Medical Research Articles

Overcoming Challenges in Interdisciplinary Collaboration Between Human and Veterinary Medicine

Companion animals, such as dogs and cats, have gained considerable attention in translational medicine due to their potential as models for human diseases. The use of these animals in research has opened new avenues for developing treatments that can benefit both human and veterinary patients, aligning with the One Health approach. Unlike traditional laboratory models like mice, rats, and rabbits, companion animals naturally develop diseases that closely mirror those in humans, including but not limited to diabetes, aging, cancer, and neurological disorders, making them particularly valuable in translational research. Recent advances have highlighted the role of companion animals in enhancing the effectiveness of novel therapies during clinical trials, as they are exposed to diverse environmental and lifestyle factors similar to those experienced by humans. However, the integration of companion animals into translational medicine presents challenges, particularly in terms of collaboration between veterinary and human medicine, where terminology differences in anatomy, clinical terminology, and animal classification can lead to miscommunication. In conclusion, these findings underscore the need for better implementation of the One Health approach by uniting the fragmented collaboration between veterinarians and doctors through interdisciplinary training and fostering unified efforts across both fields, with experts from various disciplines contributing their specialized knowledge in clinical practice and research.

Preserving Stem Cells for Potential Use in Future Reparative Medicine

With its enormous potential for regenerative medicine and therapeutic applications, stem cell preservation represents a major breakthrough in biomedical science. Stem cells are gathered, processed, and stored under carefully monitored circumstances in order to preserve their viability for potential use in the future. Because they may differentiate into a variety of cell types, stem cells—especially those derived from sources like umbilical cord blood—are essential for both therapeutic and research uses. An essential function of cord blood banking is to offer a plentiful supply of immune system cells that may be stored for potential future therapeutic applications. Immunological deficits, osteoarthritis, Parkinson's disease, and heart failure are just a few of the conditions for which stem cell treatments have shown promise. Notwithstanding the promise, there remain obstacles such immunological rejection and the need for more research to fully comprehend the development and functionality of stem cells. It is essential for the general public to be informed about stem cell treatments and cord blood banking in order for expectant parents to make well-informed decisions. Future advancements in the subject depend heavily on resolving ethical issues and enhancing the effectiveness of stem cell-based therapies. To fully realise the promise of stem cell preservation in conventional medicine, more research, creativity, and international cooperation are required.

Healthcare in the Age of Google

We were inspired to write this commentary because of an encounter at a conference where physicians told medical and undergraduate students that they laugh when patients Google search medical information. We recognized these actions to be rooted in oppression. Despite public commitments made by the medical community and other health professional groups to combat racism and other forms of oppression, some healthcare encounters continue to be rooted in racism and discrimination. We specifically address anti-Indigenous racism and its impacts on the health and well-being of Indigenous Peoples to Turtle Island. We recommend the implementation of anti-racist and anti-colonial pedagogies to ensure that medical schools, other health professional programs, and healthcare institutions are training anti-oppressive care providers.

Cold Consolidation of Pharmaceutical Waste Glass Powders Through Alkali Activation and Binder Jet 3D Printing

The recent COVID-19 emergency has led to an impressive increase in the production of pharmaceutical vials. This has led to a parallel increase in the amounts of waste glass; manufacturers typically recover material from faulty containers by crushing, giving origin to an unrecyclable fraction. Coarse fragments are effectively reused as feedstock for glass melting; on the contrary, fine powders (<100 microns), contaminated by metal and ceramic particles due to the same crushing operations, are landfilled. Landfilling is also suggested for pharmaceutical containers after medical use. This study aims at proposing new opportunities for the recycling of fine glass particles, according to recent findings concerning alkali activation of pharmaceutical glass, combined with novel processing, i.e., binder jetting printing. It has already been shown that pharmaceutical glass, immersed in low-molarity alkaline solution (not exceeding 2.5 M NaOH), undergoes surface dissolution and hydration; cold consolidation is later achieved, upon drying at 40–60 °C, by a condensation reaction occurring at hydrated layers of adjacent particles. Binder jetting printing does not realize a full liquid immersion of the glass powders, as the attacking solution is selectively sprayed on a powder bed. Here, we discuss the tuning of key parameters, such as the molarity of the attacking solution (from 2.5 to 10 M) and the granulometry of the waste glass, to obtain stable printed blocks. In particular, the stability depends on the formation of bridges between adjacent particles consisting of strong T-O bonds (Si-O-Si, Al-O-Si, B-O-Si), while degradation products (concentrating Na ions) remain as a secondary phase, solubilized by immersion in boiling water. Such stability is achieved by operating at 5 M NaOH.

