Standard Guidelines Research Articles

Vasospasm management: a meta-synthesis of current modalities used by different medical societies

Background: Cerebral vasospasm is a life-threatening complication of an aneurysmal subarachnoid hemorrhage (aSAH), with approximately 6 to 10 cases per 100,000 patients yearly. Despite the publication of numerous guidelines from various medical societies, there is a lack of standardized consensus on what the optimal management strategies for this severe complication truly are. This meta-synthesis aims to synthesize these endorsed recommendations to ultimately identify standardized care guidelines and improve patient outcomes after aSAH. Methods: A comprehensive database search of existing guidelines published by major medical societies in the past 10 years was performed. Results: The analysis included 28 relevant documents from 7 major medical societies. Key findings included: 1) Unanimous endorsement for oral nimodipine administration for 21 days post-aSAH. 2) Varying recommendations for alternative calcium channel blockers and hemodynamic management methods. 3) Targeted hypermagnesemia and routine statin therapy were not universally recommended due to insufficient evidence. 4) Use of antifibrinolytics was considered on a case-by-case basis. 5) Endovascular interventions were recommended for refractory cases, specifically. Conclusion: This meta-synthesis reveals consistencies and divergences in vasospasm management recommendations across medical societies, highlighting the need for more robust clinical trials, regular guideline updates, and increased medical society collaboration. Keywords: Vasospasm, cerebral vasospasm, aSAH, management, guidelines, meta-synthesis

Prehospital seizure management protocols need standardized guidelines. A descriptive study from Norway

BackgroundPatients with convulsive seizures constitute a significant group in acute neurology. No common European clinical practice guidelines on prehospital seizure management exist, and today most patients are brought to hospital for seizure treatment, with great variation in which prehospital treatment is provided. Only 33 % of status epilepticus patients receive a benzodiazepine as first anti-seizure medication (ASM). The aim of this study is to assess the prehospital seizure control protocols in the Emergency Medical Services (EMS) in Norway, and compare these with current evidence for acute management. MethodWe performed a descriptive analysis of the 18 regional EMS protocols in Norway and compared the findings with recent evidence on prehospital treatment. We analysed recommended drug and dosage, route of medication administration, number of additional rescue doses permitted, requirements for registration of type of seizures and seizure duration. ResultsThe protocols vary in terms of preferred medication, administration method, dosage and recommendations regarding first- and second-line therapies. 33 % of protocols explicitly define status epilepticus according to contemporary guidelines, and 16.7 % have an operational definition of when to administer benzodiazepines. All protocols showed variations in dosing and administration instructions and only 28 % had a clearly stated first line treatment. ConclusionThere are disparities in the prehospital seizure management protocols within the Norwegian healthcare system, a system comparable to other European countries. To improve seizure management there is a need for standardised guidelines for prehospital treatment.

Implantable small ultra-wideband circularly polarized antenna design for continuous blood pressure monitoring

This paper presents a miniaturized circularly polarized (CP) implantable antenna Ultra-wide bandwidth for continuous blood pressure monitoring. The miniature and CP of the antenna are gained by using a new slot method. The symmetry slots in the radiation patch, two T-shape slots in the GND, coupled with the use of a short pin make the designed antenna with good physical and radiation properties. In simulation, the fractional effective axial ratio bandwidth is 23.6% (2.36–2.94 GHz), and the peak gain is − 28.9 dBi. Its total size is only 17.78 mm3 (0.056 × 0.04 × 0.004 λ03), which size is smaller compared to other antennas with similar performance. A prototype is fabricated and measured. The experimental results are in good agreement with the simulation results. And, the radiation patterns have good symmetry both in the simulation and measurement. In addition, the maximum SAR value is in accordance with the IEEE standard safety guidelines (IEEE C95.1-2019).

