Search

Fatemeh Bakhtari,1 Parvin Sarbakhsh,2 Jalil Daneshvar,1 Devender Bhalla,3,4 Haidar Nadrian5 1Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 3Pôle Universitaire euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African Republic; 4Iranian Epilepsy Association, Tehran, Iran; 5Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Haidar Nadrian Department of Health Education and Promotion, Faculty of HealthTabriz University of Medical Sciences, Office No. 317, Attar-e-Neyshabouri St., Tabriz 6617777541, IranEmail haidarnadrian@gmail.comObjective: The objective of this study was to assess depressive symptoms among rural health workers (RHWs) through a multi-factorial socio-ecological framework (SEF) encompassing personal, interpersonal, organizational and community components.Patients and Methods: A random sample of 394 RHWs in all rural areas of East Azerbaijan and fulfilling our other inclusion criteria were recruited. The participants underwent the Short-Form Beck’s Depression Inventory and a validated researcher-constructed SEF questionnaire, including subscales on personal, interpersonal, organizational and community factors associated with depressive symptoms. Internal consistency and factor structure parameters of the SEF were also calculated.Results: A total of 394 RHWs were screened, of whom 170 (43.2%) had mild to major depressive symptoms. Only 6.8% were identified with major depressive symptoms. The SEF-based scale was found to have acceptable content validity (content validity index and ratio were 0.80 and 0.77, respectively) and reliability (Cronbach’s alpha=0.7). In the structural equation modeling, the fit indices showed our model to fit the data well (χ2=14.06, df=14, χ2/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component (β=− 2.32). Also, “work load and roles interference” (from organizational level, β=− 0.76) and “family/colleague support” (from community level, β=− 1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender (β=1.69), family history of mental illness (β=− 1.48), having chronic illnesses (β=− 1.64) and being religious (β=3.43) were the strongest direct contributors to depressive symptoms.Conclusion: Depressive symptoms were common among RHWs, arising from all personal-, interpersonal-, organizational- and community-level factors. Our SEF had adequate internal consistency and factor structure parameters to be applied in the Middle East and North Africa (MENA) region countries, such as Iran, as a theoretical framework to plan for interventional efforts aiming at preventing depressive symptoms among RHWs. The burden of depressive symptoms should be reduced through multi-factorial interventions and rational perspectives.Keywords: depression, rural healthcare, socio-ecological framework, rural health workers

Kurosh Gharagozli,1– 3 Elham Lotfalinezhad,4,5 Fatemeh Amini,5 Vida Saii,1 Devender Bhalla6– 8 1Iran Epilepsy Association, Tehran, Iran; 2Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Brain Mapping Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran; 5Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 6Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal; 7Sudan League of Epilepsy and Neurology (SLeN), Khartoum, Sudan; 8Pôle Universitaire Euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African RepublicCorrespondence: Devender Bhalla Email bhalla@mail.euclid.intIntroduction: The primary objective of this study was to evaluate fear related to epilepsy and its treatment among those with idiopathic epilepsy. Our secondary objective was to estimate the psychometric properties of a brief Bhalla-Gharagozli Fear in epilepsy Questionnaire (BG-FEQ).Methods: We conducted patient-finding exercise in our study areas through various means to obtain subjects with idiopathic epilepsy. We carefully examined each patient through a detailed case-history examination. Following that, we evaluated fear related to epilepsy by using Bhalla-Gharagozli Fear in Epilepsy Questionnaire (BG-FEQ) across two broad domains: epilepsy and pharmacotherapy.Results: The study obtained 52 subjects (39.0 years; 45.0% males, 70.0% married, 35.0% unqualified, 85.0% active epilepsy, 80.0% generalized seizures) with idiopathic epilepsy. The alpha coefficient was 92.8, with no item-specific coefficient of ≤ 0.91. The alpha coefficient was 0.90 and 0.93 for reporting a “yes” and “no” to the items, respectively. We obtained a two-factor structure of BG-FEQ that provided a cumulative variance of 83.6%. The majority (65.0%) reported at least one fear. The per-patient mean number of the fear element was 2.1 (95% CI 1.1– 3.3), which differed significantly for males and females (1.1, 95% CI 0.4– 2.6 and 3.0, 95% CI 1.4– 4.6, respectively, p=0.03). The most frequent fear was that of addiction and the bad effects of anti-seizure medications (both 45.0%). Upon bootstrap regression after constraining gender, the fear elements were associated with illiteracy, difficulty in understanding epilepsy and sleeping in a prone position. The sample power was 99.0%.Conclusion: There was a significant representation of fear among those with idiopathic epilepsy, especially among the females, particularly the fear of brain tumour, premature death and more frequent/severe seizures over time. At least 65.0% of idiopathic subjects are likely to be affected by at least one fear. The essential mitigating approach should be the education of practitioners towards better identification and therapeutic handling of comorbid constructs, and also for the education of patients and their caregivers towards better awareness and prevention. There is also a need for formal Epilepsy Educators towards better awareness, therapeutic support and prevention of epilepsy.Keywords: idiopathic epilepsy, epidemiology, behavioural, fear, mental health