Development and validation of knowledge, attitude, and practice scale regarding antibiotic use for Chinese medical students.

This study aimed to develop and validate a knowledge, attitude, and practice scale of antibiotic use for Chinese medical students. A five-phased procedure was adopted: (a) A item pool was constructed after literature review; (b) Delphi method was used to refine the items; (c) A pilot study was conducted to clarify the item; (d) Item analysis and exploratory factor analysis were used to finalize the scale; (e) Content validity, construct validity and reliability of the scale were analysed. The scale of 32 items, respectively 15, 9, and 8 for knowledge, attitude, and practice, was finalized. The item-level content validity ranged from 0.80 to 1.00. The scale-level content validity of the scale was 0.90. Model fit indices of total scale and the three dimensions met the criteria. Cronbach's α and the split-half coefficient were respectively 0.81 and 0.65 for the total scale. For each dimension, Cronbach's α varied from 0.68 to 0.89 and the split-half coefficient varied from 0.64 to 0.83. The scale can be used as a whole or separately, serving as an effective tool to measure medical students' knowledge, attitude, or practice regarding antibiotic use.

Black Women in Medical Education Publishing: Bibliometric and Testimonio Accounts Using Intersectionality Methodology.

Black women in academic medicine experience racial and gender discrimination, all while being tasked with improving a flawed system. Representation of Black women in medicine remains low, yet they bear the burden of fostering diversity and mentoring trainees, exacerbating their minority tax and emotional labor, and negatively impacting career progression. To complement qualitative accounts of Black women authors in the medical education literature with a quantitative account of their representation. We used statistical modeling to estimate the representation of Black women authors in medical education publishing as compared to other groups. An intersectional methodology employing bibliometric analysis and testimonio reflection. US-based authors of journal articles published in medical education journals between 2000 and 2020. Author race was determined using a probability-based algorithm incorporating US Census data, and author gender was ascribed using Social Security Administration records. We conducted two negative binomial generalized linear models by first and last author publications. Metadata for each article was retrieved from Web of Science and PubMed to include author names, country of institutional affiliation, and Medical Subject Headings (MeSH). Results were contextualized via the "testimonio" account of a Black woman author. Of 21,945 unique authors, Black women (and other racially minoritized groups) published far fewer first and last author papers than white women and men. In addition, major MeSH terms used by Black women authors reveal little overlap with highly ranked medical education topics. The testimonio further narrated struggles with belonging and racial identity. This study revealed that Black women are underrepresented in medical education publishing. We believe that dismantling oppressive structures in the publishing ecosystem and the field is imperative for achieving equity. Additionally, further experiential accounts are needed to contextualize this quantitative account and understand underrepresentation in medical education publishing.

Medical large language models are susceptible to targeted misinformation attacks

Large language models (LLMs) have broad medical knowledge and can reason about medical information across many domains, holding promising potential for diverse medical applications in the near future. In this study, we demonstrate a concerning vulnerability of LLMs in medicine. Through targeted manipulation of just 1.1% of the weights of the LLM, we can deliberately inject incorrect biomedical facts. The erroneous information is then propagated in the model’s output while maintaining performance on other biomedical tasks. We validate our findings in a set of 1025 incorrect biomedical facts. This peculiar susceptibility raises serious security and trustworthiness concerns for the application of LLMs in healthcare settings. It accentuates the need for robust protective measures, thorough verification mechanisms, and stringent management of access to these models, ensuring their reliable and safe use in medical practice.

