Management Of Disease Research Articles

The Therapeutic Potential of the Specific Intestinal Microbiome (SIM) Diet on Metabolic Diseases

Exploring the intricate crosstalk between dietary prebiotics and the specific intestinal microbiome (SIM) is intriguing in explaining the mechanisms of current successful dietary interventions, including the Mediterranean diet and high-fiber diet. This knowledge forms a robust basis for developing a new natural food therapy. The SIM diet can be measured and evaluated to establish a reliable basis for the management of metabolic diseases, such as diabetes, metabolic (dysfunction)-associated fatty liver disease (MAFLD), obesity, and metabolic cardiovascular disease. This review aims to delve into the existing body of research to shed light on the promising developments of possible dietary prebiotics in this field and explore the implications for clinical practice. The exciting part is the crosstalk of diet, microbiota, and gut–organ interactions facilitated by producing short-chain fatty acids, bile acids, and subsequent metabolite production. These metabolic-related microorganisms include Butyricicoccus, Akkermansia, and Phascolarctobacterium. The SIM diet, rather than supplementation, holds the promise of significant health consequences via the prolonged reaction with the gut microbiome. Most importantly, the literature consistently reports no adverse effects, providing a strong foundation for the safety of this dietary therapy.

Consideration of T-cell profile in the examination of statin efficacy in inflammatory diseases, neurodegeneration, and neurocognitive performance.

Statins are a cornerstone in the medical management of cardiovascular disease, yet their efficacy varies greatly between individuals. In this commentary, we outline evidence for the role of CD4+CD28null T-cell expansion as a critical moderator of the effects of statins in preventing cardiovascular events via the reduction of pathological inflammation. Given this relationship, we argue that T-cell profiles should be considered as a patient characteristic in clinical and pre-clinical studies examining statin efficacy in other age- and inflammation-related pathologies. We discuss the implications this may have for studies of statin use in numerous disease processes - notably, dementia and neurocognitive dysfunction - and the potential for T-cell profiles to be used as a prognosticator for statin efficacy in rheumatoid arthritis, Alzheimer's disease, and multiple sclerosis.

AVT04: An Ustekinumab Biosimilar.

AVT04 (Uzpruvo®) is a biosimilar of the reference anti-interleukin (IL)-12 and IL-23 monoclonal antibody ustekinumab. It is approved in the EU for plaque psoriasis, paediatric plaque psoriasis, psoriatic arthritis and Crohn's disease as per the reference product. AVT04 has similar physicochemical characteristics to those of reference ustekinumab, and the pharmacokinetic similarity of the agents has been shown in healthy volunteers and patients with moderate to severe chronic plaque psoriasis. AVT04 demonstrated clinical efficacy similar to that of reference ustekinumab in patients with moderate to severe chronic plaque psoriasis, and was generally well tolerated in this population. The tolerability, safety and immunogenicity profiles of AVT04 were similar to those of reference ustekinumab, and switching from reference ustekinumab to AVT04 had no impact on efficacy, safety or immunogenicity. The role of reference ustekinumab in the management of inflammatory diseases is well established and AVT04 provides an effective biosimilar alternative for patients requiring ustekinumab therapy.

Application of natural-products repurposing strategy to discover novel FtsZ inhibitors: Bactericidal evaluation and the structure-activity relationship of sanguinarine and its analogs

