Gender Research Articles

Clinical and electrocardiographic predictors of left ventricular diastolic dysfunction in patients with idiopathic premature ventricular contractions

Objectives: Tachycardiomyopathy is a well-known phenomenon with reduction in left ventricular (LV) systolic function. In our study, we aimed to investigate the effects of idiopathic premature ventricular contractions (PVCs) on LV diastolic function in patients with idiopathic PVCs. Methods: We included 63 patients who are candidates to undergo radiofrequency ablation due to idiopathic PVCs (27 male, 36 female; mean age 47.9 ±16.6 years). Patients were classified into two groups according to the presence of LV diastolic dysfunction. The percentage of PVC burden was calculated by dividing the daily PVC burden by the total heart beat per day. Coupling interval ratio was calculated with the formula of Coupling interval ratio = (Coupling interval/sinus cycle length)x100. Results: Age, presence of q wave in D2-D3, daily PVC burden, percentage of PVC burden, left atrial volume index, intervenricular septum thickness, and mitral E/e’ ratio were significantly higher; male gender, peak E-wave velocity, lateral and septal annular e' velocity were significantly lower in patients with LV diastolic dysfunction. Daily PVC burden and percentage of PVC burden were positively correlated with mitral E/e’ ratio and negatively correlated with lateral annular e' velocity. The coupling interval ratio was positively correlated with mitral E/e’ ratio. Age, daily PVC burden, and percentage of PVC burden were independent predictors of increased mitral E/e’ ratio. The cutoff value of the percentage of PVC burden was 15.59% for prediction of LV diastolic dysfunction (sensitivity: 88.9%, specificity: 66.7%). Conclusions: Daily PVC burden, percentage of PVC burden, and coupling interval ratio are correlated with echocardiographic parameters of LV diastolic function.

Standardized Patient Communication and Low-Value Spinal Imaging: A Randomized Clinical Trial.

Acute back pain is a common reason for primary care visits and often results in low-value spinal imaging. To evaluate the effect of a standardized patient-delivered intervention on rates of low-value spinal imaging among primary care patients with acute low back pain. In this randomized clinical trial, physicians or advanced practice clinicians were recruited from March 22 to August 5, 2021, from 10 adult primary care or urgent care clinics in Sacramento, California. The intervention period was from May 1, 2021, to March 30, 2022, with follow-up from October 28, 2021, to June 30, 2023. Analyses were performed from April 1 to June 25, 2024. Clinicians were randomized 1:1 to intervention or control. Intervention clinicians received 3 simulated office visits, each with a standardized patient instructor (SPI) portraying a patient with acute uncomplicated back pain. At each visit, SPIs provided clinician feedback guided by a 3-step model: (1) set the stage for deferred imaging by building trust, (2) convey empathy, and (3) communicate optimism while advocating watchful waiting without imaging. Control clinicians received no intervention. The primary outcome was lumbar spinal imaging completion within 90 days of acute low back pain visits, with study clinicians assessed up to 18 months of follow-up. Secondary outcomes were cervical spine imaging completion after acute neck pain visits, any imaging completion after an adult visit, patient experience ratings of clinicians (scale range, 0-100), and use of targeted communication skills during an audio-recorded standardized patient evaluation visit at median follow-up of 16.8 months (range, 14.1-18.0 months). The analysis included 53 clinicians; mean (SD) age was 46.7 (1.0) years, and 35 (66.0%) reported female gender. A total of 25 were in the intervention group and 28 in the control group. After adjustment for prerandomization rates, patients with acute low back pain who saw intervention and control clinicians during follow-up had similar rates of lumbar imaging (194 of 1234 clinic visits [15.7%] vs 226 of 1306 clinic visits [17.3%]; adjusted ratio of postintervention vs preintervention odds ratios [AORR], 1.00; 95% CI, 0.72-1.40). Adjusted follow-up rates of imaging for acute neck pain (AORR, 1.16; 95% CI, 0.83-1.63) and overall imaging (AORR, 1.07; 95% CI, 0.97-1.19) were not significantly different among patients of intervention and control clinicians. Intervention and control clinicians had similar mean (SD) patient experience ratings during follow-up (88.6 [28.7] vs 88.8 [28.3]; adjusted mean difference-in-differences, -1.0; 95% CI, -3.0 to 0.9). During audio-recorded standardized patient visits, intervention clinicians had significantly better ratings than controls on eliciting the patient's perspective (adjusted standardized difference [ASD], 0.62; 95% CI, 0.05-1.19) and conveying empathy (ASD, 1.16; 95% CI, 0.55-1.77). In this randomized clinical trial of an educational intervention using simulated office visits to encourage a watchful waiting approach for acute low back pain, the intervention had no significant effect on low-value spinal imaging rates or patient experience ratings. ClinicalTrials.gov Identifier: NCT04255199.