Knowledge-injected Prompt Learning for Chinese Biomedical Entity Normalization

The Biomedical Entity Normalization (BEN) task aims to align raw, unstructured medical entities to standard entities, thus promoting data coherence and facilitating better downstream medical applications. Recently, prompt learning methods have shown promising results in the natural language processing field. However, existing research falls short in tackling the more complex Chinese BEN task, especially in the few-shot scenario with limited medical data, and the vast potential of the external medical knowledge base has not yet been fully exploited. To address these challenges, this article proposes a novel Knowledge-injected Prompt Learning (PL-Knowledge) method. Specifically, the approach consists of five stages: candidate entity matching, knowledge extraction, knowledge encoding, knowledge injection, and prediction output. By effectively encoding the knowledge items contained in medical entities and incorporating them into tailor-made knowledge-injected templates, the additional knowledge enhances the model’s ability to capture latent relationships between medical entities, thus achieving a better match with the standard entities. Comprehensive experiments are conducted on a benchmark dataset in both few-shot and full-scale settings. This method outperforms existing baselines, with an average accuracy improvement of 12.96 percentage points in few-shot and 0.94 percentage points in full-data cases, showcasing its excellence in the BEN task.

Psychologists' Opportunities for Fostering Leadership Skills in Academic Medicine: The Rothenberger Leadership Academy.

Healthcare leaders must increasingly attend to the monumental challenges facing their organizations (Angood and Falcone, American Association for Physician Leadership, 2023). As such, leadership in healthcare settings demands new skills sets amongst healthcare professionals that transcend the technical skills of any given profession. Academic health center psychologists are well-positioned to contribute to the leadership of academic health centers due to knowledge, skills, and attitudes fostered in doctoral psychology education, practice, and research through the focus on Profession-Wide Competencies. This article calls for psychologists to pursue more leadership opportunities within academic health centers.The article starts by identifying parallels between psychology's Profession-Wide Competencies and needed leadership skills/concepts for healthcare leaders. An example of an academic health center psychologist's leadership in a cohort-based physician leadership program illustrates how Profession-Wide Competencies were used in three structural elements of the leadership program. The article identifies particular leadership opportunities for psychologists within academic health centers.

Low PD-L1 expression, MAP2K2 alterations, and enriched HPV gene signatures characterize brain metastases in head and neck squamous cell carcinoma

BackgroundBrain metastasis (BM) is a rare but severe complication of head and neck squamous cell carcinoma (HNSCC), with limited knowledge of molecular characteristics and immunogenicity.MethodsWe analyzed 61 cases of HNSCC-BM from three academic institutions (n = 24) and Foundation Medicine Inc (FMI, n = 37). A subset of cases underwent next-generation sequencing, multiple immunofluorescence, and proximity ligation sequencing. Gene enrichment analysis compared alterations in FMI BM samples (n = 37) with local samples (n = 4082).ResultsDemographics included: median age of 59 years, 75% male, 55% current/former smokers, 75% oropharyngeal primary, and 67% human papillomavirus (HPV) +. ATM (54%), KMT2A (54%), PTEN (46%), RB1 (46%), and TP53 (46%) were frequently altered in BM samples from academic centers (62% HPV/p16+). Structural rearrangements ranged from 9 to 90 variants by proximity ligation sequencing. BMs had low densities of CD8+, PD-1+, PD-L1+, and FOXP3 + cells, and 92% had PD-L1 combined positive scores < 1%. CDKN2A (40.5%), TP53 (37.8%), and PIK3CA (27.0%) alterations were common in the FMI BMs (51% HPV+). MAP2K2 alterations and HPV + signature were enriched in FMI BMs compared to local tumors (11.8% vs. 6.4%, P = 0.005 and 51.25% vs. 26.11%, P = 0.001 respectively), and pathogenic TSC1 inactivating mutations were enriched in local tumors (67.3% vs. 37.8%, P = 0.008). Median overall survival from BM diagnosis was 9 months (range 0–27).ConclusionsHNSCC patients with BM frequently have oropharyngeal primary sites and are HPV+. Common molecular alterations in BM samples, including targetable PIK3CA and ATM, were identified. MAP2K2 alterations were enriched and densities of immune cells were low, highlighting potential targets for further research and immunotherapy considerations.

