Central Hospital Research Articles

EGFR inhibition with erlotinib induces membrane accumulation of aquaporin-2 via PDK1 and RSK activation

In the canonical aquaporin-2 (AQP2) signaling pathway, vasopressin (VP) binds to its V2 receptor, which in turn activates adenylate cyclase and protein kinase A (PKA), resulting in AQP2 S256 phosphorylation and accumulation of AQP2 in the membrane. The epidermal growth factor receptor (EGFR) inhibitor erlotinib also increases AQP2 S256 phosphorylation and membrane accumulation, yet it does not increase cAMP or PKA activity. We hypothesize that the ribosomal s6 kinase (RSK), a downstream effector in the EGFR-MAPK/ERK pathway, is the terminal kinase phosphorylating AQP2 in this novel PKA-independent pathway activated by erlotinib, and that the phosphoinositide dependent kinase-1 (PDK1), a well-established activator of RSK, is indispensable for erlotinib-induced AQP2 activation. Using our LLC-AQP2 cell model, we show that erlotinib-induced AQP2 membrane accumulation and S256 phosphorylation are abolished by the specific RSK inhibitor BI-D1870. RSK knockdown with siRNA also blocked AQP2 S256 phosphorylation and membrane accumulation, as did RSK knockout with CRISPR/cas9 editing. Next, rat kidney slices were incubated in Hank’s buffer with or without BI-D1870 and treated with erlotinib. BI-D1870 inhibited AQP2 membrane accumulation in collecting duct principal cells, supporting the relevance of this pathway in kidney cells in situ. An in-vitro kinase assay using purified proteins demonstrated that RSK directly phosphorylates AQP2 at the S256 residue. Additionally, erlotinib consistently increased phosphorylation of RSK T359, a residue associated with RSK’s active state. In canonical RSK activation, a phosphorylation cascade results in PDK1 binding to and activating RSK. We found that PDK1 inhibition with an experimental compound PS-222 also blocked erlotinib-induced AQP2 membrane accumulation and S256 phosphorylation. This implicates PDK1 along with RSK in the novel erlotinib-induced pathway of AQP2 traffcking. Our data show that RSK and PDK1 are terminal effectors in the novel, PKA-independent pathway of AQP2 activation induced by erlotinib. Further elaboration of this new non-canonical pathway promises to uncover potential pharmacological targets for the treatment of water balance disorders. This work was supported by the National Institutes of Health (NIH) grant DK096586 (D. Brown). P. W. Cheung was supported was supported by NIH K-award DK115901. Richard Babicz is the recipient of the Ben J Lipps Research Fellowship (American Society of Nephrology). Additional support for the Program in Membrane Biology Microscopy Core came from the Boston Area Diabetes and Endocrinology Research Center (DK057521) and the Massachusetts General Hospital (MGH) Center for the Study of Inflammatory Bowel Disease (DK043351). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Development and validation of a risk scoring system to identify patients with lupus nephritis in electronic health record data

ObjectiveAccurate identification of lupus nephritis (LN) cases is essential for patient management, research and public health initiatives. However, LN diagnosis codes in electronic health records (EHRs) are underused, hindering efficient...

Posterior reversible encephalopathy syndrome post stem cell transplantation in sickle cell disease: case series and literature review.