Psychosocial Complaints and Life Satisfaction Among Greek University Students: A Pre- and Pandemic-Era Comparison

This study aims to identify and compare the prevalence and risk factors associated with psychosocial and psychological complaints, as well as life and study satisfaction, among Greek undergraduate students before and during the COVID-19 pandemic. Data were collected in two phases: initially, from 2018 to 2019 (pre-COVID), through face-to-face surveys, and later, from October 2020 to June 2021 (COVID period), through online surveys. The study, conducted at Democritus University of Thrace (DUTH) in Greece, utilized a repeated descriptive and comparative cross-sectional design. The sample comprised 540 and 641 undergraduate students during the pre-COVID and COVID period, respectively. The following questionnaires were used: I. A socio-demographic characteristics form, II. Psychosocial Complaints List (PCL), and III. Satisfaction with Life and Studies Scale (SLSS). During the COVID period, there was an increase of 63% in psychosocial complaints (p < 0.001), as indicated by the PCL total, and a 25% decrease in satisfaction with life and studies (p = 0.001), according to the SLSS, compared to the pre-COVID period. Incidences of “suicidal thoughts”, “sexual problems”, and “extreme psychological distress” nearly doubled (61%, 67%, and 104%, respectively) during the pandemic. Females exhibited a 33% increase in the PCL total during the COVID period compared to males (p < 0.001). These findings highlight the profound impact of pandemic-induced changes on students’ mental health and quality of life. Female gender and the pandemic period itself emerged as significant factors influencing these outcomes. Universities should prioritize the development of comprehensive support services to mitigate these adverse effects.

Asthma prescribing trends, inhaler adherence and outcomes: a Real-World Data analysis of a multi-ethnic Asian Asthma population

Inhaled corticosteroid (ICS) is the mainstay therapy for asthma, but general adherence is low. There is a paucity of real-world inhaler prescribing and adherence data from Asia and at the population level. To address these gaps, we performed a real-world data analysis of inhaler prescribing pattern and adherence in a multi-ethnic Asian asthma cohort and evaluated the association with asthma outcomes. We performed a retrospective analysis of adult asthma patients (aged ≥18 years) treated in the primary and specialist care settings in Singapore between 2015 to 2019. Medication adherence was measured using the medication possession ratio (MPR), and categorised into good adherence (MPR 0.75-1.2), poor adherence (MPR 0.75) or medication oversupply (MPR > 1.2). All statistical analyses were performed using R Studio. 8023 patients, mean age 57 years, were evaluated between 2015 and 2019. Most patients were receiving primary care (70.4%) and on GINA step 1–3 therapies (78.2%). ICS-long-acting beta-2 agonist (ICS-LABA) users increased over the years especially in the primary care, from 33% to 52%. Correspondingly, inpatient admission and ED visit rates decreased over the years. Between 2015 and 2019, the proportion of patients with poor adherence decreased from 12.8% to 10.5% (for ICS) and from 30.0% to 26.8% (for ICS-LABA) respectively. Factors associated with poor adherence included minority ethnic groups (Odds ratio of MPR 0.75–1.2: 0.73–0.93; compared to Chinese), presence of COPD (OR 0.75, 95% CI 0.59–0.96) and GINA step 4 treatment ladder (OR 0.71, 95% CI 0.61–0.85). Factors associated with good adherence were male gender (OR 1.14, 95% CI 1.01–1.28), single site of care (OR 1.22 for primary care and OR 1.76 for specialist care), GINA step 2 treatment ladder (OR 1.28, 95% CI 1.08–1.50). Good adherence was also associated with less frequent inpatient admission (OR 0.91, 95% CI 0.84–0.98), greater SABA overdispensing (OR 1.66, 95% CI 1.47–1.87) and oral corticosteroids use (OR 1.10, 95% CI 1.05–1.14). Inhaled corticosteroid (ICS) adherence has improved generally, however, poor adherence was observed for patients receiving asthma care in both primary and specialist care, and those from the minority ethnicities.

