Early Intervention Research Articles

Psychosocial Comorbidities in patients with pediatric alopecia areata: A Literature Review.

Alopecia areata (AA), a chronic autoimmune disorder causing non-scarring hair loss, has a greater prevalence in the pediatric population. Like many visible dermatologic disorders, AA can cause significant psychosocial impairment, particularly in children who are undergoing critical periods of psychosocial development. This paper investigates the psychosocial impact of AA on children. A systematic review was conducted using PRISMA guidelines. SCOPUS and PubMed databases were utilized with the terms "alopecia areata," "pediatric," and "psychosocial comorbidities." 12 articles were reviewed, with 6 meeting inclusion criteria for detailed analysis. The review revealed prominent associations between AA and psychosocial comorbidities in children. Psychiatric conditions including anxiety, depression, and OCD, were prevalent in pediatric AA patients, with exacerbation due to increased disease severity. These negatively impacted the Quality of Life (QoL) in affected children. Additionally, the comorbidities extended beyond psychiatric diagnoses, impacting self-esteem, academic performance, peer relationships, and body image satisfaction in children. This literature review highlights the significant impact of various psychosocial comorbidities in children with AA, emphasizing the need for early identification and intervention. Healthcare professionals, including psychiatrists, therapists, and dermatologists, can play a significant role in treating pediatric patients with AA. Dermatologists can play a critical role in diagnosing AA and identifying psychosocial comorbidities that may arise and refer patients to appropriate care. Future research should focus on elucidating effective screening tools for dermatologists to identify these comorbidities early, ultimately improving the overall well-being of children with AA.

Determinants of low birth weight and its effect on childhood health and nutritional outcomes in Bangladesh

BackgroundThe high incidence of low birth weight (LBW) is associated with an increased risk of infant mortality, adverse pregnancy outcomes for mothers, and a decline in overall health and well-being. The current study aimed to identify the various determinants of LBW and its effect on adverse health and nutritional outcomes of children aged 0–23 months in Bangladesh.MethodsBangladesh Demography and Health Survey (BDHS) 2017-18 data was used. A chi-square test and multivariable logistic regression analysis were used to find out the associations between independent variables and outcomes (e.g., LBW, child illness and undernutrition).ResultsThe overall prevalence of LBW among was 16.3%. Mother with no formal education (AOR = 2.64, 95% CI = 0.55–3.30, p = 0.01), female child (AOR = 1.31, 95% CI = 1.04–1.65, p = 0.023); and poorest economic status (AOR = 1.69, 95% CI = 1.13–2.51, p = 0.010), were identified significant determinants of LBW. Of home environment and hygiene factors, unimproved toilet facilities (AOR = 1.38, 95% CI = 1.03–1.84, p = 0.030) had a significant effect on LBW. In addition, children born with LBW were more likely to suffer fever (AOR = 1.26, 95% CI = 1.05–1.60, p = 0.050), stunting (AOR = 2.42, 95% CI = 1.86–3.15, p = < 0.001), wasting (AOR = 1.47, 95% CI = 1.02–2.25 p = 0.049), and underweight (AOR = 3.19, 95% CI = 2.40–4.23, p = < 0.001).ConclusionOne out of five children was LBW in Bangladesh. Maternal education, sex of child, wealth index, and toilet facilities had significant effects on LBW. In addition, LWB contributed to children’s poor health and nutritional outcomes. Enhancing maternal pregnancy, and child health outcomes necessitates policies addressing poverty, gender inequality, and social disparities. Key strategies include promoting regular prenatal care, early medical intervention, reproductive health education, and safe hygiene practices. To combat the negative impacts of LBW, a comprehensive strategy is vital, encompassing exclusive breastfeeding, nutritional support, growth monitoring, accessible healthcare, and caregiver education.

