Medicine Collaborative Research Articles

Genome-wide Association Study of Caffeine Consumption Using Coriell Personalized Medicine Collaborative Data

More than 90% of Americans consume caffeine daily, but the amount consumed varies widely. Previous studies have shown that genes related to caffeine metabolism and receptor binding may influence caffeine consumption. A better understanding of the relationship between genotype and caffeine consumption has the potential to inform mechanisms of this common dietary behavior. We performed a genome-wide association study (GWAS) of self-reported consumption data combining a wide range of caffeinated beverages including coffee, tea, soda, and energy drinks in the Coriell Personalized Medicine Collaborative (N=2,830) using a generalized linear model. Our analysis identified several candidate loci implicated in caffeine consumption. One previously identified SNP associated with caffeine consumption and replicated in the current study, rs2472297 (P-value=3.8x10-6), is located in an intergenic region between CYP1A1 and CYP1A2 (the gene that encodes the enzyme primarily responsible for caffeine metabolism), and has been associated with caffeine consumption in prior studies. Our results further support follow-up functional studies focused on the role of CYP1A1 and CYP1A2 on caffeine consumption habits, metabolism, and health status and outcomes.

Recognizing and addressing environmental microaggressions, know-your-place aggression, peer mediocrity, and code-switching in STEMM.

Diversity, equity, and inclusion (DEI) initiatives are critical for fostering growth, innovation, and collaboration in science, technology, engineering, mathematics, and medicine (STEMM). This article focuses on four key topics that have impacted many Black individuals in STEMM: know-your-place aggression, environmental microaggressions, peer mediocrity, and code-switching. We provide a comprehensive background on these issues, discuss current statistics, and provide references that support their existence, as well as offer solutions to recognize and address these problems in the STEMM which can be expanded to all historically underrepresented individuals.

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.

Ensemble-GNN: federated ensemble learning with graph neural networks for disease module discovery and classification.

Federated learning enables collaboration in medicine, where data is scattered across multiple centers without the need to aggregate the data in a central cloud. While, in general, machine learning models can be applied to a wide range of data types, graph neural networks (GNNs) are particularly developed for graphs, which are very common in the biomedical domain. For instance, a patient can be represented by a protein-protein interaction (PPI) network where the nodes contain the patient-specific omics features. Here, we present our Ensemble-GNN software package, which can be used to deploy federated, ensemble-based GNNs in Python. Ensemble-GNN allows to quickly build predictive models utilizing PPI networks consisting of various node features such as gene expression and/or DNA methylation. We exemplary show the results from a public dataset of 981 patients and 8469 genes from the Cancer Genome Atlas (TCGA). The source code is available at https://github.com/pievos101/Ensemble-GNN, and the data at Zenodo (DOI: 10.5281/zenodo.8305122).

Emergency departments: An underutilized resource to address pediatric influenza vaccine coverage

BackgroundEmergency department (ED) based influenza vaccine (IV) programs have been successful in adults; however, little is known about pediatric ED IV programs in terms of prevalence, feasibility, or successful implementation. AimsTo describe the reach and effectiveness of IV practices in pediatric EDs, and identify IV facilitators and barriers. MethodsWe assessed, via cross-sectional survey of pediatric ED physicians, number of EDs offering IV to children, vaccines administered annually, and perceived facilitators/barriers to vaccination. The proportion of EDs offering IV is reported. Chi-square tests compared facilitators and barriers among high performers (≥50 IV/year), low performers (<50 IV/yr), and non-vaccinators. We calculated an area of missed effect for the number of children who could be vaccinated if non-vaccinating EDs offered IV. ResultsAmong 492 physicians from 166 EDs, 142 responded (representing 61 (37.3 %) EDs). Most EDs were in large, urban, academic, freestanding children’s hospitals (Table 1). Only twenty-six EDs (44.3 %) offer ≥ 1 IV/yr. Seventeen (65.4 %) were low performers, five (19.2 %) high performers, and four (15.4 %) were model programs. High/model performers used establish workflows more commonly than lower performers (78 % vs. 33 %), although this was not statistically significant (p = 0.077). Common facilitators included: strong provider and administration buy-in, electronic health record facilitation, storage/accessibility, and having a leadership team/champion (Fig. 1). Non-vaccinators commonly perceived lack of these factors as barriers. Many (24/61, 39.3 %) EDs expressed interested in establishing or growing IV programs. Up to 18,250 unvaccinated children could receive IV annually if non-vaccinating EDs offered IV during influenza season. ConclusionsOver half of EDs participating in the Pediatric Emergency Medicine Collaborative Research Committee do not currently offer pediatric IV. Addressing identified barriers/facilitators to develop IV programs in EDs has potential to improve vaccination rates, especially among minority and underserved children.