Haleh Heizomi,1 Zeynab Iraji,2 Rogayeh Vaezi,1 Devender Bhalla,3– 5 Donald E Morisky,6 Haidar Nadrian1,7 1Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 3Pôle Universitaire Euclide, Intergovernmental UN Treaty 49006/49007®, Bangui, Central African Republic; 4Iranian Epilepsy Association®, Tehran, Iran; 5Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal; 6Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 7Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Haidar NadrianDepartment of Health Education and Promotion, Faulty of Health, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Tabriz, IranTel +989181734596Email haidarnadrian@gmail.comObjective: We examined the gender-based associations of health literacy (HL) with self-reported medication adherence (MEDA) among patients with primary hypertension (pHTN).Patients and Methods: The subjects were recruited from the general population through all health centers of the Heris county, east Azarbaijan. They were to be adults (30+ years age), with pHTN of any stage, of any gender, and without comorbid illness. All underwent detailed face-to-face interview. We used valid questionnaires for HL and MEDA. Hierarchical regression was done to establish the association between MEDA, socio-demographic variables, and nine HL domains by gender. Other statistical procedures were also done.Results: A total of 300 (48.6% males, mean age: 56.7± 9.3) subjects participated; 43.0% were uneducated, 73.0% had moderate socioeconomic status, 68.0% had poor HL, and 7.0% maintained high adherence. Men were better in reading skills (p=0.002), and accessing (p=0.01) and using (p=0.02) health information, but women were better in health knowledge (p=0.004). The average regression estimate (±standard deviation) between HL and MEDA was 0.37± 0.09, lower among men (0.361± 0.11) than women (0.396± 0.08), p=0.003. Upon hierarchical regression, the association between HL and MEDA was significant for communication and decision-making skills alone among both men (34.5%) and women (40.6%), individually.Conclusion: HL had substantial association with MEDA among those with HTN, for both men and women, particularly the communication and decision-making. With considerations on gender differences, this association should be confirmed through interventional studies to help make HL a formal mitigating strategy for MEDA and other public health goals.Keywords: medication adherence, health literacy, hypertension, gender

The article offers information on the 'Women Legislators: Building Resurgent India' Conference held in New Delhi, India, from March 5-6, 2016. The event featured President of India, Pranab Mukherjee, Vice-President Mohammad Hamid Ansari and Prime Minister Narendra Modi. It discussed the role of women in economic development, power and responsibility of women legislators, and women empowerment.

Background: Rapid diagnosis of stroke and its subtypes is critical in early stages. We aimed to discover and validate blood-based protein biomarkers to differentiate ischemic stroke (IS) from intracerebral haemorrhage (ICH) using high-throughput proteomics., Methods: We collected serum samples within 24 h from acute stroke (IS & ICH) and mimics patients. In the discovery phase, SWATH-MS proteomics identified differentially expressed proteins, which were validated using targeted proteomics in the validation phase. We conducted interaction network and pathway analyses using Cytoscape 3.10.0. We determined cut-off points using the Youden Index. We developed three prediction models using multivariable logistic regression analyses. We assessed the model performance using statistical tests., Results: We included 20 IS and 20 ICH in the discovery phase and 150 IS, 150 ICH, and six stroke mimics in the validation phase. We quantified 375 proteins using SWATH-MS. Between IS and ICH, we discovered 20 differentially expressed proteins. In the validation phase, the combined prediction model including three biomarkers: GFAP (aOR 0.04; 95%CI .02-.11), MMP-9 (aOR .09; .03-.28), APO-C1 (aOR 5.76; 2.66-12.47) and clinical variables independently differentiated IS from ICH (accuracy: 92%, negative predictive value: 94%). Adding biomarkers to clinical variables improved discrimination by 26% (p < .001). Additionally, nine biomarkers differentiated IS from ICH within 6 h, while three biomarkers differentiated IS from mimics., Conclusions: Our study demonstrated that GFAP, MMP-9 and APO-C1 biomarkers independently differentiated IS from ICH within 24 h and significantly improved the discrimination ability of prediction models. Temporal profiling of these biomarkers in the acute phase of stroke is warranted., (© 2024 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