Efficient labeling of french mammogram reports with MammoBERT

Recent advances in deep learning and natural language processing (NLP) have broadened opportunities for automatic text processing in the medical field. However, the development of models for low-resource languages like French is challenged by limited datasets, often due to legal restrictions. Large-scale training of medical imaging models often requires extracting labels from radiology text reports. Current methods for report labeling primarily rely on sophisticated feature engineering based on medical domain knowledge or manual annotations by radiologists. These methods can be labor-intensive. In this work, we introduce a BERT-based approach for the efficient labeling of French mammogram image reports. Our method leverages both the expansive scale of existing rule-based systems and the precision of radiologist annotations. Our experimental results showcase the superiority of the proposed approach. It was initially fine-tuned on a limited dataset of radiologist annotations. Then, it underwent training on annotations generated by a rule-based labeler. Our findings reveal that our final model, MammoBERT, significantly outperforms the rule-based labeler while simultaneously reducing the necessity for radiologist annotations during training. This research not only advances the state of the art in medical image report labeling but also offers an efficient and effective solution for large-scale medical imaging model development.

Medical imaging utilization in migrants compared with nonmigrants in a universal healthcare system: A population-based matched cohort study.

Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown. A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary. Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system.

Biofabricated silver nanoparticles from Calotropis procera: A potential antimicrobial solution against pathogenic bacteria

Calotropis procera has the potential as a traditional medicinal plant that offers a diverse array of healing treatments. It was used in conventional medicine to remedy several ailments, including diarrhea and snakebites. This study examines the antibacterial properties of silver nanoparticles derived from the floral and latex components of C. procera. The nanoparticles were tested for their effectiveness against Gram-negative and Gram-positive bacterial strains. For characterization, the synthesized nanoparticles underwent thorough analysis using UV spectroscopy, fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM). After the reduction process, the FTIR analysis revealed that some functional biomolecules found in plants form a coating on the nanoparticles, serving as organic agents that stabilize the nanoparticles. The size of nanoparticles analyzed with SEM falls in the 30 to 130 nm range. Furthermore, the synthesized silver nanoparticles were tested as antimicrobial agents against Escherichia coli, Bacillus subtilis, Staphylococcus aureus, and Pseudomonas aeruginosa, well-known microorganisms that can produce ulceration phases and severe health consequences. After a comprehensive examination, it was found that the silver nanoparticles have significant antibacterial effectiveness, particularly against S. aureus, a primary bacterium responsible for causing different ailments. The remarkable antibacterial efficacy of the silver nanoparticles synthesized in an environment-friendly manner underscores its potential applications in combating the evolution of antibiotic-resistant strains.

Telesimulation Use in Emergency Medicine Residency Programs: National Survey of Residency Simulation Leaders