Neonatal Outcome with Magnesium Sulphate and Fentanyl as Adjuvants for Epidural Labour Analgesia: A Prospective Comparative Study

Introduction: The pain of childbirth is arguably the most severe pain most women endure in their lifetime. Since pain relief in labor has always been surrounded by myths and controversies, providing effective and safe analgesia during labor has remained an ongoing challenge. Neuraxial techniques are accepted as the gold standard for intrapartum labor analgesia. The study aimed to determine the neonatal outcome with magnesium sulfate and fentanyl as adjuvant for epidural labor analgesia. Methods: This prospective comparative study was conducted at the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine in collaboration with the obstetric department, Dhaka Medical College, Dhaka.Bangladesh. The study was carried out from October 2020 to March 2021. A total of 60 patients were assigned by computer-generated random table to one group (Group A) and another group (Group B). Group-A (n=30): Group-A received Fentanyl 25 micrograms as adjuvant to bupivacaine (0.5% plain bupivacaine 2.5 ml+25 microgram of fentanyl 0.005% 0.5 ml + 7 ml normal saline=10 ml) via epidural catheter. Group B received MgSO4 50 mg as an adjuvant to bupivacaine (0.5% plain bupivacaine 2.5 ml + 50 mg of MgSO4 10% 0.5 ml +7 ml normal saline=10 ml) via epidural catheter. Data were statistically described in terms of mean ± standard deviation (±SD), or frequencies (number of cases) and percentages when appropriate. Comparison of numerical variables between the study groups was done using the Student t-test for independent samples. For comparing categorical data, a Chi-square (x2) test was performed. P values of less than 0.05 were considered statistically significant. F-value was determined by the Repeated measured ANOVA test where data were repeated more than one time. All statistical calculations were done using the computer program SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 22 for Microsoft Windows. Informed written consent ......

Comparison of Complications with Magnesium Sulphate &amp; Fentanyl as Adjuvants for Epidural Labor Analgesia

Introduction: Effective and safe analgesia during labor has remained an ongoing challenge. Many pharmacological and non-pharmacological methods of labor analgesia have been adopted over the years. Of these, neuraxial or regional analgesia has become the most popular method. Possible regional anesthesia techniques include epidural analgesia, spinal analgesia, or a combination of epidural and spinal analgesia. This study aimed to compare the complications with magnesium sulfate and fentanyl as adjuvants for epidural labor analgesia. Methods: This prospective comparative study was conducted at the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine in collaboration with the obstetric department, Dhaka Medical College, Dhaka.Bangladesh. The study was carried out from October 2020 to March 2021. A total of 60 patients were assigned by computer- generated random table to one group (Group A) and another group (Group B). Group-A (n=30): Group-A received Fentanyl 25 micrograms as adjuvant to bupivacaine (0.5% plain bupivacaine 2.5 ml+25 microgram of fentanyl 0.005% 0.5 ml + 7 ml normal saline=10 ml) via epidural catheter. Group B received MgSO4 50 mg as an adjuvant to bupivacaine (0.5% plain bupivacaine 2.5 ml + 50 mg of MgSO4 10% 0.5 ml +7 ml normal saline=10 ml) via epidural catheter. Data were statistically described in terms of mean ± standard deviation (±SD), or frequencies (number of cases) and percentages when appropriate. Comparison of numerical variables between the study groups was done using the student t-test for independent samples. For comparing categorical data, a Chi-square (x2) test was performed. P values of less than 0.05 were considered statistically significant. F-value was determined by the Repeated measured ANOVA test where data were repeated more than one time. All statistical calculations were done using the computer program SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 22 for ........

