Clinical Practitioners Research Articles

An IoT-Based Framework for Automated Assessing and Reporting of Light Sensitivities in Children with Autism Spectrum Disorder

Identification of light sensitivities, manifesting either as hyper-sensitive (over-stimulating) or hypo-sensitive (under-stimulating) in children with autism spectrum disorder (ASD), is crucial for the development of personalized sensory environments and therapeutic strategies. Traditional methods for identifying light sensitivities often depend on subjective assessments and manual video coding methods, which are time-consuming, and very keen observations are required to capture the diverse sensory responses of children with ASD. This can lead to challenges for clinical practitioners in addressing individual sensory needs effectively. The primary objective of this work is to develop an automated system using Internet of Things (IoT), computer vision, and data mining techniques for assessing visual sensitivities specifically associated with light (color and illumination). For this purpose, an Internet of Things (IoT)-based light sensitivities assessing system (IoT-LSAS) was designed and developed using a visual stimulating device, a bubble tube (BT). The IoT-LSAS integrates various electronic modules for (i) generating colored visual stimuli with different illumination levels and (ii) capturing images to identify children’s emotional responses during sensory stimulation sessions. The system is designed to operate in two different modes: a child control mode (CCM) and a system control mode (SCM). Each mode uses a distinct approach for assessing light sensitivities, where CCM uses a preference-based approach, and SCM uses an emotional response tracking approach. The system was tested on a sample of 20 children with ASD, and the results showed that the IoT-LSAS effectively identified light sensitivities, with a 95% agreement rate in the CCM and a 90% agreement rate in the SCM when compared to the practitioner’s assessment report. These findings suggest that the IoT-LSAS can be used as an alternative to traditional assessment methods for diagnosing light sensitivities in children with ASD, significantly reducing the practitioner’s time required for diagnosis.

Assessing and managing lower limb oedema: a clinical review.

Lower limb oedema is a common condition in clinical practice, frequently affecting the distal lower limbs. Whereas benign causes such as prolonged sitting or standing are typical, oedema can also indicate serious systemic diseases such as cardiac failure, liver disease, or renal impairment. Identifying the cause is crucial to prevent irreversible skin and tissue changes. This clinical review aims to increase the knowledge of advanced clinical practitioners (ACPs) and generalist practitioners, including practice and community nurses, by providing an overview of how to approach patients with lower limb oedema, encompassing history-taking, examinations, investigations, and management plans. The main focus is on lymphoedema, which can be primary or secondary. Primary lymphoedema results from genetic abnormalities, while secondary lymphoedema arises from acquired defects due to factors such as obesity, infections, neoplasms, and trauma. Effective management includes addressing the underlying cause, ensuring proper skin care, recommending appropriate exercises, and the use of compression garments. Referral to a lymphoedema specialist is recommended for patient education on managing and treating the condition when required. Additionally, the article discusses the importance of regular skin inspections, minor injury management, environmental considerations, and the critical role of compression garments in lymphoedema management. This comprehensive approach aims to enhance patient outcomes and provide a thorough strategy for ACPs and generalist practitioners.

Service Providers' Perceptions of Psychological, Emotional, and Behavioral Issues Among Children and Adolescents During COVID‐19 in South Korea

ABSTRACTVarious emotional and psychological support services for children and adolescents were implemented in South Korea during the COVID‐19 era. However, little is known about the limitations and future directions of current support services from the perspective of service providers. The purpose of this study was to explore service providers' perspectives on emotional and psychological support services for children and adolescents. The present study purposively recruited 11 clinical practitioners providing support services for children and adolescents to conduct semistructured focus group interviews. Thematic analysis identified four major themes: (a) a noticeable increase in problematic behaviors among children and adolescents (e.g., intrinsic and extrinsic problem behaviors); (b) changes in service use patterns (e.g., increased non‐face‐to‐face services); (c) frustrations with inadequate support systems (e.g., the absence of qualified professionals); and (d) identifying future directions (e.g., improving awareness of support services). The findings highlight the necessity of enhancing awareness of how to access services by reducing stigma. The findings also emphasize the need for improved cooperation between public and private facilities, as well as a greater number of skilled professionals to provide high‐quality programs. The practical and political implications are discussed based on the findings.

