Specific Management Recommendations Research Articles

Inherited or Immunological Thrombocytopenia: The Complex Nature of Platelet Disorders in 22q11.2 Deletion Syndrome.

22q11.2 deletion syndrome (22q11.2DS) is one of the most common congenital malformation syndromes resulting from disrupted embryonic development of pharyngeal pouches. The classical triad of symptoms described by Angelo DiGeorge is frequently accompanied by hematological and immune disorders. While it is well-established that patients with 22q11.2DS have an increased risk of recurrent autoimmune cytopenias, including immune thrombocytopenia, the platelet abnormalities in this population are more complex and multifaceted. Given this issue, we conducted a comprehensive literature review on platelet disorders in 22q11.2DS using accessible databases (PubMed and Scopus). We aimed to outline previous studies limitations and most urgent challenges concerning thrombocytopenia in these patients. One characteristic finding frequently observed in 22q11.2DS is mild macrothrombocytopenia caused presumably by the loss of one GP1BB allele, encoding the element of the GPIb-IX-V complex. This structure plays a central role in thrombocyte adhesion, aggregation, and subsequent activation. Recent studies suggest that defective megakaryopoiesis and impaired vasculogenesis may strongly influence platelet and hemostasis disorders in 22q11.2DS. Furthermore, the phenotypic manifestation may be modulated by epigenetic factors and gene expression modifiers located outside the deletion region. Although the final hemorrhagic phenotype is typically mild, these patients may require more frequent transfusions following major surgical procedures. Despite the risk of thrombocytopenia and thrombocytopathy, there is a lack of large-scale research on hematological anomalies in 22q11.2DS, and the available results are often inconclusive. Given the complexity of hemostatic disorders, it is essential to establish specific recommendations for perioperative management and autoimmune cytopenias treatment within this population.

Seizures Following Carotid Endarterectomy: A Comprehensive Meta-Analysis of 69,479 Patients and Evidence-Based Recommendations for Perioperative Care.

Background: Seizures are a rare but potentially serious complication following carotid endarterectomy (CEA). Understanding their prevalence and associated factors is crucial for optimizing perioperative care and improving patient outcomes. This meta-analysis aimed to estimate the pooled prevalence of seizures following CEA and explore clinical and procedural factors contributing to their occurrence. Methods: We conducted a systematic review and meta-analysis of studies reporting on seizures following CEA. A systematic search of PubMed, Embase, and Cochrane CENTRAL databases was performed, following PRISMA and MOOSE guidelines. Random-effects meta-analysis was used to calculate the pooled prevalence of postoperative seizures. Heterogeneity was assessed using the I2 statistic. A total of 20 studies, encompassing 69,479 patients, were included. Results: The overall pooled prevalence of seizures following CEA was 1% (95% CI: 0-2%; p < 0.001), with significant heterogeneity (I2 = 93.52%). Prospective studies reported a higher pooled prevalence (2%, 95% CI 0-4%; I2 = 76.34%) compared to retrospective studies (0%, 95% CI 0-1%; I2 = 91.51%). Male predominance was noted among patients who experienced seizures, and hypertension was the most common comorbidity. Cerebral hyperperfusion syndrome was identified as a key contributing factor to postoperative seizures. Data on long-term outcomes, including the development of epilepsy, were insufficient for further analysis. The methodological quality of the included studies varied, with most studies demonstrating a moderate risk of bias. Conclusions: Seizures occur in approximately 1% of patients following CEA, with higher rates observed in prospective studies. Cerebral hyperperfusion syndrome is an important contributor to this rare complication. We provide evidence-based specific recommendations for seizure management and introduce the SMART-CEA Checklist, a practical framework to guide perioperative care and reduce complications. Future research should focus on long-term outcomes, including epilepsy, and incorporate standardized methodologies to improve data reliability and guide clinical practice.

