Medical Research Articles

GDF15 Targeting for Treatment of Hyperemesis Gravidarum

Nausea and vomiting during pregnancy (NVP), particularly its severe form, Hyperemesis gravidarum (HG), affects up to 70% of pregnancies and significantly impacts the quality of life for those with the condition as well as generates a great economic burden, with annual costs exceeding $1.7 billion in the United States. Despite the available treatments targeting neurotransmitters like serotonin and dopamine, many patients experience inadequate relief and suffer from severe side effects, including headaches and dizziness. Recent research has underscored the role of GDF15, a protein mainly produced by the placenta and linked to NVP symptoms. This protein, part of the TGF-β superfamily, has been implicated in appetite and weight regulation and is altered in those with HG due to specific genetic mutations. Addressing the challenges of delivering effective treatments, current innovations focus on targeting GDF15 to reduce symptoms while ensuring fetal safety. Promising therapeutic strategies include non-IgG immunotherapies, small peptide and molecule antagonists, and novel administration methods such as transdermal patches. These approaches aim to optimize dosage and reduce adverse effects. The effective development and testing of these treatments necessitate advanced animal models that closely resemble human pregnancy physiology, highlighting the need for further research and funding. This ongoing research holds significant potential to improve the clinical outcomes for HG patients and decrease the economic impact on healthcare systems, urging a dedicated response from the scientific and medical communities to advance these promising treatments.

Is there an editorial glass ceiling? Editorial leadership in nephrology and transplantation journals: A gender-based cross-sectional analysis.

Editors-in-Chief (EiC) play a key role as gatekeepers in academic medicine, often shaping research agendas. Women have historically been underrepresented in editorial leadership roles in academic medicine. The purpose of this study was to examine gender representation among EiC of contemporary transplantation and nephrology journals. This cross-sectional study evaluated gender disparities among EiC of transplantation and nephrology medical journals. The study population was drawn from journals in two subject categories (1) 'Transplantation' and (2) 'Urology and Nephrology' in the 2023 Journal Citation Reports. Binary gender classification (woman/man) was determined by the names/pronouns used to describe the EiC on the journal or institutional webpage. The primary outcome was the proportion of women EiC. Secondary outcome was the proportion of women EiC based on journal topic, location and metrics. Descriptive statistics were used. Gender differences were compared using students t-test or Fisher's exact test. A total of 79 EiC were identified of which 16 (20%) were women and 63 (80%) were men (p < .001). Transplantation and nephrology journals had 21% and 20% women EiC, respectively. The proportion of women to men EiC was not impacted by journal category (p = .93), journal location (p = .61), journal impact factor (p = .71) or quartile (p = .59). There was a disparity in gender representation in EiC in nephrology and transplantation journals, with men holding 80% of all positions. These findings, among growing evidence of gender disparity, highlight a need for targeted efforts to promote gender equity in academic medicine.

Special Issue on Informatics Education: ChatGPT Performs Worse on USMLE-Style Ethics Questions Compared to Medical Knowledge Questions.

The main objective of this study is to evaluate the ability of the Large Language Model ChatGPT to accurately answer USMLE board style medical ethics questions compared to medical knowledge based questions. This study has the additional objectives of comparing the overall accuracy of GPT-3.5 to GPT-4 and to assess the variability of responses given by each version. Using AMBOSS, a third party USMLE Step Exam test prep service, we selected one group of 27 medical ethics questions and a second group of 27 medical knowledge questions matched on question difficulty for medical students. We ran 30 trials asking these questions on GPT-3.5 and GPT-4, and recorded the output. A random-effects linear probability regression model evaluated accuracy, and a Shannon entropy calculation evaluated response variation. Both versions of ChatGPT demonstrated a worse performance on medical ethics questions compared to medical knowledge questions. GPT-4 performed 18% points (P < 0.05) worse on medical ethics questions compared to medical knowledge questions and GPT-3.5 performed 7% points (P = 0.41) worse. GPT-4 outperformed GPT-3.5 by 22% points (P < 0.001) on medical ethics and 33% points (P < 0.001) on medical knowledge. GPT-4 also exhibited an overall lower Shannon entropy for medical ethics and medical knowledge questions (0.21 and 0.11, respectively) than GPT-3.5 (0.59 and 0.55) which indicates lower variability in response. Both versions of ChatGPT performed more poorly on medical ethics questions compared to medical knowledge questions. GPT-4 significantly outperformed GPT-3.5 on overall accuracy and exhibited a significantly lower response variability in answer choices. This underscores the need for ongoing assessment of ChatGPT versions for medical education. ChatGPT, Large Language Model, Artificial Intelligence, Medical Education, USMLE, Ethics.