The novel bactericidal target—filamentous temperature-sensitive protein Z (FtsZ)—has drawn the attention of pharmacologists to address the emerging issues with drug/pesticide resistance caused by pathogenic bacteria. To enrich the structural diversity of FtsZ inhibitors, the antibacterial activity and structure-activity relationship (SAR) of natural sanguinarine and its analogs were investigated by using natural-products repurposing strategy. Notably, sanguinarine and chelerythrine exerted potent anti-Xanthomonas oryzae pv. oryzae (Xoo) activity, with EC50 values of 0.96 and 0.93 mg L−1, respectively, among these molecules. Furthermore, these two compounds could inhibit the GTPase activity of XooFtsZ, with IC50 values of 241.49 μM and 283.14 μM, respectively. An array of bioassays including transmission electron microscopy (TEM), fluorescence titration, and Fourier transform infrared spectroscopy (FT-IR) co-verified that sanguinarine and chelerythrine were potential XooFtsZ inhibitors that could interfere with the assembly of FtsZ filaments by inhibiting the GTPase hydrolytic ability of XooFtsZ protein. Additionally, the pot experiment suggested that chelerythrine and sanguinarine demonstrated excellent curative activity with values of 59.52% and 54.76%, respectively. Excitedly, these two natural compounds also showed outstanding druggability, validated by acceptable drug-like properties and low toxicity on rice. Overall, the results suggested that chelerythrine was a new and potential XooFtsZ inhibitor to develop new bactericide and provided important guiding values for rational drug design of FtsZ inhibitors. Notably, our findings provide a novel strategy to discover novel, promising and green bacterial compounds for the management of plant bacterial diseases.

Prevalence and risk factors for gastrointestinal parasitosis in small ruminant farms in the Sahelian zone of Niger

The general aim of this study is to analyse the risk factors for gastrointestinal parasitosis in small ruminants in order to contribute to the emergence of targeted treatment methods, at herd and agro-climatic zone levels, for the integrated and sustainable management of parasitic diseases in Sahelian livestock systems. The methodology was based on a questionnaire survey conducted in 37 villages and coprological analysis using the McMaster method on faecal samples from 968 small ruminants, including 555 goats and 413 sheep. Multiple logistic regression was used to highlight the risk factors associated with each type of parasitosis encountered. The results showed that the most widespread farming system remained 100% traditional, with feeding based essentially on natural grazing. Coprological results showed the prevalence of nematodosis (70.2%), Cestodosis (4.1%) and Coccidiosis (79.9%), with an average prevalence of coinfection of 56.9%. These parasite loads were significantly higher during the rainy season and in the more arid northern Sahelian zone, with a marked reduction at the end of the season. Average parasitic egg excretions were 1089 EPG of nematodes and 6864 EPG of coccidia. Parasite loads were higher in the wetter southern strip and varied significantly by breed. Of the five breeds of small ruminants studied, the ara-ara sheep had the highest parasitic loads and prevalences for nematodosis (78.6%), coccidiosis (89,3%) and coinfection (70.9%), appears to be the most susceptible to parasitosis. As for risk factors for severe parasite pressure, animals at the end of the rainy season, older animals and those with poor body condition were at risk of nematodiasis or coinfection. On the other hand, animals at the beginning of the rainy season, farms located in less arid southern Sahelian zones and male subjects were the groups at significant risk of coccidiosis. In these extensive Sahelian farming conditions, the control of these parasitoses by selective treatment of animals could be developed, targeting in particular the risk groups highlighted in this study.

Agave Wilt Susceptibility by Reduction of Free Hexoses in Root Tissue of Agave tequilana Weber var. azul Commercial Plants in the Fructan Accumulation Process

Agave tequilana stems store fructan polymers, the main carbon source for tequila production. This crop takes six or more years for industrial maturity. In conducive conditions, agave wilt disease increases the incidence of dead plants after the fourth year. Plant susceptibility induced for limited photosynthates for defense is recognized in many crops and is known as “sink-induced loss of resistance”. To establish whether A. tequilana is more prone to agave wilt as it ages, because the reduction of water-soluble carbohydrates in roots, as a consequence of greater assembly of highly polymerized fructans, were quantified roots sucrose, fructose, and glucose, as well as fructans in stems of agave plants of different ages. The damage induced by inoculation with Fusarium solani or F. oxysporum in the roots or xylem bundles, respectively, was recorded. As the agave plant accumulated fructans in the stem as the main sink, the amount of these hexoses diminished in the roots of older plants, and root rot severity increased when plants were inoculated with F. solani, as evidence of more susceptibility. This knowledge could help to structure disease management that reduces the dispersion of agave wilt, dead plants, and economic losses at the end of agave’s long crop cycle.

Agave Wilt Susceptibility by Reduction of Free Hexoses in Root Tissue of Agave tequilana Weber var. azul Commercial Plants in the Fructan Accumulation Process.