Immune checkpoint inhibitors-related thyroid dysfunction: influencing factor analysis, prediction model development, and management strategy proposal

BackgroundWith the extensive utilization of immune checkpoint inhibitors (ICIs) across various cancers, ICIs-related thyroid dysfunction (ICI-TD) has become a growing concern in clinical practice. This study aimed to devise an individualized management strategy for ICI-TD to enhance the early identification and proactive management in cancer patients.MethodsWe designed and conducted a three-phase study. Initially, we analyzed the influencing factors through a systematic review and meta-analysis, which adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Moreover, the study protocol was registered with PROSPERO (CRD42019131133). Subsequently, prediction models for ICI-TD were developed utilizing 11 algorithms based on the real-world cohort data from July 20, 2018 (the approval date of the first ICIs, Pembrolizumab in China), to October 31, 2022. Considering discrimination, calibration, and clinical utility, we selected the model with the best performance for web calculator development. Finally, individualized management strategies for ICI-TD were proposed by combining evidence-based analysis with practical considerations.ResultsThe systematic review encompassed 21 observational studies involving 4,145 patients, revealing associations between ICI-TD and factors such as female gender, age, receipt of Pembrolizumab (versus other ICIs), and baseline levels of thyroid-stimulating hormone, free thyroxine, and antithyroid antibodies. In the prediction model development phase, 621 participants were enrolled, with 36 patients developing ICI-TD. The model based on the LightGBM algorithm demonstrated superior performance, leading to the development of a web calculator. Based on these findings and existing guidelines, individualized monitoring and treatment pathways for pharmacists were devised.ConclusionThis study offers comprehensive insights into managing ICI-TD, potentially enhancing tailored cancer immunotherapy management.

Investigation of Prognosis and Related Factors of Premature Neonates

The birth of premature infants remains a challenge in many societies. This cross-sectional study investigates prenatal care and influential factors in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of Fatemieh Educational-Medical Center in Hamadan, Iran, from March 2018 to March 2019. We examined premature infants with a gestational age of less than 37 weeks who were admitted to the NICU. Data on demographic and maternal characteristics, length of hospital stay, maternal underlying diseases, probable causes of preterm birth, neonatal complications, treatment types, treatment-related complications, resuscitation needs, ventilation, and mortality rates were extracted from patient records. Among 388 preterm infants studied, 204 (52.6%) were female. The mean gestational age was 31.8±2.8 weeks, birth weight was 1647.4±625.6 grams, and average hospital stay was 10.2±9.3 days. The most common maternal underlying disease was pregnancy-induced hypertension or preeclampsia (22.2%), respiratory distress syndrome, jaundice, and low birth weight were the leading reasons for hospitalization (84%). Neonatal outcomes included 92 (23.7%) deaths, 25 (6.4%) intraventricular hemorrhages, 39 (10.1%) patent ductus arteriosus cases, 20 (5.2%) bronchopulmonary dysplasia cases, and 41 (10.6%) retinopathy of prematurity cases. Regression analysis revealed significant predictors of neonatal mortality, including male gender, maternal underlying diseases, need for cardiopulmonary resuscitation, low Apgar score at one-minute, lower birth weight, shorter gestational age, and NICU stay duration. This study underscores the high neonatal mortality rate among preterm infants. Implementing preventive measures, particularly addressing maternal underlying diseases and low birth weight, can significantly reduce neonatal mortality.

Can large language models be sensitive to culture suicide risk assessment?

AbstractSuicide remains a pressing global public health issue. Previous studies have shown the promise of Generative Intelligent (GenAI) Large Language Models (LLMs) in assessing suicide risk in relation to professionals. But the considerations and risk factors that the models use to assess the risk remain as a black box. This study investigates if ChatGPT-3.5 and ChatGPT-4 integrate cultural factors in assessing suicide risks (probability of suicidal ideation, potential for suicide attempt, likelihood of severe suicide attempt, and risk of mortality from a suicidal act) by vignette methodology. The vignettes examined were of individuals from Greece and South Korea, representing countries with low and high suicide rates, respectively. The contribution of this research is to examine risk assessment from an international perspective, as large language models are expected to provide culturally-tailored responses. However, there is a concern regarding cultural biases and racism, making this study crucial. In the evaluation conducted via ChatGPT-4, only the risks associated with a severe suicide attempt and potential mortality from a suicidal act were rated higher for the South Korean characters than for their Greek counterparts. Furthermore, only within the ChatGPT-4 framework was male gender identified as a significant risk factor, leading to a heightened risk evaluation across all variables. ChatGPT models exhibit significant sensitivity to cultural nuances. ChatGPT-4, in particular, offers increased sensitivity and reduced bias, highlighting the importance of gender differences in suicide risk assessment. The findings suggest that, while ChatGPT-4 demonstrates an improved ability to account for cultural and gender-related factors in suicide risk assessment, there remain areas for enhancement, particularly in ensuring comprehensive and unbiased risk evaluations across diverse populations. These results underscore the potential of GenAI models to aid culturally sensitive mental health assessments, yet they also emphasize the need for ongoing refinement to mitigate inherent biases and enhance their clinical utility.

