Original Article Research Articles

758 An Appraisal of the Quality of Development and Reporting of Predictive Models in Neurosurgery

INTRODUCTION: Overwhelming evidence indicates that the quality of reporting of predictive models is poor, often being confounded by small datasets, inappropriate statistical methods, a lack of validation, and reproducibility. METHODS: Articles reporting prediction models published in the top five neurosurgery journals by SJR2-rank (Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of NeuroInterventional Surgery, and Journal of Neurology, Neurosurgery, and Psychiatry) between January 1st, 2018, and January 1st, 2023, were identified via a PubMed search strategy that combined terms related to machine learning and prediction models. The identified original research articles were analyzed against the TRIPOD criteria. RESULTS: 110 articles were included and analyzed against the TRIPOD checklist. Among the articles screened, the median compliance was 57.4% (50.0-66.7%). Models utilizing machine learning-based models exhibited lower compliance on average compared to conventional learning-based models (57.1%, 50.0-66.7% vs. 68.1%, 50.2-68.1%, p = 0.472). Among the TRIPOD criteria, the lowest compliance was observed in blinding the assessment of predictors and outcomes (n = 7, 12.7% and n = 10, 16.9%, respectively), including an informative title (n = 17, 15.6%) and reporting model performance measures including confidence intervals (n = 27, 24.8%). Few studies provided sufficient information to allow for the external validation of results (n = 26, 25.7%). CONCLUSIONS: Published machine learning models predicting outcomes in neurosurgery often fall short of meeting the established guidelines laid out by TRIPOD for their development, validation, and reporting. This lack of compliance may indicate the extent to which these models have been subjected to external validation or adopted into routine clinical practice in neurosurgery.

Relationship Between Subjective Questionnaires and Videofluoroscopy of Dysphagia Evaluation: A Systematic Review and Meta-Analysis.

Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access to this tool may be limited because of radiation exposure risk, high cost, and other factors. In this study, a meta-analysis was used to determine the strength of the correlation between dysphagia detection outcomes obtained using subjective questionnaires and videofluoroscopy. The PubMed and Embase databases were searched for original articles up to December 2022. Studies published in English that used cross-sectional designs to assess the correlation between subjective questionnaires and videofluoroscopy were considered eligible for inclusion. The search terms used included "dysphagia," "questionnaire," and "videofluoroscopy." Two reviewers critically appraised and extracted the correlation coefficient r values. In addition, a random-effects meta-analysis was conducted. The Q statistic was used to assess the heterogeneity among the included studies. Publication bias was checked using the funnel plot and Egger's tests. Multilevel analysis was used to determine sensitivity to consider within-study correlations. In addition, subgroup analyses were conducted based on type of questionnaire, head and neck cancer, and English-speaking regions. The meta-analysis included five studies and 856 patients using the Eating Assessment Tool-10 and one study and 27 patients using the Sydney Swallow Questionnaire. The results of the random-effects meta-analysis showed a moderate relationship between the subjective questionnaires and videofluoroscopy ( r = .35, 95% CI [0.20, 0.48]). Similar results were also obtained using multilevel analysis ( r = .34, 95% CI [0.25, 0.42]). No publication bias was found for any of the studies ( p = .88). In the subgroup analyses, a moderate relationship between Eating Assessment Tool-10 and videofluoroscopy ( r = .31, 95% CI [0.19, 0.42]) and an ultrahigh relationship between Sydney Swallow Questionnaire and video-fluoroscopy ( r = .74, 95% CI [0.50, 0.87]) were found. Furthermore, moderate associations were observed within each head and neck cancer and English-speaking regions subgroup. However, no significant differences were found between these two subgroups. These results indicate the subjective questionnaires considered in this study share a moderate relationship with videofluoroscopy. Subjective questionnaires may be used as an auxiliary tool by nurses and homecare givers for the early assessment of dysphagia risk in patients.