25 Genomic medicine in paediatric care for neurodevelopmental disorders: An assessment of practices, attitudes and education needs of Ontario paediatricians

Abstract Background Non-geneticist healthcare professionals are increasingly responsible for delivering genetics-informed care to individuals and their families affected by neurodevelopmental disorders (NDDs). Developing education tools to support their continuing education will require an understanding of physicians’ current approaches, attitudes and desired resources regarding genomic medicine, in the context of their specialty and healthcare system. Objectives Our goal was to assess paediatricians’ current practices, attitudes, and education needs regarding the provision of genomic medicine to individuals with NDDs in Ontario. Design/Methods We distributed an anonymous electronic questionnaire between April 2023 and June 2023 using online dissemination strategies. Inclusion criteria were paediatricians who self-identify as providing care to patients with NDDs. A multi-disciplinary team of genetic and non-genetic experts and a family partner developed the questionnaire. It had four sections: 1) demographic and clinical practice information, 2) experience with providing genomic medicine, 3) attitudes about providing genomic medicine, 4) education needs. Results One hundred and thirty paediatricians completed the questionnaire (estimated response rate of 10%, based on estimated 1300 Ontario paediatricians with varied practices). General paediatricians comprised 76% of responders; 50% of responders practiced outside a large urban centre. In terms of experience with genomic medicine: 58% of responders always/often discuss genetic testing options with families. Barriers to ordering genetic testing included lack of knowledge, confidence, access to lab services and time. Rates of ordering genetic testing varied by NDD and genetic test. Some paediatricians endorsed outdated testing practices (e.g., 9% order karyotype for patients with autism). Paediatricians also order genetic tests outside of standard clinical guidelines (e.g., 38% order a genetic test for patients with isolated language delay). In terms of attitudes regarding genomic medicine: majority believe that it is important to become educated about delivering genetic services to patients with NDDs. Over 60% strongly agree/agree that a genetic diagnosis may offer improved health management and research access, and about 50% strongly agree/agree that it may offer improved access to medical services and positive psychological impact for families. Commonest barriers to integrating genomic medicine in paediatric care were concerns about unanticipated genetic results, lack of local resources/logistical challenges, and competing psychosocial considerations. In terms of genetic education needs: paediatricians expressed strongest interest in learning about genetic testing (e.g. utility, interpretation, management) and advances in genomic technologies. Conclusion Ontario paediatricians integrate aspects of genomic medicine in the care of individuals with NDDs, though sometimes outside of clinically recommended contexts. They desire more support in optimizing this integration as genomic technologies and information evolve. Our study provides valuable information to guide the creation of genetic education tools to enhance collaborative healthcare for children and youth with NDDs.

Analysis of antidiabetic drug utilization patterns in type 2 diabetes patients: a perspective on real-time prescribing practices

Background: Type 2 diabetes is a most common health problem associated with significant morbidity and mortality worldwide, evaluation of drug utilization pattern is very crucial and significant in order to promote the rational use of drugs in treatment of diabetes, and offer insights in to the actual patterns of drug use. The objective is to evaluate drug utilization pattern of antidiabetic drugs among type 2 diabetic patients at Integral Institute of Medical Science & Research. Methods: This is a prospective observational study involving 100 subjects conducted for a period of 6 months after approval by Institutional Ethics Committee (IEC) of Integral University at IIMS and R Hospital. Informed consent was obtained from all the participants. Data gathered was examined using descriptive statistics and compared to the standard guidelines. Drug utilization pattern was studied and evaluated to analyse the pattern of drug therapy among type 2 diabetics. Results: Antidiabetic drugs were given 198 times among the 100 participants, averaging 2 antidiabetic drugs per prescription, Insulin therapy (58.58%) and Metformin (20.20%) were the most prescribed medications, combination therapy was common, with 66% of patients particularly with Glimepiride (DPP4 Inhibitor) at 10.61%. Most prescriptions were given by generic name (55%) and 90% of the drugs prescribed were from the WHO essential medicines. Most patients were aged 51-60 years, with a nearly equal gender distribution. Conclusion: The study highlights the prescribing patterns and characteristic use of antidiabetic medications. These findings provide valuable insights into the current prescribing practices in type-2 DM treatment and can contribute to optimizing treatment strategies for better patient outcomes.

Eyedealistic Vision: Optimizing Oxygenation to Reduce Severe Retinopathy of Prematurity in the Neonatal Intensive Care Unit.

