Case History Research Articles

Optimal choice of indicators for timely assessment of the prognosis of COVID-19 in hospitalized patients

The aim of the study was to identify the indicators that are most significant for predicting the features of the course of COVID-19 in hospitalized patients.Materials and methods. 250 case histories of patients aged 18 to 86 years with COVID-19 hospitalized in the hospital of the city of Nukus, Republic of Uzbekistan, redesigned to provide care to patients with COVID-19 from July 1, 2020 to March 2022, were analyzed. Patients who had a wave–like course of the disease with the development of complications, an increase in the volume of lung damage, were included in the main group (62 patients, 3 of whom were extremely severe). The patients who had stable positive dynamics (188 people) formed a comparison group.Results and discussion. Among patients over 65 years of age, 36% had a complicated course, in the 45–65 age group — 29% (p>0.05), and among patients under 45 years of age — 13% (p<0.05). The main group was dominated by men (79%). Among hospitalized villagers, an increase in the severity of the condition was noted in 30% of cases, and among patients from the city of Nukus, such patients were 20% (p<0.05). The highest values of D-dimer, interleukin-6 and C-reactive protein were in both groups, significant differences between the groups were revealed in the levels of D-dimer and interleukin-6. Significant differences between the groups were found in the levels of D-dimer, interleukin-6, ferritin, ALT, AST, and urea.Conclusion. COVID-19 has become one of the most studied diseases to date, but aspects of the course of this disease in certain population groups are still not sufficiently investigated. The complicated, progressive course of COVID-19, according to the results of our study, was recorded in all age groups of the adult population, more often in men from rural areas aged over 45 years with chronic diseases. The main prognostic markers of the complicated and progressive course of COVID-19 should be considered high levels of D-dimer, interleukin-6 and ferritin.

Clinical and Epidemiological Characteristics of Leptospirosis in the Gomel Region

Relevance. Leptospirosis is a zoonotic ubiquitous natural focal infectious disease that has an adverse effect on human and pet health. The territory of the Republic of Belarus in terms of its natural-climatic and soil-geographical conditions is favorable for the existence of both natural and anthropurgical foci of leptospirosis. The purpose of the work is to study the long-term dynamics of the incidence of leptospirosis in the population of the Gomel region and the clinical and epidemiological features of leptospirosis. Materials and methods. The material for the study was the data of the state statistical reporting «Report on individual infectious, parasitic diseases and their carriers» for the period from 2002 to 2022. In this work, epidemiological diagnostic methods and statistical research methods were used. Descriptive retrospective continuous study of these case histories of patients diagnosed with Leptospirosis of the Gomel Regional Infectious Diseases Clinical Hospital institution was conducted to describe clinical data. Results. In the period from 2002 to 2022, 161 cases of leptospirosis were registered in the Gomel region with an average incidence rate of 0.52 per 100 thousand population. Over this period of time, the incidence of leptospirosis was characterized by an uneven distribution and was undulating. Periods with a low incidence of 0.14–0.42 cases per 100 thousand population lasting 5-6 years alternated with periods of rising incidence to 0.99 cases per 100 thousand population lasting 3 years. In 2022, a sharp rise in the incidence of leptospirosis in the Gomel region was registered, and therefore 15.8 times higher than the incidence in 2021, the incidence rate was 1.11 per 100 thousand of the population and exceeded the national average by 4.6 times. Adults predominated among the sick (93.3%). At the same time, 73.0% of the patients were urban residents. The source of infection in 81.2% of cases were rodents, in 7.52% of cases domestic animals. In 7.52% of cases, the disease appeared as a result of professional activity, only in 3.76% of cases the disease occurred after swimming in open water. Thus, the main route of transmission of leptospirosis at present is contact (88.72%), alimentary and water are less important, respectively 7.52% and 3.76%. Results of serological examination for leptospirosis by RMA showed that 5 serogroups of leptospir circulate among rodents: L. Pomona and L. Canicola, L. Grippotyphosa, L. Icterohaemorrhagiae, L. A. Ustralis. 36.4% of the samples showed a positive result at the same time to several serogroups. L. Grippotyphosa, L. Cterohaemorrhagiae and L. Pomona were detected more often, in total, these pathogens accounted for 46.5% of positive samples. The results of the survey of farm animals showed that 60.6% of the sera studied had positive results of RMA with leptospirs of several serogroups. L. Sejroe was also isolated – in 12.3% of samples, L. Hebdomad – in 1.3% of samples, L. Icterohaemorrhagiae – in 1.2%, L. Pomona – in 0.3%, others – 24.2%. In the period from 2002 to 2021, the following serogroups were isolated in patients with leptospirosis: L. Grippotyphosa – 36%, L. Pomona and L. Canicola – 16%, L. Australi – 13%, L. Wolffi – 9%, L. Icterohaemorrhagiae – 7% and L. Tarassovi – 3%. In 2022, there is a change in the polytypage of leptospir: L. Icterohaemorrhagiae (6.7%), L. Tarassovi (6.7%), L. Wolffi (6.7%), L. Pomona (13.3), L. Astralis (13.3), L. Canicola (6.7%), 6.7% – L. Sejroe, L. Grippotyphosa Moskva – 40%. For the period from 2005 to 2022, 49 people diagnosed with leptospirosis were treated at the Gomel Regional Infectious Diseases Hospital, of which men accounted for 69%, the average age of patients was 34.5 ± 3.8 years. Most patients are hospitalized on day 6 [4 – 8] of illness. All patients complained of fever, 86% of patients had muscle pain, headaches were recorded in 56.0%, yellowing of the skin and sclera – 34.0%, abdominal pain – 38%, 25% of patients reported nausea, vomiting, diarrhea syndrome. 28.6% of patients had an icteric form of leptospirosis, Weil's syndrome was diagnosed in 9.3% of patients, hemorrhagic syndrome was observed in 18.7% of patients. All patients had laboratory confirmation of the diagnosis. The duration of hospitalization was 15 [9 – 23] days. 1 case of the disease ended with a detailed outcome for the entire observation period. Conclusion. The incidence of leptospirosis in the Gomel region is undulating and is characterized by a change in periods of rising incidence lasting up to 3 years with periods of low incidence lasting up to 5 years. The results of the study suggest that the emergence and spread of the leptospira serotype in the territory led to a new increase in the incidence. Thus, continuous qualitative monitoring of leptospira serotypes among the population of sources of infection should be carried out.

