Specific Management Approaches Research Articles

Managing Substance Use Disorders and Addiction: How to Integrate Professionalism and Ethics with the Complexity of Diagnosis and Therapy

Physicians and other healthcare staff who work with the patients having substance use disorders (SUDs) and addiction have to deal with different and complex scenario invariably in comparison to other healthcare providers dealing with regular medical services sought by the patients. Hence, the unconventional nature of practice regarding patients of SUDs and addiction and the diverse range of backgrounds among substance use workers, e.g., psychiatrist, general physician, nurse, psychotherapist, counsellor, social worker, and public health specialist highlights the universal relevance of being more professional and more ethical in practice. They are expected to demonstrate a variety of ethical and professional competences to safeguard themselves and others involved. Clinical team engaged in such activities requires specific ethical training that can help them face specific ethical dilemmas and guide through deeper consideration of those pressing and complex issues, using specific framework, professional guidelines, or institutional management approaches. Professional societies and accrediting institutions should apply their authority to establish practice standards, competencies, regulatory procedures, and codes of ethics to help guide practice and protect public trust and confidence. For the team involved in practice, it is important to become familiar with and adhere to the principles and values that define professionalism and ethical conduct in care for patients suffering from SUDs and addiction. The review paper aims to examine the intersection of professionalism and ethics with the complexity of diagnosis and therapy in this specific area of practice. Besides, some frameworks will be highlighted which may help healthcare providers to foster ethical decision making. It is also a modest effort to show some new insights for improving the quality of care in addiction and mental health by the professional team and healthcare organization from both clinical and operational viewpoint. Mugda Med Coll J. 2024; 7(1): 42-47

Characteristics of Hepatobiliary Fascioliasis and the Role of Endoscopic Retrograde Cholangiopancreatography in Management: A Single Center Experience

BackgroundHepatobiliary fascioliasis has two phases, each requiring specific management approaches. Triclabendazole has been widely effective in treating the two phases of clinical fascioliasis and endoscopic retrograde cholangiopancreatography (ERCP) in biliary phase. We aimed to characterize presentations of hepatobiliary fascioliasis and highlight the role of ERCP in management. SubjectsAnd Methods: This retrospective cohort includes patients diagnosed with clinical hepatobiliary fascioliasis between January 2013 and December 2022. Demographic data, clinical presentation, laboratory and radiological investigations, treatment, and endoscopy reports were collected from the records of 62 participants. Patients were divided into two groups: acute hepatic and chronic biliary phases. ResultsThirty-six patients were in the biliary phase, and 26 were in the hepatic phase. All patients were from rural areas, and females were predominant (76%). Hypereosinophilia was detected in 92% of acute cases and 58% of chronic biliary cases. In chronic biliary cases, the levels of liver biochemicals, including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and bilirubin, were higher at levels of 189±76, 127±47, 268±77, and 2.4±0.7 respectively, compared to acute hepatic cases, 35.6±8.2, 32.7±4.3, 69.2±45.45, and 0.58±0.01. The corresponding p-values were 0.003, 0.001, <0.001, and <0.001, respectively. Triclabendazole effectively cured 93.5% of patients and was used in combination with ERCP in biliary phase cases where the fluke was extracted from the biliary system in 34 patients (94.4%). Three patients (8.8%) were diagnosed with post-ERCP pancreatitis. None of the patients experienced bleeding, perforation, or required biliary stenting. ConclusionClinical fascioliasis could manifest in acute hepatic or chronic biliary phases. Hypereosinophilia was more evident in the hepatic phases, while ALT, AST, GGT, and bilirubin were higher in the biliary phase. Triclabendazole is effective in the hepatic phase and when combined with ERCP in the biliary phase. ERCP is highly effective for relieving obstruction and treating biliary fascioliasis.

GBA1-Associated Parkinson's Disease Is a Distinct Entity.