Rates of severe retinopathy of prematurity (ROP) continue to rise globally despite advances in healthcare. Differences in practices related to optimizing oxygenation is among key factors that increase the risk of severe ROP. A recent increase in severe ROP rates at 2 local neonatal intensive care units (NICUs) prompted further investigation into potential preventative practices. The project team's goal was to reduce rates of severe ROP by 20% in the 2 participating units. A level IV and level III NICU were targeted, including 255 infants at risk for ROP. Interventions included staff education, implementation of new established oxygen guidelines, as well as use of order sets, and alarm limits. Compliance rates and severe ROP rates before and after new guideline implementation were assessed. After implementing the new guidelines, average alarm limit compliance met project goals of 90% at both sites. Severe ROP rates declined from 10% to 7% in the level IV NICU site and from 6% to 0% in the level III NICU site during the 24-month study period from 2022 to 2023. Education and increased understanding regarding risk factors for ROP patients are crucial to successfully implementing and sustaining standardized oxygenation guidelines. Including the entire healthcare team and patient families is key to successful QI initiatives and improving patient outcomes. Further research is needed for optimal standardized oxygen alarm limits for this patient population. One of the leading causes of childhood blindness is retinopathy of prematurity (ROP).1 ROP is a disease of the retina that affects premature infants, with the highest risk to very low birthweight (VLBW) infants born with a gestational age of less than 30 to 32weeks or infants weighing less than 1500 grams.2 There are 5 stages of ROP. Stages 1 and 2 are considered mild and resolve on their own. Stage 3 is considered moderate-severe and sometimes resolves independently, with many cases requiring treatment. Stages 4 and 5 ROP are deemed severe and require treatment.

Comprehensive neurosurgical and visceral surgical therapy of retroperitoneal nerve tumors: a descriptive and retrospective analysis.

Nerve tumors in the retroperitoneal space are a rarity. Radical surgery according to soft tissue tumors can lead to persistent pain and neurological deficits. This study aims to evaluate clinical outcomes of patients treated by a visceral- / neurosurgical approach. 33 patients with a retroperitoneal nerve tumor underwent surgery between 01/2002 and 12/2022 at our department. A visceral surgeon provided access to the retroperitoneal space, followed by micro-neurosurgical tumor preparation under neuromonitoring. Clinical examination and MRI were performed 12 weeks after surgery and further 3 months (WHO grade > 1) or 12 months (WHO grade 1). Further examinations were based on MRI findings and residual symptoms with median follow-up time of 24 months. One patient was treated for two distinct masses resulting in a total of 34 histological findings. Schwannomas (n = 15; 44.1%) and neurofibromas (n = 10; 29.4%) were the most common tumors. Long-term improvements were noted in radicular pain (15/18 patients; 83.3%), motor deficits (7/16 patients; 43.8%), abdominal discomfort and pain (5/7 patients; 71.4%). Recurrences were observed in 3/33 (9,1%) patients. This study represents the largest series of retroperitoneal BPNSTs treated with microsurgical techniques. Prospective multicenter studies are warranted to establish standardized treatment guidelines.

Surveillance of Food and Waterborne Pathogens in North-East India: Protocol for a Laboratory-Based Sentinel Surveillance Study.