This review is a bird's eye view of the practice of pediatric radiology in India. The key focus of this article is training, certification and employment opportunities for radiologists aspiring to specialise in pediatric radiology. Further, we have traced the growth in academic and research opportunities over the past two decades, as well as given a peep into the future trajectory of this speciality. An understanding of these concepts is key to the expansion of pediatric radiologists not just within India, but across the globe., Competing Interests: Declarations. Conflicts of interest: None, (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This review is intended to familiarize readers with an emerging group of fungal infections that mostly manifest in immunocompetent individuals. This group was initially considered endemic to the tropics, but increasing worldwide prevalence has been reported. The organisms have been divided into dominant non-invasive forms and dominant invasive forms for ease of understanding. The non-invasive organisms include the group Entomophthoromycota, under which two genera Basidiobolus and Conidiobolus, have been identified as human pathogens. They present with plaques in the extremities and rhinofacial region, respectively. The invasive organisms are dematiaceous fungi (phaeohypomycosis), which includes Cladophialophora and Exophiala among others. They cause invasion of deep tissues, with the central nervous system being the most common target. The mycology, epidemiology, diagnosis, and treatment options have been summarized in brief. The clinical presentation, imaging manifestations, differentiation from other common infections and malignancies that show similar features have been detailed., Competing Interests: Declarations. Conflicts of interest: Manisha Jana is an editorial board member for Pediatric Radiology. Other authors: None., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The incidence of heart failure (HF) in India is estimated to be 0.5-1.7 cases per 1,000 people per year, and approximately 4,92,000-1.8 million new cases are detected every year. Despite the high rate of mortality associated with HF, most patients do not receive maximal guideline-directed medical therapy (GDMT). Current guidelines advocate early multidrug combination therapy with four classes of drugs, namely, beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose transport protein 2 inhibitors (SGLT-2is), particularly in patients with heart failure with reduced ejection fraction (HFrEF). ARNIs reduce cardiac morbidity and mortality in patients with HFrEF. However, recent data indicated that only 4.8% of patients with HFrEF receive ARNI in India. Hence, at a national consensus on HF meeting, cardiology experts from India formulated a national consensus on the use of ARNI in HF based on current evidence and guidelines. The consensus states that ARNI should be used early in HF, particularly in de novo patients with HFrEF, and those with acute decompensated heart failure (ADHF), irrespective of the presence of low systolic blood pressure (SBP) or diabetes. Moreover, those with HFrEF on renin-angiotensin-aldosterone system (RAAS) inhibitors should be switched to ARNI to reduce the risk of repeated hospitalization for HF, worsening HF, and cardiac death, and to improve the quality of life (QoL). Starting ARNI during the first hospitalization is preferable, and it is safe and effective across all doses. ARNIs can also be used for secondary benefits in patients with preserved ejection fraction [heart failure with preserved ejection fraction (HFpEF)] and HF with mildly reduced EF [heart failure with mildly reduced ejection fraction (HFmrEF)]., (© Journal of the Association of Physicians of India 2024.)

Rheumatic disorders in children include inflammatory arthritis, inflammatory bone disorders such as chronic nonbacterial osteomyelitis (CNO), connective tissue disorders, and vasculitides (juvenile dermatomyositis, scleroderma). The diagnosis in these children is based on a combination of history, clinical examination, and laboratory investigations. Radiographs play an important role in children with arthritis, who have atypical presentation or for assessment of disease-related damage and differentiation from mimics. Further, radiographs also have an ancillary role in the assessment of musculoskeletal disorders such as dermatomyositis and hemophilia. This review seeks to present a detailed analysis of the specific indications and advantages of radiographs in the situations. Further, a structured reporting format for assessment of radiographs in pediatric rheumatic disorders has also been presented for the reader's reference., Competing Interests: Conflict of Interest None declared., (Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based "HIV Prevention and Awareness Program (HIV-PAP)" on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50-65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R 2  = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (β = 0.331), perceived norms (β = 0.945), and perceived barriers (β = 0.258)], condom use negotiation (β = 1.386), and environmental factors (β = 0.333). Our IM-based framework had an adequate fit index (χ 2  = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) - .38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI - 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI - 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI - 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities., (© Journal of the Association of Physicians of India 2024.)

Stüve-Wiedemann syndrome (SWS) is a rare autosomal recessive disorder that is characterized by bowing of long bones, dysautonomia, temperature dysregulation, swallowing and feeding difficulties, and frequent respiratory infections. Respiratory distress and hyperthermic events are the leading causes of early neonatal death, and most patients are not expected to survive past infancy. Here, we report on the survival of a 5-year-old male with SWS, discussing his case presentation, providing a brief clinical course, and discussing the outcome. This case adds to the literature surrounding rare instances of childhood survivors of SWS and raises awareness for this syndrome to facilitate an earlier recognition, intervention, and genetic counseling for the families, thereby improving understanding of this disease and the health outcomes for the children affected by this condition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Bhalla, Sati, Basel and Karody.)

A significant rise in metabolic disorders, frequently brought on by lifestyle choices, is alarming. A wide range of preliminary studies indicates the significance of the gut-brain axis, which regulates bidirectional signaling between the gastrointestinal tract and the cognitive system, and is crucial for regulating host metabolism and cognition. Intimate connections between the brain and the gastrointestinal tract provide a network of neurohumoral transmission that can transmit in both directions. The gut-brain axis successfully establishes that the wellness of the brain is always correlated with the extent to which the gut operates. Research on the gut-brain axis has historically concentrated on how psychological health affects how well the gastrointestinal system works. The latest studies, however, revealed that the gut microbiota interacts with the brain via the gut-brain axis to control phenotypic changes in the brain and in behavior. This study addresses the significance of the gut microbiota, the role of the gut-brain axis in management of various metabolic disorders, the hormonal and neural signaling pathways and the therapeutic treatments available. Its objective is to establish the significance of the gut-brain axis in metabolic disorders accurately and examine the link between the two while evaluating the therapeutic strategies to be incorporated in the future., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF., (© Journal of the Association of Physicians of India 2024.)