Determinants of Between-Person Variation in Shoulder Pain in Individuals With Spinal Cord Injury: A Population-Based Cohort Study.

The aim of the study was to evaluate determinants of between-person variation in shoulder pain ("yes"/"no") in individuals with spinal cord injury living in Switzerland. This longitudinal study used data from the Swiss Spinal Cord Injury Cohort community surveys 2012, 2017, and 2022. Logistic regression analyses were used to identify determinants of between-person variability in shoulder pain while controlling for within-person variability. The prevalence of shoulder pain was 34.4% (95% CI = 33.0-35.9) when studying 4393 completed questionnaires. Significant determinants for between-subject variability revealed higher likelihoods for shoulder pain in females as compared with males (odds ratio: 1.57; 95% CI = 1.21-2.05), and when spasticity (1.49; 1.14-1.95), contractures (2.77; 2.21-3.48), and depression (1.39; 1.02-3.48) were present. In addition, shoulder pain presented highest likelihoods in individuals with incomplete tetraplegia (1.81; 1.32-2.48) versus incomplete paraplegia, in individuals over 26 yrs since injury (1.65; 1.15-2.37) versus up to 5 yrs since injury, and in individuals using a manual (2.17; 1.53-3.08) or electrical (2.16; 1.41-3.31) wheelchair versus no aids. There were significant interaction effects for gender with time since injury, contractures, and depression. Determinants of between-subject variability in shoulder pain were female gender, lesion severity, time since injury, specific health conditions, and wheelchair use.

Prevalence and Related Factors of Dizziness Among Older Adults: A Cross-Sectional Study in Ardakan City, Iran.

Dizziness and balance disorders are directly related to aging in humans- Dizziness is one of the most important factors causing the burden of disability after the age of 65. Bearing in mind the increase in the elderly population in Iran and the world and the prevalence of dizziness in old age, early diagnosis of dizziness and determination of the factors affecting its severity facilitate its treatment and are effective in preventing its adverse consequences. To determine the prevalence of dizziness and its related factors among older adults in Ardakan city, Yazd province, Iran, in 2022. This cross-sectional study was conducted in four comprehensive health centers of Ardakan city with the participation of 260 elderly people aged ≥60 years, who were randomly included in the study. Data were collected using a series of questionnaires which were completed by interviewing the participants. The variables of this study included demographic information, information related to the dizziness status, diseases, medications, use of mobility aids, physical activity level, fear of falling, quality of life and depression. The prevalence of dizziness among older adults of Ardakan city was 48.5%. In terms of the severity of dizziness, 38.8% had substantial dizziness, and 9.6% had mild dizziness. Dizziness was significantly related to physical activity (p<0.05), fear of falling (p <0.01), depression (p <0.05), history of falling (p <0.01), use of mobility aids (p <0.01), age (p<0.01), education level (p<0.01), gender (p <0.05) and diseases such as high blood pressure (p<0.05), hypothyroidism (p <0.01) and ear diseases(p <0.01). Also, elderly people with dizziness used significantly more medications such as sedatives (p<0.01), antihypertensive drugs (p <0.05) and cytotoxic drugs (p <0.01). About half of the older adults experience dizziness, and this problem is associated with depression, fear of falling, history of falling, low physical activity, age, female gender, ear diseases, high blood pressure, and hypothyroidism. In addition, the use of medications such as anti- hypertensives, sedatives and cytotoxic drugs is related to dizziness. Families with elderly people, doctors and healthcare workers need to be educated and pay more attention to the above.

Influence of metalloproteinase-3 (-1171 5A>6A) polymorphism on periportal fibrosis in patients with schistosomiasis mansoni, Pernambuco, Brazil