Food safety is a global concern, which is often underestimated owing to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, and shifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented foods pose significant health risks. Despite these challenges, systematic data on foodborne pathogens is lacking in India, highlighting a crucial gap in understanding food safety issues. The aim of this research protocol is to establish an integrated surveillance system to identify enteric pathogens circulating within humans, food animals, and the environment through a health approach in North-East India, and to conduct outbreak investigations. The Indian Council of Medical Research (ICMR) initiated a surveillance study across all 8 North-East states in India, employing a centralized digital database for data collation. The project aims to enhance theinfrastructure for microbial culture, antibiotic sensitivity testing, and molecular epidemiological studies. The study involves laboratory-based surveillance of foodborne pathogens in market foods, hospitalized diarrheal patients, poultry and animal farms, slaughterhouses, butcher shops, and diarrheal outbreaks. A standardized case report form ensures consistent data collection of age, sex, signs, symptoms, and admission dates for diarrheal cases. Stool and rectal swabs will undergo testing for pathogen identification and antimicrobial resistance. Similarly, samples of market foods, food animals, and the environment will be collected. Outbreaks confirmed by the Integrated Disease Surveillance Project (IDSP) will be thoroughly investigated following standardized guidelines. In phase I, 5 surveillance centers were established across 4 states (ie, Assam [Dibrugarh and Guwahati], Tripura, Sikkim, and Arunachal Pradesh) in 2020. Following an interim phase I data assessment and the successful establishment of a streamlined system for data procurement, investigation, recording, and analysis, along with the implementation of regular training and monitoring programs, phase II expansion was initiated in 2023-24. This includes the addition of 7 more centers (including 3 veterinary centers) in the remaining 4 states (ie, Manipur, Meghalaya, Mizoram, and Nagaland), eventually covering the entire North-Eastern Region of India. Food and waterborne diseases are a constant public health problem in many countries. Key challenges to the enhancement of food safety policy include the paucity of systematic data and awareness. With this background, ICMR's initiative is the first systematic surveillance study in the country to adopt a single health approach. Data obtained from this project will help to understand the risk of acquiring food and waterborne pathogens, their transmission pathways, and antimicrobial resistance patterns. The scientific evidence generated through this project will be helpful in formulating and strengthening food safety policy and in initiating government programs to protect the health of the nation. DERR1-10.2196/56469.

Engineering Budesonide Microparticles for Enhancing Pulmonary Targeting: Validation through In Vivo Investigations

AbstractThe study aimed to develop and evaluate budesonide inhalation micro‐suspension to target inflammation in the lower trachea and bronchi. Initially, the slurry phase is prepared by dispersing the drug (0.25 and 0.5 mg ml−1) in the Water for Injection with polysorbate 80. The slurry is mixed with the aqueous phase comprising other excipients. The mixture is further subjected to the treatment with homogenizer. The prepared formulations are subjected to various physio‐chemical analysis like description, density, pH, osmolality, viscosity, shelf life, impurities, assay, particle size, etc. Andersen cascade impactor is used to estimate the aerodynamic performance. In vivo analysis is initiated with the induction of Asthma in Sprague Dawley rats by ovalbumin challenge intranasally and the treatment is given with the aid of a nebulizer. Lastly, the biochemical estimations are carried out in blood and bronchoalveolar lavage fluid (BALF). The lungs are also subjected to morphological and histological evaluations. The physio‐chemical and analytical examination indicated a stable formulation that is compliant with the standard guidelines. The D90 value of the test formulation is ≤4.5 µm. Cascade impactor evaluation estimated almost, 2–10% higher amount of budesonide reaching the target region as compared to the marketed product. Test formulation attenuated the manifestation of ovalbumin‐induced asthma through suppression of inflammatory cell count in blood and BALF, and modulation of Lactate dehydrogenase and Alkaline Phosphatase levels which is further confirmed by histopathological analysis. The formulated budesonide micro‐suspension demonstrated stability, safety, and efficient delivery to the target site.

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

An experimental study on receiving Audio Descriptions in Iran

Despite the growing body of research on audience satisfaction, Audio Description (AD) in Iran is still in its early stages of scientific development. Given the non-professional nature of AD production for Persian films in Iran, this research aimed to determine whether the current AD services meet users' needs and satisfaction. This study is based on a questionnaire survey of 30 blind and partially sighted individuals. The results indicate that AD services in Iran are limited to movies, revealing a significant gap between supply and demand. AD in Iran faces several challenges, including low quality, a lack of specialists, and insufficient theoretical research. From the audience's perspective, common issues include inappropriate timing, unsuitable vocabulary, subjective judgments, premature disclosure of story elements, neglect of actors' characteristics, and a disregard for standard guidelines in favour of self-made norms in descriptions. However, the existing Persian AD does help the audience understand the film's storyline. Our experimental research shows that participants prefer objective AD with detailed descriptions.