Critical assessment of infants born to mothers with drug resistant tuberculosis

There have been no detailed descriptions of infants born to mothers treated for drug resistant TB in pregnancy. Critical case history assessment is important to identify risks and guide clinical practice. In a cohort of pregnant women with multidrug or rifampicin resistant (MDR/RR)-TB enrolled between 1 January 2013 and 31 December 2022, we followed mother-infant pairs until the infant was 12 months old. We performed critical case history assessments to explore potential mechanisms of Mycobacterium tuberculosis transmission to the infant, and to describe the clinical presentation and disease trajectories observed in infants diagnosed with TB. Among 101 mother-infant pairs, 23 (23%) included infants diagnosed with TB disease; 16 were clinically diagnosed and seven had microbiological confirmation (five MDR/RR-TB, two drug-susceptible TB). A positive maternal sputum culture at the time of delivery was significantly associated with infant TB risk (p=0.023). Of the 12 infants diagnosed with TB in the first three months of life, seven (58%) of the mothers were culture positive at delivery; of whom four reported poor TB treatment adherence. However, health system failures, including failing to diagnose and treat maternal MDR/RR-TB, inadequate screening of newborns at birth, not providing appropriate TB preventive therapy (TPT), and M.tuberculosis transmission from non-maternal sources also contributed to TB development in infants. Infants born to mothers with MDR/RR-TB are at greatest risk if maternal adherence to MDR/RR-TB treatment or antiretroviral therapy (ART) is sub-optimal. In a high TB incidence setting, infants are also at risk of non-maternal household and community transmission. Ensuring maternal TB diagnosis and appropriate treatment, together with adequate TB screening and prevention in all babies born to mothers or households with TB will minimise the risk of infant TB disease development. South African Medical Research Council.

To escape the pain: Paths to voluntary turnover, social pain, and influences on the selection of a new job role

SummaryThe unfolding model of voluntary turnover established that there is no “one size fits all” turnover experience. Anecdotal evidence suggests that voluntary turnover experiences can be painful, yet the role of social pain (as distinct from dissatisfaction) in turnover and subsequent job selection has not yet received much scholarly attention. In Study 1, we re‐analyze 13 detailed case histories of employees who had recently quit one organization and entered another. Using a cluster analysis of the terms they used when describing their reasons for leaving and when describing what attracted them to their new roles, we find that experiencing social pain in the prior role affected the things people prioritized when selecting a new role. Furthermore, sentiment analysis revealed that higher social pain was linked with lower positive sentiment (hope, excitement, joy, etc.) during the job search process. Study 2 creates a self‐report measure of social pain, and Study 3 quantitatively reaffirms the relationship between social pain and subsequent affect. This set of studies provides initial evidence that social pain is different from the attitudinal constructs that have been traditionally incorporated into voluntary turnover models (e.g., satisfaction, commitment, embeddedness) and that social pain may have implications for turnover, retention, and employees' post‐turnover destinations.