Standardized Methodology for Duplex Ultrasound Examination of Arteriovenous Access for Hemodialysis: A Proposal of the French Society of Vascular Medicine and the French-Speaking Society of Vascular Access.

Duplex ultrasound (DUS) is an essential tool for characterizing and monitoring arteriovenous (AV) access for hemodialysis. The aim of the work described here, requested by the French Society of Vascular Medicine in collaboration with the French-Speaking Vascular Access Society, is to propose a standardized methodology for performing and documenting DUS, taking into account the variety of AV access techniques and the problems routinely encountered. A steering committee reviewed the literature and selected the relevant references. A draft was prepared, and all items with missing or conflicting data were submitted to a Delphi consensus. The final document was discussed and approved by all participants. The principles of DUS evaluation of AV access consist of examination of the afferent artery, the anastomosis and the entire venous drainage system. DUS uses B-mode ultrasound, color flow, pulsed wave and power Doppler analysis. DUS can be used in a variety of clinical situations, which can directly influence the methodology of the examination and the interpretation of the results. Blood flow should be assessed as it correlates with the risk of thrombosis. The measurement should be adapted to the different anatomical and hemodynamic conditions encountered. Characterization of stenosis should take into account the residual diameter of the drainage vein and its hemodynamic consequences. Other complications can be assessed with a standardized DUS examination. When performed according to a rigorous methodology, DUS of the AV access allows a comprehensive assessment of its functionality and eliminates the need for further invasive diagnostic procedures.

Complications after therapeutic plasma exchange within 24 hours

Background: By therapeutic apheresis is to remove a pathologic element from blood or to modulate cellular function. By this study we observed, complications after the therapeutic plasma exchange (TPE) within 24 hours with respect to patient’s demographic profiles and procedural variations. Methods: One-year prospective observational study conducted by the Department of Transfusion Medicine in collaboration with the Medicine Department, King George’s Medical University, Lucknow India. Results: In our study total of 60 cases and total of 150 TPE cycles were performed. Maximum mean age (36±4) was observed for cough and vomiting both and maximum mean BMI was observed followed for Infection at phlebotomy site (36.34±5.09). Maximum mean variation of hemoglobin was observed for vomiting (2.28±0.00), followed by internal bleeding. Maximum mean variation of activated partial thromboplastin time (aPTT) was observed for cough (22.05±0.34), followed by vomiting. Maximum mean variation of prothrombin time (PT) was observed for hypothermia (13.16±10.47), followed by internal bleeding. Maximum mean variation of S. creatinine was observed for abdominal discomfort (0.23±1.54), followed by vomiting. Maximum mean variation of systolic blood pressure (SBP) was observed for cough (7.00±5.20), followed by bipedal edema. Maximum mean variation of SpO2 was observed for death. Conclusions: Complication within 24 hours after the procedure was abdominal discomfort mainly in males with a correlation with body mass index (BMI). We observed significant positive association with complication versus APTT, PT, S. urea, S. creatinine, pulse, SBP, SpO2 and BMI. This emphasizes the decreasing trend of the complications with the increase in number of cycles.

Collaboration against infectious diseases in border region between North and South Korea

This study aims to prepare countermeasures that prevent the spread of infectious diseases including malaria and African Swine Fever (ASF) in regions adjacent to the DMZ and border region between North and South Korea and propose exchanges and collaboration measures between North and South Korea against diseases. For this, we reviewed cases of inter-Korean cooperation promoted by the Korean government or local governments and related studies and examined collaboration and problem factors in health and medicine between North and South Korea. Additionally, rooted by the exchange model for border areas between East and West Germany, we suggest applicable measures in the inter-Korean border areas. We put forward proposals for the continuous and specific development of inter-Korean health and medical cooperation plan on the basis of establishing Committee on Border Areas and Agreement on Health and Medicine by supplementing the limitation of piecemeal approach and support at one-time in North-South Korea relations in the past. Additionally, the current study suggests the need for inter-Korean cooperation at the local government level for joint malaria prevention, and prevention of the spread of livestock infectious diseases.