How are different traditional Chinese medicine modalities deployed by clinical practitioners in China? Findings from a national survey

How are different traditional Chinese medicine modalities deployed by clinical practitioners in China? Findings from a national survey

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exists a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomical variations, disparity in healthcare resources and infrastructure and the lack of consensus on the optimal management of aortic stenosis in the Asia-Pacific region. Hence, an Asian Pacific Society of Cardiology (APSC) working group, including a multidisciplinary group of general and interventional cardiologists, cardiac surgeons and imaging specialists, developed a position statement on the recommendations for TAVI in the management of aortic stenosis. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral.’ The resulting 28 statements provide guidance for clinical practitioners in the region on the use of TAVI in the treatment of patients with aortic stenosis.

Testing the strength of thin feather-edge monolithic multilayered zirconia crowns: A pilot study with a novel acoustic test

Intoduction: Limited research has explored the mechanical characteristics of recently introduced multilayered monolithic zirconia (MZC) crowns with feather-edge margins design. Moreover, most of the conventional techniques for evaluating the mechanical behavior of brittle dental ceramics rely on destructive tests, making it impossible to precisely evaluate real strength values due to premature crack initiation detection failure. Objectives: The main objective of the study was to assess the load capacity of translucent multilayered monolithic zirconia crowns with feather-edge margin thicknesses of 0.4 mm and 0.5 mm. Additionally, the research introduced a novel non-destructive acoustic emission testing (AET) technique in the laboratory to identify early cracks in dental ceramics. Methods: Forty multilayered zirconia crowns produced using computer-aided design and computer-aided manufacturing (CAD/CAM) technology were evenly divided into two groups, each with distinct feather-edge margin thicknesses: 0.5 mm (group 1) and 0.4 mm (group 2). These crowns were securely cemented onto customized polymethyl methacrylate (PMMA) dies using a universal restorative glass ionomer. Subsequently, the crowns underwent a compressive axial loading test, controlled by an innovative AET crack detection system rooted in the principles of non-destructive laboratory testing. Fractographic analysis was conducted to determine the location of crack or eventual fracture. Results: The proportion of MZCs with a crack was statistically higher than the proportion with a fracture in the whole sample (p<0.001). In addition, the results showed that the crowns in group 1 exhibited higher loading values than those in group 2. The mean loading capacity in group was 911.2 N ± 614.7 N. Two locations of crack and fracture were registered: occlusal and marginal. No statistical association was observed between the two groups for the location of cracks or fractures. Conclusions: The feather-edge crowns with a 0.5 mm margin thickness had a higher loading capacity than those with a 0.4 mm. However, the latter supports loads that exceed occlusal force in the oral cavity suggesting that 0.4 mm feathered edge MZCs may be a valid and less invasive alternative to thicker margins. The novel load-to-fracture AET setup proved effective in detecting early crack initiation, suggesting it as a promising method for assessing the mechanical properties of brittle materials prior to failure, potentially impacting the field of dentistry. However more advanced research is needed to enhance the accuracy of the proposed technique. Clinical implications: The examined MZC demonstrates the ability to withstand occlusal forces in a patient’s mouth, offering clinical practitioners the option of embracing minimally invasive dentistry through the use of 0.4 mm feather-edge MZC in their treatment options. Furthermore, the positive results from the innovative acoustic emission testing technique, facilitating early crack detection, indicate a promising future for studying the behavior of brittle materials in dental laboratory testing.

"The Association between Vitamin D Deficiency and Childhood Obesity and Its Impact on Children’s Serum Calcium, Alkaline Phosphatase, and Bone Age"

ObjectiveThe research aimed to investigate the Association between Vitamin D deficiency and childhood obesity and its Impact on children’s serum calcium, alkaline Phosphatase, and bone Age MethodsThe study analyzed clinical data from 159 school-aged children who underwent medical examinations. The children were divided into a 25-(OH)D3 deficiency group and a non-25-(OH)D3 deficiency group based on their serum 25-hydroxy Vitamin D3 levels. The two groups were compared regarding BMI, TC, TG, FBG, HbA1c, Ca, ALP, and bone age differences. ResultsIndividuals with a deficiency in 25-(OH)D3 exhibited higher levels of BMI, TC, TG, and ALP, and lower levels of Ca and bone age than those without the deficiency. These differences were statistically significant (P<0.05). Further analysis revealed a negative association between 25-(OH)D3 levelsa positive correlation between Ca and bone age, and a positive correlation with, BMI, TC, TG, and ALP. ConclusionThe deficiency of 25-(OH)D3 in school-aged children is linked to obesity and impacts bone growth. Monitoring vitamin D levels is crucial for clinical practitioners.

