Medical Research Articles

Unveiling the efficacy and mechanism of Danggui-Shaoyao-San in treating nephrotic syndrome: A meta-analysis and network pharmacology study

Aim of the studyThe purpose of this study was to investigate the efficacy and mechanism of DSS in treating nephrotic syndrome through meta-analysis and network pharmacology methods. Materials and methodsTo conduct a comprehensive search for randomized controlled trials on the efficacy of Danggui Shaoyao San (DSS) in the treatment of nephrotic syndrome, we searched across eight electronic databases from their establishment to May 1, 2023. The Cochrane Collaboration's Risk of Bias 2 tool was used to evaluate the quality of evidence regarding bias risk and outcomes. Statistical analysis was performed using RevMan software (version 5.4). Furthermore, network pharmacology was employed to validate the underlying mechanism. ResultsThis study included 14 articles that involved 1256 patients with nephrotic syndrome. The clinical efficacy of DSS against nephrotic syndrome was significantly higher than that of Western medical treatment alone. In comparison with the control groups, which were administered Western medicines alone, the use of DSS significantly increased plasma albumin levels (mean difference [MD] = 4.32, 95 % confidence interval [CI] [2.37, 6.24], p < 0.00001) and reduced 24 h urinary protein excretion (MD = −0.92, 95 % CI [−1.11, −0.73], p < 0.00001), total cholesterol levels (MD = −1.23, 95 % CI [−1.76, −0.70], p < 0.00001), triglyceride levels (MD = −0.37, 95 % CI [−0.54, −0.20], p < 0.00001). Furthermore, the combination of DSS with Western medicines achieved better control of adverse reactions in comparison with the control groups (relative risk = 0.37, 95 % CI [0.29, 0.49], p < 0.00001). Network pharmacology analysis identified 39 important active compounds and 18 core target genes involved in the treatment of primary nephrotic syndrome by DSS. Gene Ontology enrichment analysis identified 2126 biological processes, 64 cellular components, and 115 molecular functions, while Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis identified 149 signaling pathways. Key active compounds include ginsenoside Rg5, ginsenoside Rg1, schisandrin A, berberine, gallic acid, quercetin, and β-sitosterol, while potential core target genes include IL6, AKT1, TNF, VEGFA, IL1B, and TP53. KEGG pathway analysis indicated that DSS is involved in multiple mechanisms, such as neural development, synaptic plasticity, programmed cell death, inflammation, and immunity. ConclusionsDSS has higher efficacy and safety in the treatment of nephrotic syndrome and acts on nephrotic syndrome via mechanisms that involve multiple targets, components, and pathways.

Alternative therapy for lymphoma with febrile neutropenia using traditional Chinese medicine: A case report

IntroductionFebrile neutropenia is a common complication in patients undergoing chemotherapy for hematologic malignancies and is associated with significant morbidity and mortality. Primary granulocyte colony-stimulating factor (G-CSF) prophylaxis is consistently associated with a notable reduction in the risk of febrile neutropenia. However, the use of G-CSF in patients who are already neutropenic from chemotherapy remains controversial. Studies have shown that 12.9% of cancer patients incorporate traditional Chinese medicine (TCM) to alleviate chemotherapy side effects in Taiwan; thereby providing an alternative management strategy for neutropenic fever in cancer patients. Case presentationThis is an 18-year-old female with newly diagnosed precursor T-lymphoblastic lymphoma. After chemotherapy, the patient developed febrile neutropenia. Despite the use of antibiotics and G-CSF, the febrile neutropenia persisted for two months. Approximately ten days after the initiation of traditional Chinese medicine decoction with the strategy of tonifying the spleen and stomach, clearing yin fire, and uplifting yang, her absolute neutrophil count (ANC) had gradually increased. Additionally, after two weeks of treatment, her fever subsided. The patient continued with chemotherapy and was discharged in stable condition. DiscussionAntibiotic use aligns with the TCM perspective of an “attack” approach. Conversely, our TCM decoction was designed to raise the ANC by tonifying the spleen and stomach, clearing Yin Fire, and uplifting Yang. Li Dongyuan, one of the four great masters of the Jin Yuan Dynasty, created the formula: Bupiwei Shengyang Sanhuo Decoction that is notable in this regard. The herbs in our decoction have shown hematopoietic and myelosuppression-alleviating effect. For many patients who do not respond adequately to G-CSF alone, integrative treatments involving both TCM and Western medicine can offer additional therapeutic benefits by increasing blood cell counts.