In schistosomiasis mansoni (SM), periportal fibrosis (PPF) arises due to an inflammatory response exacerbated by parasite eggs in the intrahepatic portal space, culminating in the deposition of collagen and extracellular matrix proteins. This fibrosis results from a remodeling process of the extracellular matrix, in which metalloproteinases play a significant role. The study evaluated the association between MMP-3 polymorphism (-1171 5A>6A) (rs 3025058) and sociodemographic factors with PPF in individuals with SM. This is an analytical cross-sectional study involving 242 individuals infected with S. mansoni, of these 122 were diagnosed with hepatosplenic form (HS) and 119 hepatointestinal form (HI), all from the state of Pernambuco, Brazil. Polymerase chain reaction with restriction enzyme digestion (Psyl) was used to determine the MMP-3 polymorphism (-1171 5A>6A). There was a significant association between the male gender and the HS form (OR = 1.7623 95% CI [1.0481-2.9631]; p-value = 0.0439) as well as individuals aged over 41, also had a greater chance of developing this clinical form of the disease (OR = 2.8299; 95% CI [1.5211-5.2650]; p-value = 0.0014), with greater emphasis on individuals over 61 years old (OR= 8.5541; 95% CI [3.6895-19.8326], p-value= 0.0000). There was no statistically significant association between the MMP-3 polymorphism (-1171 5A>6A) between the clinical groups (5A6A CI [0.7144-1.9879] p-value 0.5882 5A5A CI [0.0912-2.9231] p-value 0.7331 5A6A / 5A5A CI [0.6904-1.8937] p-value 0.6949). In conclusion, the results showed no association between the MMP-3 polymorphism (-1171 5A>6A) and the development of PPF. In addition, males, and age over 41 were predictive factors for the HE form of the disease in this Brazilian population.

Psychosocial characteristics of suicide deaths by regional types in Korea: An analysis based on population inflow and outflow.

This study aims to investigate the psychosocial characteristics of suicide deaths in Korea according to population inflow and outflow, and to identify high-risk suicide groups by regional type in order to establish tailored suicide prevention plans for each region. The analysis included 4193 suicide deaths from four regional types in Korea. The data source was a comprehensive survey of suicide deaths through police investigation records from the Korean government. The analysis involved collecting demographic variables, suicide-related variables, and stress variables at the time of death for suicide deaths in each region and conducting cross-analysis and multinomial logistic regression analysis. Across all regions, factors such as male gender, unemployment, hanging in one's own home, and mental health problems were prevalent. However, in population-inflow urban areas, early-middle age and economic problems were higher, in population-outflow urban areas, late-middle age and economic problems were more prominent. Additionally, in both inflow and outflow rural areas, there was a relatively higher proportion of old age and physical health problems. This study is significant for confirming common and specific factors influencing suicide in each region, and for proposing considerations when formulating tailored suicide prevention plans for local communities.

The clinicopathologic significance of psammoma bodies in cytology specimens: A series of 78 cases.

Currently the clinicopathologic significance of psammoma bodies in cytology specimens are not completely understood, including types of cytology specimens and pathologic conditions frequently associated with this unique cytologic feature. In this study, we undertook a retrospective approach to review the specimen types, cytology preparations, patient characteristics, organs or tissues involved and differential diagnoses in cytology specimens with the finding of psammoma bodies. Cytology cases with the finding of psammoma bodies from January 2004 to December 2022 were retrieved from our institution's pathology databases, and their clinicopathological features were reviewed. A total of 78 cytology specimens with the finding of psammoma bodies were recorded in our CoPath system. The mean age at diagnosis was 59 years. The patient group showed female gender predominancy (90%). FNA specimens comprised about 38.5% of total cases. Other common specimen types were body cavity fluids (38.5%), including pleural effusion and peritoneal fluid, and about 20.5% of the cases were pelvic washing performed during gynecologic surgeries. Most cytology cases with psammoma bodies had a malignant diagnosis (69%). About 18% of the cases were in the indeterminate diagnostic categories, with 12% suspicious for malignancy and 6% of the cases with atypical cells. About 5% of cases were placed in the neoplastic category, while 8% of cases were negative for malignancy. About 79% of peritoneal cytology with psammoma bodies were neoplastic and mostly gynecologic tumors. Pleural fluids with psammoma bodies were very likely to be malignant and involved by serous carcinoma (15 of 16 cases, 94%). Papillary thyroid carcinoma was the second most common malignancy in our series, present in about 53% of thyroid cytologies with the finding of psammoma bodies. Our study showed that psammoma bodies in cytology preparations were more often associated with malignancies in our study of 78 cytology specimens (69%). The most sampled location in our study was peritoneal cavity, followed by pleural cavity, thyroid, lymph nodes, neck masses, and omentum. The clinicopathologic value of psammoma bodies in predicting malignancy varies depending on locations and specimen types.

Psychological distress among nurses: Exploring the role of support in the work-place in Morocco.