Constituents over Correlation: Indicators and Arctic Urban Decision-Making

Arctic city mayors influence municipal sustainability outcomes, navigating decisions on waste management, social service funding, and economic development. How do mayors make these decisions and to what extent do they integrate sustainability indicator data? Interviews with the mayors of Fairbanks, Alaska, Yellowknife, Canada, and Luleå, Sweden, revealed indicators are used on a case-by-case basis to track trends but lack systematic integration into decision-making. Constituent concerns drive agendas rather than indicator trends. Based on International Organization for Standardization (ISO) guidelines, 128 indicators grouped into 19 sustainability themes were compiled from 2000 to 2019 for the study cities. Partial Least Squares Structural Equation Modeling (PLS-SEM) was applied to examine the utility of ISO indicators as a guiding factor for sustainability trend tracking, identifying key themes for each city. Results show that indicator trends are too inconsistent and interconnected to be useful as an independent form of guidance for mayors. For Arctic municipalities, sustainability indicator datasets are useful in specific circumstances, but they do not provide the same kind of decision-making heuristic that mayors receive from direct constituent interaction. Findings emphasize the importance of more robust data collection and the development of management frameworks that support sustainability decision-making in Arctic cities.

Acquisition of durable insulin-producing cells from human adipose tissue-derived mesenchymal stem cells as a foundation for cell- based therapy of diabetes mellitus

This study aimed to identify the suitable induction protocol to produce highly qualified insulin producing cells (IPCs) from human adipose tissue derived stem cells (ADSCs) and evaluate the efficacy of the most functionally IPCs in management of diabetes mellitus (DM) in rats. The ADSCs were isolated and characterized according to the standard guidelines. ADSCs were further induced to be IPCs in vitro using three different protocols. The success of trans-differentiation was assessed in vitro through analysis of pancreatic endocrine genes expression, and insulin release in response to glucose stimulation. Then, the functionalization of the generated IPCs was evaluated in vivo. The in vitro findings revealed that the laminin-coated plates in combination with insulin-transferrin-selenium, B27, N2, and nicotinamide could efficiently up-regulate the expression of pancreatic endocrine genes. The in vivo study indicated effectual homing of the PKH-26-labelled IPCs in the pancreas of treated animals. Moreover, IPCs infusion in diabetic rats induced significant improvement in the metabolic parameters and prompted considerable up-regulation in the expression of the pancreatic related genes. The regenerative effect of infused IPCs was determined through histological examination of pancreatic tissue. Conclusively, the utilization of laminin–coated plates in concomitant with extrinsic factors promoting proliferation and differentiation of ADSCs could efficiently generate functional IPCs.

Substituting with alternativeiodinated contrast medium to prevent recurrent adverse drug reactions associated with its use: a meta-analysis.

To systematically review and meta-analyze the recurrent rate of iodinated contrast medium (ICM)-associated adverse drug reactions (ADRs) and the preventive effect of using alternative ICM lacking a common carbamoyl side chain. A systematic literature search was conducted in the MEDLINE and EMBASE databases to identify studies that investigated the recurrence rate of ICM-associated ADRs or hypersensitivity reactions (HSRs). Studies that included patients who subsequently underwent contrast-enhanced computed tomography scans after their index reactions were included, while studies with overlapping cohorts were excluded. The first search was conducted on November 10, 2023. The pooled recurrence rate of ICM-associated ADR was determined using the DerSimonian-Laird random-effects model. Subgroup analyses were also conducted based on the substitution of ICM, with particular consideration given to the N-(2,3-dihydroxypropyl) carbamoyl side chain. A total of ten original articles were included in the analysis, collectively spanning from June 2001 to March 2021. The pooled recurrence rate of ICM-associated ADR was not significantly different from that of ICM-associated HSR (16.6% [95% CI, 7.8-31.9%] vs. 15.5% [95% CI, 10.8-21.8%], p = 0.87). In the subgroup analyses, the pooled odds ratio for ICM-associated recurrent ADR when using a different ICM compared with using the same ICM was 0.31 (95% CI, 0.21-0.45), which means a 69% reduction. Moreover, the pooled odds ratio for ICM-associated recurrent ADR when substituting ICMs with different side chains compared with substituting with common side chains was 0.65 (95% CI, 0.52-0.82), which means an additional 35% reduction. Substituting with an alternative ICM led to a 69% reduction in recurrent ADRs, with an additional 35% reduction observed when using ICM lacking a common carbamoyl side chain. Question No standardized guidelines exist for replacing previously used iodinated contrast medium (ICM) to prevent recurrent adverse reactions. Findings Using alternative contrast medium with a different carbamoyl side chain prevents adverse drug reactions effectively. Clinical relevance This study advocates using alternative ICM without a common carbamoyl side chain to prevent recurrent adverse drug reactions in patients with a history of such events.