9th Ishihara lecture: Effects of subsurface heterogeneity on liquefaction-induced ground deformation during earthquakes

The effects of subsurface heterogeneity on liquefaction phenomena during earthquakes are discussed using case histories and nonlinear dynamic analyses with different subsurface modeling approaches. The importance of geologic and anthropogenic controls and the effects of stratigraphic heterogeneity, lithological heterogeneity, and inherent soil variability at the project site scale are discussed. The results of these studies reinforce lessons regarding the importance of subsurface characterization and its representation in analyses for evaluating liquefaction-induced ground deformations and their impacts on civil infrastructure.

Sudden sensorineural hearing loss: audiological profile during the COVID-19 pandemic.

Sudden sensorineural hearing loss (SSNHL) is an otological emergency that requires prompt recognition and intervention to prevent devastating impacts on people's lives. During the COVID-19 pandemic, sensory deprivations have been reported in patients positive for SARS-CoV-2 virus, including deleterious effects on the auditory pathway. This study aims to describe the audiological profile of individuals with SSNHL during the COVID-19 pandemic and to correlate hearing recovery in subgroups of individuals with or without COVID-19. Prospective cohort including patients diagnosed with SSNHL evaluated in a tertiary care center between March 2020 and September 2022. Hearing loss was confirmed with pure-tone and speech audiometry, with Speech Recognition Threshold (SRT) and word recognition score (WRS). Audiometric testing was performed at the moment of diagnosis, then 7, 30 and 120 days after diagnosis. The average degree of hearing loss was assessed by calculating the 4-frequency pure tone average (4fPTA). The investigation of COVID-19 included RT-PCR technique for the SARS-CoV-2 virus and collection of information regarding disease severity. A statistical analysis was performed using an analysis of covariance (ANCOVA) model to compare the 4fPTA between the four groups (with and without a history of COVID-19, unilateral and bilateral cases) at the end of the follow-up period. Fifty-two patients with SSNHL were assessed, 40 (76.9%) with unilateral and 12 (23.1%) with bilateral hearing loss, totaling 64 ears included. Of those, 15 (28.8%) patients tested positive for SARS-CoV-2 and were symptomatic for COVID-19. Of all unilateral cases, 22.5% were seropositive and showed symptoms of COVID-19, a number that increased to 50% for bilateral cases. Comparing the COVID-19 positive groups, individuals with unilateral SSNHL went from 40 dB as their average 4fPTA at onset to 20 dB as their average 4fPTA after 120 days, whereas those with bilateral SSNHL went from an initial average of 60 dB to a final average of 66 dB. Although the 4fPTA value of individuals with unilateral SSNHL improved in 7 days, the mean values showed no significant difference between positive and negative groups. There was a higher incidence of bilateral simultaneous SSNHL in patients who had not been vaccinated against COVID-19 and who presented with symptoms of severe COVID-19. Infection with SARS-CoV-2 resulted in more severe SSNHL, in bilateral SSNHL, and in poorer recovery from SSNHL in bilateral cases. Bilateral SSNHL was seen more frequently in patients who had not received vaccination against COVID-19.

Clinical History of Patients with Hypertrophic Cardiomyopathy-How to Improve the Initiation Process of the Diagnosis?