Development of a machine learning-based model to predict prognosis of alpha-fetoprotein-positive hepatocellular carcinoma

BackgroundPatients with alpha-fetoprotein (AFP)-positive hepatocellular carcinoma (HCC) have aggressive biological behavior and poor prognosis. Therefore, survival time is one of the greatest concerns for patients with AFP-positive HCC. This study aimed to demonstrate the utilization of six machine learning (ML)-based prognostic models to predict overall survival of patients with AFP-positive HCC.MethodsData on patients with AFP-positive HCC were extracted from the Surveillance, Epidemiology, and End Results database. Six ML algorithms (extreme gradient boosting [XGBoost], logistic regression [LR], support vector machine [SVM], random forest [RF], K-nearest neighbor [KNN], and decision tree [ID3]) were used to develop the prognostic models of patients with AFP-positive HCC at one year, three years, and five years. Area under the receiver operating characteristic curve (AUC), confusion matrix, calibration curves, and decision curve analysis (DCA) were used to evaluate the model.ResultsA total of 2,038 patients with AFP-positive HCC were included for analysis. The 1-, 3-, and 5-year overall survival rates were 60.7%, 28.9%, and 14.3%, respectively. Seventeen features regarding demographics and clinicopathology were included in six ML algorithms to generate a prognostic model. The XGBoost model showed the best performance in predicting survival at 1-year (train set: AUC = 0.771; test set: AUC = 0.782), 3-year (train set: AUC = 0.763; test set: AUC = 0.749) and 5-year (train set: AUC = 0.807; test set: AUC = 0.740). Furthermore, for 1-, 3-, and 5-year survival prediction, the accuracy in the training and test sets was 0.709 and 0.726, 0.721 and 0.726, and 0.778 and 0.784 for the XGBoost model, respectively. Calibration curves and DCA exhibited good predictive performance as well.ConclusionsThe XGBoost model exhibited good predictive performance, which may provide physicians with an effective tool for early medical intervention and improve the survival of patients.

Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process.

An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.

MicroRNAs: exploring their role in farm animal disease and mycotoxin challenges

MicroRNAs (miRNAs) serve as key regulators in gene expression and play a crucial role in immune responses, holding a significant promise for diagnosing and managing diseases in farm animals. This review article summarizes current research on the role of miRNAs in various farm animal diseases and mycotoxicosis, highlighting their potential as biomarkers and using them for mitigation strategies. Through an extensive literature review, we focused on the impact of miRNAs in the pathogenesis of several farm animal diseases, including viral and bacterial infections and mycotoxicosis. They regulate gene expression by inducing mRNA deadenylation, decay, or translational inhibition, significantly impacting cellular processes and protein synthesis. The research revealed specific miRNAs associated with the diseases; for instance, gga-miR-M4 is crucial in Marek’s disease, and gga-miR-375 tumor-suppressing function in Avian Leukosis. In swine disease such as Porcine Respiratory and Reproductive Syndrome (PRRS) and swine influenza, miRNAs like miR-155 and miR-21-3p emerged as key regulatory factors. Additionally, our review highlighted the interaction between miRNAs and mycotoxins, suggesting miRNAs can be used as a biomarker for mycotoxin exposure. For example, alterations in miRNA expression, such as the dysregulation observed in response to Aflatoxin B1 (AFB1) in chickens, may indicate potential mechanisms for toxin-induced changes in lipid metabolism leading to liver damage. Our findings highlight miRNAs potential for early disease detection and intervention in farm animal disease management, potentially reducing significant economic losses in agriculture. With only a fraction of miRNAs functionally characterized in farm animals, this review underlines more focused research on specific miRNAs altered in distinct diseases, using advanced technologies like CRISPR-Cas9 screening, single-cell sequencing, and integrated multi-omics approaches. Identifying specific miRNA targets offers a novel pathway for early disease detection and the development of mitigation strategies against mycotoxin exposure in farm animals.

Nursing assessment of mental health issues in the general clinical environment: A descriptive study.