Analisis Permeabilitas Tanah Berpasir Dan Tanah Lempung Dalam Hubunganya Dengan Manajemen Irigasi

This research examines the permeability characteristics of sandy and clay soils and their implications for irrigation management in agricultural systems. Soil permeability is a key factor in determining water use efficiency and optimal irrigation strategies. The research methodology includes laboratory analysis of sandy and clay soil samples from various agricultural locations, measuring physical soil characteristics, infiltration rates, water storage capacity, and hydraulic conductivity. The results show significant differences between the two soil types, where sandy soil has high permeability ranging from 10^-3 to 10^-2 cm/second, low water storage capacity, and rapid infiltration rates, thus requiring more frequent irrigation with smaller volumes. In contrast, clay soil has low permeability ranging from 10^-7 to 10^-6 cm/second, high water storage capacity, and slow infiltration rates, requiring less frequent irrigation with larger volumes. Based on these results, specific irrigation management recommendations were developed that include irrigation schedule adjustments, water volume regulation, selection of appropriate irrigation methods, and water conservation techniques. This research provides important contributions to optimizing irrigation water use based on soil permeability characteristics, which can improve water use efficiency and agricultural productivity.

The Impact of Employee Benefits on Job Satisfaction in the Sales Industry: An Analytical Study Using Maslow's Hierarchy of Needs and Herzberg's Two-Factor Theory

Abstract: This study aims to explore the relationship between employee benefits and job satisfaction in the sales industry and analyze how improving employee benefit programs can affect employee job satisfaction. Through literature review and in-depth interviews with employees of sales companies of different sizes, this paper analyzed various types of employee benefits and their potential impact on employee satisfaction. The study utilized psychological and social theoretical models, such as Maslow's Hierarchy of Needs and Herzberg's Two-Factor Theory, to construct an analytical framework. The research findings indicate that certain key elements in employee benefit programs, such as health insurance, training and development opportunities, and work-life balance policies, have a significant effect on improving sales personnel's job satisfaction. Furthermore, through a case study of Starbucks Corporation, this paper further verified that implementing comprehensive and competitive employee welfare strategies in a sales environment can significantly enhance employee loyalty and reduce turnover rates. The study provides specific management recommendations for enterprises in the sales industry, emphasizing the importance of establishing or improving employee benefit plans to enhance employee satisfaction and business performance.

Colonic Adenosquamous Carcinoma: A Single-Center Review of Patient Clinicopathologic Characteristics, Genetics, and Clinical Outcomes.

(1) Background: Adenosquamous carcinoma (ASC) is a rare subtype of colon cancer. Its rarity makes characterization challenging, although colonic ASC is believed to present at more advanced stages and have worse outcomes versus adenocarcinoma. This study aims to characterize the clinicopathological characteristics and clinical outcomes of colonic ASC. (2) Methods: This is a single-center, retrospective review of patients diagnosed with colonic ASC from 2000 to 2020. Data extracted included patient demographics, staging at diagnosis, tumor clinicopathologic and genetic characteristics, and clinical outcomes. (3) Results: Among 61,126 patients with colorectal cancer, 13 (0.02%) had colonic ASC, with a mean age at diagnosis of 48.7 years. The cecum/ascending colon was the most common primary site (6/13, 46.2%), and all except one patient was diagnosed with Stage III or IV disease. Among the eight patients with mismatch repair genetics available, only one was mismatch repair deficient. Eleven patients (84.6%) underwent surgery, and 11 likewise received some form of chemotherapy. Recurrence occurred in 7 of 13 patients (53.8%), and the overall five-year survival rate was 38.5%. The median survival rate was 39.4 months overall (30.5 months for Stage III, 23.7 months for Stage IV). (4) Conclusions: Overall, colonic ASC is rare, and this cohort of colonic ASC patients demonstrated advanced stage at diagnosis, frequent recurrence, and poor overall survival. Additional research remains to compare these characteristics with those of comparably staged adenocarcinoma and to develop specific management recommendations.