Background: Regardless of genetic origin and recommended screening methods, hypertrophic cardiomyopathy (HCM) is commonly diagnosed late in the advanced stages of the disease. The aim of this study was to analyse the case history of patients with HCM in order to obtain an initiation of the diagnostic process. Methods: This study was a retrospective, tertiary, single-centre cohort analysis of 85 consecutive pts with HCM (mean age at the time of HCM diagnosis: 51 ± 15 years; F/M: 42/43) who were hospitalized during the period from 1 January 2013 to 31 December 2022. Type of referral to the hospital, the reason for hospitalization as well as accompanying symptoms, comorbidities, and family history were analysed to obtain an initiation of the diagnostic process. The analysis was limited to hospitalizations in which the diagnosis of HCM was stated for the first time. Results: An analysis of the type of referral to the hospital revealed the following data: 18% of patients were admitted as urgent hospitalizations (UHs) and 82% as elective hospitalizations (EHs). Among the UHs, the majority of patients were transferred from another hospital (13%), and among the EHs, 65% of patients were referred from a specialised outpatient medical care (SMC) facility. The majority of patients in both the UH and EH groups were symptomatic: 84% in the EH group (the most common symptom was exertional dyspnea in 56% of pts) and 93% in the UH group (the most common symptom was syncope in 60% of pts). Among the analysed population, the most frequent comorbidities were systemic hypertension (51%), lipid metabolism disorders (38%) and obesity (23%). Conclusions: A diagnosis of HCM is often made at an advanced age in symptomatic patients, mainly during an EH. Nearly one-fifth of the Polish HCM population is diagnosed during a UH after a sudden event, which suggests the need for improvements in medical care in Poland.

Overview of secondary immunodeficiency.

In contrast to inborn errors of immunity (IEI), which are inherited disorders of the immune system that predispose to infections, malignancy, atopy, and immune dysregulation, secondary immunodeficiencies and immune dysregulation states (SID) are acquired impairments in immune cell function and/or regulation, and may be transient, reversible, or permanent. SIDs can derive from a variety of medical comorbidities, including protein-losing conditions, malnutrition, malignancy, certain genetic syndromes, prematurity, and chronic infections. Medications, including immunosuppressive and chemotherapeutic drugs, can have profound effects on immunity and biologic agents used in rheumatology, neurology, and hematology/oncology practice are increasingly common causes of SID. Iatrogenic factors, including surgical procedures (thymectomy, splenectomy) can also contribute to SID. A thorough case history, medication review, and laboratory evaluation are necessary to identify the primary driver and determine proper management of SID. Careful consideration should be given to whether a primary IEI could be contributing to autoimmunity, malignancy, and posttreatment complications (e.g., antibody deficiency). SID management consists of addressing the driving condition and/or removing the offending agent if feasible. If SID is suspected to be permanent, then antibiotic prophylaxis, additional immunization, and immunoglobulin replacement should be considered.

Base-metal exploration by using remote sensing, geological, geophysical, and geochemical datasets with clues from ancient mining: A comprehensive review on Aravalli-Delhi Fold Belt, Rajasthan, India

Base metal deposits are present in different continents with evidences of their mining activities during ancient times as mentioned in the historical literature. Aravalli – Delhi Fold Belt (ADFB) in Rajasthan, India is having numerous base metal prospects where ancient mining signages are recorded. Modern-day mining has commenced taking clues from these evidences. Present-day techniques such as remote sensing, geological mapping, geophysical survey, geochemical survey, and exploration/drilling are utilized for the identification of surficial ancient mining features and identification of the mineralized zones. These techniques utilize their unique criteria to get an idea of the mineral association. The integration of all the unique characteristics of modern techniques with the help of weighted overlay analysis, fuzzy logic, multi-criteria overlay analysis, etc. helps to identify the mineral potential zones from the ancient working sites. Their integrated results provide the surficial as well as sub-surficial information of the region that gives a better revelation about the region and helps in decision-making towards the mineralization status of the region. World-over surficial ancient features have been recorded in exploratory sites for base metals, and the case histories where integrated techniques were used for mineral exploration are discussed. Zawar – Dungarpur belt also has the potential for base metals therefore, the boolean approach, weighted overlay, and multi-criteria overlay analysis were performed using remote sensing, structural, and geochemical datasets. The integrated results showed that the head zone and southern broader part near Keekawat have the potential for base metals.