Posterior reversible encephalopathy syndrome (PRES) is a serious neurological syndrome that may develop following immunosuppressive therapy for stem cell transplantation (SCT). We report 8 patients with sickle cell disease (SCD) who developed PRES, which is likely to be related to immunosuppression. This is retrospective cohort analysis of the SCD registry at the King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Saudi Arabia. Inclusion criteria included all adults SCD patients who underwent SCT from 2011 until 2022. We explored all cases of PRES in patients with SCT. PRES was diagnosed with MRI imaging showing reversible vasogenic cerebral edema associated with neurological symptoms including severe headache, seizures, encephalopathy, delirium, and visual disturbances. During ten years follow-up (2011-2022) we found 8 patients with PRES (age range between 14 to 37 years at diagnosis) PRES occurred 8 to 124 days following SCT in 7 cases and one patient developed PRES 8 months prior to SCT. All patients were on immunosuppressive medications, including tacrolimus, cyclosporine, sirolimus and or mycophenolate mofetil. Headache, seizures, visual hallucinations, confusion, and drowsiness were the most common presenting symptoms. MRI showed abnormalities in the occipital, parietal and frontal lobes in most cases. Recovery was complete in all patients and no recurrences were noted. Two patients had graft versus host disease (GVHD). We compared risk factors for PRES among the 8 cases and 136 SCT in SCD patients who did not develop PRES. There was a significant association between PRES and imaging abnormalities, including previous bi-hemispheric infarctions (p = 0.001), and cerebral microbleeds (CBMs). PRES was strongly associated with presence (p = 0.006), size (p = 0.016) and number (p = 0.005) of CMBs. PRES can develop days to weeks following SCT in patients with SCD, and is associated with immunosuppressive therapy, previous bi-hemispheric infarctions and CMB. Prompt recognition and intervention leads to good recovery.

Identification of Surgeon Outliers to Improve Cost Efficiency: A Novel Use of the Centers for Medicare and Medicaid Quality Payment Program

BackgroundBundled payment programs for total joint arthroplasty (TJA) have become popular among both private and public payers. Because these programs provide surgeons with financial incentives to decrease costs through reconciliation payments, there is an advantage to identifying and emulating cost-efficient surgeons. The objective of this study was to utilize the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) in combination with institutional data to identify cost-efficient surgeons within our region and, subsequently, identify cost-saving practice patterns. MethodsData was obtained from the CMS QPP for total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeons within a large metropolitan area from January 2019 to December 2021. A simple linear regression determined the relationship between surgical volume and cost-efficiency. Internal practice financial data determined whether patients of identified surgeons differed with respect to x-ray visits, physical therapy visits, out-of-pocket payments to the practice, and whether surgery was done in hospital or surgical center settings. ResultsThere were 4 TKA and 3 THA surgeons who were cost-efficiency outliers within our area. Outliers and nonoutlier surgeons had patients who had similar body mass index, American Society of Anesthesiologists Physical Status Score, and age-adjusted Charlson Comorbidity Index scores. Patients of these surgeons had fewer x-ray visits for both TKA and THA (1.06 versus 1.11, P < .001; 0.94 versus 1.15, P < .001) and lower out-of-pocket costs ($86.10 versus $135.46, P < .001; $116.10 versus $177.40, P < .001). If all surgeons performing > 30 CMS cases annually within our practice achieved similar cost-efficiency, the savings to CMS would be $17.2 million for TKA alone ($75,802,705 versus $93,028,477). ConclusionsThe CMS QPP can be used to identify surgeons who perform cost-efficient surgeries. Practice patterns that result in cost savings can be emulated to decrease the cost curve, resulting in reconciliation payments to surgeons and institutions and cost savings to CMS.

Factors Related to Nurse’s Response Time in Management of Upper GI Bleeding among Chronic Liver Disease Patients

Background: In emergency care, the most important thing to note is the speed of nurses in responding or acting on the first patient who enters the emergency room. This speed is often referred to as response time. Nurse response time is always a measure of the service quality of a hospital or health center. Response times depend on the speed available as well as the quality of assistance to save lives and prevent infirmity. Objectives: Patients visiting to the hospital should be treated promptly and that leads to improvement in the quality of services and patient safety. The study aimed to determine the factors related to the response time of nurses in management of upper GI bleeding among chronic liver disease patients at Institute of Liver and Biliary Sciences, New Delhi, India.Methods: Carrying out the research is from February to March 2022. Analytical survey design with a cross- sectional approach. The research subjects were 20 nurses. measuring tools, namely questionnaires. analysis used bivariate analysis used the Chi-Square Test.Results: This shows that there is a relationship between education and response time with a value of p-value =.008, knowledge and response time with a value of p-value = .003.Conclusion: The level of knowledge and clinical experience determines Nurses to make prompt decision and ability to provide assessment and nursing actions. As the Nurses getting higher education levels and experience also increasing, on average they remain engaged in their work for longer time, so they are more productive and nurses have attended more training to improve their skills.