Introduction: Coronavirus 2019 (COVID-19) accelerated the need for virtual learning including telesimulation. Many emergency medicine (EM) programs halted in-person simulation and trialed telesimulation, but specifics on its utilization and plans for future use are unknown. Telesimulation has been defined as “a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location.” Our objective in this study was to describe the patterns of telesimulation usage in EM residency programs during COVID-19-induced learning restrictions as well as its anticipated future utility. Methods: We identified EM simulation leaders via the EMRA Match website, institutional websites, or personal contact with residency coordinators and directors, and invited them to participate by email. Participants completed a confidential, web-based survey consisting of multiple-choice items and one free-response question, developed by our study team with consideration of survey research best practices and Messick’s validity framework. We collected data between January–February 2022. We calculated descriptive statistics for multiple-choice items and examined the free-response answers for common themes. Results: We obtained contact information for simulation leaders at 139 EM residency programs. Survey response rate was 65% (91/139). During in-person restrictions, 62% (56/91) of programs used telesimulation. Assuming all restrictions lifted, 38% (34/90) of respondents planned to continue to use telesimulation, compared to 9% (8/91) using telesimulation before COVID-19. Most respondents planned to use telesimulation for medical knowledge (26/34, 76%) and communication/teamwork-focused cases (23/34, 68%). In response to the free-response question regarding experience with and plans for use, we identified three major themes: 1) telesimulation is a valuable alternative to in-person learning; 2) telesimulation is an option for learners unable to participate in person; and 3) telesimulation is challenging for procedural education. Conclusion: Despite the relatively limited use of telesimulation in EM residencies prior to COVID-19, an increased number of programs have plans to continue incorporating telesimulation into their curricula. This plan for continued use opens opportunities for further innovation and scholarship within simulation education.

Use of telemedicine technologies in organizing rehabilitation of patients with bronchopulmonary pathology. Myth or reality?

In 2013, telemedicine began to penetrate widely and actively into the activities of the medical community. Telerehabilitation acts as an alternative within the framework of considering and conducting traditional rehabilitation or as an additional therapeutic tool, which allows you to achieve the set goal of recovery faster and more effectively. During the period 2022-2023, 1,318 people participated in the telerehabilitation program: 712 patients who suffered pneumonia caused by the new coronavirus infection COVID-19, 606 patients with chronic obstructive pulmonary disease. During the course, not a single patient was hospitalized for an exacerbation of the disease or for a clinical deterioration of the condition. At the same time, there was a significant improvement in the calculated indicators, which confirmed the relevance of this area of medicine.

One‐Pot Synthesis of Fused Isoxazolo[4′,5′:3,4]pyrrolo[2,1‐b] Quinazolines as Potent EGFR Targeting Anticancer Agents

AbstractIn response to the need for scaffolds for medical applications, synthetic chemists have developed simple and efficient methods for optimal synthesis. To investigate the synthesis of fused isoxazoles in the presence of [3+2] cycloaddition followed by C−N bond formation reaction between 3‐((4‐iodo‐3‐phenylisoxazol‐5‐yl)methyl)quinazolin‐4(3H)‐one and various nitrile oxides was carried out by previously reported conditions. The cancer activities of the synthesized compounds were then tested in vitro against two cancer cell lines, MCF‐7 and A‐549. Three of the compounds, 3‐(3,5‐dichlorophenyl) isoxazolo[4′,5′:3,4]pyrrolo[2,1‐b]quinazolin‐9(11H)‐one, 3‐(4‐fluorophenyl)isoxazolo[4′,5′:3,4]pyrrolo[2,1‐b]quinazolin‐9(11H)‐one, and 3‐(4‐(trifluoromethyl)phenyl)isoxazolo[4′,5′:3,4] pyrrolo[2,1‐b] quinazolin‐9(11H)‐one has shown superior activity against the non‐small‐cell lung cancer cell line (A‐549) than the standards 5‐fluorouracil and erlotinib. Later, in vitro EGFR results revealed that a more potent compound was more effective than the conventional medicine, erlotinib. In silico investigations of more potent compounds and erlotinib on the EGFR protein indicated that more potent compounds had comparable binding energies and inhibition constants to erlotinib.