Development and validation of an ICP-MS method and its application in assessing heavy metals in whole blood samples among occupationally exposed lead smelting plant workers.

Occupational exposure to heavy metals affects various organ systems and poses a significant health risk to workers. Consequently, its precise estimation is of clinical concern and warrants the need for an analytical method with reliable precision and accuracy. The current study aimed to develop an analytical method using inductively coupled plasma‒mass spectrometry (ICP-MS) to detect trace to elevated levels of potentially toxic elements in human blood. The sample preparation was optimized using a two-step ramp temperature microwave acid digestion program. The toxic elements were quantified using ICP-MS operating in kinetic energy discrimination (KED) mode, adjusting the data acquisition parameters and instrumental settings. The analytical method was validated using standard performance parameters. Each validation parameter was aligned with the acceptable criteria outlined in standard guidelines. The method achieved optimal linearity (r2 > 0.99), recovery (85.60-112.00%), and precision (1.35-7.03%), was capable of detecting the lowest concentrations of 0.32, 0.28, 0.28, and 0.19µg/L, and was capable of quantifying trace levels of 1.01, 0.88, 0.90, and 0.62µg/L for arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb), respectively. Post-validation, the method was applied to estimate heavy metals in blood samples from 250 Pb-smelting plant workers, revealing potential health implications of occupational exposure. The cohort analysis revealed that demographic and employment factors were associated with elevated blood Pb levels, leading to symptoms and health risks. Clinical analysis revealed that 33.6% of the participants experienced hypertension. These findings highlight the significant health risks associated with elevated blood Pb levels. The weak but significant correlation with systolic blood pressure underscores the need for improved monitoring and workplace safety. This emphasizes the importance of continuous monitoring, targeted interventions, and enhanced occupational hygiene to protect workers' well-being.

Breaking barriers in Parkinson’s care: the multidisciplinary team approach

Parkinson’s disease is a complex neurodegenerative disorder presenting a range of motor and non-motor symptoms that greatly impact both patients and caregivers. The diverse needs arising from these symptoms make a multidisciplinary team (MDT) approach crucial for effective management. This article explores the role and benefits of MDTs in Parkinson’s care, highlighting how collaborative models improve clinical outcomes and quality of life. MDTs integrate neurologists, nurse specialists, therapists, and other professionals to deliver comprehensive, patient-centered care. The inclusion of patients and caregivers fosters shared decision-making, enhancing health outcomes. However, challenges like limited controlled trials, lack of comprehensive guidelines, and under-referral remain. Innovative models, such as telehealth and community-based care, offer promising solutions, especially in underserved regions. The article advocates for further research and standardized guidelines to optimize the MDT approach for Parkinson’s disease.

Effect of various fibers and rice husk ash on the workability of self-compacting concrete

AbstractThe study aims to investigate and find natural fiber as concrete reinforcement using the self-compacting concrete method. Methods of adding fiber and self-compacting concrete methods are exciting because these two methods have different characteristics and advantages. Therefore, the performance of the fresh-state flow capability of the self-compacting concrete method, which contains various fibers, was observed. Coconut fiber, pineapple leaf fiber, ijuk sugar palm fiber, and artificial polypropylene fiber were used with varying compositions of 0.3, 0.5, and 0.7% by mass of binder. The results show that coconut and pineapple fiber concrete met the European Guidelines for Self-Compacting Concrete standards. The coconut and pineapple fiber concrete performed admirably in all tests.

Clinically relevant findings on 24-h head CT after acute stroke therapy: The 24-h CT score.