The Large Language Model ChatGPT-4 Exhibits Excellent Triage Capabilities and Diagnostic Performance for Patients Presenting With Various Causes of Knee Pain

PurposeTo provide a proof-of-concept analysis of the appropriateness and performance of ChatGPT-4 to triage, synthesize differential diagnoses, and generate treatment plans concerning common presentations of knee pain. MethodsTwenty knee complaints warranting triage and expanded scenarios were input into ChatGPT-4, with memory cleared prior to each new input to mitigate bias. For the 10 triage complaints, ChatGPT-4 was asked to generate a differential diagnosis which was graded for accuracy and suitability in comparison to a differential created by two orthopaedic sports medicine physicians. For the 10 clinical scenarios, ChatGPT-4 was prompted to provide treatment guidance for the patient, which was again graded. To test the higher-order capabilities of ChatGPT-4, further inquiry into these specific management recommendations was performed and graded. ResultsAll ChatGPT-4 diagnoses were deemed appropriate within the spectrum of potential pathologies on a differential. The top diagnosis on the differential was identical between surgeons and ChatGPT-4 for 70% of scenarios, and the top diagnosis provided by the surgeon appeared as either the first or second diagnosis in 90% of scenarios. Overall, 16/30 (53.3%) of diagnoses in the differential were identical. When provided with 10 expanded vignettes with a single diagnosis, the accuracy of ChatGPT-4 increased to 100%, with the suitability of management graded as appropriate in 90% of cases. Specific information pertaining to conservative management, surgical approaches, and related treatments was appropriate and accurate in 100% of cases. ConclusionChatGPT-4 provided clinically reasonable diagnoses to triage patient complaints of knee pain due to various underlying conditions that was generally consistent with differentials provided by sports medicine physicians. Diagnostic performance was enhanced when providing additional information, allowing ChatGPT-4 to reach high predictive accuracy for recommendations concerning management and treatment options. However, ChatGPT-4 may demonstrate clinically important error rates for diagnosis depending on prompting strategy and information provided; therefore, further are necessary to prior to implementation into clinical workflows.

Rationale and design of the French cohort of acute myocarditis diagnosed by cardiac magnetic resonance imaging (MyocarditIRM)

BackgroundAcute myocarditis usually presents as chest pain with rising troponin and normal coronary arteries. Despite frequent favourable evolution at the acute phase, it is associated with heart failure and ventricular rhythm disorders, and is considered the leading cause of sudden cardiac death in young, apparently healthy, adults. There are no specific recommendations for acute myocarditis diagnosis and management, only expert consensus, given the lack of large databases. AimThe main objective is to describe the contemporary presentation of acute myocarditis, its management and in-hospital outcomes. Secondary objectives are to investigate survival and event-free survival for up to 10years of follow-up, the determinants of prognosis, the modalities of treatment and follow-up and the gaps between expert consensus and real-life management. MethodsMyocarditIRM is a prospective multicentre cohort that enrolled 803 consecutive patients with acute myocarditis in 49 participating centres in France between 01 May 2016 and 28 February 2019. The diagnosis of acute myocarditis was acknowledged by cardiac magnetic resonance, using the Lake Louise Criteria. Exclusion criteria were age<18years, lack of health coverage, contraindication to cardiac magnetic resonance and refusal to participate. Detailed information was collected prospectively, starting at admission. Cardiac magnetic resonance imaging (diagnosis and follow-up) is analysed centrally by the certified core laboratory IHU ICAN. Ten years of follow-up for each patient is ensured by linking with the French National Health Database, and includes information on death, hospital admissions, major clinical events and drug consumption. ConclusionThis prospective cohort with long-term follow-up represents the largest database on acute myocarditis worldwide, and will improve knowledge about its presentation, management and outcomes.