To evaluate the effectiveness of a mental health screening form for early identification and care escalation of mental health issues in general settings. A secondary aim was to explore general nurses' use of the form and their confidence to discuss mental health issues with patients. A cross-sectional design comprising a review of clinical records to determine use of the form, instances of missed care and escalation to the mental health team. The survey focused on nurses' confidence in general settings to engage in discussions with patients about mental health. Data were collected from April to December 2022. The Strengthening the Reporting of Observational Studies in Epidemiology Statement guided this study. Of 400 patient records, 397 were analysed; 293 (73.8%) of those had mental health screening by nurses. Age was a significant factor, with younger patients more likely to be screened although concerns were typically recognized in older patients. Of the 20 patients identified with mental health concerns, 9 (45%) were referred for further evaluation by the Clinical Liaison Team. While nurses were proactive in assessing physical risks, assessing risk factors that required deeper conversations with patients, including psychiatric history, was lacking. The survey highlighted fewer than half of the respondents (46%, n = 10) felt competent to engage in discussions about mental health; however, most (59%, n = 13) knew when to seek a mental health referral. General nurses have a role in the early identification and referral of patients with mental health challenges. However, training is imperative to facilitate deeper patient interactions concerning mental health. Integrating mental health checks within general settings is crucial for early detection and intervention, aligning with global quality care standards. STROBE guidelines. We received feedback that shaped the research protocol from a consumer representative.

Case Report: The importance of early intervention for gastroesophageal reflex disease caused by hiatal hernia

BackgroundGastroesophageal reflux (GER) disease (GERD) is a condition wherein GER causes troublesome symptoms that can affect daily functioning and/or clinical complications within the esophagus or other systems. To avoid this, patients with GERD often require treatment; hence, it is important to distinguish GER from GERD. Patients with GERD exhibiting alarm signs should be examined early to differentiate it from GER and treated accordingly. Herein, we present a case of GERD caused by a hiatal hernia that required surgical intervention for esophagial cicatrical stenosis despite oral treatment. We also discussed how to choose the appropriate acid suppressants for GERD.Case presentationA 1-year-old boy was referred to our hospital for repeated vomiting and poor weight gain. He received histamine 2 receptor antagonists (H2RAs) that contributed slightly to the decreased frequency of vomiting and aided weight gain; however, he soon stopped gaining weight and had bloody vomit. His upper gastrointestinal series revealed hiatal hernia, a 24 h impedance pH monitoring test indicated abnormal values for acid reflux, and esophagogastroduodenoscopy (EGD) revealed esophagitis. He was subsequently diagnosed with GERD associated with hiatal hernia. A proton pump inhibitor (PPI) was intravenously administered to him, following which his medication was changed to a potassium-competitive acid blocker (P-CAB). Thereafter, his vomiting episodes significantly decreased and his weight increased. However, 6 months after starting P-CAB, his vomiting episodes suddenly increased in frequency. EGD revealed the presence esophageal stricture due to scarring from GERD. He was then treated via laparoscopic fundoplication, gastrostomy, and esophageal balloon dilation. Thereafter, his vomiting episodes stopped and food intake improved, leading to weight gain.ConclusionIt is essential to identify the cause of GERD early and take an appropriate treatment approach depending on the cause of GERD with alarm signs. Further, as a drug therapy for GERD as a clear acid mediated disease or in children with alarm signs, PPIs or P-CAB should be used from the beginning instead of H2RAs.

Systematic review and meta-analysis of the prevalence of myopia among school-age children in the Eastern Mediterranean Region

Background: The recent increase in myopia is a major public health concern worldwide, including in the Eastern Mediterranean Region (EMR). Aim: To provide data on the prevalence of myopia among school-age children in the EMR. Methods: This study was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. We searched the Web of Sciences, Scopus, Index Medicus for the Eastern Mediterranean Region, ProQuest, PubMed, and Medline for studies on the prevalence of myopia in the EMR published from January 2000 to May 2022. The data were analysed using MedCalc version 19.6.1 and myopia was defined as refractive error ≥ 0.50 D. The overall pooled prevalence of myopia was estimated using a random-effects model and its associated 95% confidence intervals. Results: The meta-analysis included 27 quality-assessed studies from 13 countries among 51 111 school-age children. The overall pooled prevalence of childhood myopia from 2000 to 2022 was 5.23%, which was significantly higher among females than males (4.90% vs 3.94%). The prevalence of myopia was significantly higher among children aged 11–17 years than among those aged 5–10 years (7.50% vs 3.90%). There was a higher prevalence of myopia with cycloplegic refraction than noncycloplegic refraction (5.95% vs 3.73%). There was highly significant heterogeneity between the studies. Conclusion: Prevalence of myopia among school-age children in the EMR was high, particularly among older children, and it was more common among females. Early intervention to slow myopia progression is essential in the EMR to protect children from irreversible vision loss.