Oxidative stress induced by menadione (vitamin K3) results in non-canonical AQP2 membrane traffcking in LLC-AQP2 cells

Oxidative stress affects a wide variety of cellular processes including morphology, protein traffcking, and cell death. Several studies show that reactive oxygen species (ROS) are able to pass through some water channels, and that ROS may modulate aquaporin expression and traffcking. However, a relationship between ROS status and the traffcking of aquaporin-2 (AQP2) has yet to be well-defined. To address this question, we first treated LLC-PK1 cells expressing cmyc-tagged AQP2 (LLC-AQP2 cells) for 30 min with menadione (MK3, 20 μM), an agent widely used to generate ROS in cell culture. Similar to vasopressin (VP), MK3 induced significant AQP2 accumulation in the plasma membrane of these cells. Using LLC-AQP2 cells expressing secreted soluble green fluorescent protein (ss-GFP), we revealed significantly increased vesicle exocytosis upon treatment with MK3. Surprisingly, MK3 did not affect rhodamine-labeled dextran endocytosis, suggesting that the MK3 effect is mainly due an increase in AQP2 exocytosis into the plasma membrane. Next, we studied the role of AQP2 c-terminal serine 256 phosphorylation in this process. MK3 treatment resulted in significant plasma membrane accumulation of the non-phosphorylatable AQP2 S256A mutant, whereas VP had no effect, as previously reported. To understand the contribution of protein kinase A (PKA) to MK3-mediated AQP2 traffcking, we used CRISPR-generated LLC-AQP2,koPKA cells that lack PKA isoforms. Interestingly, an increase in AQP2 membrane accumulation was still observed, suggesting that the MK3 effect is PKA-independent. By western blotting with anti-phospho-AQP2 antibodies, we found that MK3 did not affect phosphorylation of the critical S256 residue, but in contrast to VP, MK3 actually increased the phosphorylation level of S261 instead of reducing it. Finally, we showed that AQP2 accumulation in both LLC-AQP2 and LLC-AQP2 S256A cells was inhibited in the presence of glutathione (5 mM), an anti-oxidant or reducing agent. Interestingly, western blot analysis showed that glutathione abolished the MK3-induced increase of S261 AQP2 phosphorylation. In summary, our study shows that menadione (MK3) induces AQP2 membrane accumulation in LLC-AQP2 cells, suggesting a role of ROS in this process. This effect is largely due a change in AQP2 vesicle exocytosis. It does not require phosphorylation of the c-terminal S256 residue of AQP2, but MK3 does cause increased S261 phosphorylation. While incompletely understood at present, these data reveal that alternative, probably ROS-related, regulatory mechanisms can be involved in AQP2 traffcking and recycling. This work was supported by the National Institutes of Health (NIH) grant DK096586 (D. Brown). P. W. Cheung was supported was supported by NIH K-award DK115901. Richard Babicz is the recipient of the Ben J Lipps Research Fellowship (American Society of Nephrology). Additional support for the Program in Membrane Biology Microscopy Core came from the Boston Area Diabetes and Endocrinology Research Center (DK057521) and the Massachusetts General Hospital (MGH) Center for the Study of Inflammatory Bowel Disease (DK043351). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Clinical application of ERCP concurrent laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones

ObjectiveTo compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration and lithotomy (LCBDE) in the treatment of cholecystolithiasis combined with bile duct stones. MethodsFrom September 2018 to January 2022, 195 patients with cholecystolithiasis complicated with extrahepatic bile duct stones from Department of Department of General Surgery, Shanghai Jiading Central Hospital met the inclusion criteria, including 60 cases in the LC group and 86 cases in the LCBDE group. The general condition, operation success rate, complications and residual stone rate of the two groups were retrospectively analyzed. ResultsIn the simultaneous operation group, 58 patients successfully performed ERCP, and the indwelling rate of the abdominal drainage tube (41.7 % vs. 95.3 %) was significantly better than that in the LCBDE group. There was no significant difference in the conversion rate to open surgery, operation time, and intraoperative blood loss between the two groups. In the simultaneous surgery group, 4 patients (6.7 %) developed pancreatitis after ERCP, which was cured by conservative treatment. The pain score at 6 h after operation was significantly lower than that in the LCBDE group (3.9 ± 1.6 vs 6.5 ± 2.4). There were no significant differences in biliary leakage (1.7 % vs. 4.7 %), postoperative cholangitis (5.0 % vs. 5.8 %), incision infection (3.3 % vs. 3.5 %), and bile duct stone residue rate (5.0 % vs 3.5 %) between the two groups. There was no severe pancreatitis, second operation or death. The duration of hospital stay was shortened in the concurrent operation group (5.1 ± 2.3d vs 7.9 ± 3.7d), and the operation cost was significantly higher than that in the LCBDE group (48839.9 ± 8549.5 vs 34635.9 ± 5893.7 yuan). ConclusionERCP combined with LC and LCBDE are both safe and effective methods for the treatment of cholecystolithiasis combined with extrahepatic bile duct stones. The simultaneous operation group has certain advantages in patient comfort and rapid rehabilitation, which can be popularized in qualified units.

Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing

ObjectiveBoarding admitted patients in Emergency Departments (EDs) is a national crisis that is worsening despite potential financial disadvantages. The objective of this study was to assess costs associated with boarding. MethodsWe conducted a prospective, observational investigation of patients admitted through an ED for management of acute stroke at a large, urban, academic, comprehensive stroke center hospital. We employed Time-Driven Activity-Based Costing methodology to estimate cost for patient care activities during admission and aggregated results to estimate the total cost of boarding versus inpatient care. Primary outcomes were total daily costs per patient for: med/surg boarding, med/surg inpatient care, ICU boarding, and ICU inpatient care. ResultsThe total daily cost of med/surg boarding per acute stroke patient was $1,856 versus $993 for med/surg inpatient care and $2,267 for ICU boarding versus $2,165 for ICU inpatient care. These differences were even greater when accounting for costs associated with traveler nurses. ED nurses spent 293 minutes per day (mean) caring for each med/surg boarder; inpatient nurses spent 313 minutes per day for each med/surg inpatient. ED nurses spent 419 minutes per day caring for each ICU boarder; inpatient nurses spent 787 minutes per day for each ICU inpatient. Neurology attendings and residents spent 25 and 52 minutes per day caring for each med/surg boarder versus 62 minutes and 90 minutes for each med/surg inpatient. ConclusionsUsing advanced cost accounting methods, our investigation provides novel evidence that boarding of admitted patients is financially costly, adding greater urgency for elimination of this practice.

Prevalence of tuberculosis at livingstone central hospital: A retrospective cross sectional study in southern province zambia

Prevalence of tuberculosis at livingstone central hospital: A retrospective cross sectional study in southern province zambia

Comprehensive assessment of pediatric acute and inpatient care at a tertiary referral hospital in Malawi: opportunities for quality improvement

BackgroundDespite the reduction in global under-5 mortality over the last decade, childhood deaths remain high. To combat this, there has been a shift in focus from disease-specific interventions to use...

Multisystem Inflammatory Syndrome in Children (MIS-C) in a Low-income Country: What Treatment Should be Adopted in Case of a Lack of Immunoglobulin?

