Emerging Health Issues Research Articles

Decreased AGGF1 facilitates the progression of placenta accreta spectrum via mediating the P53 signaling pathway under the regulation of miR-1296-5p.

Placenta accreta spectrum (PAS), an emerging health issue worldwide, is the major causative factor of maternal morbidity and mortality in modern obstetrics, but limited studies have contributed to our understanding of the molecular biology of PAS. This study addressed the expression of AGGF1 and its specific role in the etiology of PAS. The expression of AGGF1 in the placentas of PAS was determined by quantitative PCR, western blot and immunohistochemistry. CCK-8 assay, wound healing assay, Transwell invasion assay and flow cytometry assay were performed to monitor cell proliferation, migration, invasion and apoptosis. The interaction between miR-1296-5p and AGGF1 was detected by dual-luciferase reporter gene assay. Results showed that the mRNA and protein expression of AGGF1 was decremented in placental tissues of PAS patients, compared with samples from women with placenta previa and normal pregnant women. Downregulation of AGGF1 promoted cell proliferation, invasion and migration, inhibited apoptosis in vitro, decreased P53 and Bax expression, and simultaneously increased Bcl-2 expression, whereas overexpression of AGGF1 had the opposite results. Additionally, the dual-luciferase assay confirmed AGGF1 as a target gene of miR-1296-5p in placental tissues of PAS. Particularly, miR-1296-5p fostered HTR8/SVneo cell proliferation, invasion, repression of apoptosis and regulation of P53 signaling axis by downregulating AGGF1 expression. Collectively, our study accentuated that downregulation of placental AGGF1 promoted trophoblast over-invasion by mediating the P53 signaling pathway under the regulation of miR-1296-5p.

Abstract P546: Depressive Symptoms and Perceived Stress Are Associated With Post-Acute Sequelae of Sars-CoV-2 Infection

Introduction: Post-acute sequelae of SARS-CoV-2 infection (PASC), a constellation of disabling symptoms, persisting after COVID-19, is an emerging health issue affecting substantial number of persons globally and in the US. Cardiac PASC refers to the wide range of cardiovascular-specific PASC symptoms. The psychological impact of PASC, cardiac PASC is poorly characterized. Objective: To examine whether PASC and cardiac PASC symptoms are associated with depressive symptoms and high levels of perceived stress. Methods: We conducted cross-sectional analyses among persons with history of COVID-19. Exposures were self-reported PASC and cardiac PASC symptoms. Outcomes were depressive symptoms and perceived stress measured using Patient Health Questionnaire (PHQ8) and Perceived Stress Scale (PSS4), respectively. Scores on PHQ8 ranged from 0-24, and clinical cutoff for depressive symptoms was ≥10. Scores on PHQ8 were dichotomized as minimal-mild (<10) and moderate-severe (≥10). Scores on PSS4 ranged from 0 to 16 with higher scores suggesting greater perceived stress. PSS4 scores were dichotomized as low/moderate (<6) and high (≥6) stress. We performed logistic regression analyses, adjusting for age, sex, race and comorbidities. Results: Of 197 participants, mean age was 47.3 (±15.9) years, 74% were female, 77% were White. About 48% (95/197) reported PASC, 46% (90/197 participants) reported cardiac PASC. The odds for moderate-severe depressive symptoms (adjusted Odds Ratio [aOR]: 5.03, 95%CI: 2.43-10.41, Table ) and high perceived stress (aOR: 4.19, 95%CI: 2.17-9.08) were higher compared to those who did not report PASC. Similarly, the odds for moderate-severe depression (aOR: 2.42, 95%CI: 1.25-4.70) and high perceived stress (aOR: 2.68, 95%CI: 1.43-5.02) was higher compared to those who did not report cardiac PASC. Conclusion: PASC and cardiac PASC are associated with clinical depressive symptoms and high perceived stress. Psychological and mental health interventions should be integrated into PASC care models.

