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BACKGROUND: Outcome measures are crucial to support a treat-to-target approach to rheumatoid arthritis (RA) care, yet their integration into clinical practice remains inconsistent. We developed an Electronic Heath Record-integrated, patient-facing side-car application to display RA outcomes (disease activity, functional status, pain scores), medications, and lab results during clinical visits (RA PRO Dashboard). The study aimed to evaluate patient perceptions and attitudes towards the implementation of a novel patient-facing dashboard during clinical visits using a mixed-methods approach. METHODS: RA patients whose clinicians used the dashboard at least once during their clinical visit were invited to complete a survey regarding its usefulness in care. We also conducted semi-structured interviews with a subset of patients to assess their perceptions of the dashboard. The interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. Emerging themes and subthemes were organized into four domains of the Ecological Model of Health. RESULTS: Out of 173 survey respondents, 79% were interested in seeing the dashboard again at a future visit, 71% felt it improved their understanding of their disease, and 65% believed it helped with decision-making about their RA care. Many patients reported that the dashboard helped them discuss their RA symptoms (76%) and medications (72%) with their clinician. Interviews with 29 RA patients revealed 10 key themes: the dashboard was perceived as a valuable visual tool that improved patients understanding of RA outcome measures, enhanced their involvement in care, and increased their trust in clinicians and the clinic. Common reported limitations included concerns about reliability of RA outcome questionnaires for some RA patients and inconsistent collection and explanation of these measures by clinicians. CONCLUSIONS: In both the quantitative and qualitative components of the study, patients reported that the dashboard improved their understanding of their RA, enhanced patient-clinician communication, supported shared decision-making, and increased patient engagement in care. These findings support the use of dashboards or similar data visualization tools in RA care and can be used in future interventions to address challenges in data collection and patient education.

Brain aging process is influenced by various lifestyle, environmental and genetic factors, as well as by age-related and often coexisting pathologies. Magnetic resonance imaging and artificial intelligence methods have been instrumental in understanding neuroanatomical changes that occur during aging. Large, diverse population studies enable identifying comprehensive and representative brain change patterns resulting from distinct but overlapping pathological and biological factors, revealing intersections and heterogeneity in affected brain regions and clinical phenotypes. Herein, we leverage a state-of-the-art deep-representation learning method, Surreal-GAN, and present methodological advances and extensive experimental results elucidating brain aging heterogeneity in a cohort of 49,482 individuals from 11 studies. Five dominant patterns of brain atrophy were identified and quantified for each individual by respective measures, R-indices. Their associations with biomedical, lifestyle and genetic factors provide insights into the etiology of observed variances, suggesting their potential as brain endophenotypes for genetic and lifestyle risks. Furthermore, baseline R-indices predict disease progression and mortality, capturing early changes as supplementary prognostic markers. These R-indices establish a dimensional approach to measuring aging trajectories and related brain changes. They hold promise for precise diagnostics, especially at preclinical stages, facilitating personalized patient management and targeted clinical trial recruitment based on specific brain endophenotypic expression and prognosis.

BACKGROUND: Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (RA PRO dashboard). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic. METHODS: We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM). RESULTS: 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients. CONCLUSIONS: The study provides valuable insights into clinicians perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

Immune checkpoint inhibitor (ICI) therapy has revolutionized oncology, but treatments are limited by immune-related adverse events, including checkpoint inhibitor colitis (irColitis). Little is understood about the pathogenic mechanisms driving irColitis, which does not readily occur in model organisms, such as mice. To define molecular drivers of irColitis, we used single-cell multi-omics to profile approximately 300,000 cells from the colon mucosa and blood of 13 patients with cancer who developed irColitis (nine on anti-PD-1 or anti-CTLA-4 monotherapy and four on dual ICI therapy; most patients had skin or lung cancer), eight controls on ICI therapy and eight healthy controls. Patients with irColitis showed expanded mucosal Tregs, ITGAEHi CD8 tissue-resident memory T cells expressing CXCL13 and Th17 gene programs and recirculating ITGB2Hi CD8 T cells. Cytotoxic GNLYHi CD4 T cells, recirculating ITGB2Hi CD8 T cells and endothelial cells expressing hypoxia gene programs were further expanded in colitis associated with anti-PD-1/CTLA-4 therapy compared to anti-PD-1 therapy. Luminal epithelial cells in patients with irColitis expressed PCSK9, PD-L1 and interferon-induced signatures associated with apoptosis, increased cell turnover and malabsorption. Together, these data suggest roles for circulating T cells and epithelial-immune crosstalk critical to PD-1/CTLA-4-dependent tolerance and barrier function and identify potential therapeutic targets for irColitis.