Routine head computed tomography (CT) is performed 24 h post-acute stroke thrombolysis and thrombectomy, even in patients with stable or improving clinical deficits. Predicting CT results that impact management could help prioritize patients at risk and potentially reduce unnecessary imaging. In this institutional review board (IRB)-approved retrospective study, data from 1461 consecutive acute ischemic stroke patients at our Comprehensive Stroke Center (n = 8943, 2012-2022) who received intravenous thrombolysis or endovascular therapy, exhibited stable or improving 24-h exams, and underwent 24-h follow-up head CT per standard acute stroke care guidelines. CT reports 24 h post-stroke were reviewed for edema, mass effect, herniation, and hemorrhage. The primary outcome was any clinically relevant 24-h CT finding that led to changes in antithrombotic treatment or blood pressure goals, extended intensive care unit (ICU) stays or hospitalizations, neurosurgical interventions, or administration of mannitol or hypertonic saline. Multivariable logistic regression identified independent predictors of clinically meaningful CT abnormalities. A 24-h CT score was developed and cross-validated. The mean age was 70 years, with 47% women. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 12 (interquartile range (IQR): 6-18). Stroke-related abnormalities on 24-h CT were present in 325 patients (22.2%), with 183 (12.5%) showing clinically relevant findings. Age, admission NIHSS, and blood glucose levels were independent predictors of clinically relevant 24-h CT findings. The final model C statistic was 0.72 (95% confidence interval (CI): 0.68-0.76) in the derivation cohort and 0.72 (95% CI: 0.67-0.75) in bootstrapping validation. The 24-h CT score was developed using these predictors: NIHSS score 5-15 (+3); NIHSS score ⩾16 (+5); age < 75 years (+1); admission glucose ⩾ 140 mg/dL (+1). The prevalence of clinically relevant CT findings was 4.3% in the low-risk group (24-h CT score ⩽ 4), 11.3% in the medium-risk group (score 5), and 21.4% in the high-risk group (score ⩾ 6). The 24-h CT score demonstrated good calibration. In patients undergoing thrombolysis or thrombectomy who undergo routine 24-h head CT despite remaining clinically stable or improving, only one in eight prove to have 24-h head CT findings that impact management. The 24-h CT score provides risk stratification that may improve resource utilization. A.S. and B.Z. have full access to the data used in the analysis in this article. Deidentified data will be shared after ethics approval if requested by other investigators for purposes of replicating the results.

Duodenal Adenocarcinoma Arising from Brunner’s Glands, A Rare Case Report

Abstract Introduction/Objective Malignancies arising from the Brunner’s glands in duodenum are exceedingly rare with very few cases reported in the literature. Here, we reported a case of duodenal adenocarcinoma of Brunner’s gland origin that obstructed duodenum and extended to involve the pancreatic head. Methods/Case Report A 48-year-old woman came to the Emergency Department of our hospital with epigastric and right upper quadrant abdominal pain. CT imaging demonstrated a heterogeneously enhancing 8.4 x 5.4 x 6 cm mass involving the duodenal lumen, wall, and pancreatic head. An endoscopic ultrasound showed a large fungating, infiltrative, and ulcerative mass in the second portion of the duodenum distal to the ampulla but not involving it. The pancreatic and common bile ducts were uninvolved. Her endoscopic ultrasound biopsy was positive for adenocarcinoma. CA19-9 levels were normal. The patient received chemotherapy with subsequent Whipple procedure. Gross examination revealed an exophytic, tan-white mass with the epicenter in the duodenal wall obstructing the duodenal lumen and extending to involve the pancreatic head inferiorly. The mass was predominantly solid with a few small mucus cysts. Light microscopy demonstrated moderately differentiated adenocarcinoma with prominent necrosis and inflammation. There are intestinal-type, gastric-type and indeterminate types of epithelia in the carcinoma. There are areas in the duodenal wall where a continuous transition from benign Brunner’s glands to dysplastic glands and then to adenocarcinoma is present. Neither adenoma in the overlying duodenal mucosa nor abnormalities in the pancreatic parenchyma is observed. Immunohistochemical stains showed that the neoplastic cells are positive for CAM 5.2, AE1/AE3, and CK7, while only patchy positivity with CK20 and CDX2. Taken together, a diagnosis of duodenal adenocarcinoma arising from Brunner’s glands was rendered. Results (if a Case Study enter NA) N/A Conclusion More cases are needed in order to establish standard treatment guidelines and determine prognostic factors.

Auricular Therapy to Control Pain in Women With Breast Cancer: Protocol for Systematic Review and Meta-Analysis.

The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433. DERR1-10.2196/55792.