Comparison of prognosis after transurethral resection of bladder tumor between solitary and multiple bladder cancers.

This study investigates the difference in overall survival rates after transurethral resection of bladder tumor between solitary and multiple bladder cancers, aiming to provide guidance for clinical practitioners. A retrospective analysis was conducted on 133 patients with bladder cancer who underwent transurethral resection of bladder tumor from April 2017 to October 2023, of which 112 patients had complete clinical and follow-up data. Clinical and follow-up data were collected, and the overall survival rates after surgery were compared between solitary and multiple bladder cancers. In this study, the recurrence rate after transurethral resection of bladder tumor was 23.21% (26/112), and the overall survival rate was 80.36% (90/112). The overall survival rate after transurethral resection of bladder tumor was 92.11% (35/38) in the solitary bladder cancer group and 74.32% (55/74) in the multiple bladder cancer group, with a statistically significant difference between the 2 groups (P = .025). The proportion of high-grade pathology was 7.89% (3/38) in the solitary bladder cancer group and 25.68% (19/74) in the multiple bladder cancer group after transurethral resection of bladder tumor, with a statistically significant difference between the 2 groups (P = .025). The mean tumor diameter after transurethral resection of bladder tumor was 2.76 ± 1.66 cm in the solitary bladder cancer group and 4.04 ± 3.17 cm in the multiple bladder cancer group, with a statistically significant difference between the 2 groups (P = .023). Univariate and multivariate regression analyses revealed that the number of bladder tumors is a risk factor for overall survival after bladder cancer surgery (P = .004). Multiple bladder cancers have a higher pathological grade, larger tumor diameter, and poorer prognosis after transurethral resection of bladder tumor compared to solitary bladder cancers. The number of bladder tumors is an independent risk factor for overall survival after bladder cancer surgery.

Reclaiming Social Justice

Abstract: A central tenet of the social work profession is its commitment to social justice. This commitment is outlined by the major governing bodies across social work education and practice, intra- and internationally. However, clinical social work has historically been influenced by the evidence-based movement and broadly adopted medicalized models of practice by focusing on treatment model adherence and symptom reduction. Consequently, clinical practitioners have been criticized for not adequately addressing systemic oppression and social injustices affecting vulnerable and historically marginalized populations. The absence of a social justice orientation to clinical practice not only lacks alignment with social work's core values but, in the current socio-political environment, may further perpetuate oppression. Clinical supervision, a staple in developing professional skills for graduate students and novice clinicians, offers an ideal pedagogical space for developing the cognitive, emotional, and behavioral skills and competencies needed to engage in social justice-focused practice. The aim of this article is to offer a supervisory framework, the Critical Relational Model (CRM), grounded in a metatheory that integrates principles from critical theory, critical pedagogy, and anti-oppressive and decolonizing frameworks, applied through a relational lens. A second aim is to demonstrate how the CRM can be immediately applied to practice with novice clinicians, graduate students, and any other clinical practitioner wishing to enhance their effectiveness and participation in creating a more equitable and just society for all.

Drug-associated glaucoma: A real-world study based on the Food and Drug Administration adverse event reporting system database.

This study aims to assess the risk of drug-associated glaucoma and track its epidemiological characteristics using real-world data. Adverse event reports from the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to December 2023 were analysed. Disproportionality analysis and the Bayesian Confidence Propagation Neural Network algorithm were used. The study classified drugs associated with glaucoma, assessed risk levels, and compared drug-induced times across different categories. Eight hundred and five drugs were linked to glaucoma in the FAERS database. Disproportionality analysis identified 46 drugs with significant risk, mainly adrenergic medications (clobetasol propionate, fluocinolone acetonide), antihypertensives (hydrochlorothiazide), insulin (insulin human), anticholinergics (umeclidinium, darifenacin), VEGF inhibitors (brolucizumab, faricimab), and psychotropics (topiramate, ziprasidone). The top three high-risk drugs were clobetasol propionate, umeclidinium, and fluocinolone acetonide. The shortest drug-induced times were observed with indacaterol, salmeterol, and umeclidinium. Anticholinergic medications had the shortest drug-induced time among all categories. Females (62.5%) and the elderly (average age 63.5 ± 16.8 years) were predominantly affected. Reports of drug-associated glaucoma increased over the years. Preventing drug-associated glaucoma is more effective than treatment. Identifying the risk and drug-induced times of systemic and ophthalmic drugs can reduce occurrence risk. Clinical practitioners should be vigilant and inform patients of these risks.