Habitat Selection of Three Neotropical Grassland Birds Is Dependent on Vegetation Structure and Resources

Grassland birds are globally imperiled. Those of endemic Neotropical savannas may be particularly threatened as knowledge of the ecology of many species is lacking, restricting our ability to take decisive conservation action. During the dry (non-breeding) season of 2010, we studied the population size, distribution, and habitat associations of the Cock-tailed Tyrant (Alectrurus tricolor), Black-masked Finch (Coryphaspiza melanotis), and Wedge-tailed Grass-finch (Emberiziodes herbicola) across a disturbance-mediated savanna–grassland gradient in Beni, Bolivia. We used distance sampling and surveyed structural and resource-specific habitat features at plots where birds were present versus random locations. Occupancy models identified fine-scale habitat associations. Cock-tailed Tyrant (7.1 ind./km2) specialized on open habitats in areas expected to be heavily inundated in the wet season, avoided trees, and selected tall grassy swards. Black-masked Finch (25.1 ind./km2) occurred across the gradient, associating with tall, forb-rich swards, sparse shrubs, and low levels of fruiting and seeding vegetation. Wedge-tailed Grass-finch (27.9 ind./km2) also occurred across the gradient, particularly associated with tall, forb-rich swards, abundant seeding grasses, and sparse shrubs. Our results offer the first quantitative abundance estimates for these species in Beni, provide vital baselines for future monitoring, and improve knowledge of the ecology and conservation management needs of these species. Importantly, our results suggest that populations of these three grassland birds may be best maintained in heterogenous, mosaic landscapes that can be produced by carefully managed burning and grazing. Further research in the breeding season would facilitate making stronger, more specific management recommendations.

Geotechnologies in Biophysical Analysis through the Applicability of the UAV and Sentinel-2A/MSI in Irrigated Area of Common Beans: Accuracy and Spatial Dynamics

The applicability of remote sensing enables the prediction of nutritional value, phytosanitary conditions, and productivity of crops in a non-destructive manner, with greater efficiency than conventional techniques. By identifying problems early and providing specific management recommendations in bean cultivation, farmers can reduce crop losses, provide more accurate and adequate diagnoses, and increase the efficiency of agricultural resources. The aim was to analyze the efficiency of vegetation indices using remote sensing techniques from UAV multispectral images and Sentinel-2A/MSI to evaluate the spectral response of common bean (Phaseolus vulgaris L.) cultivation in different phenological stages (V4 = 32 DAS; R5 = 47 DAS; R6 = 60 DAS; R8 = 74 DAS; and R9 = 89 DAS, in 99 days after sowing—DAS) with the application of doses of magnesium (0, 250, 500, and 1000 g ha−1). The field characteristics analyzed were mainly chlorophyll content, productivity, and plant height in an experimental area by central pivot in the midwest region of Brazil. Data from UAV vegetation indices served as variables for the treatments implemented in the field and were statistically correlated with the crop’s biophysical parameters. The spectral response of the bean crop was also detected through spectral indices (NDVI, NDMI_GAO, and NDWI_GAO) from Sentinel-2A/MSI, with spectral resolutions of 10 and 20 m. The quantitative values of NDVI from UAV and Sentinel-2A/MSI were evaluated by multivariate statistical analysis, such as principal components (PC), and cophenetic correlation coefficient (CCC), in the different phenological stages. The NDVI and MCARI vegetation indices stood out for productivity prediction, with r = 0.82 and RMSE of 330 and 329 kg ha−1, respectively. The TGI had the best performance in terms of plant height (r = 0.73 and RMSE = 7.4 cm). The best index for detecting the relative chlorophyll SPAD content was MCARI (r = 0.81; R2 = 0.66 and RMSE = 10.14 SPAD), followed by NDVI (r = 0.81; R2 = 0.65 and RMSE = 10.19 SPAD). The phenological stage with the highest accuracy in estimating productive variables was R9 (Physiological maturation). GNDVI in stages R6 and R9 and VARI in stage R9 were significant at 5% for magnesium doses, with quadratic regression adjustments and a maximum point at 500 g ha−1. Vegetation indices based on multispectral bands of Sentinel-2A/MSI exhibited a spectral dynamic capable of aiding in the management of bean crops throughout their cycle. PCA (PC1 = 48.83% and PC2 = 39.25%) of the satellite multiple regression model from UAV vs. Sentinel-2A/MSI presented a good coefficient of determination (R2 = 0.667) and low RMSE = 0.12. UAV data for the NDVI showed that the Sentinel-2A/MSI samples were more homogeneous, while the UAV samples detected a more heterogeneous quantitative pattern, depending on the development of the crop and the application of doses of magnesium. Results shown denote the potential of using geotechnologies, especially the spectral response of vegetation indices in monitoring common bean crops. Although UAV and Sentinel-2A/MSI technologies are effective in evaluating standards of the common bean crop cycle, more studies are needed to better understand the relationship between field variables and spectral responses.