GBA1-associated Parkinson's disease (GBA1-PD) is increasingly recognized as a distinct entity within the spectrum of parkinsonian disorders. This review explores the unique pathophysiological features, clinical progression, and genetic underpinnings that differentiate GBA1-PD from idiopathic Parkinson's disease (iPD). GBA1-PD typically presents with earlier onset and more rapid progression, with a poor response to standard PD medications. It is marked by pronounced cognitive impairment and a higher burden of non-motor symptoms compared to iPD. Additionally, patients with GBA1-PD often exhibit a broader distribution of Lewy bodies within the brain, accentuating neurodegenerative processes. The pathogenesis of GBA1-PD is closely associated with mutations in the GBA1 gene, which encodes the lysosomal enzyme beta-glucocerebrosidase (GCase). In this review, we discuss two mechanisms by which GBA1 mutations contribute to disease development: 'haploinsufficiency,' where a single functional gene copy fails to produce a sufficient amount of GCase, and 'gain of function,' where the mutated GCase acquires harmful properties that directly impact cellular mechanisms for alpha-synuclein degradation, leading to alpha-synuclein aggregation and neuronal cell damage. Continued research is advancing our understanding of how these mechanisms contribute to the development and progression of GBA1-PD, with the 'gain of function' mechanism appearing to be the most plausible. This review also explores the implications of GBA1 mutations for therapeutic strategies, highlighting the need for early diagnosis and targeted interventions. Currently, small molecular chaperones have shown the most promising clinical results compared to other agents. This synthesis of clinical, pathological, and molecular aspects underscores the assertion that GBA1-PD is a distinct clinical and pathobiological PD phenotype, necessitating specific management and research approaches to better understand and treat this debilitating condition.

Управление образовательным процессом субъектов креативных индустрий

The article delineates a number of characteristic features in managing the educational process within the realm of creative industries. They are defined according to the essential features of the key concepts “educational process management” and “subjects of creative industries”. They encompass a range of common traits, including issues of management organization levels, functions, methods, principles, etc. The fundamental distinctions of these components are predominantly shaped by the specific nature of creative industries subjects’ activities in the educational sphere, which typically unfold non-linearly and under conditions of high risk, uncertainty, and complexity in predicting outcomes. This is a sphere of activity oriented towards systemic innovation implementation, seeking and utilizing opportunities to satisfy human desires and needs through the realization of unique educational products, including those in the realm of additional education for both children and adults. The outcome here entails the creation, promotion, and dissemination and/or implementation of creative products in the field of additional education. In conclusion, the management of educational processes in creative industries requires a nuanced understanding of the unique challenges and opportunities inherent in this domain. By leveraging flexible and adaptive management strategies, educators and industry stakeholders can foster creativity, innovation, and collaboration, thereby enriching the educational experience and driving positive outcomes for all stakeholders involved. Further research is needed to explore specific management approaches and interventions tailored to the evolving needs of creative industries education.

The Sigatoka Disease Complex Caused by Pseudocercospora spp. and Other Fungal Pathogens Associated with Musa spp. in Puerto Rico.

Bananas (Musa spp.) are among the world's most economically important staple food crops. The most important fungal leaf diseases of Musa spp. worldwide are caused by the Sigatoka disease complex, which comprises black Sigatoka (Pseudocercospora fijiensis), yellow Sigatoka (P. musae), and Eumusae leaf spot (P. eumusae). Considering the rapid spreading rate of black Sigatoka in Puerto Rico since its first observation in 2004, a disease survey was conducted from 2018 to 2020 to evaluate the Sigatoka disease complex on the island. Sixty-one leaf samples showing Sigatoka-like symptoms were collected throughout the island for diagnosis by molecular approaches and fungal isolation. Molecular analysis using species-specific primers for P. fijiensis, P. musae, and P. eumusae detected the presence of P. fijiensis in 50 leaf samples. Thirty-eight fungal isolates were collected and identified by morphology and genomic sequencing from various nuclear genes. The analysis identified 24 isolates as P. fijiensis, while the rest of the isolates belonged to the genus Cladosporium spp. and Cladosporium-like spp. (n = 5), Neocordana musae (n = 2), Zasmidium spp. (n = 6), and Z. musigenum (n = 1). The high frequency of P. fijiensis found in leaf samples and collected isolates suggests that black Sigatoka has displaced the yellow Sigatoka (P. musae) in Puerto Rico. Accurate identification of fungal species causing foliar diseases in Musa spp. will allow the establishment of quarantine regulations and specific management approaches in Puerto Rico.

How do primary care clinicians approach the management of frailty? A qualitative interview study.