The rapidly increasing burden of hypertension is responsible for premature deaths from cardiovascular disease (CVD), renal disease, and stroke, with a tremendous public health and financial burden. Hypertension detection, treatment, and control vary worldwide; it is still low, particularly in low- and middle-income countries (LMICs). High blood pressure (BP) and CVD risk have a strong, linear, and independent association. They contribute to alarming numbers of all-cause and CVD deaths. A major culprit for increased hypertension is sympathetic activity, and further complications of hypertension are heart failure, ischemic heart disease (IHD), stroke, and renal failure. Now, antihypertensive interventions have emerged as a global public health priority to reduce BP-related morbidity and mortality. Calcium channel blockers (CCB) are highly effective vasodilators. and the most common drugs used for managing hypertension and CVD. Cilnidipine, with both L- and N-type calcium channel blocking activity, is a promising 4th generation CCB. It causes vasodilation via L-type calcium channel blockade and inhibits the sympathetic nervous system (SNS) via N-type calcium channel blockade. Cilnidipine, which acts as a dual L/N-type CCB, is linked to a reduced occurrence of pedal edema compared to amlodipine, which solely blocks L-type calcium channels. The antihypertensive properties of cilnidipine are very substantial, with low BP variability and long-acting properties. It is beneficial for hypertensive patients to deal with morning hypertension and for patients with abnormal nocturnal BP due to exaggerated sympathetic nerve activation. Besides its BP-lowering effect, it also exhibits organ protection via sympathetic nerve inhibition and renin-angiotensin-aldosterone system inhibition; it controls heart rate and proteinuria. Reno-protective, neuroprotective, and cardioprotective effects of cilnidipine have been well-documented and demonstrated., (© Journal of the Association of Physicians of India 2024.)

In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective β-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a β-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF., (© Journal of the Association of Physicians of India 2023.)

Objective: To determine the utility of whole-body magnetic resonance imaging (WB MRI) to predict relapse in children with juvenile idiopathic arthritis (JIA) in clinical remission., Methods: Consecutive patients with JIA who fulfilled the Wallace criteria for remission were recruited into this longitudinal pilot study and underwent WB MRI. A radiological score was devised, incorporating synovitis, bone marrow edema, sacroiliitis, enthesitis, and bone erosions. Two readers independently scored the MR data sets. The same score was calculated for both knee joints individually and correlated with outcome for that joint. Score-based models incorporating clinical and laboratory variables were generated. Logistic regression analysis was done to determine predictors for relapse. Receiver operating characteristic curve was drawn for significant variables., Results: Twenty-two children (median age, 12 years; interquartile range, 9.5-14.25 years) were included in the final analysis. At 24 months' follow-up, 15 joints in 5 children relapsed; knee was the most common site. Seven knee joints had disease relapse. On univariate analysis, synovitis and total score on WB MRI were significant predictors of relapse at follow-up, with odds ratios of 9.46 (bias-corrected 95% confidence interval, 3.07-29.13) and 2.8 (bias-corrected 95% confidence interval, 1.23-6.39) respectively. Two models, which included a higher number of joints involved at presentation and abrupt drug withdrawal strategy as predictor variables, were also statistically significant (odds ratio, approximately 1.9). On multivariate analysis of the predictors variables in models where p < 0.6, it was found that only synovitis score and total score were near statistical significance ( p = 0.06); no clinical or laboratory variables were significant. The areas under the receiver operating characteristic curve for relapse prediction were approximately 0.82, 0.87, 0.79, and 0.81 for synovitis score, total MRI score, and both models, respectively., Conclusion: Synovitis on WB MRI is the strongest independent predictor for disease relapse in children with JIA in remission., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Whole-body magnetic resonance imaging (MRI) has been investigated by multiple authors as a radiation-free alternative to positron emission tomography computed tomography (PET-CT) in children with lymphoma., Objective: To evaluate the sensitivity, specificity, and diagnostic odds ratio of whole-body MRI compared to PET-CT for the staging of pediatric lymphoma., Methods: The databases PubMed, Embase, and Scopus were searched for studies that reported the accuracy of whole-body MRI compared to PET-CT for lymphoma staging in children. Data was collected from included studies to formulate 2 × 2 contingency tables, including the number of true positive, true negative, false positive, and false negative. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated. Summary receiver operating characteristic curves were drawn and the area under the curve (AUC) calculated. In addition, the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool was used to assess the risk of bias and applicability concerns., Results: A total of seven studies were included in the final analysis. Of these, six studies used unenhanced whole-body MRI. The pooled sensitivity of whole-body MRI-based staging was 95.8%, while the pooled specificity was 21.8%. The DOR for whole-body MRI was 1.19. For extranodal staging, the pooled sensitivity was 88.9%, specificity was 97.4%, and DOR was 25.29. The partial AUC for overall staging was 0.63, whereas that for extranodal staging stood at 0.88. Based on the QUADAS 2 tool, all seven studies were at risk of bias (six at high risk, one at unclear risk)., Conclusion: Whole-body MRI has high sensitivity for staging of pediatric lymphoma and may be a useful alternative to PET-CT., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background  Although abundant literature is currently available on the use of deep learning for breast cancer detection in mammography, the quality of such literature is widely variable. Purpose  To evaluate published literature on breast cancer detection in mammography for reproducibility and to ascertain best practices for model design. Methods  The PubMed and Scopus databases were searched to identify records that described the use of deep learning to detect lesions or classify images into cancer or noncancer. A modification of Quality Assessment of Diagnostic Accuracy Studies (mQUADAS-2) tool was developed for this review and was applied to the included studies. Results of reported studies (area under curve [AUC] of receiver operator curve [ROC] curve, sensitivity, specificity) were recorded. Results  A total of 12,123 records were screened, of which 107 fit the inclusion criteria. Training and test datasets, key idea behind model architecture, and results were recorded for these studies. Based on mQUADAS-2 assessment, 103 studies had high risk of bias due to nonrepresentative patient selection. Four studies were of adequate quality, of which three trained their own model, and one used a commercial network. Ensemble models were used in two of these. Common strategies used for model training included patch classifiers, image classification networks (ResNet in 67%), and object detection networks (RetinaNet in 67%). The highest reported AUC was 0.927 ± 0.008 on a screening dataset, while it reached 0.945 (0.919-0.968) on an enriched subset. Higher values of AUC (0.955) and specificity (98.5%) were reached when combined radiologist and Artificial Intelligence readings were used than either of them alone. None of the studies provided explainability beyond localization accuracy. None of the studies have studied interaction between AI and radiologist in a real world setting. Conclusion  While deep learning holds much promise in mammography interpretation, evaluation in a reproducible clinical setting and explainable networks are the need of the hour., Competing Interests: Conflict of Interest None declared., (Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

