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ObjectiveThis meta-analysis includes the systematic literature review and meta-analysis involving clinical trials to assess the efficacy and safety of mesenchymal stem cell (MSC) transplantation for treating T1DM and T2DM.MethodsWe searched PubMed, ScienceDirect, Web of Science, clinicaltrials.gov, and Cochrane Library for “published” research from their inception until November 2023. Two researchers independently reviewed the studies’ inclusion and exclusion criteria. Our meta-analysis included 13 studies on MSC treatment for diabetes.ResultsThe MSC-treated group had a significantly lower HbA1c at the last follow-up compared to the baseline (MD: 0.95, 95% CI: 0.33 to 1.57, P-value: 0.003< 0.05), their insulin requirement was significantly lower (MD: 0.19, 95% CI: 0.07 to 0.31, P-value: 0.002< 0.05), the level of FBG with MSC transplantation significantly dropped compared to baseline (MD: 1.78, 95% CI: -1.02 to 4.58, P-value: 0.212), the FPG level of the MSC-treated group was significantly lower (MD: -0.77, 95% CI: -2.36 to 0.81, P-value: 0.339 > 0.05), and the fasting C-peptide level of the MSC-treated group was slightly high (MD: -0.02, 95% CI: -0.07 to 0.02, P-value: 0.231 > 0.05).ConclusionThe transplantation of MSCs has been found to positively impact both types of diabetes mellitus without signs of apparent adverse effects.

Early in the SARS-CoV-2 pandemic, polymerase chain reaction (PCR) testing was reserved for symptomatic patients. However, many infections were asymptomatic or mildly symptomatic. Positive serologic antibody (Ab) testing is theorized to be a marker of prior infection, allowing for identification of the true burden of the disease and the establishment of links between outbreaks. The objective was to assess serologic testing in subjects after PCR testing and compare seropositivity rates of household vs. non-household close contacts. We identified subjects who were PCR-positive between March 2020 and May 2021. Index cases and close contacts then underwent serologic testing for IgG against the SARS-CoV-2 nucleocapsid N-protein. One hundred and thirteen subjects underwent serologic testing with a sensitivity of 65.0%, specificity of 78.9%, positive predictive value of 92.9%, and negative predictive value of 34.9%. Index cases comprised 20.5% of subjects, and 73.9% were seropositive (p = 0.01). Close contacts included 72% household contacts and 28% non-household contacts. One seropositive case had no prior PCR and four were PCR negative. No statistical difference existed in seropositivity between household and non-household contact (53.1% vs. 43.8%, p = 0.4). Testing for IgG against SARS-CoV-2 N-protein may identify previously unrecognized infections in the community. Seropositivity rates of household vs. non-household contacts were not significantly different, and >50% of household contacts were seropositive.

Abstract Introduction Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations. Purpose To determine the association between inadequate PNC (

The main objective of this study was to analyze perinatal outcomes of women with substance use disorder in pregnancy who participated in the West Virginia University Medicine Drug Free Moms and Babies Assist Connect and Encourage program (DFMB/ACE) compared to women who were not enrolled in the program. This was a retrospective cohort study conducted in an l Academic Tertiary Care Center. Women who enrolled in DFMB/ACE services from 2018 to 2019 were termed as the intervention group. Their outcomes were compared to 734 women who delivered at the hospital between July 2015 and December 2019 with a positive urine drug screen on admission but were not enrolled in the DFMB/ACE program.Perinatal outcomes evaluated include low birth weight, preterm labor, neonatal intensive care unit (NICU) admission, preterm birth, neonatal abstinence syndrome (NAS), cesarean delivery, cord toxicology result, hepatitis c prevalence, and breastfeeding at the time of discharge. Participants of the DFMB/ACE group had a lower risk of having a preterm birth (OR = 0.56 95% CI 0.36–0.86) compared to the control group. The DFMB/ACE group had higher birth weight compared to the non-DFMB group (2865.7 g. vs. 2657.9 g, p = 0.004). NICU admission, NAS, mode of delivery, cord toxicology, and breastfeeding rates were not statistically different between the two groups. Hepatitis C rates were significantly higher in the intervention vs. non-intervention group (OR = 2.74 95 %CI 1.80 – 4.16). We concluded that the DFMB/ACE program interventions for women with substance use in pregnancy improves some perinatal outcomes for mothers and their newborns.