Blood Pressure Variability in Acute Stroke: A Narrative Review.

The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes.

Current State of Molecular Cytology in Thyroid Nodules: Platforms and Their Diagnostic and Theranostic Utility.

The high prevalence of thyroid nodules and increased availability of neck ultrasound have led to an increased incidence of diagnostic thyroid fine needle aspirations, with approximately 20% yielding indeterminate results. The recent availability of molecular tests has helped guide the clinical management of these cases. This paper aims to review and compare three main commercially available molecular cytology platforms in the U.S.-Afirma GSC, Thyroseq GC, and ThyGeNEXT + ThyraMIR. Sequential improvements of the Afirma GSC and Thyroseq GC tests have increased positive and negative predictive values, sensitivity, and specificity. Comparative studies revealed similar diagnostic performance between these tests, with considerations for factors such as cost and processing time. Thyroseq GC provides detailed genomic information and specific management recommendations. ThyGeNEXT + ThyraMIR, though less studied, presents promising results, particularly in miRNA analysis for weak driver mutations. Challenges in interpreting results include variations in reporting and the evolving nature of testing platforms. Questions persist regarding cost-effectiveness and the utility of ultrasound characteristics in selecting candidates for molecular testing. While molecular testing has primarily served diagnostic purposes, advancements in understanding genetic alterations now offer therapeutic implications. FDA-approved options target specific genetic alterations, signaling a promising future for tailored treatments.

Impact of breast surgical procedure on survival in BRCA mutated patients with invasive breast cancer: Mastectomy versus conservative treatment

IntroductionPatients with BRCA1/2 mutations have a higher risk of developing breast cancer compared to the wild-type population. For patients with a BRCA mutation, there are no specific recommendations for surgical management. The aim of this study was therefore to retrospectively investigate overall survival (OS) and recurrence-free survival (RFS) of BRCA mutated patients with localized invasive breast cancer, by comparing conservative surgery versus mastectomy. MethodsThis study was based on data from the Côte d'Or breast and gynecological cancer registry. Data from patients with a constitutional BRCA1/2 mutation who presented with invasive breast cancer were collected retrospectively from 1998 to 2018. The Kaplan-Meier method was used to describe RFS and OS. ResultsA total of 104 patients were included in the analysis, of whom 69 had conservative surgery and 35 underwent mastectomy. Regarding survival, there was no significant difference in OS (HR =1.49; 95 % confidence interval (CI) [0.76–2.93], p = 0.25). Similarly, there was no significant difference in RFS (HR =1.40; 95 % CI [0.81–2.40], p = 0.22), survival without homolateral recurrence (HR =0.88; 95 % CI [0.30–2.61], p = 0.89), without contralateral recurrence (HR =1.50; 95 % CI [0.55–4.09], p = 0.42), or without distant metastatic recurrence (HR =1.42, 95 % CI [0.69–2.90], p = 0.33). ConclusionIn invasive breast cancer in a patient with a germline BRCA1/2 mutation, conservative surgery, when possible, appears to be a feasible option over total mastectomy, with no difference in overall survival. However, the patient should be informed of the aggressive nature of recurrence in this population requiring chemotherapy in most cases.