The Aryl hydrocarbon receptor is an ancient transcriptional factor originally discovered as a sensor of dioxin. In addition to its function as a receptor of environmental toxicants, it plays an important role in development. Although a significant amount of research has been carried out to understand the AHR signal transduction pathway and its involvement in species' susceptibility to environmental toxicants, none of them to date has comprehensively studied its evolutionary origins. Studying the evolutionary origins of molecules can inform ancestral relationships of genes. The vertebrate genome has been shaped by two rounds of whole-genome duplications (WGD) at the base of vertebrate evolution approximately 600 million years ago, followed by lineage-specific gene losses, which often complicate the assignment of orthology. It is crucial to understand the evolutionary origins of this transcription factor and its partners, to distinguish orthologs from ancient non-orthologous homologs. In this study, we have investigated the evolutionary origins of proteins involved in the AHR pathway. Our results provide evidence of gene loss and duplications, crucial for understanding the functional connectivity of humans and model species. Multiple studies have shown that 2R-ohnologs (genes and proteins that have survived from the 2R-WGD) are enriched in signaling components relevant to developmental disorders and cancer. Our findings provide a link between the AHR pathway's evolutionary trajectory and its potential mechanistic involvement in pathogenesis., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: We report a case of biopsy-proven prostate cancer metastasis to the rectum and presumed metastasis to a mesorectal lymph node, identified as radiotracer-avid lesions on prostate-specific membrane antigen PET/CT during workup for biochemically recurrent prostate cancer. This case adds to a growing number of atypical sites of metastatic prostate cancer being reported since the approval of prostate-specific membrane antigen PET/CT for staging of prostate cancer., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To determine high resolution CT (HRCT) patterns of pulmonary fibrosis (PF) in children; and their etiological correlates., Methods: This was a retrospective study involving 149 children with diffuse lung disease (DLD). Patterns of involvement were classified based on dominant lung finding as ground glass opacity (GGO) dominant, nodule dominant, cystic lung disease, or PF. Patterns of PF were classified based on distribution and morphology into airway centric fibrosis (ACF), subpleural fibrosis (SPF), progressive massive fibrosis (PMF) and fibrocavitary. A comparison was made between the two dominant groups for apicobasal distribution, associated findings (GGO, nodules, cysts), and pulmonary artery hypertension (PAH)., Results: Nineteen patients showed PF on HRCT. ACF was commonest (52.6%), followed by SPF (42.1%). The common etiology was sarcoidosis (30%) in ACF, and connective tissue disorders (CTD) (50%) in SPF. Significant difference was found between ACF and SPF in apicobasal distribution (p = 0.04), presence of nodules (p = 0.03), and cysts (p = 0.02)., Conclusion: PF may present as an end stage of several childhood lung diseases. PF on imaging has discernible morphological patterns that correlate with underlying etiology., (© 2022. Dr. K C Chaudhuri Foundation.)

;Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril-Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril-Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril-Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril-Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40-50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk., (© Journal of the Association of Physicians of India 2011.)

Summary: Xpaths is a collection of algorithms that allow for the prediction of compound-induced molecular mechanisms of action by integrating phenotypic endpoints of different species; and proposes follow-up tests for model organisms to validate these pathway predictions. The Xpaths algorithms are applied to predict developmental and reproductive toxicity (DART) and implemented into an in silico platform, called DARTpaths., Availability and Implementation: All code is available on GitHub https://github.com/Xpaths/dartpaths-app under Apache license 2.0, detailed overview with demo is available at https://www.vivaltes.com/dartpaths/., Supplementary Information: Supplementary data are available at Bioinformatics online., (© The Author(s) 2022. Published by Oxford University Press.)

With the rapid integration of artificial intelligence into medical practice, there has been an exponential increase in the number of scientific papers and industry players offering models designed for various tasks. Understanding these, however, is difficult for a radiologist in practice, given the core mathematical principles and complicated terminology involved. This review aims to elucidate the core mathematical concepts of both machine learning and deep learning models, explaining the various steps and common terminology in common layman language. Thus, by the end of this article, the reader should be able to understand the basics of how prediction models are built and trained, including challenges faced and how to avoid them. The reader would also be equipped to adequately evaluate various models, and take a decision on whether a model is likely to perform adequately in the real-world setting., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Anorectal malformations (ARMs) encompass a complex spectrum of congenital anomalies and H/N type anorectal malformations are extremely rare. In the presence of colostomy, an augmented pressure colostogram with or without retrograde or micturating cystourethrogram is the investigation of choice. Transperineal ultrasound is an imaging technique that allows a fairly accurate morphological assessment of ARMs along with dynamic evaluation of the anorectal structures and pelvic floor anatomy. Here we describe the role of transperineal ultrasound as an adjunctive modality in diagnosis of one such complex anomaly., Competing Interests: Conflict of Interest None declared., (Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: We assessed knowledge, attitude, and practice regarding two malaria prevention measures (long-lasting impregnated mosquito nets, LLINs, and intermittent preventative therapy with sulphadoxine-pyrimethamine (IPTp-SP)) among pregnant women in Nigeria., Methods: Pregnant women selected from among the four communities of Nnewi were interviewed by using a semistructured, interviewer-administered questionnaire on the respondents' demography, knowledge of the cause, consequences, and malaria prevention methods. Also, a total of 48 focused group discussions, 24 key informant interviews, and 24 in-depth interviews were held among women leaders, village heads, pregnant women, community health workers, husbands of pregnant wives, and drug and insecticide-treated net sellers., Results: A total of 384 women (88.0% third trimester, 90.0% literate, and 41.1% primigravidae) participated. About 80.0% suffered from malaria during their current pregnancy. The majority was aware of the cause of malaria, local name of malaria, mode of transmission, risk of malaria among pregnant women, etc. However, their knowledge and attitude were inadequate regarding the symptomatology and complications of malaria in pregnancy, benefits of sleeping under the net or taking chemoprophylactic doses, or the concurrent use of both. About 80.0% had LLINs, yet only 41.5% slept under it the previous night. Only 31.0% had IPTp-SP doses under direct observation. Only 35.9% had a good understanding of IPTp-SP during pregnancy., Conclusion: Our work presents important practice gaps associated with the prevention of malaria during pregnancy. The pregnant women seemed to be aware of the basic concepts related to malaria but that does not translate into adequate attitude and practice necessary for malaria reduction., Competing Interests: The last author receives research funds and attends and gives talk in meetings that may have been funded directly or indirectly by commercial entities. All other authors have no conflicts of interest., (Copyright © 2022 Stephen Kalu et al.)