Around 15% of adults aged over 65 live with moderate or severe frailty. Contractual requirements for management of frailty are minimal and neither incentivised nor reinforced. Previous research has shown frailty identification in primary care is ad hoc and opportunistic, but there has been little focus on the challenges of frailty management, particularly within the context of recent introduction of primary care networks and an expanding allied health professional workforce. Explore the views of primary care clinicians in England on the management of frailty. Semi-structured interviews were conducted with clinicians across England, including general practitioners (GPs), physician associates, nurse practitioners, paramedics and clinical pharmacists. Thematic analysis was facilitated through NVivo (Version 12). A total of 31 clinicians participated. Frailty management was viewed as complex and outside of clinical guidelines with medication optimisation highlighted as a key example. Senior clinicians, particularly experienced GPs, were more comfortable with managing risk. Relational care was important in prioritising patient wishes and autonomy, for instance to remain at home despite deteriorations in health. In settings where more formalised multidisciplinary frailty services had been established this was viewed as successful by clinicians involved. Primary care clinicians perceive frailty as best managed through trusted relationships with patients, and with support from experienced clinicians. New multidisciplinary working in primary care could enhance frailty services, but must keep continuity in mind. There is a lack of evidence or guidance for specific interventions or management approaches.

Assessing Growth, Productivity, Profitability and Yield Gaps of Spring Maize Using Site Specific Nutrient Management Approaches in Kailali

A field experiment was conducted during spring season of 2023 at the sub-tropical climate of Tikapur, Kailali to evaluate the impact of site-specific nutrient management on growth, productivity, profitability and yield gaps of spring maize. The experiment followed a Randomized Complete Block Design (RCBD) with six treatment combinations and four replications. Maize seeds were sown in four different farms on 27 February, 2023 with different site-specific nutrient management (SSNM) approaches viz. with Nutrient Expert®-Maize recommended dose (T1), three omission plots i.e., Omission of Nitrogen (T2), Omission of Phosphorus (T3), Omission of Potassium (T4), Government Recommended Dose (T5), and Farmer’s Fertilizer Practices (T6). Using the Nutrient Expert® Maize model Computer Software, the SSNM+NE dose was recommended via a household survey in the respective farmer's field before the start-up of the experimentation. Various growth parameters, yield, yield attributing traits, and total cost of production of spring maize were recorded and subjected to analysis using Duncan's Multiple Range Test (DMRT) in R-studio. The results revealed that the highest grain yield (3.71 t ha-1) was achieved with SSNM+NE, which was statistically at par with the Government Recommendation Dose (3.12 t ha-1). Moreover, SSNM+NE showed significantly higher thousand grains weight (442.75 g) and straw yield (6.81 t ha-1), respectively. Notably, the straw yield, grain yield, and thousand grain weight of SSNM+NE were statistically comparable to those obtained with the government recommendation. Economic analysis showed higher benefit-cost ratio as well as increased net and gross returns in SSNM+NE as compared to the other nutrient management practices. The SSNM+NE and Governmental Recommended Fertilizer based treatments were about 231% and 178% advantageous over the Farmer’s Fertilizer Practices. It could be suggested that SSNM+NE would the best approach for increasing the growth, productivity and profitability of spring maize in the sub-tropical terai of Far Western Nepal.

Assessment of the status of presentation and management of tuberculosis patients in central India

Tuberculosis (TB) continues to pose a notable public health issue not just within India but on a worldwide scale. Analyzing the causes of presentation, management, and treatment delays of tuberculosis can offer valuable understanding into local trends and aid in crafting specific approaches for the successful management of TB. This research involves a cross-sectional examination conducted among TB patients residing in the regions served by the District Tuberculosis Centre, Wardha, and the directly observed treatment short course center in Sawangi. Information will be collected using a standardized questionnaire endorsed by the World Health Organization.