Automated Workflow Uses Pressure, Rate Measurements for Well Monitoring

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 218470, “A New Automated Workflow for Well Monitoring Using Permanent Pressure and Rate Measurements,” by Anton Shchipanov, SPE, NORCE; Boyu Cui, SPE, University of Stavanger; and Vitaly Starikov, SPE, Heriot-Watt University, et al. The paper has not been peer reviewed. _ The complete paper describes an integrated workflow for automated well monitoring using pressure and rate measurements obtained with permanent gauges and flowmeters. The workflow is based on time-lapse pressure transient analysis (PTA) and integrates the following components: virtual flowmetering (VFM), transient identification, feature extraction and pattern recognition in transient pressure responses, and assessment of well performance based on PTA metrics. The methodology behind the workflow combines different physics-informed and data-driven methods described in the paper. A New Workflow for Automated Well Monitoring The concept of the automated workflow described in the complete paper has been suggested in the literature. The workflow consists of four main steps (Fig. 1), and integrates the following components: - VFM - Pressure transient identification - PTA feature extraction and time-lapse pattern recognition - PTA metrics to obtain the well-performance profile VFM. The well flow rate is often measured more sparsely than its bottomhole or wellhead pressure for many reasons. However, the permanent downhole or wellhead gauges, when installed in a well, provide high-frequency real-time pressure and temperature measurements. This disparity in the pressure- and rate-measurement sampling rates is a problem for PTA, which requires accurate and synchronized input for flow rates in line with the pressure time series. VFM helps reconstruct missing flow-rate measurements using available pressure measurements. The automated well-monitoring workflow described in this paper would benefit from integration of a relatively simple but robust and scalable VFM model having modest input-data requirements. The steady-state vertical-lift-performance-based VFM model was chosen for use by the authors after testing. The model uses only the bottomhole and wellhead pressure difference, which fits well with the automated workflow requirements. Put simply, the VFM-developed algorithm identifies the suitable pressure and flow-rate samples to train the VFM model; estimates, filters, and verifies the evolution of the model coefficients; and predicts the missing flow-rate values using the pressure measurements where available. This prediction applies only to the time when the well is flowing; as for shut-in periods, the algorithm assigns zero rate values. Transient Identification. Proper transient identification is crucial for PTA because accurate identification of the starting break point of a transient and sequential synchronization with corresponding rate governs the reliability of PTA interpretation results. This is important not only for the transient in question but also for the well history preceding the transient. In the latter case, proper transient identification may help in reliable rate time allocation throughout the well history for common cases of uncertain rates. The workflow of the extended method consists of two main stages. First, the breakpoints indicating start and end of shut-in transients are detected using the topographic prominence max rotation (TPMR) method. This automatically provides detection of flowing transients between the shut-ins identified. Second, the breakpoints of multirate periods (assuming stepwise rate changes) are detected within the long flowing transients using the local minimum in rotation (LMIR) method. As a result, the well pressure history is divided into sequential flowing and shut-in transients, also differentiating flowing transients governed by stepwise rate changes. Neither TPMR nor LMIR methods require denoising, so raw data from permanent gauges may be used without any preprocessing.

For Whom the Note Scrolls: A Brief History of the Medical Record's Role in Education and the Risks It Faces in the Age of OpenNotes.

Dating back to ancient civilizations when records were carefully transcribed onto papyrus, clinical documentation has long served as a cornerstone of medical-and especially neurologic-education. From the case histories of Hippocrates to the diurnal patient logs used by trainees in the 18th and 19th centuries, clinical notes have an extended history as invaluable instruments of pedagogy, scholarly practice, and interprofessional communication. The novel paradigm introduced by Lawrence Weed in the 1950s, advocating for the problem-oriented medical record system, revolutionized the clinical note template and emphasized the need for physicians' carefully considered analyses of a patient's presentation to be clearly reflected in well-organized documentation. In the realm of medical records today, however, a profound shift is underway, largely propelled by the emergence of electronic medical records, the OpenNotes mandate of the federal 21st Century Cures Act, and, most recently, artificial intelligence (AI). Appropriately, patients now have full access to their medical records, but this raises critical questions. Should clinical notes now prioritize patient comprehension over their traditional role as educational instruments, aide-mémoire, and repositories of detailed assessments and insights? What role, if any, should AI have in the creation of physician notes and patient-facing clinical documents? These tensions underscore the delicate balance between transparency and the preservation of notes' clinical integrity and analytical depth. As we navigate the path forward, finding an equilibrium between openness and the continued utility of medical records as tools for education and professional communication will be imperative.