Defining characteristics of categorical general surgery resident lateral transfers

BackgroundFew studies describe rationales for intraspecialty (‘lateral’) general surgery (GS) resident program transfers.ObjectiveWe aimed to describe the key features of GS residency programs reporting lateral transfers, to characterize reasons behind...

Pasteurella multocida infection induces blood-brain barrier disruption by decreasing tight junctions and adherens junctions between neighbored brain microvascular endothelial cells.

Meningitis induced by Pasteurella multocida has been substantially described in clinical practice in both human and veterinary medicine, but the underlying mechanisms have not been previously reported. In this study, we investigated the influence of P. multocida infection on the permeability ofthe blood-brain barrier (BBB) using different models. Our in vivo tests in a mouse model and in vitro tests using human brain microvascular endothelial cell (hBMEC) model showed that P. multocida infection increased murine BBB permeability in mice and hBMEC monolayer permeability. Furthermore, we observed that P. multocida infection resulted in decreased expression of tight junctions (ZO1, claudin-5, occludin) and adherens junctions (E-cadherin) between neighboring hBMECs. Subsequent experiments revealed that P. multocida infection promoted the activation of hypoxia inducible factor-1α (HIF-1α)/vascular endothelial growth factor A (VEGFA) signaling and NF-κB signaling, and suppressed the HIF-1α/VEGFA significantly remitted the decrease in ZO1/E-cadherin induced by P. multocida infection (P < 0.001). NF-κB signaling was found to contribute to the production of chemokines such as TNF-1α, IL-β, and IL-6. Additionally, transmission electron microscopy revealed that paracellular migration might be the strategy employed by P. multocida to cross the BBB. This study provides the first evidence of the migration strategy used by P. multocida to traverse the mammalian BBB. The data presented herein will contribute to a better understanding of the pathogenesis of the zoonotic pathogen P. multocida.

Innovative Research on the Integration of Traditional Chinese Medicine and Artificial Intelligence for the Treatment of Herpes Zoster

Herpes zoster is a skin disease caused by the varicella-zoster virus (VZV), primarily manifesting as painful skin rashes in localized areas. Traditional Chinese medicine has a long history of treating herpes zoster, and the integration of modern artificial intelligence (AI) technologies holds promise for further enhancing treatment efficacy. This study aims to construct an AI-based traditional Chinese medicine treatment plan by analyzing large-scale clinical data and traditional medical literature to establish individualized diagnostic models. The experimental results demonstrate that this method effectively shortens the disease course and reduces the incidence of complications. Additionally, the study reveals the mechanisms of action of various components of traditional Chinese medicine in treatment, providing a basis for further optimization of treatment plans. This innovative integration approach not only improves treatment precision but also offers a new paradigm for combined traditional and Western medicine treatment. This paper not only showcases the potential of AI in the field of traditional Chinese medicine but also provides new insights into the treatment of herpes zoster.

Allergens causing contact dermatitis of the feet: Investigation and analysis of allergic reaction causes.