Management of postoperative outcomes of polytetrafluoroethylene membranes in alveolar ridge reconstruction: a systematic review

Guided bone regeneration (GBR) is a validated technique with satisfactory outcomes during 30 years of follow-up.The use of polytetrafluoroethylene (PTFE) membrane for vertical augmentation has been studied extensively.However, studies have reported exposure rates of up to 31%, there is no consensus on the management of postoperative exposure.The objective of this study was to propose a management approach for postoperative exposure of polytetrafluoroethylene (PTFE) membranes in alveolar ridge reconstruction.Material and method: An electronic search in PubMed Central's and additional electronic databases was performed. The search strategy was limited to human studies, full-text English or French articles published from 1990 until april 2023.The extracted data included defect location, membrane type, biomaterials, time to postoperative exposure, and Fontana classification stage.Protocol bias assessment was performed using an adaptation of the QUADAS-2 tool.This review has been registered on PROSPERO (ID: CRD42023445497).Results: A total of 43 articles were found to be eligible, and 11 of these met the predefined inclusion and exclusion criteria.Based on the results of this systematic review, an algorithm for the management of PTFE membrane exposure is proposed.Conclusion: Postoperative membrane exposure is not a determining factor for the success of bone grafting.In cases with postoperative complications, the majority of cases still achieved adequate implant-prosthetic rehabilitation.Lastly, this series of 11 articles was insufficient to draw conclusions regarding good practice recommendations. A larger series is required to validate the specific management approaches.

Strategies for the Analysis of Large Social Media Corpora: Sampling and Keyword Extraction Methods

In the context of the COVID-19 pandemic, social media platforms such as Twitter have been of great importance for users to exchange news, ideas, and perceptions. Researchers from fields such as discourse analysis and the social sciences have resorted to this content to explore public opinion and stance on this topic, and they have tried to gather information through the compilation of large-scale corpora. However, the size of such corpora is both an advantage and a drawback, as simple text retrieval techniques and tools may prove to be impractical or altogether incapable of handling such masses of data. This study provides methodological and practical cues on how to manage the contents of a large-scale social media corpus such as Chen et al. (JMIR Public Health Surveill 6(2):e19273, 2020) COVID-19 corpus. We compare and evaluate, in terms of efficiency and efficacy, available methods to handle such a large corpus. First, we compare different sample sizes to assess whether it is possible to achieve similar results despite the size difference and evaluate sampling methods following a specific data management approach to storing the original corpus. Second, we examine two keyword extraction methodologies commonly used to obtain a compact representation of the main subject and topics of a text: the traditional method used in corpus linguistics, which compares word frequencies using a reference corpus, and graph-based techniques as developed in Natural Language Processing tasks. The methods and strategies discussed in this study enable valuable quantitative and qualitative analyses of an otherwise intractable mass of social media data.

ASPECTS OF MANAGEMENT OF MEDICAL AND EVACUATION SUPPORT FOR THE TROOPS IN THE CONDITIONS OF THE UNIFIED MEDICAL SPACE OF UKRAINE

The article focuses on the need for the integration of civil and military medical institutions into the unified medical space of Ukraine. It substantiates the development of a holistic system of medical and evacuation support for the troops in combination with the resource capabilities of the civil health care system. It also defines the necessary prerequisites for the development of such a system, namely unity of views on the organization, tactics and procedure for the use of forces and means of medical services, and the capacity of civilian health care facilities for medical and evacuation support of military personnel. The Article describes specific management approaches regarding the medical and evacuation support capabilities of the Armed Forces of Ukraine (AFU) that will contribute to the implementation of efficient medical and evacuation measures and adequate support as well as measures for the medical protection of military personnel, etc. It also proves the importance of defining and clearly demarcating levels of medical care and required resources and considers the possibility of working out interdepartmental civil and military cooperation as well as refining the system of medical and evacuation support for servicemen of the Armed Forces of Ukraine in the conditions of the unified medical space of Ukraine.

Imaging Recommendations for Diagnosis, Staging, and Management of Hereditary Malignancies

AbstractHereditary cancer syndromes, characterized by genetically distinct neoplasms developing in specific organs in more than one family members, predispose an individual to early onset of distinct site-specific tumors. Early age of onset, multiorgan involvement, multiple and bilateral tumors, advanced disease at presentation, and aggressive tumor histology are few characteristic features of hereditary cancer syndromes. A multidisciplinary approach to hereditary cancers has led to a paradigm shift in the field of preventive oncology and precision medicine. Imaging plays a pivotal role in the screening, testing, and follow-up of individuals and their first- and second-degree relatives with hereditary cancers. In fact, a radiologist is often the first to apprise the clinician about the possibility of an underlying hereditary cancer syndrome based on pathognomonic imaging findings. This article focuses on the imaging spectrum of few common hereditary cancer syndromes with specific mention of the imaging features of associated common and uncommon tumors in each syndrome. The screening and surveillance recommendations for each condition with specific management approaches, in contrast to sporadic cases, have also been described.