In multisystem inflammatory syndrome (MIS-C), children typically present high-grade fever, gastrointestinal symptoms, Kawasaki-like symptoms, and even a toxic shock-like syndrome days to weeks after recovering from SARS-CoV-2 infection. It is important to raise awareness of this condition in order to have early diagnosis and immediate treatment of patients. We have, herein, reported 44 cases of MIS-C with various risk factors and symptoms. Furthermore, we have emphasized the efficacy of experience in treating children with MIS-C with high-dose corticosteroids as an alternative to immunoglobulin in low-income countries. We conducted a targeted survey of MIS-C from early May 2020 to October 2022 on 44 children and adolescents with characteristics of multisystem inflammatory syndrome admitted to the pediatric department of the university hospital center in Oujda, Morocco, to which patients diagnosed with MIS-C were referred. The case definition included six criteria: serious illness leading to hospitalization, age under 18 years, fever of at least 24 hours, laboratory evidence of inflammation, multi-organ involvement, biological inflammatory syndrome, and evidence of coronavirus infection based on polymerase chain reaction, antibody testing or exposure to people with COVID-19 in the past month. The criteria used to diagnose myocarditis were impaired left ventricular function, central mitral leak, and elevation of BNP or pro-BNP. Coronary involvement was assessed by the z-score and the criteria for its presence was a z-score equal to or greater than 2.5. Our study included 44 children and adolescents with MIS-C in our hospital, with male predominance (79%) and a median age of six years. Cardiovascular involvement was present in 91%, mucocutaneous in 78%, gastrointestinal in 70%, hematologic in 84%, and respiratory in 2% of patients. Coronary abnormalities (z-score ≥ 2.5) were documented in 21 cases (48%). Glucocorticoids were frequently used in comparison to immunoglobulin, which were uncommonly available and expensive. The therapeutic protocol that was adopted was high doses of short-term prednisone (Cortancyl) at 4mg/kg/day for 4 days. Favorable outcome was noted in all patients over a 2-year period.

Les soins palliatifs au Liban, un essor freiné mais une résilience à toute épreuve

The history of palliative care in Lebanon is marked by resilience and perseverance. Supported by personal initiatives, legislative battles and private donations, Palliative Care has managed to gradually anchor itself in the medical landscape, despite the meager means offered by the State. The delivery of Palliative Care in Lebanon has the particularity of being supported mainly by non-profit NGOs, whose operation is halfway between French HAD (Home hospitalization) and EMSP (Mobile palliative care units) and which offer free care to patients. More than 30% of patients followed by the NGO BALSAM suffer from chronic non-cancerous diseases. Pediatric palliative care is almost non-existent, with BALSAM being the only NGO providing support for children in their homes. Faced with the major financial difficulties facing the country, these NGOs are now turning to international partnerships, both to ensure the means to pursue their missions, and to reserve a place on the world stage. The Lebanese model developed by BALSAM is presented in developing countries as a possible example of operation in a crisis context. A delegation from the Medical-Chirurgical Center for Rehabilitation of Massues (CMCR) in Lyon also intervened at the Rafik Hariri Hospital Center in Beirut to discuss three themes: management, rehabilitation and palliative care. The same difficulties that we encounter in France regarding the temporality of intervention in care could be noted: It is uncommon for Lebanese medical colleagues to seek palliative care support early. The place of palliative care within the hospital institution is still new, and the resources allocated are too low, both in terms of nursing time and suitable premises. The road remains long, but everything is being done to ensure that palliative care continues to be talked about and extends ever deeper within the Lebanese health system.

Impact du mode de suivi des ruptures prématurées des membranes avant 36 SA sur la durée de latence

IntroductionPreterm premature rupture of membranes (PPROM) is the main cause of premature delivery, complicating 1–3% of all pregnancies. Conventional hospitalization (CH) is the most frequent mode of follow-up, but homecare (HC) seems to be an alternative. ObjectivesStudy of the impact of the monitoring mode on the duration of the latency period and on the latency ratio after PPROM, and analysis of the risk factors modifying this ratio. MethodsThis was a bicentric retrospective cohort study here-abouts including patients who presented a PPROM between 24 and 36weeks of gestation from 2016 to 2018. Patients had a follow-up in HC at Lille University Hospital center (UHC) and in CH at Nantes UHC according to two different follow-up protocols. The latency ratio corresponded to the real latency period divided by the latency period to theoretical term. ResultsWe included 154 patients: 102 in HC and 52 in CH. The mean latency period was significantly higher in HC: 36.9±21.8 days, corresponding to an 85.5±23.7% latency ratio versus 20.2±12 days, corresponding to an 66.9±29.8% latency ratio in CH (P<0.001). The latency ratio in CH was correlated with term at PPROM (P=0.001). ConclusionsThe duration of the latency period seems prolonged for PPROM followed by HC management versus CH in selected populations. This study suggests a benefit to HC in stable patients.