Blood pressure to height ratio for screening hypertension among Indonesian adolescents

Background Pediatric hypertension is an emerging health issue due to its increasing prevalence. Age-, gender-, and height-specific blood pressure percentiles have been widely used as a primary tool for detection of hypertension in the pediatric population. However, this method is too complicated to be used in general pediatric practice. The blood pressure to height ratio has been proposed as a practical tool to detect hypertension in children.
 Objective To evaluate the accuracy of blood pressure to height ratio to be used as a tool for screening high blood pressure in Indonesian adolescents.
 Methods This diagnostic test study using data from the 2013 Indonesia Basic Health Research (Riset Kesehatan Dasar/RISKESDAS) report included 39,057 adolescents aged 15-18 years with complete data on age, gender, weight, height, and blood pressure. Blood pressure values were classified using the 2017 American Academy of Pediatrics (AAP) hypertension clinical guidelines. Blood pressure to height ratio was calculated as mmHg/cm body height. A receiver-operator characteristics (ROC) curve analysis was performed to assess the accuracy of systolic blood pressure to height ratio (SBPHR) and diastolic blood pressure to height ratio (DBPHR) for screening high blood pressure in adolescents. The optimal cut-off points, sensitivity, and specificity of SBPHR and DBPHR were calculated.
 Results The optimal cut-off points for defining elevated blood pressure in male adolescents aged 13-18 years were SBPHR 0.69 for male adolescents (sensitivity 96%, specificity 80%) and DBPHR 0.46 (sensitivity 97%, specificity 84%). In female adolescents, the optimal cut-offs were SBPHR 0.72 (sensitivity 97%, specificity 82%) and DBPHR 0.48 (sensitivity 98% and specificity 79%).
 Conclusion Blood pressure to height ratio is a practical method with high sensitivity and specificity for detecting elevated blood pressure in Indonesian adolescents aged 15 to 18 years.

Improvement in the diagnosis and practices of emergency healthcare providers for heat emergencies after HEAT (heat emergency awareness & treatment) an educational intervention: a multicenter quasi-experimental study

BackgroundThe incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting.MethodsA quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition—measured by increased frequency of diagnosing heat emergencies and improved management—measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention.ResultsFour thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention.ConclusionThe HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.

A network of empirical ethics teams embedded in research programmes across multiple sites: opportunities and challenges in contributing to COVID-19 research and responses.

Covid-19 continues to teach the global community important lessons about preparedness for research and effective action to respond to emerging health threats. We share the COVID-19 experiences of a pre-existing cross-site ethics network-the Global Health Bioethics Network-which brings together researchers and practitioners from Africa, Europe, and Southeast Asia. We describe the network and its members and activities, and the work-related opportunities and challenges we faced over a one-year period during the pandemic. We highlight the value of having strong and long-term empirical ethics networks embedded across diverse research institutions to be able to: 1) identify and share relevant ethics challenges and research questions and ways of 'doing research'; 2) work with key stakeholders to identify appropriate ways to contribute to the emerging health issue response - e.g., through ethics oversight, community engagement, and advisory roles at different levels; and 3) learn from each other and from diverse contexts to advocate for positive change at multiple levels. It is our view that being embedded and long term offers opportunities in terms of deep institutional and contextual knowledge, existing relationships and access to a wide range of stakeholders. Being networked offers opportunities to draw upon a wide range of expertise and perspectives, and to bring together internal and external insights (i.e.drawing on different positionalities). Long term funding means that the people and resources are in place and ready to respond in a timely way. However, many tensions and challenges remain, including difficulties in negotiating power and politics in the roles that researchers and research institutions can and should play in an emergency, and the position of empirical ethics within research programmes. We discuss some of these tensions and challenges and consider the implications for our own and similar networks in future.

New science, drug regulation, and emergent public health issues: The work of FDA's division of applied regulatory science.