Agave tequilana stems store fructan polymers, the main carbon source for tequila production. This crop takes six or more years for industrial maturity. In conducive conditions, agave wilt disease increases the incidence of dead plants after the fourth year. Plant susceptibility induced for limited photosynthates for defense is recognized in many crops and is known as "sink-induced loss of resistance". To establish whether A. tequilana is more prone to agave wilt as it ages, because the reduction of water-soluble carbohydrates in roots, as a consequence of greater assembly of highly polymerized fructans, were quantified roots sucrose, fructose, and glucose, as well as fructans in stems of agave plants of different ages. The damage induced by inoculation with Fusarium solani or F. oxysporum in the roots or xylem bundles, respectively, was recorded. As the agave plant accumulated fructans in the stem as the main sink, the amount of these hexoses diminished in the roots of older plants, and root rot severity increased when plants were inoculated with F. solani, as evidence of more susceptibility. This knowledge could help to structure disease management that reduces the dispersion of agave wilt, dead plants, and economic losses at the end of agave's long crop cycle.

Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population.

Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI. This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression. Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay. Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.

Mechanism and therapeutic potential of traditional Chinese medicine extracts in sepsis

Sepsis is a complex syndrome characterized by multi-organ dysfunction, due to the presence of harmful microorganisms in blood which could cause mortality. Complications associated with sepsis involve multiple organ dysfunction. The pathogenesis of sepsis remains intricate, with limited treatment options and high mortality rates. Traditional Chinese medicine (TCM) has consistently demonstrated to have a potential on various disease management. Its complements include reduction of oxidative stress, inhibiting inflammatory pathways, regulating immune responses, and improving microcirculation. Traditional Chinese medicine can mitigate or even treat sepsis in a human system. This review examines progress on the use of TCM extracts for treating sepsis through different pharmacological action and its mechanisms. The potential targets of TCM extracts and active ingredients for the treatment of sepsis and its complications have been elucidated through molecular biology research, network pharmacology prediction, molecular docking analysis, and visualization analysis. Our aim is to provide a theoretical basis and empirical support for utilizing TCM in the treatment of sepsis and its complications while also serving as a reference for future research and development of sepsis drugs.

Management and breeding for rust resistance in legumes

AbstractRust diseases are a major concern in legume production worldwide causing heavy losses especially in developing countries that depend on grain legumes as staple food. Fungal species from Uromyces, Phakopsora and Puccinia genera are the main causal agents of the various legume rust diseases. They induce up to 100% yield losses on susceptible cultivars and are emerging as a substantial threat to global food security. Developing durable resistance to rust has thus become a critical breeding objective alongside efforts to improve cultural and disease management practices. This review specifically focuses on the recent advances in understanding and enhancing genetic rust resistance across diverse legume crops. Key topics covered include: (i) the diversity and host range of the rust species affecting legumes; (ii) the disease management strategies from cultural practices to chemical control; (iii) the available screening methods for identifying new sources of resistance; (iv) the genetic basis of resistance, encompassing both major resistance genes and quantitative trait loci; (v) insights into gene regulation and effector molecules leading to legume-rust interactions; and (vi) emerging genomic-assisted breeding techniques that can accelerate the development of durable rust resistance in legumes. Overall, this review highlights the progress made to date and the remaining challenges in sustainably managing rust diseases across diverse legume crops through integrated approaches spanning pathogen biology, advanced phenotyping, genetic resistance, and molecular breeding.

Relationship Between the Atmosphere of Psychiatric Wards and the Motivation, Attitude, and Perception of Patients Hospitalized in Shiraz and Bushehr University Hospitals-2019