Research Note : Recovering Vernacular Landscapes in World War II Incarceration Camps Through Japanese American Newspapers

abstract: In February 1942, an estimated 120,000 Japanese and Japanese Americans in the United States were forced to move into seventeen temporary holding camps formally and euphemistically named reception or assembly centers, and later were removed to ten semipermanent relocation centers. This Research Note seeks to demonstrate how knowledge about the ephemeral and lost assembly center landscapes may be recovered by critically examining reporting about carceral conditions in government-censored incarceration camp newspapers, using the Tanforan Totalizer , a prison camp newspaper published at the Tanforan Assembly Center, as a methodological case history. It takes into account the trauma and oppression the imprisoned population was experiencing at Tanforan Assembly Center, a racetrack in San Bruno, California, that was repurposed to serve as an assembly center. This article demonstrates the ability to recover substantial information about Tanforan landscapes in the Totalizer as well as the humor its journalists used as a strategic mode to evade censorship. Given that the newspaper was subject to extreme censorship, I evaluate it as a filter for what could be revealed about the landscapes at Tanforan Assembly Center and the prisoners' building practices at this temporary site of the incarceration. The prisoners' resilience in dealing with their oppressive living conditions is conveyed in this journalism along with the gravitas and poignancy of their agency, leavened with ironic humor and cooperative community efforts. This article also explores the embodied spatialized experience of Taro Katayama, editor of the Totalizer , as he moved from the Tanforan Assembly Center to the Central Utah Relocation Center at Topaz, Utah, where he was managing editor of the Topaz Times and an editor of the art journal Trek .

A Retrospective Study on Risk Factors, Clinical Presentation AndManagementOfEctopic Pregnancy In Tertiary Care Centre, Rajasthan

Background: Ectopic pregnancy is not an uncommon condition and is potentially a life-threatening emergency. There is a rising trend in incidence which necessitates the gynecologists to have comprehensive knowledge about the disease. Aim of the study: To determine the incidence, risk factors, clinical features and management. Materials and Methods: This study is conducted in the Department of Obstetrics and Gynecology of Umaid Hospital, Jodhpur. It is a retrospective descriptive study on patients who presented to our department with clinical features of ectopic pregnancy and later confirmed with intraoperative findings or ultrasound, in the 6 month period from January 2024 to June 2024. Results: A total of 84 patients were diagnosed to have ectopic pregnancy with an incidence of 1.8 percent. Previous ectopic pregnancy found in 3.57% of pregnancy. Tubal surgeries were carried out in 4.7% . H/O previous abortion/MTP found in 26.19% of cases . Previous abdominopelvic surgeries including caesarean sections were responsible for 22.61% of ectopic pregnancy. PID was found in 16.6% of cases History of tuberculosis was found in 3.57% of cases. In this study, 13.09% cases were using an intrauterine device (IUD) as a method of contraception. Combining OCPs and IUD, 21.39% cases had ectopic pregnancy Surgical treatment with salpingectomy was done in majority of the cases and medical management in 4 patients. Blood transfusions were given in 83.3% of cases. The postoperative period is uneventful in all the cases. Conclusion: Ectopic pregnancy is the leading cause of maternal mortality in first trimester. In spite of advanced diagnostic techniques, it poses great diagnostic difficulties due to varied signs and symptoms. Previous tubal surgery pelvic inflammatory disease and infertility are the risk factors of tubal pregnancy

Changing the narrative: Addressing American Indian/Alaska Native mental health needs through academic holistic support

American Indian/Alaska Natives (AIAN) have some of the highest health disparities and poorest outcomes of all racial or ethnic minority groups in the United States. Across all age groups, suicide is 2.5 times higher in AIANs than the national average (National Indian Council on Aging, 2019). Cultural and institutional barriers prevent AIAN undergraduate and graduate college students from seeking mental health services, and many serious mental health problems remain untreated.While numerous barriers to mental health services exist for AIAN students, Indigenous faculty and support staff who share deep understanding of history, culture and traditional view of health and wellness can reduce the barriers and promote mental health and wellness for students. Shifting the focus to introduce a new narrative gives way to greater recognition of factors that create health and may help academic institutions provide holistic support for AIAN and other underrepresented students. The new narrative includes holistic strength-based support, social support, and fostering cultural identity and pride enhances mental health and success. Indigenization of the doctoral nursing curriculum supports faculty who are committed to decolonizing course content and institutionalized pedagogy.Improved health outcomes for Indigenous individuals and other underrepresented students will positively affect communities through increasing diversity of APRNs, nursing faculty, and nursing scholars.