Perception of Climate Change Impacts on Livelihoods in Central Mali

The main objective of this research is to analyze the perceptions of local communities on climate change and its impacts on livelihoods in Central Mali. A survey data collected using multistage random sampling methods have been used for that purpose. From the result, the multinomial logit analysis, shows that households in Central Mali are well aware of climate change, its different manifestations (change in temperature, in precipitation duration and amount, in wind etc.) and the related adverse effects on their livelihoods. However, they face considerable challenges in adapting to those changes in climate. Lack of funds and credit facilities, lack of access to timely weather information, lack of technologies (physical infrastructure, technical material and equipment), lack of knowledge regarding adaptation technics (required human skills, e.g., applying specific planning and management approaches and methods), lack of appropriate seeds have been identified as the major critical barriers to climate change adaptation in the region. These constraints probably explain why individuals often resort to poor but more affordable adaptation strategies which are conflict sensitive and likely to disrupt social cohesion between local communities. In this context, implementing policies aiming at improving the effectiveness of extension services in supporting households to better adapt to climate change could be of great importance.

ИННОВАЦИИ КАК МЕТОД ОПЕРАТИВНОГО УПРАВЛЕНИЯ ПРЕДПРИЯТИЕМ

Goal. The purpose of the article is to study effective innovation management to create a favorable business environment that promotes the development and commercialization of ideas. To do this, the company must carry out horizontal and vertical management. Horizontal management involves the integration of various functional areas and stakeholders in the innovation process, while vertical management involves the coordination of strategic planning, organizational structure, access to resources and cultural aspects. Through a specific innovation management mechanism and approach, the company strives to implement innovations at all levels of the organization, involving all personnel in them, providing full-fledged innovative work time and creating global innovations within the enterprise. Tasks. This article defines the expediency of creating an innovative model based on mutually beneficial partnership with consumers, research institutions, universities, suppliers, distributors and even competitors. Within the framework of such a model, enterprises exchange innovative resources and mutually beneficial conditions. Methodology. The authors used such research methods as statistical analysis, observation, generalization, description and graphical modeling. Results. The article presents a classification of innovations based on their level of openness, including closed innovations, cooperative innovations, open innovations and innovations of a network organization. It is argued that for the successful commercialization of ideas, the management of an enterprise’s innovation activities must simultaneously take into account several aspects, such as strategy, organization, resources, culture and others, based on the external innovation environment of the enterprise, and contribute to its development. Conclusions. This article presents arguments in favor of using methods of operational innovation management in enterprises. It has been proven that the process of inventing and creating new products and services is only the first stage of innovation, while commercialization is a key part of the entire innovation process. In the process of technological innovation, business enterprises use both internal and external additional innovative resources to achieve innovative development goals. Companies have the opportunity to commercialize innovative products using both internal technology channels and with the involvement of external partners.

Evidence of seasonal changes in airborne particulate matter concentration and occupation-specific variations in pulmonary function and haematological parameters among some workers in Enugu Southeast Nigeria: a randomized cross-sectional observational study