The U.S. Food and Drug Administration (FDA) Division of Applied Regulatory Science (DARS) moves new science into the drug review process and addresses emergent regulatory and public health questions for the Agency. By forming interdisciplinary teams, DARS conducts mission-critical research to provide answers to scientific questions and solutions to regulatory challenges. Staffed by experts across the translational research spectrum, DARS forms synergies by pulling together scientists and experts from diverse backgrounds to collaborate in tackling some of the most complex challenges facing FDA. This includes (but is not limited to) assessing the systemic absorption of sunscreens, evaluating whether certain drugs can convert to carcinogens in people, studying drug interactions with opioids, optimizing opioid antagonist dosing in community settings, removing barriers to biosimilar and generic drug development, and advancing therapeutic development for rare diseases. FDA tasks DARS with wide ranging issues that encompass regulatory science; DARS, in turn, helps the Agency solve these challenges. The impact of DARS research is felt by patients, the pharmaceutical industry, and fellow regulators. This article reviews applied research projects and initiatives led by DARS and conducts a deeper dive into select examples illustrating the impactful work of the Division.

Interim analysis results of a retrospective study on clinical characteristics and unmet needs in patients with ASCVD and hypercholesterolaemia

Atherosclerotic cardiovascular disease (ASCVD) is an emerging health issue in Asia Pacific region despite many lipid-lowering therapies (LLT) extensively used to subside the risk of ASCVD. Local Malaysian data on outcomes in patients with ASCVD is limited and obsolete. Therefore, a single-centered non-interventional study on ASCVD patients with hypercholesterolemia was initiated to define clinical characteristics and outcomes in such patients.

Prevalence of non-alcoholic fatty liver disease among diabetes, prediabetes and healthy population.

Non-alcoholic fatty liver disease (NAFLD) is a global emerging health issue, which is due to extra fat deposition in the liver that poses a serious risk of liver cirrhosis. Our study assessed the glycaemic status and NAFLD in health patients coming for a regular health check-ups. This descriptive study was done on 192 healthy populations aged 30-70 years who underwent general health check-ups. History, clinical examination, heamtological and radiological workup were done and data were statistically evaluated. The age of the study population was between 30 and 70 years with an average age of 50 years and the study sample size was 190. Prevalence of prediabetes was 35.93%, diabetes at 17.18% and euglycaemics were 45.83% in our study group. Among diabetics and prediabetics, 30% and 31% were having raised transaminase. Among euglycaemics, around 19% had raised transaminase. On ultrasound scans among the diabetic group, the prevalence of fatty liver was 57.6% whereas in the prediabetic group it was 46.4%. Among the normal euglycaemic group, 22.7% had fatty liver. NAFLD is multifactorial and associated with diabetes and can progress to cirrhosis of the liver if untreated. There is a need to have more focus on screening, awareness, nutritional counselling and treatment at the primary care level.

Kocuria Species: Important Emerging Pathogens in Pediatric Patients

Kocuria spp., are frequently documented members of the human microbiota and were formerly thought to be opportunistic bacteria, initiating infection only in immunocompromised patients. This study aimed to determine the prevalence of Kocuria species in samples from Iraqi pediatric patients, in addition to their sensitivity pattern. Bacterial identification was performed using a VITEK 2 device, and the Kirby-Bauer disk diffusion method was used to determine antibiotic susceptibility. Of 261 positive cultures, we found Kocuria isolates from 7 cases (2.68%). The mean age of the patients was 5.47 years, ranging from 4 months to 10 years; there were 3 males and 4 females. All patients had either urinary tract disease or symptomatic bacteremia. Vitek-2 identification using a gram-positive (GP) card revealed the presence of Kocuria kristinae in five cases, K. rhizophila in one case, and K. rosea in one case. Susceptibility of the Kocuria species isolates to amikacin, gentamicin and ceftazidime were demonstrated 100% resistance. In conclusion, Kocuria species, which are associated with serious clinical manifestations are an emerging health issue and further attention should be taken for appropriate management of antibiotic treatment as they are intrinsically multi-drug resistant.