This study aimed to assess the psychological distress, specifically anxiety and depression, among nurses employed at University Hospital Center of Rabat in Morocco and tested the associations between support in the workplace and nurses' psychological well-being. A cross-sectional observational study was conducted at University Hospital Center of Rabat in Morocco, based on a prospective data collection employing an ad-hoc self-report questionnaire. 223 nurses were enrolled with a minimum of 1 year of practice in any care unit. Socio-demographic and professional characteristics of each participant were included. A validated tool was utilized to measure the support from superiors and colleagues in the workplace, while the Hospital Anxiety and Depression Scale (HADS) was employed to evaluate anxiety and depression. Univariate and multivariate analyses were conducted to explore the relationships between different independent and dependent variables. Significant socio-demographic and professional factors associated with increased anxiety included female gender, age over 41 years old, Baccalaureate level of education, intention to leave the hospital, and less support from superiors. Regarding the levels of depression, the Baccalaureate level of education was significantly associated with higher levels of depressive symptoms (β 2.444; CI [1.203, 3.686]). Our findings suggested that ensuring support from superiors was crucial for safeguarding the psychological well-being of nurses. Therefore, hospital managers should prioritize addressing the workplace support for professionals, and the organizational enhancement.

Correlation between severity of preoperative low back pain and postoperative outcomes in lumbar disc herniation surgery: A retrospective cohort study.

BACKGROUND CONTEXTLow back pain (LBP) frequently occurs in patients with lumbar disc herniation (LDH), however the extent to which discectomy ameliorates it and how preoperative LBP influences postoperative outcomes remains unclear. PURPOSETo evaluate the improvement in LBP and its impact on postoperative patient-reported outcome measures (PROMs). STUDY DESIGN/SETTINGMulticenter retrospective observational study. PATIENT SAMPLEPatients undergoing discectomy for LDH at eight hospitals from April 2017 to March 2021. OUTCOME MEASURESData were collected on patients’ backgrounds, operative factors, and PROMs, including the Numeric Rating Scale (NRS) for pain in the low back, buttock, or leg, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction. METHODSPatients were categorized into mild (NRS 0–3), moderate (NRS 4–7), or severe (NRS 8–10) LBP groups. Inverse probability weighting with propensity scores was used to adjust for demographic and clinical differences between groups. Chi-square tests and one-way analysis of variance were conducted to compare background data and clinical characteristics. Additionally, multivariate logistic regression was performed to identify risk factors for less than 50% improvement in LBP. RESULTSThis study included 928 patients: 270 mild, 343 moderate, and 315 severe. After adjustment, preoperative NRS scores were significantly different across groups, with scores of 1.6 (SD 1.3), 5.6 (SD 1.0), and 8.8 (SD 0.9), respectively. Postoperative NRS scores also varied significantly, with worse outcomes observed in the severe group compared to the mild group, yet similar to the moderate group. A total of 46.8% of the mild group, 86.6% of the moderate group, and 72.9% of the severe group achieved a 50% decrease in NRS scores of LBP. Preoperative EQ-5D and ODI scores were significantly worse in the severe group compared to the mild or moderate groups, but postoperative scores were not significantly different between the severe and moderate groups. No significant differences in postoperative satisfaction were observed among the groups. Being female was a significant risk factor for less than 50% improvement in LBP (odds ratio = 1.56, p = 0.022). CONCLUSIONSDiscectomy significantly improved LBP in patients with LDH, including those with moderate or severe LBP. Patients with severe LBP showed similar improvements in PROMs as those with moderate LBP. Female gender emerged as a significant risk factor for less than optimal improvement in LBP.

War-related trauma and posttraumatic stress disorder in refugees, displaced, and nondisplaced people during armed conflict in Sudan: a cross-sectional study

BackgroundThe ongoing armed conflict in Sudan has caused mass displacement, affecting mental health. This study aimed to assess the prevalence of posttraumatic stress disorder (PTSD) and trauma among refugees, internally displaced, and nondisplaced people, while also examining the link between displacement type, PTSD severity, and associated factors.MethodsThis cross-sectional study used the Posttraumatic Stress Disorder Checklist for DSM-5 to assess PTSD symptoms and the General Health Questionnaire-28 to evaluate depression. Data were collected from 642 participants, targeting general social media groups for those within Sudan and specific groups for refugees outside the country. Sociodemographic and trauma event data were also gathered. Data analysis was conducted using SPSS, applying one-way ANOVA and independent t-tests to compare PTSD and depression. Binary logistic regression identified associations between sociodemographic factors and PTSD symptoms.ResultsAmong the 642 participants, 46.3% were internally displaced people (IDP), 42.1% were refugees, and 11.7% were non-displaced individuals. Clinically significant PTSD symptoms were identified in 36.6% of the participants. Refugees had a significantly greater percentage of traumatic events (M = 4.31, SD = 2.605, p < .01). Depression symptoms were found to be strongly associated with clinically significant PTSD (p < .001). Factors significantly linked to depression symptoms included female gender (p = 0.015), being single (p = 0.048), younger age (p = 0.036), dissatisfaction with living conditions (p < 0.001), and unemployment (p = 0.021). Dissatisfaction with living conditions also significantly influenced the likelihood of developing PTSD (p < .001).ConclusionThe study found that 36.6% of participants experienced PTSD, with refugees having a 1.4 times greater risk of developing PTSD compared to IDP and non-displaced individuals. Traumatic events were moderately correlated with PTSD symptoms, though non-displaced individuals had higher exposure to such events. These findings highlight the need for targeted mental health interventions, particularly for refugees and those affected by traumatic events. Further research using probability sampling is necessary to confirm these results and inform more effective mental health policies and programs for displaced populations.