Allergic contact dermatitis of the feet is a significant problem that affects the quality of life and requires attention from the medical community due to the number of studied and still unidentified allergens. The purpose of this review article is to summarize the available scientific data regarding the most common allergens that cause ACD of the feet. Nickel sulphate, neomycin sulphate, thiuram mix and colophony occupy a significant place in the prevalence of allergies. The prevalence of sensitization to rubber and leather products can vary depending on the ethno-demographic characteristics of the country, as well as the specifics of a person's professional activity, such as the use of protective waterproof shoes, increased humidity of the microclimate, and atopy in anamnesis. Patch testing has been shown to be an important method for identifying allergens, however, not all footwear components are tested during patch testing with standard allergen series, requiring the use of patches made from patient shoe samples. Expanding the scope of patch testing to include other possible allergens is important for the accurate diagnosis of ACD of the feet and a more detailed study of those allergens that were previously considered rare.

Review of Influencing Factors of Patients' Medical Choice Behavior in Online Health Community

The development of information technology has made online medical communities a new avenue for addressing medical resource shortages. However, the complexity of information and the asymmetry between physicians and patients makes patients confused when they consult in online health community (OHC). This study systematically analyzed and summarized relevant theories and factors influencing patients' medical choice behavior through literature review. The objective is to offer guidance for patients' decisions in selecting physicians and to support the sustainable development of online medical community platforms, as well as to provide practical insights for further exploration in this field. Objective: This review examines recent theories and factors influencing patients' medical choice behavior in online health community (OHC), aiming to offer insights for patient choice regarding physician selection and the sustainable development of online medical platforms. Methods: A literature analysis was conducted to summarize studies on patients' medical choice behavior in OHC, identifying relevant theories and influencing factors. Results: The analysis identified seven key theories in the study of patients' medical choice behavior: signal theory, trust theory, social capital theory, social exchange theory, the stimulus-organism-response (SOR) model, the elaboration likelihood model (ELM), and the opportunity-motivation-ability (OMA) framework. Factors such as physicians' professional capital, online effort, service quality, online reputation, patient preferences and disease heterogeneity significantly influence patients' medical choice behavior. Conclusion: There is a trend toward integrating multiple theories in understanding patients' medical choice behavior in OHC; however, interdisciplinary research remains limited. Most studies focus on patients’ medical choice behavior from the physicians' perspective, while research from the patients' viewpoint is lacking. This study suggests two future research directions: enhancing the integration of multidisciplinary theories and expanding the scope of research subjects.

Disability Identity and Perceptions of Institutional Fairness and Climate in Academic Medicine

This cross-sectional study examines whether students and employees with or without disabilities at a major academic medical center in the US feel respected and are treated equitably at their institution

Lessons for expanding virtual mentoring in academic medical institutions: a qualitative study among senior mentors.

Virtual activities, hybrid work and virtual mentoring have become part of the ongoing milieu of academic medicine. As the shift to remote mentoring continues to evolve, it is now possible to adapt, refine, and improve tools to support thriving mentoring relationships that take place virtually. This study explores strategies for virtual mentoring as a cornerstone for effective training programs among senior mentors participating in an ongoing mentoring program. We conducted a qualitative study among prior and current participants of an ongoing "Mentoring the Mentors" program about key strategies for optimizing virtual mentoring. Data were coded and analyzed following a thematic analysis approach. Respondents were mostly female (62%), white (58%), and associate (39%) or full professors (32%). We found that, with the expansion of hybrid and fully remote work, there are now fewer opportunities for informal but important chance meetings between mentors and mentees; however, virtual mentoring provides opportunities to compensate for reduced interactivity normally experienced in the workplace. The heightened need to plan and be more deliberate in the virtual sphere was woven throughout narratives and was the foundation of most recommendations. Specifically, a central obstacle for respondents was that spontaneous conversations were harder to initiate because virtual conversations are expected to have set agendas. Developing new ways to maintain meaningful interpersonal relationships in a virtual training environment, including opportunities for serendipitous and informal engagement, is critical to the success of virtual mentoring programs.