Reconciling pregnancy and business continuity at the Roubaix hospital center

This project is a way of improving the quality of working life for female professionals during their pregnancy, with shared benefits for the agent and the team. But it's also a lever of attractiveness for caregivers and a guarantee of quality for users.

Effect of increasing doses of colchicine on the treatment of 333 COVID-19 inpatients.

Previous research done in Bulgaria demonstrated a fivefold reduction in mortality from COVID-19 with increased doses of colchicine from two hospitals in the country. We report here a further 333 cases of COVID-19 inpatients, treated with different doses of colchicine and its effect on mortality. A case-control comparison from two additional hospitals was conducted between increased doses of colchicine and added bromhexine to standard of care (SOC) versus current SOC. Risk and odds ratio, as well as subgroup analysis, was conducted with newly reported data, alongside aggregate data from all hospital centers to determine the extent of mortality reduction in COVID-19 inpatients. There was a clear reduction in the mortality of inpatients with increasing doses of colchicine-between twofold and sevenfold. Colchicine loading doses of 4 mg are more effective than those with 2 mg. Despite these doses being higher than the so-called "standard doses," colchicine inpatients experienced lower mortality than SOC patients (5.7% vs. 19.53%). This mortality benefit was evident in different age subgroups, with a 4-mg loading dose of colchicine proving slightly superior to a 2-mg loading dose. Colchicine led to an overall relative risk reduction of 70.7%, with SOC patients having 3.91 higher odds of death. The safety of the doses was not different than the reported in the summary of product characteristics. Inpatients in Bulgaria with added colchicine and bromhexine to SOC achieved better clinical and mortality outcomes than those on SOC alone. These results question the World Health Organization-recommended strategy to inhibit viral replication. We posit that our treatment strategy to inhibit the Severe acute respiratory syndrome coronavirus 2 entry into the cell with inhaled bromhexine and the hyperactivated NLRP3 inflammasome with higher doses of colchicine, prevents the development of cytokine storm. The timing of the initiation of treatment seems critical.

Evaluation of the pre-analytical phase in the hospital departments of University Hospital Center Mohammed VI Oujda

Evaluation of the pre-analytical phase in the hospital departments of University Hospital Center Mohammed VI Oujda

A Retrospective Analysis of Cases Evaluated by Endoscopy in a Newly-Established Endoscopy Unit at A Second-Level Hospital

The aim of this study is to retrospectively analyze the cases who underwent upper and lower gastrointestinal system endoscopic evaluation between 2021-2022 in the endoscopy unit, which was established for the first time in a second level hospital, and to emphasize the importance of endoscopy units in district hospitals located far from central hospitals. The study comes to the fore in terms of dealing with the data of a district hospital where an endoscopy unit was established for the first time. The data of 440 patients who underwent endoscopic evaluation were analyzed. The study included 320 patients who underwent upper gastrointestinal tract and 120 who underwent lower gastrointestinal tract endoscopic examination. The endoscopic and pathological diagnoses given to patients were examined based on the data obtained, and descriptive statistics were performed. The cases undergoing upper gastrointestinal endoscopic examination had a mean age of 53.93±16.14 years, and those undergoing lower gastrointestinal tract endoscopic examination had a mean age of 53.71±15.86. Of cases undergoing upper gastrointestinal tract endoscopic examination, 70.3% had antral gastritis (n=225), 34.8% had ulcers (n=111), 10.3% had hiatus hernia (n=28), 9.1% had esophagitis (n=29), and 9.1% had duodenitis (n=29). Among the cases endoscopically diagnosed with cancer, 0.9% were localized in the distal esophagus (n=3) and 0.6% in the antrum (n=3). Of cases undergoing lower gastrointestinal tract endoscopic examination, 20% were diagnosed with polyp (n=24), 10% with diverticulum (n=12), 3.3% with hemorrhoidal disease (n=4), and 5% with cancer (n=6). As a result, the data obtained from the study emphasize the importance of endoscopy units in district hospitals located far from central hospitals.