Antimicrobial stewardship and education in optometry

ABSTRACT Clinical relevance Antimicrobial stewardship aims to improve how antibiotics are prescribed by clinicians and used by patients, to ensure safe appropriate use, and to prevent and contain antimicrobial resistance. Background Australian optometrists can prescribe a range of antimicrobial agents, but to what extent they consider antimicrobial stewardship is not known. This study evaluated what final-year optometry students and optometrists understood about antimicrobial stewardship in eye care and considered relevance to oral prescribing and education. Methods A knowledge, attitude, and practice (KAP) questionnaire was developed comprising four sections: i) demographic questions, ii) 10 multiple choice questions regarding Knowledge about antimicrobial agents and likely pathogens, diagnosis, treatment, and preventing resistance, iii) 10 Likert rating scale questions about thoughts and Attitudes, iv) mix of question types (5× MCQ: course of action, 16 Likert scale: confidence) related to Practice (diagnosis, management, and prescribing). Descriptive analyses were conducted (medians, mean±SD, and distributions). Results Thirteen students and 36 optometrists completed the survey. Both groups had a good understanding of microbial resistance and antibiotic prescribing for ocular conditions; average knowledge scores were 9.2 ± 0.7 and 8.7 ± 1.1 for students and practitioners, respectively. Scores were neutral to agree for questions related to the need for more educational programs. The answers of practice-related MCQs had a dichotomy of answers indicating a diversity of opinion, as can be the case in practice. Average total practice confidence scores were approximately 57/80 for students and 68/80 for optometrists. Optometrists and students were very confident in their ability to conduct an appropriate case history and use their knowledge and clinical skills, including slit lamp anterior eye assessment. The lowest confidence scores were for conducting microbial testing, i.e. taking swabs for pathology. Conclusion Student and optometrist knowledge, attitudes, and practice around antimicrobial stewardship were high and in line with other health professions globally. There is scope for increased stewardship training.

Discharge Against Medical Advice: The Causes, Consequences and Possible Corrective Measures.

Patients who discharge themselves against medical advice comprise 1%-2% of hospital admissions. Discharge against medical advice (DAMA) is defined as when a hospitalised patient chooses to leave the hospital before the treating medical team recommends discharge. The act of DAMA impacts on both the patient, the staff and their ongoing care. Specifically, this means that the patient's medical problems maybe inadequately assessed or treated. Patients who decide to DAMA tend to be young males, from a lower socioeconomic background and with a history of mental health or substance misuse disorder. DAMA has an associated increased risk of morbidity and mortality. In this review of studies across Western healthcare settings, specifically adult medical inpatients, we will review the evidence and seek to address the causes, consequences and possible corrective measures in this common scenario.

Ricin intoxication by lethal dose of castor seeds ingestion: a case report

IntroductionRicin intoxication is a serious condition with symptoms ranging from mild gastroenteritis to fatal outcomes due to shock and multi-organ failure. Intoxication from the ingestion of castor seeds is uncommon. However, its diagnosis is crucial, particularly with a clear history of exposure to castor seeds, regardless of the route of exposure (enteral or parenteral). Prompt diagnosis is essential to monitor and manage the patient effectively and to prevent potentially fatal outcomes. We report a case where ingestion of castor seeds resulted in gastroenteritis severe enough to necessitate emergency medical care.Case reportWe present the case of a 47-year-old Belgian woman of Moroccan descent, previously healthy who was admitted to the emergency department with symptoms of colicky abdominal pain, diarrhea, and vomiting following the ingestion of six castor beans. The patient was diagnosed with ricin intoxication, admitted for observation, and received symptomatic treatment. She was discharged home after a complete recovery three days later.ConclusionOur report underscores the clinical manifestations, hemodynamic changes, laboratory findings, and treatment of intoxication due to castor seed ingestion. It contributes to the limited literature on castor seed poisoning in humans, with a specific focus on cases in Belgium. This report aims to raise awareness among clinicians about this condition and emphasizes the importance of a comprehensive history-taking to prevent misdiagnosis and malpractice.

A case report of a bleeding case after removal of chest drain after lung surgery.

Postoperative bleeding after lobectomy is relatively rare. By analyzing and discussing the case history and management of hemorrhagic shock caused by chest tube removal after lobectomy, we can achieve the purpose of preventing postoperative bleeding after thoracic surgery and reducing postoperative complications, which can help avoid the risk of second surgery, shorten the patient's hospital stay, reduce the cost of medical care, and improve the patient's quality of life. A case of bleeding from tube removal after lobectomy. The bleeding from chest drain removal on the 3rd day after thoracoscopic lobectomy resulted in hemorrhagic shock, which was stopped by thoracoscopic exploration again under active antishock, and there was no recurrence of bleeding after the operation, and the patient was discharged from the hospital after chest drain removal. Enhanced computed tomography of the chest revealed a space-occupying lesion in the middle lobe of the right lung. Thoracoscopy was performed again on the condition of active anti-shock. On the third day after thoracoscopic lobectomy, the patient underwent removal of the chest drain and subsequently experienced hemorrhagic shock. Given the necessity of maintaining anti-shock measures, the patient was subjected to a second thoracoscopic exploration with the objective of halting the hemorrhage. Following this procedure, the patient did not present with any further episodes of bleeding. Subsequently, a new chest drain was placed, and once the drainage flow had diminished to an acceptable level, the chest drain was removed. The patient subsequently made a full recovery and was discharged from the hospital. Even if the safely inserted drain tube is removed, the thoracic surgeon must be aware of possible vascular bleeding.