BackgroundUpsurge in cardiopulmonary dysfunctions in Enugu, Nigeria, involved mainly cement workers, automobile spray painters, woodworkers, and Cleaners and was worsened in the dry season, suggesting the need for an occupation-specific characterization of the disease features and seasonal evaluation of air quality for prevention and management.MethodsWe conducted a randomized cross-sectional study of eighty consenting participants (in Achara Layout, Enugu), comprising 20 cement workers (39.50 ± 14.95 years), 20 automobile spray painters (40.75 ± 9.85 years), 20 woodworkers (52.20 ± 9.77 years), and 20 cleaners (42.30 ± 9.06 years). The air quality, some haematological (fibrinogen-Fc, and C-reactive protein-CRP), and cardiopulmonary parameters were measured and analyzed using ANCOVA, at p < 0.05.ResultsThe dry season particulate matter (PM) in ambient air exceeded the WHO standards in the New layout [PM10 = 541.17 ± 258.72 µg/m3; PM2.5 = 72.92 ± 25.81 µg/m3] and the University campus [PM10 = 244 ± 74.79 µg/m3; PM2.5 = 30.33 ± 16.10 µg/m3], but the former was twice higher. The PM differed significantly (p < 0.05) across the sites. Forced expiratory volume at the first second (FEV1) (F = 6.128; p = 0.001), and Peak expiratory flow rate (PEFR) (F = 5.523; p = 0.002), differed significantly across the groups. FEV1/FVC% was < 70% in cement workers (55.33%) and woodworkers (61.79%), unlike, automobile spray painters (72.22%) and cleaners (70.66%). FEV1 and work duration were significantly and negatively related in cement workers (r = -0.46; r2 = 0.2116; p = 0.041 one-tailed). CRP (normal range ≤ 3.0 mg/L) and Fc (normal range—1.5–3.0 g/L) varied in cement workers (3.32 ± 0.93 mg/L versus 3.01 ± 0.85 g/L), automobile spray painters (2.90 ± 1.19 mg/L versus 2.54 ± 0.99 mg/L), woodworkers (2.79 ± 1.10 mg/L versus 2.37 ± 0.92 g/L) and cleaners (3.06 ± 0.82 mg/L versus 2.54 ± 0.70 g/L).Conclusion(s)Poor air quality was evident at the study sites, especially in the dry season. Cement workers and automobile spray painters showed significant risks of obstructive pulmonary diseases while woodworkers had restrictive lung diseases. Cement workers and cleaners recorded the highest risk of coronary heart disease (CRP ≥ 3.0 mg/L). The similarity in Fc and CRP trends suggests a role for the inflammation-sensitive proteins in the determination of cardiovascular risk in cement workers and cleaners. Therefore, there are occupation-specific disease endpoints of public health concern that likewise warrant specific preventive and management approaches among the workers.

Diving into the uncertainties of open innovation: A systematic review of risks to uncover pertinent typologies and unexplored horizons

The open innovation paradigm has created substantial new opportunities for firms in various sectors. However, scholars have long expressed concern that open innovation also entails a dark side, which can result in value co-destruction. This concern highlights the importance of devoting attention to the perils of pursuing open innovation. Existing scholarship has given due credence to these perils by examining various associated risks and uncertainties. We observe that the extant literature is siloed and unorganized, which impedes future research. Positing that an endeavor to organize existing studies may enhance the pace of research in the area, we attempt to address this gap by reviewing the relevant literature. We thus utilize the systematic literature review approach to identify, synthesize, and critically analyze 80 related research articles. Based on this analysis, we present the bibliometric profile of the extant research and a typology of five risks in open innovation: data-related risks, people-related risks, firm-level risks, outcome risks, and other risks. In addition, we discuss a specific risk management approach for each of the identified risks. Beyond providing a lucid narrative of the extant literature, we also identify unexplored avenues and offer an overarching framework to conceptualize future research potential in the area. From a practical perspective, managers can utilize this framework as a risk assessment tool when engaging in open innovation. In sum, this review—one of the first of its kind—offers a valuable consolidation of the state of the art of open innovation risk research, which can meaningfully advance theory and practice in the area.

The Utility of Nasal Challenges to Phenotype Asthma Patients.

Asthma is a heterogeneous disease in terms of both phenotype and response to therapy. Therefore, there is a great need for clinically applicable tools allowing for improved patient classification, and selection for specific management approaches. Some interventions are highly helpful in selected patients (e.g., allergen immunotherapy or aspirin desensitization), but they are costly and/or difficult to implement. Currently available biomarkers measurable in peripheral blood or exhaled air display many limitations for asthma phenotyping and cannot identify properly the specific triggers of the disease (e.g., aeroallergens or NSAID). The united airway concept illustrates the relevant epidemiological and pathophysiological links between the upper and lower airways. This concept has been largely applied to patient management and treatment, but its diagnostic implications have been less often explored. Of note, a recent document by the European Academy of Allergy and Clinical Immunology proposes the use of nasal allergen challenge to confirm the diagnosis of allergic asthma. Similarly, the nasal challenge with lysine acetylsalicylate (L-ASA) can be used to identify aspirin-sensitive asthma patients. In this review, we will summarize the main features of allergic asthma and aspirin-exacerbated respiratory disease and will discuss the methodology of nasal allergen and L-ASA challenges with a focus on their capacity to phenotype the inflammatory disease affecting both the upper and lower airways.