Background: Treatment of psychiatric patients is a challenging issue that requires special attention due to their unique nature and conditions. Identifying the factors that influence treatment acceptance among these patients can aid in disease management and health promotion. The environment in which individuals reside can significantly impact their behaviors. Objectives: The present study aimed to determine the correlation between ward atmosphere and the motivation, perception, and attitude of patients towards continuing the treatment process in psychiatric wards of certain university hospitals in Shiraz and Bushehr in 2019. Methods: The present cross-sectional study included 299 patients admitted to the psychiatric wards of hospitals in Bushehr and Shiraz, Iran. A convenience sampling method was employed. Data collection tools included a demographic characteristics form, a short-form psychiatric ward questionnaire, and patient attitude, motivation, and treatment perception questionnaires. Data were analyzed using SPSS 19 with Pearson or Spearman correlation tests, independent t-test, one-way analysis of variance, and linear regression. The significance level was set at less than 0.05 in all cases. Results: The mean score of ward atmosphere was lower than average (18.37 ± 2.99) from the patients' point of view. Among the subscales of ward atmosphere, the "support" subscale correlated with patients' attitudes towards continuing the treatment process (P = 0.042). Patients exhibited a more positive attitude towards treatment at higher levels of support. Two subscales, "support" (P = 0.048) and "programme clarity" (P < 0.001), correlated with patients' perceptions of the treatment continuation. In other words, patients' perception of the treatment process was higher at elevated levels of these two subscales. None of the ward atmosphere subscales correlated with the patient's motivation to continue the treatment process from the patient's point of view. Conclusions: Given the correlation between certain subscales of ward atmosphere and patients' attitudes and perceptions about continuing the treatment process, it is recommended to design programs to optimize the ward atmosphere. This could improve patients' attitudes and perceptions regarding continuing their treatment. Additionally, it is suggested to study other factors affecting treatment in psychiatric patients.

Particles versus Other Embolic Agents in Emergency Renal Artery Embolization, Various Indications And Techniques

Abstract Background Renal artery embolization (RAE) refers to the occlusion of the renal artery, or some of its branches, by injection of an embolic agent through an endovascular catheter. Aim and Objectives to compare various embolic agents such as metallic microcoils, microspheres (embospheres), polyvinyl alcohol (PVA), gelfoam and histoacryl in emergent indications and techniques for RAE in management of emergency renal diseases. Subjects and Methods This combined retrospective and prospective observational study was conducted at Egyptian Military Hospitals, Radiodiagnosis and Intervention departments, and Ain Shams hospitals. The study included 18 patients with clinical and radiological confirmation of symptomatic indications for urgent RAE from 2019 to 2022. The duration of the study was 3 years. Result small sample sized and emergent cases showing mean embolization time was 12.6 minutes with no detected recanalization nor post embolic syndrome. Conclusion Renal artery embolization has become an effective, versatile therapeutic and adjuvant tool for many urologic conditions, both acute and chronic. It can be applied successfully in improving preoperative management of renal tumors prior to nephrectomy, achieving hemostasis in cases of hemorrhage from trauma or from tumors such as angiomyolipomas, treating complications of renal transplantation and biopsies such as arteriovenous fistulas and pseudoaneurysms, improving symptoms in patients with arteriovenous malformations and certain chronic renal parenchymal diseases, and for treating renal artery aneurysms.

Highly Sensitive Room-Temperature Detection of Ammonia in the Breath of Kidney Disease Patients Using Fe2Mo3O8/MoO2@MoS2 Nanocomposite Gas Sensor.

A novel Fe2Mo3O8/MoO2@MoS2 nanocomposite is synthesized for extremely sensitive detection of NH3 in the breath of kidney disease patients at room temperature. Compared to MoS2, α-Fe2O3/MoS2, and MoO2@MoS2, it shows the optimal gas-sensing performance by optimizing the formation of Fe2Mo3O8 at 900°C. The annealed Fe2Mo3O8/MoO2@MoS2 nanocomposite (Fe2Mo3O8/MoO2@MoS2-900°C) sensor demonstrates a remarkably high selectivity of NH3 with a response of 875% to 30ppm NH3 and an ultralow detection limit of 3.7 ppb. This sensor demonstrates excellent linearity, repeatability, and long-term stability. Furthermore, it effectively differentiates between patients at varying stages of kidney disease through quantitative NH3 measurements. The sensing mechanism is elucidated through the analysis of alterations in X-ray photoelectron spectroscopy (XPS)signals, which is supported by density functional theory (DFT) calculations illustrating the NH3 adsorption and oxidation pathways and their effects on charge transfer, resulting in the conductivity change as the sensing signal. The excellent performance is mainly attributed to the heterojunction among MoS2, MoO2, and Fe2Mo3O8 and the exceptional adsorption and catalytic activity of Fe2Mo3O8/MoO2@MoS2-900°C for NH3. This research presents a promising new material optimized for detecting NH3 in exhaled breath and a new strategy for the early diagnosis and management of kidney disease.