Background and Purposes: Recent developments in high-throughput proteomic approach have shown the potential to discover biomarkers for diagnosing acute stroke and to elucidate the pathomechanisms specific to different stroke subtypes. We aimed to determine blood-based protein biomarkers to diagnose total stroke (IS+ICH) from healthy controls, ischemic stroke (IS) from healthy controls, and intracerebral hemorrhage (ICH) from healthy control subjects within 24 h using a discovery-based SWATH-MS proteomic approach., Methods: In this discovery phase study, serum samples were collected within 24 h from acute stroke (IS & ICH) patients and healthy controls and were subjected to SWATH-MS-based untargeted proteomics. For protein identification, a high-pH fractionated peptide library for human serum proteins (obtained from SCIEX) comprising of 465 proteins was used. Significantly differentially expressed (SDE) proteins were selected using the following criteria: >1.5-fold change for upregulated, < 0.67 for downregulated, p- value < 0.05, and confirmed/tentative selection using Boruta random forest. Protein-protein interaction network analysis and the functional enrichment analysis were conducted using STRING 11 online tool, g:Profiler tool and Cytoscape 3.9.0 software. The statistical analyses were conducted in R version 3.6.2., Results: Our study included 40 stroke cases (20 IS, 20 ICH) within 24 h and 40 age-, sex-, hypertension-, and diabetes-matched healthy controls. We quantified 375 proteins between the stroke cases and control groups through SWATH-MS analysis. We observed 31 SDE proteins between total stroke and controls, 16 SDE proteins between IS and controls, and 41 SDE proteins between ICH and controls within 24 h. Four proteins [ceruloplasmin, alpha-1-antitrypsin (SERPINA1), von Willebrand factor (vWF), and coagulation factor XIII B chain (F13B)] commonly differentiated total stroke, IS, and ICH from healthy control subjects. The most common significant pathways in stroke cases involved complement and coagulation cascades, platelet degranulation, immune-related processes, acute phase response, lipid-related processes, and pathways related to extracellular space and matrix., Conclusion: Our discovery phase study identified potential protein biomarker candidates for the diagnosis of acute stroke and highlighted significant pathways associated with different stroke subtypes. These potential biomarker candidates warrant further validation in future studies with a large cohort of stroke patients to investigate their diagnostic performance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Misra, Singh, Nath, Bhalla, Sengupta, Kumar, Pandit, Aggarwal, Srivastava, Mohania, Prasad and Vibha.)

Ultrasonography (US) is the workhorse of pediatric imaging; however, lung US is only a recently developed application. US of the lung is based predominantly on the imaging of chest wall-air-fluid interfaces. In this review, we summarize the available literature on applications of lung US in neonatal as well as pediatric care. We describe the imaging appearance of various commonly encountered pathologies including pneumonia and respiratory distress syndrome, among others, and provide illustrative images. Finally, we describe the limitations of the technique that are essential knowledge for radiologists, critical care physicians, sonographers and technologists attempting to use lung US effectively for diagnosis and management., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: We aimed to determine the role of demographic, lifestyle, and personality trait factors in predicting control of blood pressure (BP) among patients with hypertension (HTN) in West Azerbaijan, Iran. Methods: In this case control study we recruited participants from all primary health centers of Salmas city; who were at least 18 years of age, had a HTN diagnosis during the previous six months, and had a mandatory household record. Of 490 random subjects approached, 441 (84.2%) fulfilled our inclusion criteria (case: 221; control: 220). The age-matched controls were recruited from the same source population and were required to have controlled HTN. Data were collected through demographic Checklist, Ten-Item Personality Inventory (TIPI) and International Physical Activity Questionnaire (IPAQ). Results: Upon multivariate analyses, factors related to personality traits subdomains including extraversion personality (odd ratio [OR]: 0.85; CI: 0.73, 0.97) was effective in control of BP. Factors related to uncontrolled BP were agreement and consciences subdomains (OR 1.26 [CI: 1.07, 1.48] and OR 1.21 [CI: 1. 02, 1.44]), rare fruit consumption (OR 5.95 [CI: 1.24, 12.1]), Grade 1 and 2 obesities (OR 2.29 [CI: 1.28, 4.09] and OR 7.11 [CI: 2.21, 12.52]) and smoking (OR 3.27 [CI: 1.56, 6.89]). Conclusion: In addition to regular physical activity and fruit consumption and quitting smoking; personality traits such as Agreement and conscience personality traits were predictive of HTN control. We believe our work provides the required knowledge to design comprehensive HTN prevention programs by taking into account the multi-level causality approach., (© 2022 The Author(s).)

Objective: This study aims to evaluate the utility of computed tomography angiography (CTA) signs of vascular injury in the differentiation of vessel transection from pure thrombosis with intact vessel wall., Methods: Retrospective analysis was done on 146 consecutive patients who had undergone CTA and surgical exploration from January 2015 to September 2019. Twelve imaging parameters were assessed. Chi-square was used to test the difference between groups. In addition, a scoring system was devised where one point each was added for the presence of 5 signs and absence of 3 signs. ROC analysis was done for the variables which had shown significant difference between groups and for the composite score., Results: On surgical exploration, 87 patients had transection of vessel, while 59 had thrombosis. Significant difference was found among the two groups in non-opacification, pseudoaneurysm, extravasation (p = 0.04 each), thrombosed cord (p < 0.001), collaterals (p = 0.001) and hematoma (p = 0.002), while other signs did not show significant difference. The AUC value for each of these variables was < 0.650, while for the score, AUC was .843(.773-.913). A cut-off value of ≥ 1.5 gave 83.1% sensitivity and 70% specificity for diagnosing transection., Conclusion: CTA is a useful tool to classify the nature of vascular injury. It is advisable to use a composite score for maximum diagnostic value., (© 2022. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).)