Unraveling TAFRO Syndrome: An In-Depth Look at the Pathophysiology, Management, and Future Perspectives

TAFRO syndrome is a rare and aggressive inflammatory entity characterized by thrombocytopenia, anasarca, fever, renal failure, reticulin fibrosis, and organomegaly. This entity supposes a diagnostic and therapeutic challenge due to its significant overlap with Castleman’s disease. However, distinct clinical and histological features warrant its classification as a separate subtype of idiopathic multicentric Castleman’s disease (iMCD). While recent modifications have been made to the diagnostic criteria for iMCD, these criteria lack specificity for this particular condition, further complicating diagnosis. Due to its inflammatory nature, several complex molecular signaling pathways are involved, including the JAK-STAT pathway, NF-kB, and signal amplifiers such as IL-6 and VEGF. Understanding the involvement of immune dysfunction, some infectious agents, genetic mutations, and specific molecular and signaling pathways could improve the knowledge and management of the condition, leading to effective treatment strategies. The current therapeutic approaches include corticosteroids, anti-IL6 drugs, rituximab, and chemotherapy, among others, but response rates vary, highlighting the need for personalized strategies. The prognosis is uncertain due to diagnostic difficulties, emphasizing the importance of early intervention and appropriate targeted treatment. This comprehensive review examines the evolving landscape of TAFRO syndrome, including the pathophysiology, diagnostic criteria, treatment strategies, prognosis, and future perspectives.

Effectiveness of Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome in Mechanically Ventilated Patients

Background: Acute respiratory distress syndrome (ARDS) requires rapid diagnosis for early intervention and improved outcomes. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS but the effectiveness of lung ultrasound in ARDS diagnosis is still uncertain. The objective of the study is to explore the efficacy of lung ultrasound (LUS) for diagnosis of ARDS in mechanically ventilated patients. Methods: A cross sectional study was conducted among 75 patients in Critical Care Centre, Combined Military Hospital, Dhaka from September 2021 to January 2022. The study was approved by the ethical committee in the hospital. In this study, the Bedside Lung Ultrasound in Emergency (BLUE) protocol for the immediate diagnosis of acute respiratory failure was followed. Purposive sampling technique was used. Data were analyzed by using Statistical Package For Social Sciences (SPSS) version 25.0. Results: A total of 75 patients were assessed. Among them male were 42(56%) and female 33(44%). The median age of patients was 48 years (Interquartile range 30-60). Primary diagnoses were pneumonia (22.67%), pulmonary oedema (20%), sepsis (20%) and trauma (17.33%). A total of 34(45.33%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 36(48%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as reference standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of lung ultrasound were 85.29%, 82.92%, 80.55%, 87.18% and 84% respectively. Conclusion: Lung ultrasound can be an effective tool for the diagnosis &amp; management of ARDS in the intensive care unit. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 51-57

Dynamic renal scans as a modality for follow-up of flexible ureteroscopy.

To determine whether dynamic renal scans - DTPA or MAG3 - routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative "triple test". The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

