients received corticosteroid therapy, and 8 also received immunosuppressive agents. All patients recovered well, with a mean recovery time of 2 months. Early diagnosis and early treatment are crucial to the prognosis of patients with VKH after vaccination with COVID-19 vaccine. The risk of vaccination against COVID-19 in patients with a history of VKH disease should be evaluated clinically.
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Affiliation(s)
- Ke Xu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Bingqian Gao
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Jiayi Li
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yixin Xiang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Lin Cao
- Academician Workstation, Changsha Medical University, Changsha, China
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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50
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Moreira Dos Santos M, Ishida K. We need to talk about Candida tropicalis: Virulence factors and survival mechanisms. Med Mycol 2023:myad075. [PMID: 37505455 DOI: 10.1093/mmy/myad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Candida tropicalis is a notable species of the Candida genus representing an impressive epidemiology in tropical regions, especially in South America and Asia, where India already presents the species as the first in Candida epidemiology. C. tropicalis has also shown a worrying antifungal resistance profile in recent years. It is essential to highlight that each pathogenic species of Candida genus has a particular biology; however, Candida virulence factors are almost entirely based on studies with Candida albicans. The intrinsic resistance of Candida krusei to some azoles, the intrinsic osmotolerance of C. tropicalis, and the multidrug resistance of Candida auris are just a few examples of how the biology of each Candida species is unique. Despite being a phylogenetically close species, C. tropicalis can support 15% NaCl, antagonistically metabolize and signal N-acetylglucosamine, encode 16 reported ALS genes, and other specificities discussed here compared to C. albicans. It is essential to clarify the details of the C. tropicalis infectious process, including identifying the participating secreted enzyme(s), the factors responsible for tissue damage, and the mechanisms underlying the morphogenesis and tolerance signaling pathways. In this review, we thoroughly assembled what is known about the main virulence factors of C. tropicalis, highlighting the missing pieces to stimulate further research with C. tropicalis and other non-Candida albicans species.
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Affiliation(s)
- Murilo Moreira Dos Santos
- Laboratory of Antifungal Chemotherapy, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Kelly Ishida
- Laboratory of Antifungal Chemotherapy, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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