Ischemic stroke associated with amyloid-related imaging abnormalities in a patient treated with lecanemab.

Anti-amyloid antibody therapies such as lecanemab are increasingly being used to treat Alzheimer's disease (AD). These therapies are associated with a high rate of amyloid-related imaging abnormalities (ARIA). We review the case history of a patient who developed ARIA associated with lecanemab treatment. In addition to microhemorrhages and cerebral edema that are recognized features of ARIA, the patient developed several ischemic strokes. The patient also experienced frequent electrographic seizures without overt clinical seizures. The patient demonstrated clinical and radiographic improvement after steroid treatment. Our case suggests that ischemic strokes may be a feature of ARIA and highlights the importance of having a high clinical suspicion for seizures in ARIA. As anti-amyloid therapies are likely going to be increasingly used to treat AD, it is important to appreciate the spectrum of clinical and radiographic findings that can result as side effects from this class of therapies. We report a patient who developed severe amyloid-related imaging abnormalities (ARIA) after treatment with lecanemab. Our report suggests that ischemic strokes may be a novel imaging feature of ARIA. Our report highlights the need for high clinical suspicion for seizures in ARIA.

Transforming Health Care Through Chatbots for Medical History-Taking and Future Directions: Comprehensive Systematic Review.

The integration of artificial intelligence and chatbot technology in health care has attracted significant attention due to its potential to improve patient care and streamline history-taking. As artificial intelligence-driven conversational agents, chatbots offer the opportunity to revolutionize history-taking, necessitating a comprehensive examination of their impact on medical practice. This systematic review aims to assess the role, effectiveness, usability, and patient acceptance of chatbots in medical history-taking. It also examines potential challenges and future opportunities for integration into clinical practice. A systematic search included PubMed, Embase, MEDLINE (via Ovid), CENTRAL, Scopus, and Open Science and covered studies through July 2024. The inclusion and exclusion criteria for the studies reviewed were based on the PICOS (participants, interventions, comparators, outcomes, and study design) framework. The population included individuals using health care chatbots for medical history-taking. Interventions focused on chatbots designed to facilitate medical history-taking. The outcomes of interest were the feasibility, acceptance, and usability of chatbot-based medical history-taking. Studies not reporting on these outcomes were excluded. All study designs except conference papers were eligible for inclusion. Only English-language studies were considered. There were no specific restrictions on study duration. Key search terms included "chatbot*," "conversational agent*," "virtual assistant," "artificial intelligence chatbot," "medical history," and "history-taking." The quality of observational studies was classified using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria (eg, sample size, design, data collection, and follow-up). The RoB 2 (Risk of Bias) tool assessed areas and the levels of bias in randomized controlled trials (RCTs). The review included 15 observational studies and 3 RCTs and synthesized evidence from different medical fields and populations. Chatbots systematically collect information through targeted queries and data retrieval, improving patient engagement and satisfaction. The results show that chatbots have great potential for history-taking and that the efficiency and accessibility of the health care system can be improved by 24/7 automated data collection. Bias assessments revealed that of the 15 observational studies, 5 (33%) studies were of high quality, 5 (33%) studies were of moderate quality, and 5 (33%) studies were of low quality. Of the RCTs, 2 had a low risk of bias, while 1 had a high risk. This systematic review provides critical insights into the potential benefits and challenges of using chatbots for medical history-taking. The included studies showed that chatbots can increase patient engagement, streamline data collection, and improve health care decision-making. For effective integration into clinical practice, it is crucial to design user-friendly interfaces, ensure robust data security, and maintain empathetic patient-physician interactions. Future research should focus on refining chatbot algorithms, improving their emotional intelligence, and extending their application to different health care settings to realize their full potential in modern medicine. PROSPERO CRD42023410312; www.crd.york.ac.uk/prospero.