Discerning the Multi-dimensional Role of Salicin: Bioactive Glycoside Beyond Analgesic: Different Perspectives

: Salicin is a glycoside that can be found in several Salix and Populus species. Salicin is also connected to the glycoside populin, commonly known as benzoyl Salicin, in the Salicaceae tree barks. D-glucose is a component of the alcoholic glycoside Salicin (C13H18O7). The willow tree, as well as other trees like poplar and aspen, contains the natural chemical Salicin, which is a member of the salicylate family. Salicin is an anti-inflammatory and analgesic used in conventional medicine, and it served as the inspiration for the creation of aspirin. This molecule may have important human pharmacological actions that need to be considered in determining the efficacy and safety of willow herbal medicines. The extracts obtained from the bark of the tree, belonging to the Saliceae family in different solvents have been known for possessing many important medicinal values by potent pharmacological actions. The current effort deals with exquisite detailed aspects and concerns related to Salicin, which will be fruitful for the futuristic approaches to Salicin.

Enhancing early detection of cognitive decline in the elderly: a comparative study utilizing large language models in clinical notes

BackgroundLarge language models (LLMs) have shown promising performance in various healthcare domains, but their effectiveness in identifying specific clinical conditions in real medical records is less explored. This study evaluates LLMs for detecting signs of cognitive decline in real electronic health record (EHR) clinical notes, comparing their error profiles with traditional models. The insights gained will inform strategies for performance enhancement. MethodsThis study, conducted at Mass General Brigham in Boston, MA, analysed clinical notes from the four years prior to a 2019 diagnosis of mild cognitive impairment in patients aged 50 and older. We developed prompts for two LLMs, Llama 2 and GPT-4, on Health Insurance Portability and Accountability Act (HIPAA)-compliant cloud-computing platforms using multiple approaches (e.g., hard prompting, retrieval augmented generation, and error analysis-based instructions) to select the optimal LLM-based method. Baseline models included a hierarchical attention-based neural network and XGBoost. Subsequently, we constructed an ensemble of the three models using a majority vote approach. Confusion-matrix-based scores were used for model evaluation. FindingsWe used a randomly annotated sample of 4,949 note sections from 1,969 patients (women: 1,046 [53.1%]; age: mean, 76.0 [SD, 13.3] years), filtered with keywords related to cognitive functions, for model development. For testing, a random annotated sample of 1,996 note sections from 1,161 patients (women: 619 [53.3%]; age: mean, 76.5 [SD, 10.2] years) without keyword filtering was utilised. GPT-4 demonstrated superior accuracy and efficiency compared to Llama 2, but did not outperform traditional models. The ensemble model outperformed the individual models in terms of all evaluation metrics with statistical significance (p<0.01), achieving a precision of 90.2% [95% CI: 81.9%-96.8%], a recall of 94.2% [95% CI: 87.9%-98.7%], and an F1-score of 92.1% [95% CI: 86.8%-96.4%]. Notably, the ensemble model showed a significant improvement in precision, increasing from a range of 70%-79% to above 90%, compared to the best-performing single model. Error analysis revealed that 63 samples were incorrectly predicted by at least one model; however, only 2 cases (3.2%) were mutual errors across all models, indicating diverse error profiles among them. InterpretationLLMs and traditional machine learning models trained using local EHR data exhibited diverse error profiles. The ensemble of these models was found to be complementary, enhancing diagnostic performance. Future research should investigate integrating LLMs with smaller, localised models and incorporating medical data and domain knowledge to enhance performance on specific tasks.

Gynecologic Pathology Journal Club: A 2-year, Worldwide Virtual Learning Experience With a Focus on Mentorship and Inclusion.

Journal clubs (JCs) are a common format used in teaching institutions to promote trainee engagement and develop skills in seeking out evidence-based medicine and critically evaluating literature. Digital technology has made JC accessible to worldwide audiences, which allows for increased inclusion of globally diverse presenters and attendees. Herein we describe the experience of the first 2 years of a virtual gynecologic pathology JC designed with the goal of providing mentorship and increasing inclusivity. JC began in a virtual format in April 2020 in response to the need for remote learning during the coronavirus disease 2019 pandemic. Each JC had 1 moderator, lasted 1 hour, featured up to 3 trainees/early-career pathologists, and covered articles on gynecologic surgical pathology/cytopathology. Trainees were recruited through direct contact with moderators and advertising through social media (eg, Twitter). A template was used for all presentations, and before presenting, live practice sessions were conducted with the moderator providing constructive feedback and evaluations were provided to presenters and attendees for feedback. Recordings of the meetings were made publicly available after the event through YouTube, a society website, and emails to registrants. Fifty-nine presenters participated, covering 71 articles. Most were trainees (53/59; 89%) from North America (33/59; 56%), with additional presenters from Asia (14/59; 24%), Australia/Oceania (5/59; 8%), Africa (4/59; 7%), and Europe (3/59; 5%). An average of 20 hours were spent per month by moderators on the selection of papers, meeting preparation, and provision of mentorship/feedback. Live events had a total of 827 attendees, and 16,138 interactions with the recordings were noted. Among those who self-identified on provided surveys, the attendees were most commonly from Europe (107/290; 37%) and were overwhelmingly practicing pathologists (275/341; 81%). The experience, including mentorship, format, and content, was positively reviewed by attendees and presenters. Virtual JC is an inclusive educational opportunity to engage trainees and early-career pathologists from around the world. The format allowed for the JC to be widely viewed by attendees from multiple countries, most being practicing pathologists. Based on feedback received, virtual JC appears to expand the medical knowledge of the attendees and empower presenters to develop their expertise and communication skills.