Impact of COVID-19 pandemic on the utilization of ART Centre Services of a teaching hospital

Background- COVID-19 pandemic has had a huge impact on the collateral health system. It made access to essential health services difficult. Such an essential service is a service provided to HIV patients. This study was planned to assess the effect of the current COVID-19 pandemic on Anti-Retroviral therapy (ART) center services. Methods -Pre-recorded epidemiological data from an ART center of a teaching hospital was used to answer the research question. Data was collected for retrieving 4 parameters i.e. number of registrations, number of HIV-positive patients kept on ART, number of deaths, and loss to follow up of the COVID-19 year and non-COVID-19 year then comparison was made between both. Data analysis was done with the help of SPSS. Independent t-test, one-way ANOVA test, and multiple comparison Tuckey’s test were applied. Results- Statistically significant difference was noted in the total number of registrations, the number of patients kept on ART, death, and loss to follow-up in non- COVID-19 &amp; COVID-19 years. After appling above mentioned statistical test the p-value came out to be &lt;0.05. Conclusion-COVID-19 pandemic has adversely affected the auxiliary non-COVID-19 health services and health programs. The current study gives evidence that ART functioning is negatively affected by the COVID-19 pandemic.

The Impact of Religious Beliefs on Early Lactation in Israeli Mothers.

Objective: To explore the influence of religious beliefs and faith on breastfeeding initiation among mothers in Israel. Materials and Methods: The study, conducted from February 2022 to July 2023 at Bnai Zion Medical Center (located in Haifa district) and Laniado hospital (located in Netanya, Sharon plain), included mothers and their partners who voluntarily completed questionnaires. The survey, comprising 26 questions, delves into religion, faith, religiosity, and infant feeding approaches, while considering various socioeconomic and health-related factors. Results: Religious and secular mothers exhibited a higher inclination toward exclusive breastfeeding compared with the traditional mothers (p < 0.001). Notably, more maternal education years were associated with more exclusive breastfeeding (odds ratio [OR] 1.59; 95% confidence interval [CI] 1.09-2.32; p = 0.017). However, older age of youngest sibling (OR 0.56; 95% CI 0.32-0.98; p = 0.041), cesarean delivery (OR 0.64; 95% CI 0.44-0.94; p = 0.023), and no desire to breastfeed during pregnancy (OR 0.67; 95% CI 0.57-0.80; p < 0.001) emerged as significant factors decreasing exclusive breastfeeding. Conclusion: The study indicates that the level of religiosity and prenatal intention to breastfeed impact breastfeeding practices, along with maternal education, age of the youngest sibling, and delivery mode. These insights provide valuable guidance for initiatives aimed at boosting breastfeeding rates, particularly in sectors where rates are comparatively low.

Efficacy and Safety of Neoadjuvant Subcutaneous Envafolimab in dMMR/MSI-H Locally Advanced Colon Cancer.

Neoadjuvant immunotherapy with programmed death-ligand 1 blockade for colon cancer, especially for mismatch repair-deficient (dMMR)/high microsatellite instability (MSI-H) colon cancer, has gained considerable attention recently. This study aimed to assess the safety and efficacy of neoadjuvant subcutaneous envafolimab in patients with dMMR/MSI-H locally advanced colon cancer. Patients with dMMR/MSI-H locally advanced colon cancer treated with envafolimab at Sun Yat-sen University Cancer Center and Yunnan Cancer Hospital from October 2021 to July 2023 were retrospectively reviewed and analyzed. The primary endpoint was the pathological complete response (CR) rate, and secondary endpoints were treatment-related adverse events and complete clinical response rate. Overall, 15 patients were analyzed. After neoadjuvant immunotherapy with envafolimab, six patients achieved a CR, with five partial responses, and four stable disease. Three patients achieving a complete clinical response chose to accept a "watch and wait" strategy, and surgery was performed in 12 patients. Postoperative pathology results revealed seven patients achieved pathological CRs, and five patients achieved tumor regression grade 2, with 66.7% of the total CR rate. The most common treatment-related adverse events were pruritus and rash (40%), with no severe cases. No recurrences occurred over a 7.9-month follow-up. Envafolimab yielded promising surgical outcomes and safety in dMMR/MSI-H locally advanced colon cancer, representing a promising treatment modality for this population.