El papel de los revisores de artículos de investigación científica en medicina

The aim of this article is to describe the task and responsibility of the peer reviewers of medical scientific articles. It succinctly defines what constitutes an original scientific research article and discusses the responsibility and ethics involved in performing this task. Reviewing scientific articles is a commendable yet challenging job that requires knowledge and time to delve into the depth required. This has generated a shortage of reviewers of scientific articles willing to carry out this important task.

Fine-needle aspiration cytology for neck lesions in patients with antithrombotic/anticoagulant medications: systematic review and meta-analysis.

This systematic review and meta-analysis aimed to determine the true risk of bleeding and nondiagnostic (ND) specimens associated with fine-needle aspiration cytology (FNAC) for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications. Using the Population Intervention Comparison and Outcome modeling, we searched PubMed and Google Scholar databases to identify studies published between January 2000 and March 2023 reporting the safety and sample adequacy of FNAC for neck lesions in patients taking AT/AC medications. The pooled incidences of bleeding and ND specimens and pooled risk ratio (RR) with 95% confidence intervals (CIs) obtained using a fixed-effects model were compared for patients continuing AT/AC (AT/AC group) and patients not receiving AT/AC therapy (no-AT/AC group). We included six original articles involving a total of 3014 patients. The pooled incidence of bleeding was 0.9% (95% CI, 0.344-2.026) and 0.7% (95% CI, 0.390-1.146) in the AT/AC and no-AT/AC groups, respectively. The pooled RR under the fixed-effects model was 1.39 (95% CI, 0.56-3.44) with no evidence of between-study heterogeneity (I2 = 0.0%; p = 0.92). The pooled incidence of ND specimens was 7.6% (95% CI, 5.617-10.073) and 7.6% (95% CI, 6.511-8.752) in the AT/AC and no-AT/AC groups, respectively. The pooled RR under the fixed-effects model was 1.33 (95% CI, 0.98-1.81) with moderate between-study heterogeneity (I2 = 60.0%; p = 0.06). The AT/AC medication is not associated with increased risk of bleeding or ND specimens in FNAC for neck lesions. Therefore, interruption of the AT/AC medication is not recommended before FNAC even in patients taking AT/AC medications. This study is the first meta-analysis evaluating risk of bleeding and nondiagnostic specimens associated with fine-needle cytology for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications. This suggests withholding AT/AC medications is not mandatory for safe and diagnostic FNACs. • True risk of fine-needle aspiration cytology (FNAC) for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications is still controversial. • This meta-analysis demonstrated that maintaining AT/AC medication was not associated with increased risk in terms of both bleeding and nondiagnostic samples. • Interruption of the AT/AC medication is not needed for safe and diagnostic FNAC for neck lesions even in patients taking AT/AC medications.

Research gap in esophageal achalasia: a narrative review.

In recent years, new translational evidence, diagnostic techniques, and innovative therapies have shed new light on esophageal achalasia and revamped the attention on this relatively rare motility disorder. This narrative review aims to highlight the most recent progress and the areas where further research is needed. The four senior authors identified five topics commonly discussed in achalasia management: i.e. pathogenesis, role of functional lumen imaging probe in the diagnostic flow chart of achalasia, how to define the outcome of achalasia treatments, how to manage persistent chest pain after the treatment, and if achalasia patients' may benefit from a regular follow-up. We searched the bibliographic databases to identify systematic reviews, meta-analyses, randomized control trials, and original research articles in English up to December 2023. We provide a summary with the most recent findings in each of the five topics and the critical points where to address future research, such as the immune-genetic patterns of achalasia that might explain the transition among the different phenotypes, the need for a validated clinical definition of treatment success, the use of neuromodulators to manage chest pain, and the need for identifying achalasia patients at risk for cancer and who may benefit of long-term follow-up. Although undoubtedly, progress has been made on the definition and management of achalasia, unmet needs remain. Debated aspects range from mechanistic insights, symptoms, objective measure relationships, and accurate clinical responses to therapeutic interventions. Translational research is eagerly awaited to answer these unresolved questions.