The influence of pair duration on reproductive success in the monogamous ‘Alalā (Hawaiian crow, Corvus hawaiiensis)

Conservation breeding program practitioners select potential mates in an attempt to maximize pair compatibility and maintain genetic diversity. Therefore, pair duration, or the number of breeding seasons that individuals retain the same mate, is practitioner-determined in these settings. There is a critical need to evaluate whether pair duration influences reproductive success in ex situ assurance populations, particularly for socially monogamous species. The ‘Alalā (Hawaiian crow, Corvus hawaiiensis) is a monogamous forest bird that is currently extinct in the wild. Today, ‘Alalā exist only in human care for intensive conservation breeding. We analyzed breeding program data from 2018-2021 to determine the effects of ‘Alalā pair duration and age on reproduction (nest building, egg laying, hatching, and fledging). We found that pair duration does not influence reproductive outcomes, and thus practitioners can be more proactive when re-pairing birds. Female and male age, on the other hand, influenced the probability of nest building, clutch production, and overall reproductive success. Nest building and clutch production probabilities were high (near 1) and stable as females aged from 2 to ~ 12 years old, declining sharply thereafter. In males, overall reproductive success (from building robust nests to rearing at least one nestling to fledge) increased with age from 2 to ~ 9 years old, peaked and reached an asymptote with males ≳ 9 to ~ 13 years old, and decreased in males ≳ 13 years old. Thus, integrating age into the pair selection process will increase the likelihood of achieving conservation goals. To our knowledge, we are the first to utilize empirical pair duration results to provide specific management recommendations for mate selection in an avian conservation breeding program. Our findings have critical utility for guiding ‘Alalā pairing decisions, and more broadly underscore the importance of evaluating mate retention and selection protocols in other conservation breeding programs.

Practice Recommendations in the Perioperative Chronic Medication Management in the Surgical Patient

At least 50 percent of patients undergoing surgery take medications on a regular basis. Anesthesiologists in the preoperative assessment of the surgical patient often must decide if chronic medications should be continued in the perioperative period. Unfortunately, there are few outcome data about the majority of medications taken in the perioperative period. The evidenced-based medical literature shows great variability in the attitude taken by different centers regarding the patient`s taking of chronic preoperative medication. This lack of medical evidence is reflected by the large variation in perioperative management recommendations. This topic will focus on medications known to have perioperative effects, those known to interact with anesthetic agents, and those in common use. The present article aims to provide an evidenced-based review of perioperative chronic medication management. Emphasis is placed on the importance of specific recommendations for medication management by different categories of therapeutic agents: cardiovascular, gastrointestinal, pulmonary and endocrine agents. Medications affecting kidney function, psychotropic agents, chronic opioid therapy, rheumatologic and neurologic agents, medications for benign prostatic hypertrophy, herbal medications, and antiretroviral agents have been reviewed. The management of patients taking glucocorticoids, oral diabetic agents and insulin preoperatively and agents affecting hemostasis is complex and should not be discussed in this paper because probably they should need and specific protocol en each center. The recommendations in this review are to a large degree expert opinion, based on information from other review and textbooks, along with clinical experience and theoretic considerations.

Australian evidence-based guidelines for the prevention and management of diabetes-related foot disease: a guideline summary.

Diabetes-related foot disease (DFD) - foot ulcers, infection, ischaemia - is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian guideline for DFD was outdated. We developed new Australian evidence-based guidelines for DFD by systematically adapting suitable international guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC. This article summarises the most relevant of the 98 recommendations made across six new guidelines for the general medical audience, including: prevention - screening, education, self-care, footwear, and treatments to prevent DFD; classification - classifications systems for ulcers, infection, ischaemia and auditing; peripheral artery disease (PAD) - examinations and imaging for diagnosis, severity classification, and treatments; infection - examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments; offloading - pressure offloading treatments for different ulcer types and locations; and wound healing - debridement, wound dressing selection principles and wound treatments for non-healing ulcers. For people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self-monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD.