Comparative Cardiovascular Risks of Radical Prostatectomy and External Beam Radiation Therapy in Early-Stage Prostate Cancer: A Comprehensive Retrospective Analysis.

The risk of cardiac disease mortality has recently become a focal point of concern within the medical community for patients with prostate cancer (PCa). Given that radical prostatectomy (RP) and external beam radiation therapy (EBRT) are the main treatment modalities for localized PCa, their specific impact on cardiovascular-specific mortality (CSM) remains unclear. This study explored the specific effects of RP and EBRT on CSM risk to guide clinical treatment decisions. Data from patients aged 45-74years, who were diagnosed with T1-2N0M0 stage PCa from the SEER database (2010-2015), were used. Multivariate statistical methods, including propensity score matching (PSM), competing risk regression, COX regression analysis, and Fine-Gray testing, were applied to assess the impact of RP and EBRT on CSM risk. Among 146,082 T1-2 stage PCa patients, cardiac disease emerged as the primary cause of death, surpassing PCa itself. Multifactorial COX regression and competing risk regression analyses indicated that local treatments do not increase CSM risk. Further analysis revealed a significant increase in CSM risk for patients undergoing only EBRT compared with those undergoing only RP (hazard ratio [HR] = 2.71, 95% confidence interval [CI] 1.96-3.74, P < 0.001), with subsequent PSM adjustment, further confirming a significantly reduced risk in the RP treatment group (HR 0.23, 95% CI 0.13-0.40, P < 0.001). T1-2 stage PCa patients face a significant risk of CSM, with RP offering a potential advantage over EBRT in reducing this risk. These findings encourage clinicians to comprehensively consider the potential impact on cardiac health when formulating treatment plans, providing crucial guidance for optimizing treatment strategies.

Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions

Integrative Medicine (IM), which includes therapies such as acupuncture, herbal medicine, yoga, and meditation, is gaining attention for managing chronic pain conditions. However, concerns about the quality of evidence supporting the use of these interventions persist. The 5th Annual Jaseng Academic conference 2024, in Seoul, South Korea, themed "Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions," addressed these concerns by focusing on advancements in study design, evidence synthesis, and open science practices. This conference proceeding summarizes key insights from the conference, emphasizing the role of pragmatic randomized controlled trials (pRCTs) in evaluating real-world effectiveness, and addressing the complexities involved in IM research such as sham controls. The integration of IM therapies into comprehensive pain management strategies (particularly in Korea), supported by government-backed research and policy initiatives was also discussed. Advancements in methodologies were addressed, such as bibliometric analysis, evidence mapping, and the development of clinical practice guidelines (CPGs) for integrative therapies. These methodologies offer valuable insights but face challenges due to the heterogeneity of IM interventions, and potential synergistic or antagonistic effects when combined with conventional medicine. Finally, the potential of open science to enhance transparency, reporting, and reproducibility in IM was explored, emphasizing the increased role of adherence to reporting guidelines (CONSORT and PRISMA). The future of IM research is built upon the continued efforts of refined study designs, rigorous evidence synthesis, and the integration of open science principles, for a robust and more credible evidence base.