Genomic characterization of Pantoea dispersa A003 isolated from a clinical patient

IntroductionPantoea dispersa is a Gram-negative bacterium generally considered as a plant pathogen and rarely causes human infections. To date, there have been 13 studies that have documented clinical infections linked to P. dispersa, with a primary emphasis on the initial identification of this pathogen. The genomic features and the mechanisms underlying the pathogenesis of P. dispersa remain largely uninvestigated. In the present study, we describe a clinical infection caused by P. dispersa and provide the first genomic analysis of this bacterium.MethodsThe bacterial strain designated A003 was isolated from blood samples. Preliminary identification of strain A003 was conducted using matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) technology (VITEK® MS, bioMérieux, France). Biochemical and antimicrobial susceptibility assessments were carried out utilizing the VITEK-2 compact automated microbial analysis system (bioMérieux, France). Additionally, whole genome sequencing and subsequent analysis were performed to further elucidate the potential pathogenicity.ResultsThe bacterial isolate was cultured overnight at 35°C in a CO2-enriched environment on Columbia blood agar, resulting in the appearance of a white, smooth, Gram-negative rod-shaped bacterium with diameters ranging from 1 to 2 mm. Identification of strain A003 was achieved with a high confidence level of 99.9% as P. dispersa using MALDI-TOF mass spectrometry. The average nucleotide identity (ANI) value between strain A003 and the reference strain P. dispersa DSM 30073T was 98.08%, while the DNA–DNA hybridization (DDH) value was 84.10% (Formula 2) based on genome sequencing data, which further confirmed that A003 belonged to the P. dispersa species. Comprehensive analysis revealed the presence of 372 virulence factors, 15 antibiotic resistance genes, 222 carbohydrate-active enzymes, and 666 genes related to Type III secretion system (T3SS) effector proteins, as identified through the core databases of VFDB (Virulence Factors of Pathogenic Bacteria), CARD (Comprehensive Antibiotic Resistance Database), CAZY (Carbohydrate-Active enZYmes Database), and T3SS. The virulence factors included type IV pili (TFP), type VI secretion system, flagella, iron uptake system, and ompA, which are implicated in bacterial pathogenicity. The antibiotic resistance profile indicated resistance to fluoroquinolones, cephalosporins, penams, macrolides, and aminoglycosides, as annotated by the CARD database.ConclusionThe draft genome sequenced represents the inaugural genomic sequence of P. dispersa derived from clinical sources. This advancement may enhance clinical practitioners’ comprehension of the organism’s clinical attributes and serve as a foundational resource for future research into its virulence, antibiotic resistance, and host–pathogen interactions.

Unveiling diagnostic information for type 2 diabetes through interpretable machine learning

The interpretability of disease prediction models is often crucial for their trustworthiness and usability among medical practitioners. Existing methods in interpretable artificial intelligence improve model transparency but fall short in identifying precise, disease-specific primal information. In this work, an interpretable deep learning-based algorithm called the data space landmark refiner was developed, which not only enhances both global interpretability and local interpretability but also reveals the intrinsic information of the data distribution. Using the proposed method, a type 2 diabetes mellitus diagnostic model with high interpretability was constructed on the basis of the electronic health records from two hospitals. Moreover, effective diagnostic information was directly derived from the model’s internal parameters, demonstrating strong alignment with current clinical knowledge. Compared with conventional interpretable machine learning approaches, the proposed method offered more precise and specific interpretability, increasing clinical practitioners’ trust in machine learning-supported diagnostic models.

Clinical Insights and Future Prospects: A Comprehensive Narrative Review on Immunomodulation Induced by Electrochemotherapy.

Electrochemotherapy (ECT) is an emerging therapeutic approach gaining growing interest for its potential immunomodulatory effects in cancer treatment. This narrative review systematically examines the current state of knowledge regarding the interplay between ECT and the immune system. Through an analysis of preclinical and clinical studies, the review highlights ECT capacity to induce immunogenic cell death, activate dendritic cells, release tumor antigens, trigger inflammatory responses, and occasionally manifest systemic effects-the abscopal phenomenon. These mechanisms collectively suggest the ECT potential to influence both local tumor control and immune responses. While implications for clinical practice appear promising, warranting the consideration of ECT as a complementary treatment to immunotherapy, the evidence remains preliminary. Consequently, further research is needed to elucidate the underlying mechanisms, optimize treatment protocols, explore potential synergies, and decipher the parameters influencing the abscopal effect. As the field advances, the integration of ECT's potential immunomodulatory aspects into clinical practice will need careful evaluation and collaboration among clinical practitioners, researchers, and policymakers.