Recent developments in the therapeutics of SARS-CoV-2 infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmittable respiratory virus that causes COVID-19 disease. Since its emergence in the early 2000s, SARS has posed significant public health challenges and continues to be a concern. This review provides an overview of current treatment strategies for SARS-CoV and explores the potential utility of herbal molecules in combating this viral infection. The primary treatment approach for SARS-CoV has historically centered on supportive care, which includes oxygen therapy, mechanical ventilation, and antipyretic medications to manage symptoms. However, with the ongoing advancement of medical research and our evolving understanding of the virus, several antiviral drugs have been developed and repurposed to target SARS-CoV. Recent developments in the field of herbal medicine have drawn attention to the potential efficacy of natural compounds in the management of viral infections, including SARS. Herbal molecules, characterized by their diverse bioactive constituents, exhibit antiviral properties that could be harnessed to mitigate SARS symptoms and inhibit viral replication. Ocimum sanctum, Tinospora cordifolia, Zingiber officinale, Curcuma longa, Panax ginseng, and Aloe vera have been identified for their immunomodulatory effects. This review highlights promising herbal molecules such as quercetin, and curcumin, which have demonstrated antiviral effects in–vitro and in some preclinical studies. While current treatment strategies for SARS primarily rely on supportive care and antiviral medications, the exploration of herbal molecules presents an exciting avenue for potential adjunctive therapies. Further research is required to validate their efficacy, safety profiles, and mechanisms of action. A holistic approach that combines conventional medicine with herbal remedies may offer new insights into the treatment of SARS and other viral respiratory illnesses.

Are case reports valuable? Exploring their role in evidence based medicine and patient care

Case reports, often overlooked in evidence-based medicine (EBM), play a pivotal role in healthcare research. They provide unique insights into rare conditions, novel treatments, and adverse effects, serving as valuable educational tools and generating new hypothesis. Despite their limitations in generalizability, case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals. By acknowledging their limitations and adhering to reporting guidelines, case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM. This editorial explores the intrinsic value of case reports in EBM and patient care.

Pharmacovigilance in Ayurveda: Present &amp; Future

Pharmacovigilance is an important element of contemporary healthcare systems, as it involves the detection and evaluation of risks associated with medications and devices. Though originally a construct linked to conventional medicine, pharmacovigilance is now embraced as crucial for Ayurvedic medicine that employs numerous herbal and mineral drugs. The main focus of this paper is to discuss how pharmacovigilance can be incorporated into Ayurveda to maintain the safety, efficacy, and credibility of Ayurvedic treatments. It provides an overview of how pharmacovigilance is currently practised, the issues related to Ayurveda, and the importance of implementing standard practices and guidelines. The future of pharmacovigilance in Ayurveda is presented as combining the holistic approach with contemporary tools, technologies, and global trends. Implementation processes customised for Ayurvedic treatments, measures regarding quality control, reporting mechanisms, and awareness creation are suggested to maintain the international acceptability and effectiveness of Ayurveda.

Occurrence of bacteremia, bacteriuria and bacteriuria-related bacteremia in dogs and cats with chronic kidney disease. A pilot study

In human medicine, major infections are the most significant and critical non-cardiovascular complications in patients affected by chronic kidney disease (CKD), with bacteriuria being the primary source of bloodstream infections and its evolution toward sepsis. The availability of data on prevalence of bacteremia and its association with bacteriuria in dogs and cats with CKD is limited. The aim of this observational cross-sectional study was to determine the occurrence of bacteremia, bacteriuria, and bacteriuria-related bacteremia in dogs and cats affected by CKD. Client-owned dogs and cats with a documented history of CKD undergoing disease follow-up were enrolled. Each included animal underwent a comprehensive physical examination, clinico-pathological and microbiological analyses of blood and urine, along with molecular detection of the 16S rRNA bacterial gene in blood. Aseptically collected blood and urine were obtained through jugular venipuncture and cystocentesis, respectively. After collection, blood and urine samples underwent bacteriological culture within one hour. In the population enrolled, 2/47 dogs and 1/41 cats presented bacteriemia. Moreover, 8/47 dogs and 6/41 cats presented a positive urine culture. Additionally, in one out of the 47 dogs, the same pathogen was identified from blood and urine samples, with a final diagnosis of urosepsis. No instances of bacteriuria-related bacteriemia were observed in the cat population. In conclusion, this study shows a low prevalence of bacteremia and confirms a high prevalence of bacteriuria in companion animals affected by CKD. Moreover, a low prevalence of bacteriuria-related bacteremia was also found.