Abstract Background Genetics education can be integrated into general care medicine through primary care residency programs. A study of primary care residents was done to evaluate quality, satisfaction, and barriers in genetics education in residency training programs. Thus, providing more evidence for the necessity for its development and progress. Methods A cross-sectional descriptive self-administered questionnaire survey was delivered to four primary care West Virginia University (WVU) residency training programs in 2020–2021. The anonymous 14-item survey included the following questionnaire domains: general data, genetics training satisfaction, and genetics education barriers. Results The survey response rate was 52% (70/123) and 59 participants completed the survey. Overall, respondents viewed genetic education as critical to their chosen specialty (90%). Trainees at all educational levels obtained their education mostly from class based educational curricula (77% from lectures, 65% from didactic and 49% from grand rounds). The majority of survey respondents indicated insufficient experience with genetic patient care (34% ward genetic consultation, 5% clinic experience, 0% genetic department rotation). The percentage of residents who were satisfied with genetic topics were as follows: basic genetics (57%), capturing family history (82%), initiating basic genetic workup (15%), a basic understanding of the genetic report (23%), basic management surveillance in the genetic patient (18%), understanding the genetic referral and explaining it to a patient (47%). Residents reported barriers to genetic interest included complexity of the field (87%), followed by limited utility of genetics testing (41%). The most common suggestions for improving the genetic education component were to provide more lectures (61%), followed by enhanced advertisement of genetic education resources specifically rotations in the genetics department (22%). Other suggestions include the integration of genetic education in inpatient learning (20%) and providing research experience (7%). Conclusion Primary care residents were satisfied with their genetic knowledge in the classroom and stated a clear need for enhanced hands-on clinical skills and research experience in their current residency training. The survey suggestions for improvement can enhance primary care residents’ genetic training that can lead to advances in rare disease recognition, precision medicine, and improve access to genetics testing.

OBJECTIVES:. Source control is important in management of septic shock. We studied differences in outcomes of patients with sepsis and septic shock who required source control intervention compared with those who did not need such intervention and the effect of the timing of source control on various clinical outcomes. DESIGN:. Prospective observational study from February 28, 2020, to March 31, 2021. SETTING:. Medical ICU of academic quaternary medical center. PATIENTS:. Two hundred five adult (≥18 yr) ICU patients. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Patients were divided into a medical treatment group and a source control group. Patients requiring source control were further divided into early (intervention performed < 24 hr) and late (≥ 24 hr) source control groups. The primary outcomes were 30-day and ICU mortality. Secondary outcomes were ICU and hospital length of stay (LOS), days on mechanical ventilation, and need for renal replacement therapy. A total of 45.9% patients underwent source control. Of these, early source control was performed in 44.7% and late source control in 55.3% of patients. There was no significant difference in 30-day mortality or ICU mortality in the medical versus source control groups or in early versus late source control groups. Compared with the medical group, mean hospital LOS (11.5 vs 17.4 d; p < 0.01) and ICU LOS (5.2 vs 7.7 d; p < 0.01) were longer in the source control group. The hospital LOS (12.5 vs 21.4 d; p < 0.01) and ICU LOS (5.2 vs 9.7 d; p < 0.01) were also longer in patients who had delayed source control than in patients who had early source control. There were no significant differences in other outcomes. CONCLUSIONS:. Although mortality was similar, patients who had delayed source control had a longer ICU and hospital LOS. Early source control may improve health care utilization in septic shock patients.