Cardiovascular Dysautonomy as a Sequel of SARS COV 2. Case Series

The impact of COVID-19, caused by the SARS-CoV-2 virus, a pandemic that originated in Wuhan, China, can lead to serious complications, in addition to mild symptoms, with special interest in the autonomic nervous system (ANS). Damage to the ANS by SARS-CoV-2 can cause dysautonomia, an imbalance between the sympathetic and parasympathetic system, with unclear mechanisms such as cytokine storm, excessive inflammation, and virus neurotropism. A significant sequelae of COVID-19 is cardiac dysautonomia, which affects heart rate, blood pressure and other autonomic reflexes, causing postural tachycardia, orthostatic hypotension, arrhythmias and fatigue. There is decreased heart rate variability (HRV) in patients, suggesting dysautonomia. Long COVID syndrome can also include cardiac dysautonomia. To diagnose cardiac autonomic neuropathy, at least two of six criteria must be met, such as an SDNN less than 50 ms and an RMSSD less than 15 ms. The cases of cardiac dysautonomia below present several of these criteria met. Methods to evaluate cardiac dysautonomia include the COMPASS 31 scale and the orthostatic hypotension questionnaire (OHQ), but more research is still needed, especially in Mexico. The case study shows that those who followed non-pharmacological recommendations such as cardiovascular exercise, increased water intake and BMI control had improvement, while cases that did not follow these recommendations did not show significant improvements. Cardiac dysautonomia is a post-COVID-19 sequelae with high prevalence, highlighting the importance of non-invasive methods for its diagnosis. Even without symptoms, people can have this sequelae, so it is important to suspect cardiovascular disorders. The need for early intervention and monitoring of hygienic-dietary measures is emphasized to avoid the worsening and chronicity of cardiac dysautonomia, with the hope of preventing the development of chronic diseases and fatal outcomes.

ARTIFICIAL INTELLIGENT SYSTEM FOR AUTOMATIC DEPRESSION LEVEL ANALYSIS THROUGH VISUAL AND VOCAL EXPRESSIONS

Depression is a major mental health disease of human which is rapidly affecting lives worldwide. Early detection and intervention are crucial for effective treatment and management. Depression is regularly identified with thoughts of suicide. Significant depression can bring about a determination of social and physical side effects. It could remember changes in rest, craving, vitality level, concentration, day by day conduct or confidence. In recent years, deep-learned applications concentrated on neural networks have shown superior performance at hand-crafted apps in various areas. This system presents an innovative artificial intelligence (AI) system designed for automatic depression level analysis by analyzing visual and vocal expressions. Leveraging advances in computer vision and natural language processing, the proposed system extracts relevant features from facial expressions and speech patterns to assess depression severity levels accurately. Deep-learned apps that settle the above issues that may precisely assess the degree of voice and face depression. In the proposed method, Convolutionary Neural Networks (CNN) is developed for learning deep-learned features and descriptive raw waveforms for visual expressions. Second. Keywords: Artificial Intelligence, Depression, Vocal, Facial Expressions, Deep Learning

Impact of Malnutrition on Survival and Treatment-Related Morbidity of Cancer in Children

Background: Malnutrition is a prevalent and severe issue in pediatric oncology, affecting treatment outcomes and survival rates significantly. In developing countries, where access to comprehensive healthcare is limited, malnutrition's impact is even more profound, complicating treatment protocols and increasing morbidity and mortality rates among children with cancer. Objective: To evaluate the effects of malnutrition on survival rates and treatment-related morbidity in pediatric cancer patients, and to assess the efficacy of nutritional interventions in improving these outcomes. Methods: This retrospective study was conducted at SKMCH &amp; RC, involving 160 newly diagnosed cancer patients aged between one and eighteen years. Patients were followed from January 2021 through March 2023. Malnutrition was assessed using WHO growth charts and defined using BMI and weight/height Z-scores. Data analysis was performed using SPSS software, version 25, focusing on survival rates, incidence of febrile neutropenia (FN), and nutritional status changes over time. Statistical significance was set at a p-value of 0.025. Results: At diagnosis, 42.5% (n=68) of the children were malnourished. After six months, 35% (n=56) remained malnourished, indicating some improvement. Malnourished children showed significantly lower survival rates, with those having a BMI Z-score ≤ -2 at six months post-diagnosis having a mortality rate HR of 4.05 (95% CI= 1.58-6.33, P = 0.009). Children experiencing a weight/height loss of &gt;10% had an HR of 1.98 (95% CI= 1.23-6.91, P=0.04) for increased mortality. Increased episodes of FN were correlated with severe malnutrition (HR 7.32, 95% CI=1.98-10.14, P=0.0007). Conclusion: Malnutrition significantly impacts the survival rates and treatment-related morbidity in pediatric cancer patients. Early and aggressive nutritional interventions can improve survival outcomes and reduce the rate of hospitalizations due to complications like febrile neutropenia.