The association between Chorionic Villus Sampling and preterm birth: A systematic review

Abstract Background Preterm birth is defined as a syndrome that can be initiated via various mechanisms. During the past few decades, it has been an emerging health issue worldwide and thus, several actions to benefit public health have been undertaken to reduce its rate. Chorionic Villus Sampling (CVS) is one of the methods that are performed prognostically for prenatal diagnosis. However, several complications can occur after this invasive method is performed. The aim of this review is to identify whether CVS may result in preterm birth as a complication, compared to other invasive or non-invasive methods. Methods A systematic literature review was conducted in PubMed and Scopus from inception until December 2021, to identify studies examining the above association. The research strategy included a combination of search and MESH terms related to CVS and preterm birth, Inclusion and exclusion criteria were set. The research was conducted by two researchers that thoroughly screened the articles and extracted the data. Results 37 studies met the inclusion criteria. Comparisons were performed between CVS and amniocentesis or control group or between the different weeks that CVS was performed. No significant difference was observed in most of the studies when CVS was compared to amniocentesis, control groups, or between different weeks of gestation that was performed. Conclusions The risk of preterm birth of women undergoing CVS was relatively lower or had no difference compared to the other methods or controls investigated. Therefore, CVS is considered as a safe prenatal diagnostic procedure with minimum rates of preterm birth as a complication. Key messages • The risk of preterm birth of women undergoing CVS was found to be relatively lower with no significant differences compared to the other methods or controls. • Future studies should be performed recruiting a large sample with women of different age and compare it with a control group that will not undergo any invasive method.

Heart disease detection based on internet of things data using linear quadratic discriminant analysis and a deep graph convolutional neural network.

Heart disease is an emerging health issue in the medical field, according to WHO every year around 10 billion people are affected with heart abnormalities. Arteries in the heart generate oxygenated blood to all body parts, however sometimes blood vessels become clogged or restrained due to cardiac issues. Past heart diagnosis applications are outdated and suffer from poor performance. Therefore, an intelligent heart disease diagnosis application design is required. In this research work, internet of things (IoT) sensor data with a deep learning-based heart diagnosis application is designed. The heart disease IoT sensor data is collected from the University of California Irvine machine learning repository free open-source dataset which is useful for training the deep graph convolutional network (DG_ConvoNet) deep learning network. The testing data has been collected from the Cleveland Clinic Foundation; it is a collection of 350 real-time clinical instances from heart patients through IoT sensors. The K-means technique is employed to remove noise in sensor data and clustered the unstructured data. The features are extracted to employ Linear Quadratic Discriminant Analysis. DG_ConvoNet is a deep learning process to classify and predict heart diseases. The diagnostic application achieves an accuracy of 96%, sensitivity of 80%, specificity of 73%, precision of 90%, F-Score of 79%, and area under the ROC curve of 75% implementing the proposed model.

Psychobiotics and Dietary Supplementation in the Clinical Practice: A Mini Review

Mental health defined as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make meaningful contribution to his or her community‟ reflects the individual ability to adapt to changing environment through thoughts, emotions and behaviors. Recently, the prevalence of psychiatric diseases is an emerging health issue that significantly impact on the quality of life and productivity of societies worldwide. Despite recent research advancements, the effectiveness off the curative approaches for the mental illness are still limited to pharmacologic treatments and/or psychotherapy, thereby indicating the need of development of alternative strategies. Growing number of research efforts into the better understanding of mental health determinants, prompted scientific interests into the use of dietary interventions, as potential approach to modify the mental state and improve wellbeing. A growing body of evidence to demonstrate the importance of diet, in particular intake of plant foods, in achieving optimal nutritional and health status, which has been attributed to plant-derived bioactives that consumed as whole food or dietary supplement may provide benefits for mental health, therefore providing an alternative for common pharmacotherapies in the psychiatry practice applied to treat metal conditions, including anxiety, depression, ADHD or schizophrenia. In addition, the discovery of a bidirectional communication between brain and gut microbiome, followed by the studies linking thee gut microbiota composition with behavior and mood, support use of microbial-derived metabolites in the form of live probiotic bacteria (probiotics), as well as their metabolites (post-biotics) may help in stress management and prevent anxiety-/depression-like symptoms in high-risk populations.

A putative new genus of avian schistosome transmitted by Biomphalaria straminea (Gastropoda: Planorbidae) in Brazil, with a discussion on the potential involvement in human cercarial dermatitis.