Efficacy, Feasibility and Acceptability of a Mediterranean Diet Intervention on Hormonal, Metabolic and Anthropometric Measures in Overweight and Obese Women with Polycystic Ovary Syndrome: Study Protocol

Polycystic ovary syndrome (PCOS) is a common endocrine condition in reproductive-aged women associated with metabolic, reproductive and psychological features. Lifestyle modification (diet/physical activity) is considered first-line treatment for PCOS. However, there is limited high-quality evidence to support therapeutic dietary interventions for PCOS beyond general population-based healthy eating guidelines. Adherence to a Mediterranean diet (MedDiet), with or without energy restriction, improves cardiometabolic health in populations including persons with or at high risk of cardiovascular disease and type 2 diabetes. However, there is limited research examining the MedDiet in PCOS. Therefore, this 12 week randomized controlled trial will investigate the efficacy of a MedDiet on cardiometabolic and hormonal parameters and explore its acceptability and feasibility in PCOS. Forty-two overweight and obese women with PCOS (aged 18–45 years) will be randomized to receive dietary advice consistent with Australian Dietary Guidelines or an ad libitum MedDiet intervention. All participants will receive fortnightly counselling to facilitate behaviour change. The primary outcomes will be changes in insulin resistance, glucose, total testosterone and sex hormone-binding globulin. Secondary outcomes include changes in body weight and feasibility and acceptability of the MedDiet intervention. The results of this study will provide further evidence on specific dietary approaches for management of PCOS.

Classic and exertional heatstroke.

In the past two decades, record-breaking heatwaves have caused an increasing number of heat-related deaths, including heatstroke, globally. Heatstroke is a heat illness characterized by the rapid rise of core body temperature above 40 °C and central nervous system dysfunction. It is categorized as classic when it results from passive exposure to extreme environmental heat and as exertional when it develops during strenuous exercise. Classic heatstroke occurs in epidemic form and contributes to 9-37% of heat-related fatalities during heatwaves. Exertional heatstroke sporadically affects predominantly young and healthy individuals. Under intensive care, mortality reaches 26.5% and 63.2% in exertional and classic heatstroke, respectively. Pathological studies disclose endothelial cell injury, inflammation, widespread thrombosis and bleeding in most organs. Survivors of heatstroke may experience long-term neurological and cardiovascular complications with a persistent risk of death. No specific therapy other than rapid cooling is available. Physiological and morphological factors contribute to the susceptibility to heatstroke. Future research should identify genetic factors that further describe individual heat illness risk and form the basis of precision-based public health response. Prioritizing research towards fundamental mechanism and diagnostic biomarker discovery is crucial for the design of specific management approaches.

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

The Coronavirus Disease (COVID-19) pandemic imposed a high burden of morbidity and mortality. In COVID-19, direct lung parenchymal involvement and pulmonary microcirculation dysfunction may entail pulmonary hypertension (PH). PH and direct cardiac injury beget right ventricular dysfunction (RVD) occurrence, which has been frequently reported in COVID-19 patients; however, the prevalence of RVD and its impact on outcomes during COVID-19 are still unclear. This study aims to evaluate the prevalence of RVD and associated outcomes in patients with COVID-19, through a Systematic Review and Meta-Analysis. MEDLINE and EMBASE were systematically searched from inception to 15th July 2021. All studies reporting either the prevalence of RVD in COVID-19 patients or all-cause death according to RVD status were included. The pooled prevalence of RVD and Odds Ratio (OR) for all-cause death according to RVD status were computed and reported. Subgroup analysis and meta-regression were also performed. Among 29 studies (3813 patients) included, pooled prevalence of RVD was 20.4% (95% CI 17.1–24.3%; 95% PI 7.8–43.9%), with a high grade of heterogeneity. No significant differences were found across geographical locations, or according to the risk of bias. Severity of COVID-19 was associated with increased prevalence of RVD at meta-regression. The presence of RVD was found associated with an increased likelihood of all-cause death (OR 3.32, 95% CI 1.94–5.70). RVD was found in 1 out of 5 COVID-19 patients, and was associated with all-cause mortality. RVD may represent one crucial marker for prognostic stratification in COVID-19; further prospective and larger are needed to investigate specific management and therapeutic approach for these patients.