АДГЕЗИВНАЯ АКТИВНОСТЬ МИКРООРГАНИЗМОВ К СТОМАТОЛОГИЧЕСКИМ МАТЕРИАЛАМ ДЛЯ 3D ПЕЧАТИ И ВАКУУМНОЙ ФОРМОВКИ

Relevance: The adhesive activity of the oral microbiome to new generation materials is the subject of study by the global medical community, and the issue of choosing structural materials is still being discussed in the scientific community and is of a controversial nature. Objective: To study the adhesion of representatives of the oral microbiome to samples of modern dental materials under experimental conditions (in vitro). Materials and methods: Samples of photopolymer resins for 3D printing: Dental Crown LCD, Dental Sand A1-A2, Dental Clear Pro, (n=30), (1-3 groups), thermoforming plates for vacuum forming: EV Gasket Bleaching 080, Bioplast multicolor 3.0*123 mm, Bioplast color 3.0*125 mm (n=30), (groups 4-6); clinical isolates of the microbiome as test strains: Staphylococcus aureus, Streptococcus oralis, Neisseria subflava, Actinomyces oris, Candida albicans (n=5). Research methods: experimental, microbiological, cultural, analytical and statistical. Results: The degree of adhesion of representatives of the oral microbiome to the studied structural materials is in the range from 0 to 4.91 (Ia) and depends on both the species composition of the microbiome and the physico-chemical properties of the materials. The high adhesion index for all microbiota groups was noted for vacuum forming materials (4.91), and the lowest was Dental Crown LCD (0), which makes it possible to recommend it for practical use. Conclusions: The choice of structural material should be made, including taking into account the adhesive activity of the oral microbiome in order to reduce the risk of complications. It is recommended to give preference to materials with a low adhesive activity index.

Digitalising the past decades: automated ICD-10 coding of unstructured free text dermatological diagnoses

BackgroundCurrent digital medical databases record systematically coded diagnoses, but many legacy databases are full of hand-written, free text diagnoses, which can only be meaningfully analysed after mapping them to a coding system. While diagnoses can be extracted from full medical notes with good accuracy, no algorithm using only an unstructured free text diagnosis with no additional data has been published to date.Objectives/methodsTherefore, we sought to create an algorithm which maps hand-written German diagnoses from our clinical photography database to ICD-10 diagnosis codes, validate its output manually by dermatologists and analyse diagnosis counts over time as a proof-of-concept of its application.ResultsOur rule-based algorithm mapped 50,884 unprocessed hand-written German free-text diagnoses covering five decades to ICD-10 codes, while reaching an accuracy of 82% against 817 dermatologist-validated diagnoses. Out of 41,021 data points with the highest algorithm confidence the top 3 identified diagnosis classes were psoriasis, eczema, and non-melanoma skin cancer. The number of ICD-10 codes belonging to chronic inflammatory diseases showed a seasonal pattern with peaks in July, and when analysed aggregated by year, peaks correlated to events such as new therapy classes for these diseases.ConclusionUsing the presented algorithm, it is possible to reliably match hand-written free text of German dermatological diagnoses to ICD-10 codes, thus enabling systematic analysis of legacy databases, making past medical knowledge accessible to today’s patient care.

Traditional medicine use to manage hypercholesterolemia, hyperglycaemia and hypertension in Ecuador

Abstract Background Although the use of traditional medicine (TM) to manage health issues is frequently reported, clinical guidelines often overlook this practice. This study aimed to describe the frequency of TM use to control 3 cardiometabolic risk factors for non-communicable diseases (arterial hypertension, hypercholesterolemia, and hyperglycaemia, collectively referred to as CMRF here); and associated sociodemographic, economic, and clinical characteristics. Methods Descriptive cross-sectional study with a representative population of two health districts in Ecuador, one urban in southern Quito and one in a forested rural area with diverse ethnic groups in Esmeraldas. We included 602 individuals with at least one CMRF and calculated the proportion of those who reported regular use of TM (herbal or traditional remedies) to control their CMRF. We used a multivariable logistic regression model to calculate Odds Ratios for TM use according to sociodemographic, economic, and clinical characteristics. Results TM was commonly used to control CMRF in both sociocultural contexts (39.4% Esmeraldas, 31.1% Quito), often in combination with conventional medicine (CM). A notable percentage of people (33.9% Esmeraldas, 39.0% Quito) did not take any treatment for their CMRF, and the rest used CM alone. In both settings, education was significantly associated with TM use. While in Quito people with higher education were more likely to use TM (aOR 2.04, 95%CI 1.03-3.90), in Esmeraldas, it was more common among people without formal schooling (aOR 3.76; 95%CI 1.59-8.88) as well as those of younger age (aOR per year 0.97; 95%CI 0.95-0.99) and from Afro-Ecudorian ethnicity (aOR 2.13; 95%CI 1.02-4.45). Conclusions Traditional medicine is used by a significant portion of Ecuador’s population, highlighting the need for a more accessible and intercultural approach to healthcare. Key messages • The use of traditional medicine to address hypertension, hypercholesterolemia, and hyperglycaemia appears to be widespread in different sociocultural and economic contexts of Ecuador. • To promote intercultural health, understanding the diverse sociocultural patterns associated with the use of traditional medicine, often combined with conventional medicine, is crucial.