Evaluating the Efficacy and Safety of Bimekizumab for Plaque Psoriasis and Psoriatic Arthritis: An Expert Consensus Panel Report

Background: While there are numerous effective therapies for psoriasis, there remains an unmet need as some patients still suffer from inadequate response with available medications. Bimekizumab is a first-in-class monoclonal antibody that inhibits both interleukin (IL)-17A and IL-17F and was recently approved by the Food and Drug Administration. The aim of this study was for a panel of experts in psoriasis management to review the available data on bimekizumab and create consensus statements on its use in clinical practice.
 Methods: A comprehensive literature search of PubMed, Scopus, and Google Scholar was conducted for English-language original research articles, systematic reviews, and meta-analyses discussing the safety and efficacy of bimekizumab for moderate to severe plaque psoriasis and psoriatic arthritis. A panel of nine dermatology physician assistants and one dermatology nurse practitioner with significant expertise in the management of psoriasis convened virtually on December 16, 2023, to review the studies and create recommendations for their peers on the use of bimekizumab. A modified Delphi process was implemented to reach a consensus on these statements and the Strength of Recommendation Taxonomy was used to assign each one a strength of recommendation.
 Results: The literature search resulted in 92 articles that met search criteria. After a thorough screening of these studies for relevance to the discussion questions, 20 articles remained and were distributed to each panelist prior to the meeting. The panel unanimously voted to adopt 10 consensus recommendations and assigned all 10 statements a strength of recommendation of “A.”
 Conclusion: Bimekizumab has a very high efficacy in the treatment of moderate to severe psoriasis and psoriatic arthritis. It also has a favorable safety profile that is consistent with that of other biologics, except for an increased risk of oral candidiasis.

The advancement in irrigation solution within the field of endodontics, A Review

The purpose of endodontic treatment is to eliminate all germs, microbial by-products, and vital tissues from the root canal system. Root canals can be mechanically and chemically used for this purpose. The needs and details of the irrigation solutions are described in this article. Because of its wide range of antibacterial activities and its ability to dissolve organic tissues, sodium hypochlorite is suggested as the main irrigation. On the contrary, chelation solutions are recommended as supplemental treatments to either eliminate the smear layer or prevent it from forming on the dentin surface. Data: Only articles that were published electronically were searched within the review. Sources: ‘Google Scholar’ and "Pub-med" websites were used to search data, The most papers related to the topic were chosen, specifically original articles , including only articles from 1999 to 2023.Journal papers that weren't published in a highly regarded publication, irrelevant studies, editorials, personal viewpoints, and social media sources were all disqualified from consideration. 98 articles were retained after the filtering procedure. In conclusion, this article reviews many types of new irrigations that may be used in endodontic practice in the future.                              

Current use of artificial intelligence in the diagnosis and management of acute appendicitis.

Acute appendicitis is a common and time-sensitive surgical emergency, requiring rapid and accurate diagnosis and management to prevent complications. Artificial intelligence (AI) has emerged as a transformative tool in healthcare, offering significant potential to improve the diagnosis and management of acute appendicitis. This review provides an overview of the evolving role of AI in the diagnosis and management of acute appendicitis, highlighting its benefits, challenges, and future perspectives. We performed a literature search on articles published from 2018 to September 2023. We included only original articles. Overall, 121 studies were examined. We included 32 studies: 23 studies addressed the diagnosis, five the differentiation between complicated and uncomplicated appendicitis, and 4 studies the management of acute appendicitis. AI is poised to revolutionize the diagnosis and management of acute appendicitis by improving accuracy, speed and consistency. It could potentially reduce healthcare costs. As AI technologies continue to evolve, further research and collaboration are needed to fully realize their potential in the diagnosis and management of acute appendicitis.

Methods of measurement for pneumothorax in pediatric patients: a systematic review.

Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used to measure PTX size with CXR in pediatric patients. A systematic review of the literature through 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted using the following databases: Ovid/MEDLINE, Scopus, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Original research articles that included pediatric patients (< 18years old) and outlined the PTX measurement method were included. 45 studies were identified and grouped by method (Kircher and Swartzel, Rhea, Light, Collins, Other) and societal guideline used. The most used method was Collins (n = 16; 35.6%). Only four (8.9%) studies compared validated methods. All found the Collins method to be accurate. Seven (15.6%) studies used a standard classification guideline and 3 (6.7%) compared guidelines and found significant disagreement between them. Pediatric-specific measurement guidelines for PTX are needed to establish consistency and uniformity in both research and clinical practice. Until there is a better method, the Collins method is preferred.

Exploring the nutritional landscape and emerging trends in kidney stone research: visualization and bibliometric analysis

BackgroundKidney stones, or renal nephrolithiasis, are common and dangerous, increasing the risk of chronic kidney disease. Dietary manipulation is essential for the prevention and recurrence of kidney stones. Research into nutrition and kidney stones lacks library analysis, making it difficult to identify new trends. This bibliometric study was conducted to explore the current landscape of research on nutrition and kidney stones worldwide. This paper also emphasizes significant research trends in this area over the past two decades, aiming to assist researchers in understanding the current research status and identifying potential future directions.MethodsThe scholarly literature pertaining to diet and kidney stones was systematically explored utilizing SciVerse Scopus to identify pertinent research articles released from 2003 to 2022. The examination encompassed an assessment of publication patterns, key contributors, focal areas of research, prevalent themes, influential articles, and emerging research avenues. Following data extraction to Excel, analyses, including frequencies, percentages, and linear regression, were conducted. Visual exploration was facilitated through the use of the VOSviewer program version 1.6.19.ResultsBetween 2003 and 2022, 697 publications on nutrition and kidney stones were identified. There were 478 original articles (68.58%), 120 reviews (17.22%) and 99 other types of publications (14.20%). The United States is the most productive country, with significant growth in research in the fields of nutrition and kidney stones. The United States has demonstrated the strongest partnerships between researchers’ networks from various countries. Cluster analysis revealed three major research themes: sex differences in kidney stone disease, the correlation between increased dietary acid consumption and calcium oxide kidney stones, and nephrolithiasis associated with a ketogenic diet.ConclusionsThis study offers a thorough examination of nutrition and kidney stone research, encompassing key research domains, collaborative networks, and emerging patterns. The findings can aid researchers in gaining insight into the present landscape of the discipline and determining future research directions.

A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions.

To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca. A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence. The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively. Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.

Monoclonal Antibodies Targeting CGRP to Treat Vestibular Migraine: A Rapid Systematic Review and Meta-Analysis

AbstractVestibular migraine (VM), a subtype of migraine characterized by vestibular symptoms, poses a significant diagnostic and therapeutic challenge. This study aimed to evaluate the effectiveness of monoclonal antibodies targeting Calcitonin Gene Related Peptide (CGRP) in the treatment of VM. Therefore, we conducted a rapid systematic review and meta-analysis following PRISMA and Cochrane guidelines. A search of databases (PubMed, Scopus, Cochrane and Google Scholar) was performed in October 2023. Inclusion criteria required original research articles focusing on patients diagnosed with VM and utilizing CGRP-targeting monoclonal antibodies. We performed qualitative assessments of study design, patient characteristics, and outcomes and, for studies with comparable outcome measures, a meta-analysis was conducted. Our search yielded four relevant studies, including cohort studies and a case report, totaling 99 patients. Proper vestibular instrumental tests were employed in half of the studies. Overall, the included studies reported significant improvements in VM symptoms. Our quantitative analysis, focused on migraine symptoms, demonstrated a substantial reduction in Monthly Days with Migraine at 6 months following treatment. No severe adverse drug reactions were reported. In conclusion, this rapid systematic review and meta-analysis provide preliminary evidence for the efficacy of CGRP-targeting monoclonal antibodies in treating Vestibular Migraine. However, the absence of randomized controlled trials and variations in study designs and diagnostic criteria introduce some limitations. Further research is needed, including controlled trials, to establish a more robust evidence base. Nonetheless, this treatment approach offers hope for the effective management of VM, potentially enhancing the well-being of affected individuals and reducing their associated disability.