Effectiveness of Nutritional Supplementation in Liver Transplant Recipients during Early Postoperative Course: A Systematic Review and Meta-Analysis

Abstract Background Nutrition is an integral part of health maintenance. The liver is the largest and most important metabolic organ, playing a pivotal role in integrating several biochemical pathways of carbohydrate, fat, protein, and vitamin metabolism. Malnutrition is a common complication of end- stage liver disease (ESLD). Progressive deterioration of nutritional status has been associated with poor outcome in cirrhotic patients. Liver transplantation (LT) revolutionized the management of liver disease. Nutritional therapy is an integral part of liver transplant care. Objective To identity the efficacy of different dietary nutritional supplements as zinc, vit D and immunonutrients (glutamine, omega 3, arginine and ribonucleic acid) for recipient at early post operative course. Material and Methods In this systematic review and meta-analysis we enrolled a total of 7 studies for assessing the clinical outcomes of ICU patients underwent liver transplantation surgery and supplied with dietary supplements during early postoperative period. The studies also assessed the laboratory assessment of patients postoperatively during ICU admission period. Results Regarding postoperative dietary supplementations with HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB. Also we did not find significant difference between base line and postoperative in both groups for Mid-arm muscle-circumference (MAMC), Fat mass index (FMI), 6-minute walk test (6MWT), and Handgrip (HG). Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Conclusion BCAA as dietary supplementation showing a significant favorable effect regarding the baseline and the postoperative BTR levels, also for BCAA levels, Tyrosine levels, prealbumin levels, retinol binding protein and PTINR levels in both intervention and control groups. For HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB.

Exploring the Perceptions and Behaviours of UK Prescribers Concerning Novel Lipid-Lowering Agent Prescriptions: A Qualitative Study

Reducing low-density lipoprotein cholesterol levels lowers the risk of atherosclerotic cardiovascular disease. With the current and future portfolios of emerging lipid-lowering therapies included in various national and international guidelines, the objectives of this study were (i) to investigate the perceptions of UK prescribers’, including doctors, pharmacists, and nurses, on current lipid management for cardiovascular diseases and prescriptions of novel lipid-lowering therapies, and (ii) to explore the challenges and facilitating factors of prescribing novel lipid-lowering therapies through qualitative interviews. Qualitative semi-structured interviews with twelve medical and non-medical prescribers were conducted, around 20–30 min in length. The interviews were audio-recorded and transcribed on an online platform. A thematic analysis was deployed. Four major themes emerged from the analysis: (1) prescribing barriers; (2) prescribing enablers; (3) inter-profession variability; and (4) health literacy. These themes highlighted the contrast between the need for optimal shared decision making and the various constraints in practice. Participants expressed their inexperience with novel lipid-lowering therapies and acknowledged the requirement and importance of these agents for primary cardiovascular disease prevention. Participants recognised confidence and competence as key drivers for prescribing therapies and welcomed further education and training to enhance their skillset. Patients’ misconceptions towards current lipid-lowering therapies contributed to their refusal of newer agents, highlighting a requirement to improve patient education. Targeting communities through awareness campaigns was identified as a viable solution.

Factors influencing utilization of physiotherapy services by health care providers at Busia County Referral Hospital in Kenya