Healthcare professionals and students’ knowledge on termination of pregnancy: A systematic review

Abstract Background Providing safe termination of pregnancy (TOP) according to each country’s legalisation is an important public health matter internationally. Healthcare professionals (HCPs) and healthcare students have key roles and need to be aware of legislation and clinical practice guidelines on TOP in their country to facilitate safe and effective care. The main aim of this systematic review was to investigate the level of knowledge on TOP legislation among HCPs and healthcare students. The second objective was to assess the knowledge of TOP methods, procedures and/or potential associated complications. Methods This is a systematic review of qualitative and quantitative peer-reviewed studies published in English or Portuguese until July 2020. Databases included in the search were EBSCO, PubMed, Embase and Scopus. The quality appraisal was done using the CASP Critical Appraisal tools. Results A total of 31 studies were included, published between 2002 and 2020 and from several regions around the globe. No studies were carried out in Europe or the United Kingdom. A total of 22 studies included healthcare professionals and nine studies included students. Overall, all the studies showed poor knowledge of TOP legislation and TOP methods, procedures and complications. Knowledge of special circumstances established in the law where TOP might be legal was also very limited. In studies focussing on medical (MA) and surgical (SA) TOP, knowledge of MA was lower than of SA. Studies reported that practitioners and students have limited training in TOP. Overall, education/training and experience with TOP seem to be the main factors associated with increased levels of knowledge. Similar results were found for student’s knowledge. Conclusions This study highlighted the importance of involving and promoting the participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown. Key messages • TOP training is limited and broadly excluded from medical and healthcare education globally. Students and staff have recognised this issue and the critical impact it has on TOP care provided. • Adequate knowledge and training in TOP ensures service sustainability and preparation of current and future healthcare practitioners to provide high-quality, respectful and compassionate care.

The Health-Employment-Longevity Nexus: Implications for Retirement Age Policies in European Countries

Abstract Background Advances in medical knowledge and technology have led to increased general and healthy life expectancy in Europe. Combined with declining fertility rates, these trends have resulted in an aging population. Many European countries have been reluctant to adjust the retirement age, putting pension funds and Pay-As-You-Go social insurance systems at risk. Linking entitlement age to life expectancy could mitigate this risk and extend working life, but such policies are politically unpopular. This study investigates the empirical relationship among self-perceived health, employment, job quality, and life expectancy in the European context. Methods The study analyzes the determinants of self-rated health using the SHARE database, combined with general and healthy life-expectancy data from EUROSTAT and, where missing, the WHO, focusing on European countries. Results In Europe, both past and present employment improve self-rated health. Job quality has a detrimental effect on self-rated health for women and a positive effect on men. Life expectancy and healthy life expectancy raise self-rated health, while poverty rates negatively affect it. Job quality is widespread among European women, and its negative effect on health rises with age. For European men, job quality has a positive effect, peaking around age 56. The effects of employment and job quality on self-rated health are simultaneous. In European countries with an elasticity &amp;gt;1, healthy life expectancy rises faster than general life expectancy at higher ages, suggesting an improved ability to work at older ages. This finding indicates that adjusting the retirement age could be a powerful tool for improving the sustainability of social insurance systems in Europe. Conclusions For younger European women, it may be rational to set higher retirement-age increments and put them on a declining course as they age, considering the gender-specific age dynamics and job quality effects on health. Key messages • In Europe, employment and job quality significantly influence self-rated health, with gender-specific effects that vary with age and impact retirement age policies. • Adjusting retirement age in line with healthy life expectancy could improve the sustainability of European social insurance systems, considering health-employment dynamics.

Safety and efficacy of leadless pacemaker extraction using a novel retrieval tool: a multicenter analysis

Abstract Background Leadless pacemakers (LP) have emerged as a safe and effective alternative for cardiac pacing, increasingly adopted by the medical community. While rare, complications such as pacemaker syndrome or device dislodgment can occur. In such instances, the extraction of the leadless pacemaker and its replacement with a new device should be considered. Purpose This multicenter study aimed to describe the use of the Aveir retrieval sheath during Micra extraction procedure and to assess the success rates and potential complications associated with the procedure. Methods In this observational study, we analyzed prospectively collected data from 14 patients that underwent leadless pacemaker using Abbott retrieval catheter at three high volume centers for pacemaker extraction and leadless implant in United States. Thought femoral vein the Aveir steerable retrieval catheter is advanced to the right atrium and then across the tricuspid valve. Under TEE and fluoroscopy guidance the snare is advanced over the Micra, and the button is secured. A protective sleeve is advanced over the LP. With application of traction to snare and countertraction with the sleeve against the endocardium, the LP is free from the myocardium and removed via the sheath. (Fig. 1) The procedural duration should be intended as the combined total of the time taken for the extraction of the existing pacemaker and the implantation time of the new device. Extractions performed during the first year were described as early and thereafter as late. Procedural success was described as complete extraction of LP without procedural complication. Results The reason for early explant was LP dislodgment and for late explant was pacemaker syndrome. Median time to extraction was 4±2 months in early explant and 35±9 months in late explant. Procedural time in early and late groups was 68.7 and 72.3 min respectively (P=0.32). Fluoroscopy time in early and late groups was 12.2 and 16.4 respectively (P= 0.18). LP was then replaced with a transvenous pacemaker. Success was 100% in both groups. No complication occurred in both groups. Conclusion Micra pacemaker using Aveir retrieval catheter is an effective tool irrespective of dwell time.