Impact of carotid stenosis on the outcome of stroke patients submitted to reperfusion treatments: a narrative review.

Intravenous thrombolysis (IT) and mechanical thrombectomy (MD) are the two interventional approaches that have changed the outcome of patients with acute ischemic stroke (AIS). Ipsilateral and contralateral carotid stenosis (ICS, CCS) play an important role in regulating cerebral hemodynamics, both in chronic and acute situations such as AIS. Several studies have explored their role in the incidence and severity of stroke, but very few have investigated the possible impact of ICS and CCS on the efficacy of interventional procedures. The purpose of this review was to I) highlight the incidence and prevalence of carotid stenosis (CS); II) assess the impact of ICS and CCS on cerebral hemodynamics; III) evaluate the effect of carotid stenosis on the efficacy of interventional therapies (IT and MT) for AIS; and IV) report therapeutic complications related to CS. We searched PubMed/Medline for case reports, reviews, and original research articles on English-language review topics during the period from January 1, 2000 to October 1, 2023. CS is associated with 15-20 % of the total number of AIS. ICS and CCS had a negative influence on both cerebral hemodynamics before AIS and outcome after interventional procedures (IT, MT alone or in bridging). Available data on cerebral hemodynamics and efficacy of interventional therapies for AIS suggest a negative role of CS. Therefore, early diagnosis of CS may be considered relevant to preventive and post-stroke treatment strategies.

Geochemistry of Terrestrial Plants in the Central African Copperbelt: Implications for Sediment Hosted Copper-Cobalt Exploration

Mineral exploration has increasingly targeted areas covered by in situ or transported overburden for shallow to deep-seated orebodies. It remains critical to develop better means to detect the surficial chemical footprint of mineralized areas covered by thick regolith. In such settings, plant geochemistry could potentially be a useful exploration tool, as different plant species have varying degrees of tolerance to metal enrichment in the soil. This review provides insights into the geological and geochemical controls on metal accumulation patterns in soil–plant systems of the Central African Copperbelt. In addition, it highlights the opportunities for integrating the geochemistry of terrestrial plants in emerging exploration technologies, identifies research gaps, and suggests future directions for developing phytogeochemical sampling techniques. This review was conducted using reputable online scholarly databases targeting original research articles published between January 2005 and March 2023, from which selected articles were identified, screened, and used to explore current advances, opportunities, and future directions for the use of plant geochemistry in sediment hosted Cu–Co exploration in the Central African Copperbelt. Various plant species are recognized as ore deposit indicators through either independent phytogeochemistry or complementary approaches. In the Central African Copperbelt, the successful application of hyperaccumulator species for phytoremediation provides the basis for adopting phytogeochemistry in mineral exploration. Furthermore, current advances in remote sensing, machine learning, and deep learning techniques could enable multi-source data integration and allow for the integration of phytogeochemistry.

Adherence to Reporting Guidelines in Major Otolaryngology Publications.

The aim of this study is to determine the adherence rate to reporting guidelines in published otolaryngology research. We performed an evidence-based review of all original clinical research published in 2021 in five otolaryngology journals for adherence to the appropriate guideline for the study type by evaluating whether the corresponding reporting guideline was mentioned in the body of the published manuscript. There were 1140 original research articles included in this study. Most studies were observational, for which the STROBE reporting guidelines are recommended (n = 791, 70.3%). All studies had an average adherence rate of 16.8% (n = 192/1140). The STROBE adherence rate was 4.9%, with JAMA Otolaryngology having the highest proportion of observation studies using the STROBE guidelines (23/49, 46.9%). Reporting guidelines are important tools to use in presenting original research. The use of these guidelines varies in the otolaryngology literature and highlights the ongoing need to support research reproducibility and usefulness.