BackgroundThe surging trend of noncommunicable diseases complicated by trauma and infectious diseases has left many with marked physical limitations. Physiotherapy component of primary health care could be utilized for management of both communicable and noncommunicable diseases to restore physical functions.ObjectivesTo establish the health care providers’ level of knowledge and factors that influence the utilization of physiotherapy services among community members of Busia County in Kenya. The association between level of knowledge and demographic profile of health care providers at BCRH was also established.MethodDescriptive cross-sectional quantitative study involved 192 participants (nurses, doctors, and clinical officers) who were purposively selected. They completed self-administered questionnaire between August and November 2019. They were both sexes above 18 years of age, drawn from Busia County Referral Hospital. Data was analysed by Microsoft Excel and SPSS version 25.ResultsThe majority (92%) of the health care service providers had adequate knowledge about physiotherapy from their training to working with likelihood ratio chi-square of 7.714 with p-value at 0.01 at 5% level of significant. They had excellent communication (86.03%) with physiotherapists and helped to refer patients at BCRH for physiotherapy (χ2 = 52.02 and p-value = 0.01) at 5% level of significant. They had trust (91.56%) that physiotherapists were knowledgeable enough to handle patients on their own.ConclusionThe health care service providers are knowledgeable about the importance of physiotherapy and have supported its utilization. However, there is need to integrate physiotherapy service at all levels of training and practice of the components of primary health care. This will lead to a holistic patient’s care in terms of preventive, curative, and rehabilitative. Quality of life for the community members will be enhanced for appropriate functionality to meet the population needs. Lower utilization of physiotherapy services in Busia County could be due to factors associated with dynamics within the community and the health care service providers.

Mechanical mitral valve endurance in children under 2 years

BackgroundThe management of mitral valve disease in young children is challenging. Mechanical mitral valves could provide long-term durability; however, the need for anticoagulation increases the risk profile of mechanical valves. We report our experience in mechanical mitral valve replacement (MVR) in children under 2 years of age and evaluate factors affecting the outcomes.The study included all patients younger than 2 years who underwent mechanical MVR between 2000 and 2023. The study outcomes were mitral valve reoperation, bleeding, valve-related thrombosis, and survival.ResultsTwenty-three patients were included, with a mean age of 10.2 ± 5.9 months. The mitral valve sizes ranged from 16 to 25 mm, and 6 (26%) were placed in the supra-annular position. Complete heart block occurred in seven patients (30%), and operative mortality occurred in three patients (13%). Postoperative warfarin was used in 17 patients (74%). After discharge, bleeding occurred in five patients (22%), four were managed conservatively, and one had intracranial hemorrhage treated with craniotomy. Nine patients (39%) had valve-related thrombosis; two underwent reoperation, while seven were treated with alteplase in 26 patients. Valve-related thrombosis was more common in patients with supra-annular valves (p < 0.001) and in those who were not on warfarin (p < 0.001). A total of seven patients (30%) underwent redo MVR, and redo was more common in young patients (p = 0.029) and in patients with supra-annular valves (p < 0.001). Survival of the whole cohort was 73% at 5 years. Among the annular position group, 5-year survival was 88%, while among the supra-annular position group, survival was 50% after 3 months and 25% after 14 months (p = 0.009).ConclusionsMechanical MVR in children younger than 2 years is associated with high complication rates, including thrombosis and bleeding. The supra-annular valve position appears to be a risk factor for thrombosis and reoperation. Anticoagulation with warfarin remains challenging. However, further studies evaluating alternative options are needed.Graphical

Gender Differences in Perceptions of Psoriatic Arthritis Disease Impact, Management, and Physician Interactions: Results from a Global Patient Survey.

We evaluated the impact of gender on disease severity, health-related quality of life (HRQoL), treatment management, and patient-healthcare professional (HCP) interactions from the perspectives of patients with psoriatic arthritis (PsA). Data were collected from a global online patient survey conducted by The Harris Poll (November 2, 2017 to March 12, 2018). Eligible patients were aged ≥ 18years, with a self-reported diagnosis of PsA for > 1year, had visited a rheumatologist/dermatologist in the past 12months, and had reported previously using ≥ 1 conventional synthetic or biologic disease-modifying antirheumatic drug. Data were stratified by gender and analyzed descriptively, inferentially by binomial (chi-square) tests, and by multivariate logistic regression models. Data from 1286 patients who participated were included: 52% were female, 48% were male. Varying perceptions of disease severity between males and females were indicated by differences in symptoms leading to a diagnosis of PsA, and in symptoms reported despite treatment; more females than males reported joint tenderness, skin patches/plaques, and enthesitis. More females than males reported a major/moderate impact of PsA on their physical activity and emotional/mental well-being. Reasons for switching medication differed between genders, with more females switching because they perceived their medication to not be effective enough related to their joint symptoms. More females than males were very satisfied with their communication with their rheumatologist and were more likely to discuss the impact of PsA on their daily lives, their treatment satisfaction, and treatment goals with their rheumatologist. Patients' perceptions of the impact of PsA on HRQoL, treatment management, and interactions with HCPs varied between males and females. More females than males reported major/moderate physical and emotional impacts of PsA. When treating patients, it is important for HCPs to consider the potential impact of gender on patients' experience of PsA and its symptoms. Graphical plain language summary available for this article.