Prediction of Diabetes Using Machine Learning Algorithms in Healthcare

This study introduces a new approach to prognosticating the onset of detection of diabetes via using machine learning ways. By assaying a dataset containing different demographic, clinical, and life factors, the study identifies crucial predictors for assessing diabetes threat. Several ML algorithms, similar as logistic regression, KNN, Ada-boost, and support vector machine, are utilized and estimated for their prophetic performance. The results demonstrate that the ML- grounded models effectively identify individualities at high threat of developing diabetes. These models give precious decision making aids for healthcare interpreters, easing early intervention and substantiated operational strategies. Overall, this approach has the implicit to significantly reduce the burden of diabetes on public health systems. Keywords: : prognosticating, individualities, operational strategies, Public health systems.

RADIANTYOU: Personalized PCOS Prediction Partner

The abstract outlines a study aimed at addressing the challenge of detecting polycystic ovary syndrome (PCOS) in women, particularly in Asia where a significant portion of cases go undetected. PCOS is a complex hormonal disorder affecting reproductive health, characterized by irregular menstrual cycles, excessive androgen levels, and the presence of multiple cysts on the ovaries. The researchers employed machine learning techniques to develop a predictive model for early detection of PCOS. This approach leverages data on various physiological markers such as prolactin levels, blood pressure, thyroid-stimulating hormone (TSH), and pregnancy status. These factors are known to be associated with PCOS and can potentially serve as indicators for its presence. The abstract highlights the effectiveness of Random Forest, a machine learning algorithm, in accurately predicting PCOS with minimal computational time. This implies that the model developed by the researchers can reliably identify individuals at risk of PCOS, allowing for early intervention and management

The effect of Qi‐Shao‐Tong‐Mai‐An‐Shen herbal paste on coronary heart disease patients with depression and/or anxiety: Study protocol for a randomized controlled trial

AbstractCoronary heart disease (CHD) poses a significant threat to human life and well‐being. The presence of psycho‐cardiology diseases not only exacerbates the progression of CHD but also imposes a substantial financial burden. Consequently, there is a pressing need to prioritize the prevention and management of psycho‐cardiology conditions. Given the complex adverse effects associated with antidepressants, it is imperative to investigate alternative, safer, and more efficacious early interventions for psycho‐cardiology diseases. The trial will randomly divide 99 patients who meet the inclusion criteria into two groups in a ratio of 1:2. Both groups will be administered standard western medicine treatment for CHD. The Qi‐Shao‐Tong‐Mai‐An‐Shen (QSTMAS) group will be treated with an additional 30 mL QSTMAS herbal paste orally twice daily for up to 12 weeks. The primary endpoints are the changes of Generalized Anxiety Disorder‐7 and Patient Health Questionnaire‐9 scores after the intervention for 12 weeks. The secondary endpoints include the scores of Traditional Chinese medicine syndromes, 6‐min walking test, Insomnia severity index sleep scale, laboratory tests, and other examinations of both groups after the intervention for 12 weeks. The QSTMAS herbal paste exhibits potential and promise as a treatment modality for mild‐to‐moderate psychological disorders within the department of cardiology. The implementation of a rigorous trial design will facilitate an objective and scientific assessment of the clinical effectiveness and safety of combining QSTMAS herbal paste with standard western medicine for CHD patients with depression and/or anxiety. Trial Registration: China Clinical Trial Registry, ChiCTR2200065179. Registered 31 October 2022.