Spider's Silk as a Potential Source of Antibiotics: An Integrative Review.

Spiders produce webs, which are still a largely unexplored source of antibacterial compounds, although the reports of its application in the medical field. Therefore, this study aims to present an integrative review of the antibacterial activity of spider webs. The research was conducted using Google Scholar, Scielo, Web of Science, PubMed, ScienceDirect, Medline EBSCO, LILACS, and Embase. The inclusion criteria were original articles written in English that studied the antibiotic properties of the web or isolated compounds tested. The studies were compared according to the spider species studied, the type of web, treatment of the sample, type of antimicrobial test, and the results obtained. Nine hundred and seventy-three publications were found, and after applying the inclusion and exclusion criteria, sixteen articles were selected. Bacterial inhibition was found in seven studies against various species of bacteria such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Salmonella Typhi, Bacillus megaterium, Listeria monocytogenes, Acinetobacter baumannii, Streptococcus pneumoniae, Pasteurella multocida, and Bacillus subtilis. Additionally, there was no apparent relationship between the proximity of the spider species evaluated in the studies and the presence or absence of activity. Methodological problems detected may affected the reproducibility and reliability of the results in some studies, such as the lack of description of the web or microorganism strain, as well as the absence of adequate controls and treatments to sterilize the sample. Spider webs can be a valuable source of antibiotics; however, more studies are needed to confirm the real activity of the web or components involved.

Study protocol for a systematic review of the social determinants of mental health and well-being of older migrants aged 50 years and above

Background Migration is a milestone event in a person’s life, bringing with it the challenges of settling down in an unfamiliar environment. The age at which migration takes place and the way migrants negotiate their old and new world significantly impacts their mental health. Thus, this systematic review seeks to analyse and summarize existing research detailing the contexts in which people migrate later in life and the associations between these contexts and social determinants of their mental health and well-being. Methods Seven databases including PsycINFO, Web of Science, PubMed, Applied Social Sciences Index, Abstracts: ASSIA, Ageline, CINAHL, and Informit will be searched systematically for original journal articles published in English. In the first screening stage, the first reviewer (PB) will screen all titles and abstracts and mark all potentially eligible texts for full-text screening. The second reviewer (HM) will review the decisions made. Any potential conflicts will be resolved with discussion. Afterward, full texts of potentially eligible studies will be assessed for eligibility by two reviewers (PB and HM). The methodological quality (or risk of bias) of individual studies will be appraised using the Mixed Method Appraisal Tool. The thematic synthesis of the data will be performed using a hybrid approach incorporating deductive (framed against a customised social determinants of health framework) and inductive data-driven processes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Reg: CRD42022359881).

Emergence and dissemination of equine-like G3P[8] rotavirus A in Brazil between 2015 and 2021.