Analysis of Probiotic Role in Non-Alcoholic Fatty Liver Disease (NAFLD) Management: A Meta-Analysis

Background: Non-alcoholic fatty liver disease (NAFLD) is an increasing global health problem. Probiotics have emerged as a potential therapy for NAFLD, but evidence for their efficacy remains mixed. This meta-analysis aims to evaluate the effectiveness of probiotics in the management of NAFLD. Methods: A comprehensive literature search was performed on PubMed, Embase, Cochrane Library, and Web of Science databases until December 2023. Randomized controlled trials (RCTs) evaluating the effects of probiotics in NAFLD patients were included. The main outcomes evaluated were changes in liver enzymes (ALT, AST), insulin resistance index (HOMA-IR), and hepatic steatosis score. Meta-analysis was performed using a random effects model, and heterogeneity was assessed using the I² statistic. Results: Twenty-five RCTs involving 1845 patients met inclusion criteria. Meta-analysis showed that probiotics significantly reduced ALT (MD -8.45; 95% CI -12.67 to -4.23; p&lt;0.0001) and AST (MD -6.89; 95% CI -10.11 to -3.67; p&lt;0.0001) levels compared with placebo. Significant reductions were also observed in HOMA-IR (MD -0.68; 95% CI -1.02 to -0.34; p&lt;0.0001) and hepatic steatosis scores (SMD -0.45; 95% CI -0.71 to -0.19; p=0.0008). Subgroup analysis showed that the effects of probiotics were more pronounced in patients with NAFLD non-alcoholic steatohepatitis (NASH) and those receiving multi-strain probiotics. Conclusion: This meta-analysis provides strong evidence that probiotics have beneficial effects on biochemical and imaging parameters in NAFLD patients. Probiotics may be considered as an adjunct therapy for NAFLD, especially in patients with NASH. However, more research is needed to determine the optimal probiotic strain, dosage, and duration of treatment.

Assessing the relationship between malaria incidence levels and meteorological factors using cluster-integrated regression

This paper introduces a novel approach to modeling malaria incidence in Nigeria by integrating clustering strategies with regression modeling and leveraging meteorological data. By decomposing the datasets into multiple subsets using clustering techniques, we increase the number of explanatory variables and elucidate the role of weather in predicting different ranges of incidence data. Our clustering-integrated regression models, accompanied by optimal barriers, provide insights into the complex relationship between malaria incidence and well-established influencing weather factors such as rainfall and temperature.We explore two models. The first model incorporates lagged incidence and individual-specific effects. The second model focuses solely on weather components. Selection of a model depends on decision-makers priorities. The model one is recommended for higher predictive accuracy. Moreover, our findings reveal significant variability in malaria incidence, specific to certain geographic clusters and beyond what can be explained by observed weather variables alone.Notably, rainfall and temperature exhibit varying marginal effects across incidence clusters, indicating their differential impact on malaria transmission. High rainfall correlates with lower incidence, possibly due to its role in flushing mosquito breeding sites. On the other hand, temperature could not predict high-incidence cases, suggesting that other factors other than temperature contribute to high cases.Our study addresses the demand for comprehensive modeling of malaria incidence, particularly in regions like Nigeria where the disease remains prevalent. By integrating clustering techniques with regression analysis, we offer a nuanced understanding of how predetermined weather factors influence malaria transmission. This approach aids public health authorities in implementing targeted interventions. Our research underscores the importance of considering local contextual factors in malaria control efforts and highlights the potential of weather-based forecasting for proactive disease management.