Human cercarial dermatitis (HCD) caused by avian schistosomes is an emerging health issue in different parts of the world. Nevertheless, parasite diversity, life cycle, and involvement in HCD remain poorly known or neglected in South America. Herein, we reported data obtained during a long-term malacological survey carried out in Pampulha Reservoir, an urban eutrophic waterbody from Brazil between 2009 and 2012. An ocellate brevifurcate cercaria emerged from 55 of 16,235 (0.34%) specimens of Biomphalaria straminea. Samples of the cercariae were subjected to morphological, experimental, and molecular study (analysis of partial sequences of nuclear 28S and mitochondrial cox1 genes). The molecular analysis revealed that the larva corresponds to an avian schistosome; however, it does not correspond to any named genus. A close related isolate was previously reported in Biomphalaria sudanica from Kenya (molecular divergences of 0.54% and 9.62% for 28S and cox1, respectively). The morphology of this cercaria was compared with other avian schistosome larvae from Biomphalaria spp. Attempts to infect experimentally ducks (Cairina moschata) and mice revealed cutaneous manifestations after exposure to cercariae, but adult parasites were not obtained in these hosts. Phylogenetic analysis suggests this parasite is a putative new genus and species of avian schistosome. The potential involvement of the larvae herein described in cases of HCD in Brazil cannot be ruled out. Surprisingly, HCD was not reported in the country so far, which can be related to difficulties in its diagnosis in areas of overlap with human schistosomes.

Prevalence and Molecular Mechanisms of Carbapenem Resistance among Gram-Negative Bacilli in Three Hospitals of Northern Lebanon

Carbapenem resistance (CR) is an emerging health issue. Epidemiological surveys on carbapenem-resistant Gram-negative bacilli (CR-GNB) in Lebanon remain scarce. In this study, we determined the prevalence of CR-GNB isolated between 2015 to 2019 in three hospitals in northern Lebanon: 311 CR-Enterobacterales (out of 11210; 2.8%), 155 CR-Pseudomonas (out of 1034; 15%) and 106 CR- Acinetobacter (out of 184; 57.6%) were identified. CR mechanisms were determined for 146 randomly chosen isolates: the Carba NP test revealed an enzymatic resistance to carbapenems in 109 isolates (out of 146, 74.7%). Produced carbapenemases were evaluated by the NG-Test Carba5, NG-Test OXA-23 immunochromatographic assays and PCR. Carbapenemase-producing (CP) Enterobacterales expressed blaOXA-48-like, blaNDM-like and blaVIM-like genes and CP-Pseudomonas expressed blaIMP-like and blaVIM-like genes, whereas CP-Acinetobacter expressed blaOXA-23-like genes. The NG-Test Carba5 results were confirmed by PCR sequencing and revealed several variants, such as NDM-19, VIM-62 and OXA-162, never described so far in Lebanon. Isolates with discordant results were sequenced by WGS and highlighted novel variants of the natural oxacillinases of Pseudomonas aeruginosa: blaOXA-50-like genes. Their role in carbapenem resistance should be further studied. Overall, our findings highlight an alarming situation and encourage health care centers to establish performant registration systems that could help in limiting resistance spread.

Bronchial Asthma and Sarcopenia: An Upcoming Potential Interaction.

Background: Sarcopenia seems to be an emerging health issue worldwide, concerning the progressive loss of skeletal muscle mass, accompanied by adverse outcomes. Asthma is a chronic inflammatory respiratory condition that is widespread in the world, affecting approximately 8% of adults. Although data are scarce, we aim to shed light on the potential association between low muscle mass and asthma and point out any probable negative feedback on each other. Methods: We searched within the PubMed, Scopus, MEDLINE, and Google Scholar databases. Study selections: Three studies were included in our analysis. Only original studies written in English were included, while the references of the research articles were thoroughly examined for more relevant studies. Moreover, animal model studies were excluded. Results: 2% to 17% of asthmatics had sarcopenia according to the existent literature. Sarcopenic asthmatic patients seem to have reduced lung function, while their mortality risk may be increased. Furthermore, patients with asthma- chronic obstructive pulmonary disease (COPD) overlap syndrome phenotype and sarcopenia might have a higher risk of osteopenia and osteoporosis progression, leading consequently to an increased risk of fractures and disability. Conclusions: Emerging data support that pulmonologists should be aware of the sarcopenia concept and be prepared to evaluate the existence of low muscle mass in their asthmatic patients.