Development and Validation of the Emergency Medical Technicians Occupational Stress Scale

Introduction. The population of interested workers for this study included Emergency Medical Technicians (EMTs) in the United States. This group of workers was chosen because of the nature of their work, which requires their presence at the scenes of life and death situations. Certainly, their work conditions can have an effect on their psychological well-being. Yet, the work of these workers, with all of its stressors, has not been adequately studied through the use of appropriate measuring instruments. Emergency Medical Technicians are not unknown in occupational stress research. This report discusses previous studies on EMT workers and occupational stressors and explains the curative process through the development and validation of an EMT Occupational Stress Scale. The report also highlights the psychometric investigation of this scale. Paramedics/EMTs face increased risk of physical and psychological stress due to the nature of their work. It is crucial to understand the stressors affecting their well-being in order to develop appropriate management strategies. Research suggests that EMTs may lack preparation for their roles, requiring additional training in empathy and emotional intelligence. The relationship between stressors experienced and clinical service provided needs further investigation. Standardized measures of stress for paramedics/EMTs are lacking and more comprehensive instruments are needed. This report aims to develop a comprehensive stress scale specifically for EMTs/paramedics, addressing validation concerns and incorporating environmental stress within a larger theoretical framework. Methods. This study was This study was conducted using a mixed-methods approach to develop and validate the Emergency Medical Technicians Occupational Stress Scale. The scale was pilot tested with a sample of EMTs to ensure reliability and validity. by the ethics committee and is based on a literature review. The Canadian EMT Job Satisfaction Questionnaire was used to measure organizational stress levels of EMTs. The questionnaire was reviewed by professionals and academics, resulting in the inclusion of five new items. The final item list consisted of 58 questions. Permission was obtained. Results. The outcomes and findings obtained from the comprehensive study conducted on the Development and Validation of the Emergency Medical Technicians Occupational Stress Scale have shed light on significant discoveries pertaining to the intricate realm of stress levels experienced by our dedicated EMT professionals. Conclusion. The rapidly evolving scope of Emergency Medical Services (EMS) practice has placed increasing demands on the relatively small professional community that consists of EMTs and paramedics. An Occupational Stress model was developed to examine interpersonal work stressors unique to the EMT role, and a measure was developed to assess the construct. Initial results suggest that the OSM is an accurate, reliable, and potentially valuable assessment tool. High levels of interpersonal stress may influence the EMTs to cope with their daily activities by seeking outlets for tension and depression through increased use of alcohol, legal drugs, and caffeine. Alcohol is used more frequently than other legal drugs are to modify interpersonal stress symptoms. The EMTs are in a prime position to help each other identify these symptoms when arising and offer assistance. Staff stress management programs are essential in solving and preventing occupational stress. A move toward prevention rather than reaction to such stress, which for many results in alcoholism, drug addiction, or job related emotional illness, will serve to preserve the health of the EMTs. The medical community has a vested interest in the health of these dedicated professionals. Not only does such prevention attempt to manage the human tragedy of alcoholism, legal drug addiction, and job related emotional illness, but it also prevents the more tangible, but no less important cost factors to the EMT.

Internet usage time and trust in doctors: evidence from China

BackgroundThe growth of internet use has greatly impacted many societal sectors, including healthcare. However, current evidence about the relationship between internet usage time and public trust on doctors is insufficient.ObjectiveTo examine the relationship between the time spent on the internet and the level of trust in doctors, and explore its mechanism.MethodsMultiple regression models are employed, utilizing a sample of 19,193 observations from the China Family Panel Studies (CFPS) in 2020. First, we regress the relative trust in doctors compared to trust in strangers on internet usage time. Subsample results across distinct population groups are explored. Second, we examine the mechanism of using the internet as an information channel through the mediation method, and further investigate the role of the internet as a communication platform by analyzing the moderation effects of socializing activity as well as social media engagement.ResultsWe find a significant negative relationship between increased internet usage time and trust in doctors. This correlation remains robust across different model specifications and variable measurements. The negative correlation is more pronounced among population groups who are elderly, male, married, with low educational levels, insured and residing in urban areas. The role of the internet as a source of information is validated as a mechanism producing the negative influence. The role of the internet as a communication platform tends to mitigate the negative consequences of internet usage, as engaging in online socializing activity can have a positive moderation effect. However, for social media engagement, its overall effect on trust in doctors is negative, potentially due to social media’s dual function as a communication platform and an information source.ConclusionsAlthough individual-focused literature tends to demonstrate a positive impact of the internet on trust in doctors in China, our study, which focuses on the general public, reveals contrasting results. Our findings imply that the primary manner in which internet usage, encompassing social media usage, influences public trust in doctors is by molding a collective perception of them. Consequently, the medical community may need to take a more proactive approach in expanding online communication channels for interacting with patients and the wider public.