Background: Tracheobronchial (TB) tumors follow same pathological classification as lung neoplasms; however, some entities are known to favor airways. Distinction of pathological types is necessary for suggesting appropriate management strategy., Purpose: To evaluate utility of multidetector CT (MDCT) in differentiation of primary TB tumors; and assess validity of a scoring system based on imaging biomarkers to differentiate tumor types., Methods: MDCT features of 45 patients were analyzed for location, shape, calcification, attenuation, parenchymal changes, bronchoceles, extraluminal extension, lymphadenopathy, metastases. The two largest groups were compared with each other and remaining entities using Chi square tests. Six-point scoring system combining the differentiating features was devised and receiver operating characteristic curve analysis performed., Results: The most frequent type was neuroendocrine tumors (NET) (51.1%), followed by salivary gland tumors (SGT) (20%); including adenoid cystic carcinoma (ACC) (13.3%) and mucoepidermoid carcinoma (MEC) (6.7%). Comparing NETs with other entities as a whole, and independently with SGTs, significant difference was found among location (p = 0.05 and 0.001 respectively), shape (p < 0.001), calcification (p = 0.038 and 0.041 respectively), attenuation (p = 0.001 and 0.019 respectively), bronchoceles (p = 0.013 and 0.010 respectively). Significant difference was found among ACC and MEC in location (p = 0.01) and morphology (p < 0.001). On receiver operating characteristic (ROC) curve analysis of the score, areas under curve for NET, SGT and ACC were 0.913, 0.872 and 0.962 respectively. Suggested cut-off values were >3.5 for carcinoid (sensitivity 70%, specificity 91%), <2.5 for SGT (sensitivity 78%, specificity 75%), <1.5 for ACC (sensitivity 83%, specificity 92%)., Conclusion: Use of a scoring system enables maximum diagnostic accuracy in MDCT differentiation of TB tumors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Ultrasonography (US) forms the mainstay of imaging in children; however, in the chest, its use has traditionally been limited to evaluation of pleural pathology. US techniques such as endobronchial and endoscopic ultrasound, which are commonly used for detection of mediastinal lymphadenopathy are invasive, aerosol generating, and often require sedation. Transcutaneous mediastinal sonography (TMUS) offers a useful alternative, which is easier to perform and overcomes these limitations. In this review, we summarize the technique, as well as imaging appearances of lymph nodes on TMUS. We also list common problems faced by operators and suggest troubleshooting methods for these., (© 2021 American Institute of Ultrasound in Medicine.)

Hemorrhage is the most frequently encountered post renal biopsy complication; reported in 12% to 14% of patients. Although the vast majority of these are due to renal artery injury, involvement of gonadal arteries is also rarely seen. These may be managed by the endovascular route, which has several limitations in this subset of patients. We report a case of a 69-year-old male with rapidly progressive glomerulonephritis, who underwent renal biopsy and developed a testicular artery pseudoaneurysm (PA). Successful embolization of this PA was performed under ultrasound guidance using a direct percutaneous approach. This is the first such case reported in the literature., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Nephrology.)

Competing Interests: None

With the lack of respite care, caregivers will often suffer from physical, mental, and financial hardships. In the Middle East and North African countries, religion and cultural considerations may pull in opposite directions as a vast majority of families in the region care for their loved ones at home. Moreover, the sense of responsibility and obligations toward caring for an older family member also influences caregivers' decision-making, even though such considerations may deprive them of even a short vacation or break. It is important for policymakers and stakeholders, in close participation with families and older adults receiving care, to take into account how various factors related to social, cultural, and religious matters affect quality of care and the well-being of care recipients and caregivers. Official policies could have an essential role in opening new avenues for temporary respite care, but authorities should be aware of the importance of cultural and religious principles while setting up such policies. Therefore, policymakers should engage with the relevant organizations, such as municipalities, nongovernmental organizations, charities, and religious institutions, to help the health system in establishing respite care facilities. In this article, we discuss a number of key issues and provide suggestions as to how this goal might be achieved. The availability of respite services could have a positive influence on the physical and mental health of both older adults in need of care and informal caregivers. In conclusion, those receiving care, caregivers, and the public health-care system will gain from the development of a range of respite care services., (© 2021 S. Karger AG, Basel.)

Background: Primary extramedullary plasmacytomas (EMP) are rare; however, secondary forms may be seen in ~10-15% of patients with systemic multiple myeloma (MM). The diagnosis of EMP is based on the demonstration of monoclonal plasma cells in the lesion, which requires tissue sampling., Case Presentation: We present a case of a 38 year old female with MM who underwent diagnostic US at our institute. Multiple focal liver lesions were detected, which were suspicious for EMP. She underwent fine needle aspiration cytology (FNAC) for diagnosis, following which she developed hemoperitoneum secondary to deranged clotting parameters (prothrombin time and platelet count). CT angiography revealed active hepatic capsular bleed. She was taken up for percutaneous embolisation, and the supplying vessel successfully embolised using gel foam particles., Conclusion: Complications may rarely occur in interventional procedures, particularly in patients with comorbidities. However, prompt diagnosis and management help prevent adverse outcomes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)