Concise guidelines for the clinical management of thrombocytopenia in cirrhosis

Thrombocytopenia in cirrhosis is causing puzzlement in clinical practice. Therefore, in order to help clinical practitioners grasp quickly and standardize the diagnosis and treatment of thrombocytopenia in cirrhosis, liver fibrosis, and portal hypertension, the Group of the Chinese Society of Hepatology of the Chinese Medical Association has organized relevant field experts to formulate the "Concise Guidelines for Clinical Management of Thrombocytopenia in Cirrhosis" with aim of providing guidance for the clinical diagnosis and treatment.

Treatment switch from multiple daily insulin injections to sulphonylureas in an African young adult diagnosed with HNF1A MODY: a case report

BackgroundMaturity onset diabetes of the young is one of the commonest causes of monogenic diabetes and can easily be mistaken for type 1 diabetes. A diagnosis of maturity onset diabetes of the young can have direct implications for genetic counseling, family screening, and precision diabetes treatment. However, the cost of genetic testing and identifying individuals to test are the main challenges for diagnosis and management in sub-Saharan Africa. We report the very first documented case of HNF1A maturity onset diabetes of the young in the sub-Saharan African region.Case presentationA 20-year-old female Black African young adult diagnosed with type 1 diabetes aged 14 presented for routine out-patient diabetes consultation. She was on multiple daily insulin injections; total combined dose 0.79 IU/kg/day with an HbA1c of 7.7%. The rest of her laboratory examinations were normal. On extended laboratory analysis, she had good residual insulin secretion with post-meal plasma C-peptide levels at 1150 pmol/L. She tested negative for glutamic acid decarboxylase (GAD65), islet antigen-2 (IA-2), and zinc transporter 8 (ZnT8) islet autoantibodies. Targeted next-generation sequencing (t-NGS) for monogenic diabetes was performed using DNA extracted from a buccal sample. She was diagnosed with HNF1A maturity onset diabetes of the young, with the c.607C > T; p.(Arg203Cys) pathogenic variant, which has never been reported in sub-Saharan Africa. Her clinical practitioners provided genetic and therapeutic counseling. Within 10 months following the diagnosis of maturity onset diabetes of the young, she was successfully switched from multiple daily insulin injections to oral antidiabetic tablets (sulphonylurea) while maintaining stable glycemic control (HBA1c of 7.0%) and reducing hypoglycemia. She expressed a huge relief from the daily finger pricks for blood glucose monitoring.ConclusionThis case reveals that HNF1A maturity onset diabetes of the young (and probably other causes of monogenic diabetes) can present in sub-Saharan Africa. A diagnosis of maturity onset diabetes of the young can have significant life-changing therapeutic implications.

Predictive factors for the development of depression in children and adolescents: a clinical study.

The prevalence of depression among adolescents has been gradually increasing with the COVID-19 pandemic, and the purpose of this study was to develop and validate logistic regression models to predict the likelihood of depression among 6-17 year olds. We screened participants from the National Center for Health Statistics (NCHS) in 2022. Independent risk factors were identified via univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) for feature screening. Area under the curve (AUC) and decision curve analysis (DCA) were used to compare the predictive performance and clinical utility of these models. In addition, calibration curves were used to assess calibration. Multivariate logistic regression analyses revealed that risk factors for depression included girls, higher age, treated/judged based on race/ethnicity, ever lived with anyone mentally ill, experienced as a victim of/witnessed violence, and ever had autism, ever had attention-deficit disorder (ADD), etc. Afterwards, the results are visualized using a nomogram. The AUC of the training set is 0.731 and the AUC of the test set is 0.740. Also, the DCA and calibration curves demonstrate excellent performance. Validated nomogram can accurately predict the risk of depression in children and adolescents, providing clues for clinical practitioners to develop targeted interventions and support.

Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial

ObjectiveTo rigorously evaluate the short-term and long-term effectiveness of Tuina (TN), alone and in combination with physiotherapy (PT), for Chronic nonspecific low back pain (CNLBP) through a comprehensive, high-quality clinical trial. MethodsThis randomized, single-blind trial was conducted from September 2020 to July 2023, involving 204 CNLBP patients from the First Affiliated Hospital of Jinan University. Participants underwent a baseline assessment, 6 treatment sessions over 8 weeks, a post-treatment evaluation in the 9th week, and a 20-week follow-up. Participants were randomly assigned to TN, PT, or a combination of TN and PT (TP) groups. Each treatment involved 6 sessions with a minimum 7-day interval, each lasting 30 minutes. Primary outcome was the change in Visual Analog Scale (VAS) for pain. Secondary outcomes included the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Range of Motion (ROM) of the spine, Traditional Chinese Medicine Syndrome Scale (TCMSS), and adverse events (AE). ResultsAmong the 204 participants, 67.16 % were female, and 88.73 % completed the 20-week follow-up. All groups showed significant reductions in VAS scores post-treatment and at follow-up. Secondary outcomes improved significantly, with notable decreases in ODI and TCMSS scores. Pairwise comparisons within groups indicated statistical significance, particularly in ODI scores, with clinical relevance. No significant differences were found between the groups. ROM and SF-36 showed statistical but not clinical significance. Only one AE (0.49 %) was reported, with no severe incidents. ConclusionAll treatment groups, including TN, TP, and PT, demonstrated significant reductions in VAS scores for CNLBP patients, with effects lasting up to 20 weeks. While TN and TP showed substantial improvements in secondary outcomes, particularly in ODI scores, no significant differences were found between the groups. These findings suggest that all treatments can be effective for managing CNLBP, supporting clinical practitioners in selecting appropriate interventions for patients, especially for those unable to engage in active exercises, utilizing passive movements like TN to enhance health outcomes.

Diagnosing acute appendicitis: a case study.

Advanced clinical practitioners (ACPs) are experienced health professionals educated to master's level. They are accountable for the assessment, diagnosis and treatment of individuals, and are responsible for making complex decisions. The case study presented in this article critically analyses the consultation involving a male patient in his sixties with a 2-day history of abdominal pain, who was referred by his GP to a surgical assessment unit. Analysis was carried out using the Calgary-Cambridge Model. The article discusses history-taking, abdominal examination and differential diagnoses, and presents the process of how the trainee ACP arrived at the diagnosis of appendicitis.

The role of ACPs in recognising and treating diabetic ketoacidosis and hyperosmolar hyperglycaemic state.

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are both diabetic emergencies that require immediate identification and intervention. Advanced clinical practitioners (ACPs) play a crucial role in the early detection, management and co-ordination of care for patients with these conditions, although some may feel less confident in handling such complex cases. This clinical review explores the role of ACPs in managing DKA and HHS, focusing on their responsibilities in diagnosis, treatment initiation, and communication within multidisciplinary teams. It also examines the epidemiology, pathogenesis, risk factors, and causes of these conditions, alongside diagnostic criteria and management strategies. In addition, the review highlights the importance of minimising risks and preventing recurrence to ultimately enhance patient outcomes.

Biological Methods for Diagnosing Depressive Symptoms in Patients with Schizophrenia: A Narrative Review.

Depressive symptoms in patients with schizophrenia lead to more frequent exacerbations of the underlying disease, worsen the prognosis, and increase the risk of suicide. Clinical practitioners continue to face challenges in diagnosing this disorder. This study aims to analyze published material on biological markers of depressive symptoms in patients with schizophrenia. The search of literature was conducted using the following electronic search engines (the total number of relevant papers found is also specified): ACCESSSS (n=150), Cochrane Library (n=48), PubMed (n=623), eLIBRARY (n=216), and Google Scholar (n=367). The final discussion included 67 papers consistent with the study aim and were published between January 1, 2018 and December 31, 2023. Based on the available scaterred data, it appears that plasma biomarkers (e.g. C-reactive protein, metabolic parameters, hormones, enzymes, neurotrophic factors) are limited in specificity when it comes to diagnosing depressive symptoms in schizophrenia. Our analysis of the neuroimaging findings showed that depressive manifestations are associated with a decrease in the volume of the gray matter in the parietal, frontal, and temporal lobes (particularly in Broca's and Wernicke's areas) and in specific regions of the prefrontal cortex (including the medial right superior frontal, medial orbitofrontal, and superior and middle frontal gyri). It has been suggested that the SIRT1, OXT, CDKAL1, and APOE genes are involved in the development of depressive symptoms in patients with schizophrenia. Understanding and identifying depressive symptoms in schizophrenia will improve the quality of care for patients with this disorder.