Clinical characteristics of Behçet's disease in an Egyptian cohort

Background: Behçet's disease is a multi-systemic vasculitis characterized by recurring lesions in the skin mucosa and sight-threatening uveitis. The aim of the research: This research aimed to investigate the clinical features of Behçet's disease (BD) in individuals residing in Egypt. Patients and methods: 150 individuals with BD were recruited, examined, and put through a skin allergy test, musculoskeletal assessment, laboratory tests, and comprehensive medical history. The disease's activity was evaluated using the Behçet Disease Current Activity Form (BDCAF). Complete ophthalmological evaluation and imaging studies were performed according to the organ involved. Results: Cases were 116 men (77.3%) and 34 women (22.7%) (M: F 3.4:1). Their mean age was 34.05 ± 9.28 years, and the disease duration range was 1–20 years. Oral and genital aphthosis were reported in 86.7% and 82.0%, respectively. Eye affection was observed in 68.7%, mainly in anterior uveitis (35.3%). Vascular manifestations occurred in 58.7%, affecting primarily the venous side (31.3%) in the form of deep venous thrombosis (DVT). 32.7% had joint affection, and the pathergy test was positive for 28%. Central nervous system (CNS), skin lesions, and gastrointestinal tract involvement were the slightest common manifestations observed in 26%, 25.3%, and 7.3%, respectively. Articular manifestations were markedly linked to skin lesions (P = 0.002), and there was a significant predominance of articular manifestations among females (P = 0.042). BDCAF score was significantly related to male gender (P = 0.037), smokers (P &lt; 0.000), those with older age (P = 0.028), delayed age of disease onset (P = 0.025), and additionally those with the eye (P = 0.000) and CNS involvement (P = 0.003). Conclusion: The clinical features of Egyptian Behçet's patients were significantly dominated by mucocutaneous involvement, followed by ocular affection. Articular manifestations were markedly more significant in women. The disease activity score was more remarkable in males, smokers, those of older age, and those with a delayed age of disease onset.

Prevalence of human Schistosoma mansoni infection in endemic regions (2010–2024): a systematic review and meta-analysis

Schistosoma mansoni infection poses a substantial public health challenge globally, and the World Health Organization (WHO) aims for the elimination of schistosomiasis by 2030. This study aimed to assess the current prevalence of human S.mansoni infection in endemic regions worldwide between 2010 and2024. We conducted a comprehensive search in PubMed/Medline and Scopus databases as well as other public sources from 1 January 2010 to 15 July 2024. Population-based studies reporting the prevalence of S.mansoni infection were eligible. We undertook a random-effects meta-analysis to estimate pooled prevalences with 95% confidence intervals (CIs) in WHO-defined regions and assessed potential risk factors associated with S.mansoni infection. The protocol for this study was registered on PROSPERO (CRD42023438455). We identified a total of 542 eligible studies involving 1,163,866 individuals who had been tested for S.mansoni infection in 38 countries. The overall, pooled global prevalence of S.mansoni infection in endemic region was 14.8% (95% CI, 13.5%-16.1%). The pooled prevalences (95% CI) in specific regions were: 15.3% (13.9-16.8%) in sub-Saharan Africa, 12.4% (8.9-16.4%) in South America and 9.5% (5.4-14.6%) in the Eastern Mediterranean region. There was a 52.6% decrease in prevalence of S.mansoni infection and a 37% decrease in high-intensity infection for studies conducted between 2010 and 2014 compared to those conducted between 2020 and 2023. The present analysis revealed that factors including male gender, bathing or swimming in natural water bodies, crossing rivers or lakes, and engaging in water irrigation activities such as fishing, working in rice paddies or maintaining irrigation canals were significantly associated with S.mansoni infection. The findings of this investigation revealed that, despite a decline in prevalence and high-intensity infection, 7-12% of people in endemic regions, notably in sub-Saharan Africa, remained affected by schistosomiasis mansoni between 2020 and 2024. This study provides data of relevance to policymakers to support efforts to eliminate this disease. This study received no funding.