Effect of Diet and Dietary Patterns on the Progression of Multiple Sclerosis: A Review

The link between diet and the progression of Multiple Sclerosis (MS) is a topic of growing interest and investigation within the medical community. This review explored the mechanisms through which dietary interventions can impact the course of MS and shape the clinical outcomes and quality of life of individuals with the disease. By synthesizing current knowledge from clinical studies and observational research, the review aimed to provide insights into the role of diet in managing MS. A comprehensive literature search was conducted, focusing on the effect of diet and dietary patterns on the progression of MS. Key findings indicated that individuals with higher diet quality exhibit reduced disability levels and lower symptom severity, emphasizing the importance of maintaining a healthy diet and adopting a holistic, healthy lifestyle in managing MS. The review also delved into the potential impact of macronutrients, vitamins, and minerals on the progression of MS, highlighting the importance of adequate nutrient intake for optimal health outcomes. Additionally, the study explored the association between dietary intake variations and the severity of MS, suggesting that further investigation is needed to understand the potential implications of nutrient deficiencies in MS patients. Overall, the review serves as a valuable resource for healthcare professionals and individuals living with MS, providing evidence-based dietary approaches that may help optimize health outcomes and mitigate the burden of the disease. It also calls for future research directions in the critical area of dietary management of MS to enhance our understanding and improve patient care.

New strategies to classify canine pleural effusions and the diagnostic value of acute phase proteins, amylase, and adenosine deaminase in pleural exudates.

In dogs, simplified Light's criteria can discriminate transudates from exudates. Other tests used in human medicine are pleural effusion cholesterol (CHOLPE) and butyrylcholinesterase [BChEPE], the pleural effusion/serum ratio of these analytes (CHOLratio and BChEratio), and the serum albumin minus pleural effusion albumin gradient (SEAG). We aimed to assess the diagnostic accuracies of different biomarkers in dogs with pleural effusion in differentiating exudates from transudates. Secondarily, we evaluated the potential diagnostic utility of pleural effusion acute phase proteins, amylase, and adenosine deaminase in discriminating causes of exudative effusions. Cross-sectional study including 68 client-owned dogs with pleural effusion. There were 48 exudates (10 septic, 16 neoplastic, 9 hemorrhagic, and 13 classified as other exudates) and 20 transudates. All the variables analyzed, except SEAG, were significantly different between exudates and transudates. Using the cut-off values adopted in human literature, accuracies for CHOLPE, CHOLratio, BChEPE, and BChEratio were between 82.35% and 85.29%; all values were significantly lower compared with the previously published simplified Light's criteria accuracy (i.e., 98%, p < .001 for all comparisons). We found the accuracy of the simplified Light's criteria to be similar to what has been previously reported (95.59%, p = .238). Paraoxonase-1 (PON-1PE) activity and the pleural effusion/serum paraoxonase-1 ratio (PON-1ratio) were significantly lower in exudative neoplastic effusions than in exudative hemorrhagic (p = .004 and p = .001) and septic (p = .004 and p < .001) effusions. Simplified Light's criteria were the best method for discriminating transudates from exudates, and a low PON-1PE activity and PON-1ratio in exudative effusions may suggest an underlying neoplasia.