A long journey from telemedicine to digital (public) health: the vision of different stakeholders

Abstract The healthcare system willingly adopts new innovative means of communication and solutions offered by computer science. Telemedicine was one of the first terms used in this context. It was initially associated with providing medical services but quickly extended to other areas of health-related activities, including public health. The growth of the global web yielded new prospects for the provision of health services, also resulting in new terms to name the use of information and telecommunication technologies in healthcare. E-health, stemming from the end of 90ies in the 20th century, was initially defined as a new domain strongly associated with public health, especially in the context of access to health information. Quickly, its understanding was extended to all health-related interventions based on innovative digital technologies. Today, digital health and digital public health have emerged as the key terms, signifying the next phase of emerging applications that leverage the advancements made on the technical front. The medical community is probably more inclined to use the former term, while public health professionals are dedicated to the latter. But do these terms carry distinct meanings? Or is it merely a matter of the professional group’s background? Is the focus on individual or population health a differentiating factor? In the meantime, business and technical communities have developed the concept of Health 4.0. This concept emphasizes using technologies like the Internet of Things, cloud computing, big data, and artificial intelligence. However, digital (public) health benefits hugely from these solutions. One can ask whether every professional community needs other concepts and new terms for naming fields, resulting from the multidisciplinary effort. And where are the plain people in this landscape? Do they have sufficient digital and health literacies to accept new modes of health service delivery?

Perception of fatphobia and pesocentrism within medical consultation

Abstract Background About 42% of adults living with overweight or obesity suffer a marked pattern of stigmatization and thanks to this discrimination the risk of death has increased up to 60%. Objectives To identify the factors that contribute to the perception of fatphobia and pesocentrism within the first level of medical care. Methods A prospective cross-sectional study was carried out. Statistical analysis was performed with X2 test and 95% confidence interval (OR/CI95%). Results 104 participants with obesity and overweight were included. The factors associated with the perception of pesocentrism were, started eating plans before the age of 10 years (3.38/1.12-10.7); being denied consultation for being a fat person (0.27/-0.16-0.46); perceiving mistreatment by the physician regarding weight (0. 2/0.13-0.3); perceiving physical harassment by the physician (0.23/0.16-0.82); perceiving discomfort on physical examination (0.44/0.23-0.82); perceiving fat-phobic behaviors by the physician (5.45/3.24-9.16). Factors associated with perceived fatphobia were, started eating plans before the age of 10 years (4.89/1.71-14.01); being denied consultation for being a fat person (0.19/-0.08-0.44); perceiving mistreatment by the physician regarding weight (0. 07/0.04-0.15); perceiving physical harassment by the physician (0.11/0.06-0.19); perceiving discomfort on physical examination (0.28/0.11-0.67); perceiving weight-centered behaviors by the physician (0.05/0.01-0.23). All with p value &amp;lt;0.05. Conclusions Factors such as the beginning of eating plans in childhood, refusal of consultation for being a fat person, mistreatment regarding weight, physical harassment by the physician, discomfort during physical examination are associated with and favor the perception of both fat-phobia and weight-centeredness in the medical consultation. Key messages • It is of vital importance to know more about the concepts of fatphobia and pesocentrism, in order to promote non-discrimination around them. • Fatphobia and pesocentrism are still little known issues within the medical community, the perception of them is due to discriminatory behaviors that have been normalized.

Phase I results of both IV and oral administration for CG-0255: a novel fast-acting antiplatelet drug with a new activation pathway