Introduction: A Practical Guide to Central Nervous System Malformations—From Genetics, to Diagnosis and Treatment

AbstractCentral nervous system (CNS) malformations encompass diverse congenital anomalies impacting brain and spinal cord development, profoundly affecting neurological function. They arise from disruptions in embryonic neural tube formation, neuronal migration, and cortical organization. This abstract provides a comprehensive overview of CNS malformations, covering classification, etiology, clinical manifestations, and diagnostic challenges. CNS malformations fall into distinct groups: neural tube defects (e.g., anencephaly, spina bifida), resulting from incomplete neural tube closure; malformations of cortical development (e.g., lissencephaly, polymicrogyria), featuring irregularities in cortical folding; and anomalies affecting structures like the corpus callosum, cerebellum, and CNS vasculature, alongside conditions such as hydrocephalus and Chiari malformations. Genetic factors, including mutations in LIS1, DCX, and RELN, contribute significantly, while environmental factors like maternal folic acid deficiency also play a role. Some malformations occur in genetic syndromes (e.g., tuberous sclerosis, neurofibromatosis). Clinical presentations vary, with neural tube defects typically presenting severe deficits at birth, while cortical malformations manifest as intellectual disabilities, seizures, and motor deficits. Hydrocephalus elevates intracranial pressure, and Chiari malformations cause headaches and neurological symptoms. Diagnosis necessitates a multidisciplinary approach involving clinical evaluation, neuroimaging, genetic testing, and histopathological analysis. Prenatal diagnosis via ultrasound and magnetic resonance imaging is crucial for planning interventions, while postnatal diagnosis relies on clinical and imaging findings.Understanding CNS malformations is vital for early detection, intervention, and comprehensive care provision. Advances in genetics and neuroimaging offer hope for improved outcomes and better quality of life for affected individuals.

Exposure to polycyclic aromatic hydrocarbons promotes the progression of low-grade cervical intraepithelial neoplasia: A population-based cohort study in China.

Low-grade cervical intraepithelial neoplasia (CIN1) is an early stage of cervical cancer development. Previously, we reported that exposure to polycyclic aromatic hydrocarbons (PAHs) increases the risk of cervical precancerous lesions, especially in females with a high-risk human papillomavirus (HR-HPV) infection. However, the effects of PAHs on CIN1 progression remain unclear. A community-based prospective cohort study was conducted to evaluate the role of exposure to PAHs in the progression of CIN1. A total of 564 patients diagnosed with CIN1 were followed-up at 6, 12, and 24 months, post-diagnosis, to determine CIN1 reversion, persistence, and progression. Exposure to PAHs was determined by the urine 1-hydroxipayrene (1-OHP) level. Our results showed that the 1-OHP level was significantly higher in patients with CIN1 persistence/progression than in those with reversion (P < .05). High exposure to PAHs increased the risk of CIN1 persistence/progression, with hazard ratios (HR), 95% confidence intervals (CI) of (1.62, 1.24-2.67), (1.98, 1.42-2.75), and (2.37, 1.61-3.49) at 6, 12, and 24 months, post-diagnosis, respectively. The effect was enhanced with HR-HPV positivity, as determined at 6 (1.82, 1.24-2.67), 12 (3.02, 1.74-5.23), and 24 (2.51, 1.48-4.26) months, post-diagnosis. Moreover, the predictive value of exposure to PAHs for CIN1 persistence/progression was higher in HR-HPV-positive patients than in HR-HPV-negative patients. The results revealed that exposure to PAHs facilitated the malignant progression of CIN1 and hindered its reversal, particularly in patients with HR-HPV infection. Our findings provide novel insights into early prevention and intervention targeting the initiation and progression of cervical neoplasia.

PARENTAL PERSPECTIVES ON EARLY CHILDHOOD EDUCATION IN BANGLADESH

This study used a phenomenological qualitative approach to explore the intricate landscape of early childhood education in Bangladesh, focusing on the perspective of parents. The study involves 47 people from three different cities, using in-depth interviews to discover a diverse range of experiences. The application of thematic analysis uncovers six fundamental themes that encompass the various aspects of parental perspectives. The themes encompassed in this study consist of prioritizing holistic development, cultural values and educational aspirations, socio-economic challenges and access barriers, positive perception of early intervention, desire for communication and collaboration with educators, and the need to balance tradition and innovation in education. Through an examination of these issues, the study not only sheds light on the complex nature of parental attitudes but also offers crucial insights for the development of policies and the creation of early childhood education Programs in Bangladesh. The results emphasize the significance of considering cultural, economic, and educational subtleties to develop comprehensive and efficient solutions that align with the varied parental perspectives throughout various regions of Bangladesh.