Effectiveness of Ultrasonography Guided Pectoral Nerve Block for Post-Operative Analgesia in Modified Radical Mastectomy

Background: Modified radical mastectomy surgery results in high morbidity and patient dissatisfaction due to incomplete postoperative pain relief. The most frequent malignancy among women worldwide is breast cancer. Objectives: The aim of this study was to assess effectiveness of ultrasonography-guided Pectoral nerve block for postoperative analgesia after Modified radical mastectomy. Methods: This descriptive type of cross-sectional study was carried out in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine in collaboration with department of surgery, Dhaka Medical College &amp; Hospital, Dhaka during July 2021 to June 2022. A total of 28 patients were participate in this study. Purposive sampling technique was followed. After taking consent and matching eligibility criteria, data were collected from patients using the predesigned structured questionnaire by interview. Statistical analyses of the results were obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-25). Results: Mean age of patient was 54.7 ± 7.3 years majority belonged to 50-59 years of age (39.2%). Maximum patient had ASA Class II (60.7%). In case of staging of the cancer 39.2% were in stage I and 60.8% were in stage II. Average duration of surgery was 119.4 ± 14.2 minutes. The mean VAS score of the patients at 2nd hrs was 0.52±0.2, at 4th hrs was 0.65±0.3, at 6th hrs was 1.12±0.6, at 8th hrs was 2.31±1.35, at 10th hrs was 3.34±1.45, at 12th hrs was 4.83±1.40, at 14th hrs was 2.24±1.30, at 16th hrs, at 18th hrs 2.74±1.65, at 20th hrs was 4.48±1.70 and at 24th hrs was 2.28±1.80. the mean 1st analgesic demand (hour) was 12.2±2.1 and the Total opioid consumption (mg) was 165.7±18.2. Conclusion: For postoperative pain management after breast surgery, various procedures have been employed, including local anesthetic infiltration, intercostal nerve block, thoracic epidural block, and paravertebral block. They might not be appropriate ..

Refreshing the emergency medicine research priorities

BackgroundThe priorities for UK emergency medicine research were defined in 2017 by a priority setting partnership coordinated by the Royal College of Emergency Medicine in collaboration with the James Lind...

Enhancing professional development and promoting collaboration in hospital medicine through the visiting professor exchange program.

Enhancing professional development and promoting collaboration in hospital medicine through the visiting professor exchange program.

The clinical impact of amino acid positron emission tomography measurements in the treatment of primary malignant brain tumors

Despite the large-scale diagnostic and therapeutic progress of recent years, the heterogeneity and therapeutic management of adult primary malignant brain tumors pose a significant challenge to the attending physician. Based on the research and experience accumulated over the past two decades, the range of patients who can benefit the most from complex oncology treatment has been outlined, and it has been confirmed that a reliable complex diagnostic background is essential for adequate therapeutic management. However, after some necessary therapeutic steps, the "gold standard" magnetic resonance imaging (MRI) is not always able to accurately assess and diagnose post-therapeutic conditions. Thanks to the collaboration of the nuclear medicine and neuro-oncology professions, more and more types of radiotracer compounds are now available in more and more centers, including amino acid ligands and thus, positron emission tomography (PET) examinations with the radiopharmaceutical O-(2-[18F]fluoroethyl)-L-tyrosine. The metabolic state, as a kind of fourth dimension of imaging, is an essential part of adequate modern diagnostics. Combining advanced MRI techniques and PET-based (PET/CT, PET/MRI) measurements with a suitable tracer can place therapeutic decisions on a reliable basis. We present the clinical significance of amino acid-PET-based hybrid nuclear medicine imaging studies in the therapeutic management of these patients by reviewing the literature data on the practice of the method in Hungary and abroad and presenting the results of our retrospective summary research so far. Orv Hetil. 2023; 164(32): 1247-1255.