Addition of neutrophil-to-lymphocyte ratio to Pre-DAA FIB-4 does not increase prediction value for de novo liver complications in hepatitis C

Background and aimsDirect-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation. Our study aimed to investigate whether the addition of NLR can increase the prediction power of pre-DAA FIB-4 for de novo liver complications after SVR. MethodsWe recruited patients via The Taiwan HCV Registry (TACR) and National Health Insurance Registry Database. The inclusion criteria were patients who achieved SVR12 after DAA and were followed for at least 24 months after SVR12. Liver complications included ascites, hepatic encephalopathy, variceal bleeding, and HCC. ResultsTotally 7657 patients were recruited from 2013 to 2018. Among them, 3674 patients (48.0%) had a FIB-4 value > 3.25 and 491 patients (6.4%) had a NLR >4 before DAA. After two-year of follow-up after SVR 12, 214 patients (2.8%) developed de novo liver complications. Factors associated with liver complications included male gender, diabetes mellitus, hyperlipidemia, chronic kidney disease, and pre-DAA FIB-4 >3.25 in multivariate analyses. Addition of NLR slightly did not increase the power of predicting liver complications. ConclusionsThe overall incidence of de novo liver complications after SVR is low during short-term follow-up. Elevated pre-DAA FIB-4 is associated with de novo liver complications after SVR, whereas the addition of pre-DAA NLR does not increase the prediction power.

Impact of Fibromyalgia on Disease activity in Inflammatory Arthritis: A Cohort Study Conducted at Tertiary Care Hospital of Peshawar, Pakistan

Objective: To determine the frequency of fibromyalgia in patients with inflammatory arthritis and to evaluate the impact of fibromyalgia treatment on disease activity in these patients. Study Design: Prospective cohort study. Place and Duration of Study: Rheumatology Division, Lady Reading Hospital, Peshawar Pakistan, from Apr to Dec 2021. Methodology: A total of 400 patients were enrolled in the study of which 320 were diagnosed with rheumatoid arthritis, 55 with ankylosing spondylitis and 25 with psoriatic arthritis. The diagnosis of fibromyalgia was made with 2016 American College of Radiology Criteria and patients were classified according to the presence or absence of fibromyalgia. Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS28-ESR), Bath Ankylosing Spondylitis Disease Activity Index and Disease Activity in Psoriatic Arthritis Score-28 were recorded for rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, respectively. Patients of fibromyalgia were treated by either pregabalin or duloxetine with 3-month follow-up. Patients with Widespread Pain Index &lt;7 and Symptoms Severity Scale &lt;5 after treatment for 3 months were labeled as responders. Results: Fibromyalgia was present in 90(28.1%) patients with Rheumatoid Arthritis, 14(25.5%) with ankylosing spondylitis and 8(32%) with Psoriatic arthritis. Fibromyalgia was more common in Rheumatoid Arthritis patients whose disease duration exceeded 5 years (p-value &lt;0.001). Similarly, obesity significantly contributed to Fibromyalgia development in Rheumatoid Arthritis (p-value &lt;0.001) but not in Ankylosing spondylitis and Psoriatic arthritis patients. Disease duration &gt;5 years, obesity, female gender and rising age increased the odds of developing Fibromyalgia in ... Conclusion: Patients with concomitant Fibromyalgia presented higher

Sodelovanje in vztrajanje bolnikov z multiplo sklerozo pri zdravljenju z zdravili

Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system that presents the second highest cause of disability among young adults in their thirties. Medication treatments are based on parenteral and novel oral disease-modifying therapies (DMTs) for their simple dosage form, increased efficacy, and safety. Medication adherence (MA) assesses the extent to which patients’ medication administration corresponds with the agreed-upon treatment recommendations from health-care providers. Medication persistence (MP) is part of the MA continuum and defined as the interval between the initiation and last dose of the applied medication immediately preceding discontinuation. Adherence measures are based on medication availability and gaps over the period it is dispensed. Medication adherence in persons with MS is complex due to disease chronicity and more demanding routes of administration. Adherence is higher in patients on oral compared to older injectable parenteral treatment. Younger age, female gender, and longer disease course are key risk factors leading to lower adherence, which declines substantially after six months of treatment. The association of disability with adherence remains unknown. The major adherence barriers in the course of treatment are adverse effects, injectophobia, and dosage frequency. Common non-adherence reasons among patients are forgetfulness, depression, and fatigue. Medication non-adherence is associated with lower health and economic outcomes. Interventions for increasing MA in persons with MS are complex and individualized. Overcoming adherence barriers in MS should be aimed at injectophobia, coping with adverse effects, and increasing beliefs towards treatment necessity.