Abstract Background During the COVID-19 pandemic, telemedicine has provided an alternative to in-person visits for patients practicing social distancing and undergoing quarantine. During this time, there has been a rapid expansion of telemedicine and its implementation in various clinical specialties and settings. In this observational study we aim to examine the utility of telemedicine in a pediatric rheumatology clinic, for 3 months during the COVID-19 pandemic. Methods A review of outpatient pediatric rheumatology telemedicine encounters were conducted from April–June 2020. Telemedicine visits (n = 75) were compared to patients seen in practice over the prior year in office-based visits (March 2019–March 2020) (n = 415). Patient characteristics, information on no-show visits, completed visits, new patient or follow-up status, and if new patients had received a visit within 2 weeks of calling to schedule an appointment were analyzed by chart review. An independent sample t-test and Chi Square statistic was used to determine statical significance between the two groups. A two-proportion z-test was used to compare visit metrics. Results The percentage of new patients utilizing telemedicine (60%) was lower and statistically significant compared to the percentage of new patient office visits (84%) the previous year (p

The Internet of Things (IoT) is a complete ecosystem encompassing various communication technologies, sensors, hardware, and software. IoT cutting-edge technologies and Artificial Intelligence (AI) have enhanced the traditional healthcare system considerably. The conventional healthcare system faces many challenges, including avoidable long wait times, high costs, a conventional method of payment, unnecessary long travel to medical centers, and mandatory periodic doctor visits. A Smart healthcare system, Internet of Things (IoT), and AI are arguably the best-suited tailor-made solutions for all the flaws related to traditional healthcare systems. The primary goal of this study is to determine the impact of IoT, AI, various communication technologies, sensor networks, and disease detection/diagnosis in Cardiac healthcare through a systematic analysis of scholarly articles. Hence, a total of 104 fundamental studies are analyzed for the research questions purposefully defined for this systematic study. The review results show that deep learning emerges as a promising technology along with the combination of IoT in the domain of E-Cardiac care with enhanced accuracy and real-time clinical monitoring. This study also pins down the key benefits and significant challenges for E-Cardiology in the domains of IoT and AI. It further identifies the gaps and future research directions related to E-Cardiology, monitoring various Cardiac parameters, and diagnosis patterns.

Objectives:. The recent conflicting data on the mortality benefit of neuromuscular blocking agents in acute respiratory distress syndrome and the potential adverse effects of continuous neuromuscular blocking agent necessitates that these medications should be used judiciously with dose reduction in mind. The aims of the study were to improve the process of care by provider education of neuromuscular blocking agent titration and monitoring and to determine the impact of clinical endpoint based neuromuscular blocking agent titration protocol. Design:. We conducted a proof-of-concept historically controlled study of protocol-based intervention standardizing paralytic monitoring and titration using clinical variables. Education of the protocol was provided to ICU staff via bedside teaching and workshops. The primary outcomes were the time to reach goal paralysis and cumulative neuromuscular blocking agent dose. Secondary outcomes included maintenance of deeper sedation (Richmond Agitation and Sedation Scale –5) prior to neuromuscular blocking agent initiation, total time on mechanical ventilation, length of stay, and mortality. Setting:. Medical ICU at a quaternary academic hospital between March 2019 and June 2020. Patients:. Adult severe acute respiratory distress syndrome (Pao2/Fio2