Abstract Clopidogrel is an extremely widely used antiplatelet drug, but with serious shortcomings. It is a prodrug that depends critically on liver CYP oxidation enzyme CYP2C19 for activation to its active metabolite H4. However, large fractions of world population carry loss of function CYP2C19 alleles, ranging from a low ~21% in Latino to a strikingly high ~59% in east Asian population. Known as clopidogrel resistance, US FDA added a black box warning to clopidogrel label. Despite this issue, routine CYP2C19 screening for clopidogrel patients is not performed, putting many patients at risk. Clopidogrel is also slow to take effect and not amenable for IV formulation, limiting its clinical use in emergency. To overcome these issues, we have invented a novel antiplatelet drug CG-0255, which is the world’s first thioester prodrug with a new activation pathway. CG-0255 has been designed to require only abundantly present and widely distributed carboxylesterases for metabolizing to its active metabolite, which is identical to clopidogrel active metabolite H4 generated through CYP metabolism. Thus, CG-0255 completely bypasses the CYP metabolism and overcomes clopidogrel resistance. In addition, CG-0255 has a much faster onset of action and high solubility in water and has been formulated for both IV and oral administration. Here we report the results of an open label phase I study of CG-0255 oral tablets to assess safety, tolerability, pharmacodynamics (PK), and pharmacokinetics (PD: inhibition of platelet aggregation, IPA) in healthy volunteers. It was a single dose escalation study, 4 cohorts with 6 participants each given CG-0255 oral tablets at doses ranging from 2 to 10 mg. Clopidogrel was the positive control and given at 300 mg. Blood samples for PK/PD analysis were collected pre-dosing and at various time points post dosing. VerifyNow was used for IPA measurement. CG-0255 is generally safe and well tolerated. PK analysis shows fast and consistent conversion of CG-0255 to active metabolite H4. PD results indicate that CG-0255 IPA is dose-dependent, easily matching or surpassing that of clopidogrel 300 mg for all doses. At the highest 10 mg dose, CG-0255 IPA reaches over 90% in less than 30 minutes, well above that of clopidogrel. In addition, CG-0255 IPA shows minimum individual variations, and the antiplatelet effect is long lasting due to its irreversible binding to the P2Y12 receptor. These results are consistent with our earlier reported Phase I results for CG-0255 IV injection. In conclusion, CG-0255 is a novel, fast-acting and long-lasting antiplatelet drug. It shares identical metabolite H4 with clopidogrel but relies only on carboxylesterases for activation, overcoming the resistance and other issues associated CYP-based oxidation metabolism. As the only antiplatelet drug available for both IV and oral administrations, CG-0255 fills unmet medical needs and will greatly benefit patients and medical community.

One Health in Europe: from concept to practice

Abstract The One Health concept is a comprehensive approach that highlights the interconnectedness of human, animal, and environmental health. Understanding these interrelationships is essential for effectively managing and mitigating emerging health threats. This approach emphasizes that health issues arise from a complex web of interactions involving humans, animals, and ecosystems. Emerging health threats, such as zoonotic diseases (e.g., mpox, Ebola, avian influenza), antibiotic resistance, and environmental degradation, pose significant risks to global health. Zoonotic diseases, which are transmitted between animals and humans, highlight the direct links between animal and human health. The increase in antibiotic resistance, driven by overuse in both human medicine and livestock farming, leads to the rise of resistant pathogens. Environmental issues like climate change, deforestation, and pollution further exacerbate these threats by altering habitats, disrupting ecosystems, and affecting disease vectors. Addressing these interconnected challenges requires a unified approach that integrates human, animal, and environmental considerations. For example, climate change can shift the distribution of disease vectors like mosquitoes, leading to the spread of diseases such as malaria and dengue fever. Likewise, deforestation can heighten the risk of zoonotic spillover by bringing humans into closer contact with wildlife. 1. To tackle these complex challenges, several measures are crucial: • Integrated surveillance systems Developing systems that monitor human, animal, and environmental health data collectively can improve early detection of outbreaks. Sharing information across sectors is a prerequisite for effective identification of emerging threats. • Strengthening veterinary and public health collaboration Joint research, surveillance, and outbreak management efforts can lead to a more coordinated approach to health emergencies. • Promoting One Health education and training Educating professionals in various fields fosters a collaborative approach to health issues. Training programmes can build a shared understanding of health interconnections. • Implementing sustainable environmental practices Adopting sustainable practices to address environmental degradation helps reduce risks associated with habitat destruction and pollution. • International collaboration and agreements facilitate resource sharing, information exchange, and best practices. 2. To enhance public health strategies within the One Health framework: • Enhance interdisciplinary research Promote research on the intersections of human, animal, and environmental health to understand how changes in one area affect others and to develop more effective interventions. • Foster community engagement Engage communities to improve the adoption of preventive measures and build resilience against health threats through public awareness and community-based programs. Leverage technology and innovation Innovations can offer valuable insights such as data analytics, remote sensing, and genomic surveillance. In our upcoming plenary session, experts from veterinary and public health sciences will present practical examples on One Health collaboration in Europe and discuss how to address challenges in implementing the approach. Moderator Ricardo Mexia Chair of the 17th EPH Conference 2024, President EUPHA Infectious diseases control section Keynote speaker Lorena Boix Deputy Director-General, Directorate General for Health and Food Safety (DG SANTE), European Commission Speakers/Panellists Stef Bronzwaer Cross-Agency One Health Task Force, European Food Safety Authority (EFSA) Barbara Häsler Royal Veterinary College, UK Susana Guedes Pombo Chief Veterinary Officer, Portugal, President World Organization for Animal Health (WOAH) Eva Zažímalová Member of European Commission's Group of Chief Scientific Advisors, Professor of Plant Anatomy and Physiology, Charles University, Czech Republic