Antibiotic resistance and the COVID-19 pandemic: A dual crisis with complex challenges in LMICs.

Antimicrobial resistance (AMR), a global health crisis of mounting urgency, has been further complicated by the ongoing COVID-19 pandemic. The intricate relationship between these two phenomena is especially pronounced in low- and middle-income countries (LMICs) due to the distinct obstacles encountered by their healthcare systems and policy structures. This study aims to explore the complex challenges arising from the coexistence of these two crises in LMICs and proffer specific recommendations for holistic management. An exhaustive bibliographic survey was executed, employing search queries in specialized databases such as PubMed, SCOPUS, and Web of Science's SCI-EXPANDED index. The timeframe for the literature search extended from January 2020 to January 2023. The search strategy employed key terms including antibiotic resistance, AMR, COVID-19 pandemic, low- and middle-income countries, SARS-CoV-2, and LMICs. The pandemic has aggravated various drivers of AMR in LMICs, including limited capabilities, weak frameworks, and socioeconomic factors. New challenges have emerged, such as disruptions in the antibiotic supply chain and an increased risk of healthcare-associated infections. The interaction between these drivers presents a complex problem that demands a coordinated response. Specific recommendations include strengthening health systems, funding research and innovation, and enhancing infection prevention control measures. The coexistence of AMR and the COVID-19 pandemic in LMICs demands an integrated approach involving multiple stakeholders. Emphasis must be placed on constructing aligned regulatory frameworks, nurturing regional collaborations, and focusing on accessible therapeutic options. The study underscores the necessity for actionable strategies to achieve sustainable access to clean water and sanitation and also highlights the importance of long-term planning, funding, and specialized expertise in emerging modalities like phage therapy.

Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy.

The management of cardiotoxicity concerning the use of oral antineoplastic agents (OAAs) is a challenge for healthcare professionals. Our objective was to create a comprehensive medication management guide with dose adjustment recommendations on OAAs concerning cardiotoxic and lipid metabolic adverse events (AEs) to assist healthcare professionals when prescribing OAAs. A review of the available information on all dose adjustments necessary to safely prescribe and dispense OAAs concerning cardiotoxicity was conducted. In January 2023, we identified all OAAs authorized by the European Medicines Agency (EMA). For each drug, the latest summary of product characteristics (SPC) approved by the EMA and the tertiary data source Lexicomp® were reviewed. Cardiotoxic AEs were recorded, namely, QT interval prolongation, decrease in left ventricular ejection fraction (LVEF), imbalances in blood pressure (hypertension and hypotension), alterations in heart rate (tachycardia and bradycardia), and thrombosis. Any available dose adjustment recommendations in case of an occurrence of these adverse events were collected. In all, 93 different OAAs had been approved by the EMA and were reviewed. Among them, 51.6% have recognized cardiotoxic AEs and 10.8% can cause alterations in lipid metabolism. A total of 27 (29.0%) OAAs had specific recommendations regarding QT prolongation; 88.9% were listed in the SPC and 59.3% in Lexicomp®. Eight OAAs (9.68%) have reported a decrease in LVEF, and four of these drugs, namely, encorafenib, lorlatinib, ripretinib, and sunitinib, have specific management recommendations. Almost half (49.5%) of currently approved OAAs can potentially alter blood pressure; 34 (36.6%) of them have been reported to cause hypertension and 12 (12.9%) are related to hypotension. Tachycardia and/or bradycardia are associated with 22.6% and 8.6% of the evaluated drugs, respectively. Regarding thrombosis, 30 (32.3%) of the drugs analyzed included the appearance of a thrombus as a possible AE. More than half of the OAAs can produce cardiotoxic effects, with the most frequent being blood pressure alteration and QT interval prolongation with a non-depreciable incidence of LV dysfunction or thrombosis. Before starting the treatment, it is necessary to stratify baseline cardiovascular risk, plan a surveillance schedule, and consider referral to cardio-oncology units.