Abstract Background Overweight and obesity is a major public health concern that includes associations with the development of cardiovascular disease (CVD) risk factors during childhood and adolescence as well as premature mortality in adults. Despite the high prevalence of childhood and adolescent obesity as well as adult CVD, individual studies as well as previous systematic reviews examining the relationship between childhood obesity and adult CVD have yielded conflicting results. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. Methods Studies were included if they met the following criteria: (1) longitudinal and cohort studies (including case-cohort), (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the original study authors, (4) English-language articles, (5) studies published up to June, 2015, (6) one or more of the following CVD risk factors [systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG)], (7) outcome(s) not self-reported, and (8) exposure measurements (child’s adiposity) assessed by health professionals, trained investigators, or self-reported. Studies were retrieved by searching three electronic databases as well as citation tracking. Fisher’s r to z score was calculated for each study for each outcome. Pooled effect sizes were calculated using random-effects models while risk of bias was assessed using the STROBE instrument. In order to try and identify sources of heterogeneity, random-effects meta-regression was also performed. Results Of the 4840 citations reviewed, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggested that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and significantly and inversely associated with adult HDL (Zr = −0.06; 95% CI: -0.10, −0.02). For those studies that adjusted for adult body mass index (BMI), associations were reversed, suggesting that adult BMI may be a potential mediator. Nine studies had more than 33% of items that placed them at an increased risk for bias. Conclusions The results of this study suggest that childhood obesity may be a risk factor for selected adult CVD risk factors. However, a need exists for additional, higher-quality studies that include, but are not limited to, both unadjusted and adjusted measures such as BMI before any definitive conclusions can be reached. Systematic review and meta-analysis PROSPERO 2015: CRD42015019763 .

The main objective of this study is to present qualitative and quantitative results of the Drug Free Moms and Babies (DFMB) Project pilot program. The program was designed to integrate and evaluate treatment and recovery services for pregnant and postpartum women with substance use disorders. Qualitative assessment was conducted via interviews regarding programmatic design components (four West Virginia sites; 2012–2018). The quantitative assessment utilized a survey that included information on patients' (N = 550) demographic, medical and substance use histories, health care services, and maternal and infant health outcomes. The qualitative results noted that program development for this population is time- and resource-intensive, and implementation requires collaborative team work. A dedicated staff position and team flexibility were critical towards programmatic success. For quantitative results, among the 393 participants that completed the program, urine drug screen data showed a significant reduction of non-prescribed positive screens from 81% (N = 178) positive in the first trimester to 22% (n = 86) positive at delivery, p

Little is known about patterns and correlates of Complementary Health Approaches (CHAs) in chronic pain populations, particularly in rural, underserved communities. This article details the development and implementation of a new survey instrument designed to address this gap, the Complementary Health Approaches for Pain Survey (CHAPS).Following pilot-testing using pre-specified criteria to assess quality and comprehension in our target population, and after feedback regarding face-validity from content experts and stakeholders, the final cross-sectional self-report survey required 10-12 minutes to complete. It contained 69 demographic, lifestyle and health-related factors, and utilized a Transtheoretical Model (TTM) underpinning to assess short- and long-term use of 12 CHAs for pain management. Twenty additional items on pain severity, feelings, clinical outcomes, and activities were assessed using the Short-Form Global Pain Scale (SF-GPS); Internal reliability was assessed using Cronbach's alpha.Investigators conducted consecutive sampling in four West Virginia pain management and rheumatology practices.301 Appalachian adult patients seeking conventional care for pain management.Response rates were high (88% ± 4.1%). High quality and comprehension deemed the CHAPS an appropriate measurement tool in a rural population with pain. Missing data were unrelated to patient characteristics. Participants predominantly experienced chronic pain (93%), had five or more health conditions (56%, Mean = 5.4±3.1), were white (92%), female (57%), and middle-aged (Mean = 55.6 (SD = 13.6) years). Over 40% were disabled (43%) and/or obese (44%, Mean BMI = 33.4±31.5). Additionally, 44% used opioids, 31% used other prescription medications, and 66% used at least one CHA for pain, with 48% using CHAs for greater than 6 months. There was high internal reliability of the SF-GPS (alpha = .93) and satisfactory internal reliability for each of the five TTM stages across (all) twelve CHAs: precontemplation (0.89), contemplation (0.72), preparation (0.75), action (0.70), and maintenance (0.70).The CHAPS is the first comprehensive measurement tool to assess CHA use specifically for pain management. Ease of administration in a population with pain support further use in population- and clinic-based studies in similar populations.