Improving asthma management and enhancing quality of life for adults in Thailand

The objective of this study was to examine the association between asthma control and quality of life among Thai asthmatic adults in Thailand. More than eighty percent of deaths from asthma disease occur in low- and middle income countries without proper treatment and care, which is mainly related to quality of life. This study conducted a cross-sectional study on asthma patients aged between 18 to 55 years (N = 114) recruited by random sampling methods at Phrapokklao Hospital (Thailand). Self-administered questionnaires, including general characteristic questionnaire, asthma control test, Thai Perceived Stress Scale, and Thai Mini AQLQ questionnaire, were used to collect the data. Logistic regression models were used to identify the relationship between independent variables and quality of life. The result found that most asthma patients (34.2%) were classified as having uncontrolled symptoms. About 81.5% of asthma patients were defined as having moderate (score 14-26) to high stress (score 27-40). The mean score of QoL suggested by the asthma patients in this study was good QoL (score = 88.58). Moreover, this study found a significant positive relationship between asthma control and QoL in all dimensions (rs = 0.584, ρ &lt; 0.001). The linear regression model presented the association between asthma control and quality of life after adjusted age (years), gender (male/female), education (elementary to secondary, higher secondary school), medical use (yes/no), and stress (low stress, moderate to high stress). This study confirms the correlation between asthma control and quality of life (β= 2.12, ρ &lt; 0.001).

Diagnosis journey for children with juvenile idiopathic arthritis: a qualitative study

ObjectiveThe objective is to explore the journey to diagnosis and referral pathway from the onset of symptoms to the initial assessments at paediatric rheumatology (PR) centres, based on the experience...

Tracing wide-spread infectious contacts using GeoSpark in preventive medicine

A threat to governments and the medical community globally are infectious illness outbreaks such as COVID-19, Spanish flu, and Ebola, which kill millions of people. Furthermore, because people are afraid to go to their employment, infectious diseases hinder economic progress. Therefore, it is imperative to implement interventions to lessen the spread of infectious diseases. From this angle, the practice of tracking contacts might be viewed as a mitigation strategy to stop the spread of contagious diseases. As this is going on, users’ trace data sets are growing exponentially larger over time, making it difficult to conduct contact tracing queries over them. In this paper, a novel Spark contact-tracing query processing method is proposed. This method determines if users are suspected cases by analyzing their paths based on two variables: nearby social distance and exposure time. Additionally, the developed method makes full use of the Spark framework to address scalability issues and effectively respond to contact tracing inquiries over a wide range of trajectories.

Research Progress on the Clinical Treatment of Iron Deficiency Anemia in Pregnancy by Combining Chinese and Western Medicine

Research Progress on the Clinical Treatment of Iron Deficiency Anemia in Pregnancy by Combining Chinese and Western Medicine

Research Progress of Integrated Traditional Chinese and Western Medicine in Diagnosis and Treatment of Heart Failure

Research Progress of Integrated Traditional Chinese and Western Medicine in Diagnosis and Treatment of Heart Failure

Observation on the Clinical Efficacy of Integrated Traditional Chinese and Western Medicine in the Treatment of Pityriasis Versicolor

Observation on the Clinical Efficacy of Integrated Traditional Chinese and Western Medicine in the Treatment of Pityriasis Versicolor