Decriminalizing and Legalizing Cannabis for Clinical Benefits in Malaysia: Perspective Among Pharmacists (A Qualitative Study)

ABSTRACT Cannabis, often criticized, has active compounds that indicate multiple medical benefits. However, before the potential decriminalization and legalization of medical cannabis, pharmacists play a crucial role in the decision-making for personalized therapy and evidence-based medicine. This study investigates pharmacists’ perspectives on medical cannabis, covering medical use, societal impact, research, legality, and regulation. This study was conducted through semi-structured interviews with pharmacists from different sectors. Interviews were conducted with 16 pharmacists, with 4 from each sector: industry, academia, community, and hospital. There was a consensus on the need for streamlined research before potential decriminalization and legalization of cannabis, highlighting concerns about abuse and misuse despite its benefits. With that in mind, all participants agree that there is a need to update the current legislation and regulations to better control the use and distribution of medical cannabis. Several participants also called to attention that education plays an important role in the potential decriminalization of medical cannabis, with cannabis-related stigma being a potential deterrent for not only the public but also healthcare professionals. As medical cannabis is a new subject in Malaysia, this study could ignite further multidisciplinary human-related research with strict regulations which will ultimately result in evidence-based medicine.

Empowering Continuing Medical Education (CME) in India: leveraging Kern’s instructional design model

IntroductionContinuing Medical Education (CME) is vital for healthcare professionals to remain current with advancements and maintain their competence. In India, CME remains in its early stages, lacking a systematic approach. There is a pressing need for a comprehensive framework that addresses needs assessment, program development, accreditation, and credit allocation. Specifically, there is a gap in delivering targeted CME that meets the needs of different medical professionals at appropriate times. The aim of this study is to employ Kern’s six steps of curriculum design to plan and evaluate a faculty development program focused on Entrustable Professional Activities (EPAs) for MD (Doctor of Medicine) Biochemistry professionals.MethodsThis study utilized Kern’s six-step approach to design a training program on Entrustable Professional Activities (EPAs) tailored for MD Biochemistry professionals. Approval was obtained from the Institutional Human Ethics Committee. Following problem identification, a targeted needs assessment was conducted through expert consultations. The goal of the program was established, focusing on the development and delivery of an interactive online CME program. The program was developed, implemented and evaluated using surveys and feedback questionnaires.ResultsA comprehensive literature review revealed a notable gap in EPA-related works for MD Biochemistry program. Expert consultations highlighted significant training needs and barriers, such as limited resources and professional commitments. Consequently, the program’s primary objective was to raise awareness and sensitize participants to EPA development. A 4-h online CME was designed, featuring expert-led sessions and collaborative group activities. The program attracted 152 participants and utilized interactive elements, such as polls and chats, to foster engagement. Group activities allowed participants to apply concepts in EPA validation. Pre- and post-program surveys demonstrated significant improvements in participants’ knowledge and confidence. Feedback highlighted the practical relevance of the content and the interactive, hands-on nature of the sessions.ConclusionKern’s six-step approach provided a structured and effective framework for developing the CME program, addressing identified needs and barriers, and enhancing faculty development in MD Biochemistry. This study underscores the importance of a systematic approach in CME to improve program effectiveness.Trial registrationNot applicable.

Clinical Observation of the Therapeutic Effects of Wenzhong Hewei Formula in Treating Spleen and Stomach Qi Deficiency Syndrome in Internal Medicine Diseases

Objective: To observe the clinical efficacy and safety of Wenzhong Hewei Formula in treating spleen and stomach qi deficiency syndrome in internal medicine diseases. Methods: Sixty patients with spleen and stomach qi deficiency syndrome admitted to the hospital from April 2022 to June 2023 were randomly divided into observation and control groups, with 30 patients in each group. The control group received conventional internal medicine treatment, while the observation group was additionally treated with Wenzhong Hewei Formula on the basis of conventional treatment. Both groups were treated for 4 weeks. Results: The total effective rate of treatment in the observation group was higher than that of the control group (P &lt; 0.05). After treatment, the traditional Chinese medicine syndrome scores of both groups were significantly lower than before treatment, with the observation group showing a more pronounced reduction (P &lt; 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P &gt; 0.05). Conclusion: Wenzhong Hewei Formula can effectively improve clinical symptoms in patients with spleen and stomach qi deficiency syndrome, enhance clinical efficacy, and have a high level of safety, making it worthy of clinical promotion.