Addressing PTSD in Implantable Cardioverter Defibrillator Patients: State-of-the-Art Management of ICD Shock and PTSD.

This paper reviews the unique processes and treatments of post-traumatic stress in implantable cardioverter-defibrillator (ICD) patients and posits specific clinical management recommendations. PTSD is a common presenting problem for a prospective ICD patient and is a common response to ICD shocks. Approximately 32% of patients with sudden cardiac arrest report significant PTSD symptoms. Following ICD shock, approximately 20% experience PTSD from the shocks. Regardless, PTSD can interrupt and undermine clinical management from a cardiologist perspective and create significant disturbance in patients and families. Few cardiology clinics are outfitted to effectively manage psychological distress, in general, and PTSD, in particular. Effective management of PTSD patients can be achieved with both direct care in the cardiac clinic, as well as indirect care via multidisciplinary consultation and expertise. The importance of emotional validation, return to physical activity, and family engagement is emphasized in current management.

Spatial and temporal fishery management assessment using DEA: Case study of spanner crabs in Queensland, Australia

The aim of this case study was to assess potential temporal and spatial differences in productivity measures of vessels operating in the Queensland spanner crab fishery. This fishery’s logbook records of catch and effort data allowed analysis of the impact of fishery management changes on productivity measures. Data envelopment analysis (DEA) with a ‘window analysis’ approach was used to derive estimates for measures of technical efficiency, capacity utilisation and scale efficiency over time for five different spanner crab fishing regions. The results suggest that average technical efficiency and capacity utilisation were relatively low over time and across fishing regions, implying a high level of technical inefficiency and the existence of excess capacity in the fishery. Scale efficiency was found to be high historically but decreased slightly since 2006 for all regions. The results suggest that this decline is likely not caused by the fishery management changes, but instead is due to other factors. Additional data (e.g., revenue, profit, costs, skipper experience) and analysis is needed to assess the causes for the low technical efficiency and capacity utilisation and reasons for the decrease in scale efficiency as a baseline for specific fishery management recommendations. The study shows that temporal and spatial efficiency and productivity analysis of fisheries can help identify potential issues that are not otherwise apparent.

Fisheries restoration: Lessons learnt from four benefit-cost models

Globally, fisheries are in decline and in many parts of the world illegal fishing is a major cause of these declines. Ecological restoration of fisheries needs to be promoted, inter alia through improved enforcement, but, which method is the most successful at improving fish stocks, as well as having the highest economic returns? We compare one open-loop (without feedback) and three closed-loop (with feedback) benefit–cost models representing different restoration interventions aimed at promoting compliance. The hybrid systems methodology has been utilized, combining system dynamics, systems archetypes, mathematical differential equations and economic benefit–cost methodologies. The model is tested with reference to a case study of abalone (Haliotis midae) biomass restoration in the Table Mountain National Park marine area (Zone E), Cape Town. Stocks in Zone E have dropped to below the government’s management threshold for sustainable fisheries of 20 percent of the pre-fished levels, and urgent action is required to restore the stocks. According to the model, all proposed restoration interventions produce stock recovery to 100 percent of carrying capacity, well in excess of government targets of 40 percent. Also, all four models had a net present value of greater than zero, indicating substantial positive net benefits to restoration. Each model had specific management recommendations associated with it- greater involvement by the state, capital investment in restoration, changing poacher behavior and entrepreneurship. Although the Post Keynesian and Institutional model produced the highest net returns to restoration over 80 years (Net present value = US$12.66 million at a 6 % discount rate, 2021 prices), all the models are essentially co-evolutionary models, and have merit over different time periods, compliance rates and assumptions around discount rates. While the case study is developed for abalone the findings of the model are likely to be applicable in a wide range of fishery restoration contexts.