Interdisciplinary multimodal assessment : Interprofessional interaction in team meetings and final talks

In PAIN2020 (Innovation Fund, 01NVF17049), an outpatient interdisciplinary multimodal assessment (IMA) was introduced early in the course of the disease. The central quality feature is the close interdisciplinary collaboration of pain medicine, physiotherapy and psychology, which requires acomplex organizational and coordination process, especially in team meetings and final discussions. The (different) views of the professional groups involved are brought together in the team process as acommon consensus. The process of shaping the interaction of the professional groups among each other in the team meeting and final discussion as well as with the patients is examined (qualitatively) and discussed. In PAIN2020, aworkshop on IMA was held to jointly reflect on the insights and experiences gained in the process so far through monitoring with staff or teams of the PAIN2020 centers. In one of three work phases, interprofessionally composed groups gathered statements from participants on the design of the interaction in team meeting and final discussion in three rotating rounds within the framework of aWorld Café. It was possible to identify conducive and obstructive factors for the design of interdisciplinary collaboration in team meetings and final discussions, which were brought together in asuperordinate framework model. The provision of the new care service as an interdisciplinary task in ateam goes beyond existing structural and process parameters in the definition of framework conditions in interdisciplinary multimodal pain therapy and should therefore also take personal competencies and professional competencies into account. Therefore, new dimensions arise for the implementation of the IMA, which should be discussed in the future.

Collaborations in Art and Medicine: Institutional Critique, Patient Participation, and Emerging Entanglements

Abstract In recent decades, collaborations between artists and clinicians or biomedical researchers have become increasingly common and now constitute a distinctive category of art-science collaboration. This article reflects on the intellectual and material conditions of such collaborations, exploring two genealogies for these practices—”sciart” and arts and health—with a focus on two key areas: (1) the need for stakeholders to recognize fine art practice as research and knowledge-production (rather than merely as illustrative, educational, or therapeutic); (2) the challenges and opportunities presented by patient-participant involvement. Finally, it explores critical medical humanities as an emergent framework currently shaping these kinds of collaborations.

Prolidase activity in adult bipolar disorder patient: a case - control study

Background: Bipolar disorder is one of the major neuropsychiatric illnesses. It is responsible for 6.8% of disability-adjusted life years among all mental disorders. Few studies have evaluated the biochemical basis of bipolar disorder. Prolidase is an enzyme that degrade extracellular matrix into proline. In stress condition, prolidase by releasing proline maintain ATP generation, redox state, apoptosis and cell proliferation. The relationship between serum prolidase with bipolar disorder was investigated in this study. Method: A case - control study was conducted at the Department of Laboratory Medicine in collaboration with the Department of Psychiatry of Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2021 to February 2022. Thirty-five patients with bipolar disorder type I consisting of 15 euthymic and 20 manic patients were enrolled in the study according to the availability of patients as cases. Thirty-five age - and sex-matched healthy individuals were recruited from the Department of Laboratory Medicine as controls. Serum prolidase level was measured in cases and controls using venous blood. Result: Serum prolidase level was significantly higher in cases than controls (P=0.021). There was no significant differences between euthymic and manic patients (P=0.629). Significant positive correlation was found between Young Mania Rating Scale severity score and serum prolidase level (P=0.001). Conclusion: Serum prolidase activity may be associated with bipolar disorder. This needs further corroboration because our sample size was small.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Authors’ response to Letters to the Editor re: Clinical public health: harnessing the best of both worlds in sickness and in health

We are pleased that our paper on clinical public health1 received support from Dr. Shah,2 who also provides important historical aspects of clinical public health. Dr. Shah was the inaugural director of a newly created residency program (Community Medicine, now known as Public Health and Preventive Medicine) at the University of Toronto in 1976. Although he claims to have failed to “bring clinicians and public health professionals together to define the common elements and synergy needed,”2 we believe he did not fail, because his efforts ignited sparks among his students (including several co-authors of this paper1). Building on his important legacy, subsequent generations of clinicians and public health professionals have made strides towards effective collaboration of clinical medicine and public health.