Rotavirus A (RVA) is a major cause of acute gastroenteritis globally that is classically genotyped by its two immunodominant outer capsid proteins, VP7 (G-) and VP4 (P-). Recent evidence suggests that the reassortant equine-like G3P[8] strain played a substantial role in RVA transmission in Brazil since 2015. To understand its global emergence and dissemination in Brazilian territory, stool samples collected from 11 Brazilian states (n = 919) were genotyped by RT-qPCR and proceeded to sequence the VP7 gene (n = 102, 79 being newly generated) of the G3P[8] samples with pronounced viral loads. Our phylogenetic genotyping showed that G3P[8] became the dominant strain in Brazil between 2017 and 2020, with equine-like variants representing 75%-100% of VP7 samples in this period. A Bayesian discrete phylogeographic analysis strongly suggests that the equine-like G3P[8] strain originated in Asia during the early 2010s and subsequently spread to Europe, the Caribbean, and South America. Multiple introductions were detected in Brazil between 2014 and 2017, resulting in five national clusters. The reconstruction of the effective population size of the largest Brazilian cluster showed an expansion until 2017, followed by a plateau phase until 2019 and subsequent contraction. Our study also supports that most mutations fixed during equine-like G3P[8] evolution were synonymous, suggesting that adaptive evolution was not an important driving force during viral dissemination in humans, potentially increasing its susceptibility to acquired immunity. This research emphasizes the need for comprehensive rotavirus genomic surveillance that allows close monitoring of its ever-shifting composition and informs more effective public health policies.IMPORTANCEOur original article demonstrated the origin and spread in a short time of equine-like G3P[8] in Brazil and the world. Due to its segmented genome, it allows numerous mechanisms including genetic drift and reassortment contribute substantially to the genetic diversity of rotavirus. Although the effectiveness and increasing implementation of vaccination have not been questioned, a matter of concern is its impact on the emergence of escape mutants or even the spread of unusual strains of zoonotic transmission that could drive epidemic patterns worldwide. This research emphasizes the need for comprehensive rotavirus genomic surveillance, which could facilitate the formulation of public policies aimed at preventing and mitigating its transmission.

Erratum to: A hybrid feature selection approach for urinary tract infection detection and prediction in IoT-fog environment

The online version of the original article can be found at https://doi.org/10.31893/multiscience.2024080

A INFLUÊNCIA DO AMBIENTE FAMILIAR NA MANIFESTAÇÃO DO TRANSTORNO DE PERSONALIDADE NARCISISTA

The manifestation of Narcissistic Personality Disorder (NPD) is often influenced by various factors, with the family environment being an important component. Family dynamics play a crucial role in the development of this disorder, impacting the formation of the individual's self-image and patterns of interpersonal relationships. In this context, understanding the influence of the family environment on the expression of NPD is fundamental to effectively address this complex psychological condition. Objectives: To investigate and understand the specific influence of the family environment on the manifestation of narcissistic personality disorder, exploring interaction patterns, parental styles, and family dynamics that may contribute to the development of this disorder. Methodology: Articles found were read, and inclusion and exclusion criteria were applied. Within the inclusion criteria, original articles addressing the investigated topic and allowing full access to the study's content were considered, published between 2016 and 2023, in Portuguese and English. The research was conducted through online access to the databases of the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Health Sciences Literature (LILACS) in February 2024. Results and Discussions: The complexity of treating narcissistic personality disorder (NPD) is highlighted. Psychopharmacological treatments have shown limited efficacy, being more useful in comorbidities with other conditions. Several psychotherapeutic approaches were explored, with Dialectical Behavioral Therapy and Schema-Focused Therapy standing out, as well as psychoanalytic approaches such as Transfer-Centered Psychotherapy and Mentalization-Based Therapy. However, regardless of the approach, narcissistic patients are challenging to treat due to difficulty in accepting the diagnosis and lack of empathy. Motivation for change often arises from external crises, making therapeutic commitment fragile. Therapists' countertransference is also a challenge, with difficult-to-manage negative feelings that, when understood, can provide valuable information about the patient's internal world. In summary, the results highlight the need for therapeutic strategies adapted to the complexity of NPD, considering the specific characteristics of narcissistic patients and the inherent challenges in the therapeutic process. Conclusion: In conclusion, addressing Narcissistic Personality Disorder (NPD) demands a deep understanding of therapeutic nuances. The results underscore the complexity in the effectiveness of psychopharmacological treatments and the importance of specific psychotherapeutic approaches. Difficulty in accepting the diagnosis, lack of empathy, and challenges in countertransference emphasize the need for adapted therapeutic strategies. Amidst these challenges, the pursuit of realistic treatment goals and the creation of therapeutic contracts are crucial. These findings underline the importance of continuing research and refining therapeutic approaches to effectively manage NPD.