School Nurse Management of Behavioral Health, Violence, and Trauma-Related Emergencies: Findings from a Statewide Survey.

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities.

NeuroCORD: A Language Model to Facilitate COVID-19-Associated Neurological Disorder Studies.

COVID-19 can lead to multiple severe outcomes including neurological and psychological impacts. However, it is challenging to manually scan hundreds of thousands of COVID-19 articles on a regular basis. To update our knowledge, provide sound science to the public, and communicate effectively, it is critical to have an efficient means of following the most current published data. In this study, we developed a language model to search abstracts using the most advanced artificial intelligence (AI) to accurately retrieve articles on COVID-19-associated neurological disorders. We applied this NeuroCORD model to the largest benchmark dataset of COVID-19, CORD-19. We found that the model developed on the training set yielded 94% prediction accuracy on the test set. This result was subsequently verified by two experts in the field. In addition, when applied to 96,000 non-labeled articles that were published after 2020, the NeuroCORD model accurately identified approximately 3% of them to be relevant for the study of COVID-19-associated neurological disorders, while only 0.5% were retrieved using conventional keyword searching. In conclusion, NeuroCORD provides an opportunity to profile neurological disorders resulting from COVID-19 in a rapid and efficient fashion, and its general framework could be used to study other COVID-19-related emerging health issues.

Development and prognosis of hepatocellular carcinoma in patients with diabetes.

The incidence of diabetes mellitus and hepatocellular carcinoma (HCC) has been increasing worldwide during the last few decades, in the context of an increasing prevalence of obesity and non-alcoholic fatty liver disease (NAFLD). Epidemiologic studies have revealed that patients with diabetes have a 2- to 3-fold increased risk of developing HCC, independent of the severity and cause of the underlying liver disease. A bidirectional relationship exists between diabetes and liver disease: advanced liver disease promotes the onset of diabetes, and HCC is an important cause of death in patients with diabetes; conversely, diabetes is a risk factor for liver fibrosis progression and HCC development, and may worsen the long-term prognosis of patients with HCC. The existence of close interconnections among diabetes, obesity, and NAFLD causes insulin resistance-related hyperinsulinemia, increased oxidative stress, and chronic inflammation, which are assumed to be the underlying causes of hepatocarcinogenesis in patients with diabetes. No appropriate surveillance methods for HCC development in patients with diabetes have been established, and liver diseases, including HCC, are often overlooked as complications of diabetes. Although some antidiabetic drugs are expected to prevent HCC development, further research on the optimal use of antidiabetic drugs aimed at hepatoprotection is warranted. Given the increasing medical and socioeconomic impact of diabetes on HCC development, diabetologists and hepatologists need to work together to develop strategies to address this emerging health issue. This article reviews the current knowledge on the impact of diabetes on the development and progression of HCC.

A rare case of abnormal narrowing and bifurcation of descending thoracic aorta and perioperative anaesthetic management during aortic bypass surgery

Hypertension in paediatric population is an emergent global health issue, where the prevalence is varied among nations. Although vascular pathologies are one of the causes for secondary hypertension, mid aortic anomalies are not seen commonly. These patients usually present with uncontrolled hypertension or hypertension emergency or hypertension associated organ dysfunction. Medical management per se will be not enough to achieve a satisfactory control in blood pressure and most of them will have to undergo either surgical repair or an endovascular procedure. Perioperative management of these patients is a challenge to an anaesthetist due to multiple reasons such as haemodynamic instabilities, organ dysfunction, metabolic derangements and the need for invasive monitoring.Here we present an 8 years and 10 months old boy who was investigated for hypertension and found to have abnormal narrowing and bifurcation of the descending aorta at T10 level and underwent successful aorto-aortic bypass surgery.

Moving Forward Through the Pandemic With Strength, Resilience, and Adaptation in Academic Medicine.

Moving Forward Through the Pandemic With Strength, Resilience, and Adaptation in Academic Medicine.