Amide cross-couplings that rely on C-N bond activation by transition metal catalysts have emerged as valuable synthetic tools. Despite numerous discoveries in this field, no catalytic asymmetric variants have been disclosed to date. Herein, we demonstrate the first such transformation, which is the Mizoroki-Heck cyclization of amide substrates using asymmetric nickel catalysis. This proof-of-concept study provides an entryway to complex enantioenriched polycyclic scaffolds and advances the field of amide C-N bond activation chemistry.

Abstract Malaria, though witnessing a decline in prevalence, remains a global health threat. Despite its primarily recognized impact on the hematological system, recent studies shed light on severe cardiac complications, particularly myocarditis, associated with Plasmodium infections. This review examines the literature on malaria-induced myocarditis to elucidate its mechanisms, clinical manifestations, regional perspectives, treatment outcomes, and diagnostic challenges. A literature search spanning PubMed, Scopus, and Web of Science identified relevant studies up to January 2024, encompassing case reports, cohort studies, clinical trials, and experimental studies. The relationship between severe malaria and myocardial involvement is explored, showcasing elevated biomarkers indicative of myocardial damage. Notably, while Plasmodium falciparum is traditionally linked to malaria-induced myocarditis, instances of Plasmodium vivax contributing to cardiac complications are documented. Regional perspectives reveal diverse cases, emphasizing the importance of considering malaria-induced myocarditis in endemic regions and beyond. Treatment outcomes underscore the efficacy of timely antimalarial therapy, advocating for integrated approaches to patient care. Diagnostic challenges, often complicated by overlapping symptoms with other cardiac conditions, highlight the need for heightened clinical suspicion. Addressing therapeutic challenges involves balancing antimalarial drugs, supportive care, and long-term monitoring. Future research directions are outlined, emphasizing the necessity for understanding host-parasite interactions, elucidating molecular mechanisms, and developing targeted diagnostic tools. This review consolidates the current knowledge on malaria-induced myocarditis, emphasizing the significance of continuous vigilance, research, and improved diagnostic approaches to mitigate the impact of this overlooked complication.

Seizures, characterized by excessive electrical discharges in the brain, can lead to severe complications, including cardiac arrhythmias and Takotsubo syndrome, a form of stress-induced cardiomyopathy mimicking acute coronary syndrome. We present a case of a 66-year-old female with epilepsy and postcerebrovascular accident status who experienced a 45-minute seizure resulting in elevated troponin levels and ECG changes. Echocardiography revealed severe hypokinesia and hyperkinesia with a left ventricular ejection fraction of 30%-35%, and coronary angiography was normal, leading to the diagnosis of a variant of Takotsubo syndrome characterized by basal rather than apical dysfunction. The patient showed significant improvement after 96 hours in the coronary care unit following adjusted anti-seizure medications and supportive cardiac care. This case highlights the importance of recognizing and managing cardiac complications such as Takotsubo syndrome in patients with neurological events, emphasizing the need for close collaboration between neurology and cardiology to improve patient outcomes.

In the medical diagnostics domain, pathology and histology are pivotal for the precise identification of diseases. Digital histopathology, enhanced by automation, facilitates the efficient analysis of massive amount of biopsy images produced on a daily basis, streamlining the evaluation process. This study focuses in Stain Color Normalization (SCN) within a Whole-Slide Image (WSI) cohort, aiming to reduce batch biases. Building on published graphical method, this research demonstrates a mathematical population or data-driven method that optimizes the dependency on the number of reference WSIs and corresponding aggregate sums, thereby increasing SCN process efficiency. This method expedites the analysis of color convergence 50-fold by using stain vector Euclidean distance analysis, slashing the requirement for reference WSIs by more than half. The approach is validated through a tripartite methodology: 1) Stain vector euclidean distances analysis, 2) Distance computation timing, and 3) Qualitative and quantitative assessments of SCN across cancer tumors regions of interest. The results validate the performance of data-driven SCN method, thus potential to enhance the precision and reliability of computational pathology analyses. This advancement is poised to enhance diagnostic processes, therapeutic strategies, and patient prognosis.

The advent of social media has simplified the rapid publishing of explanations on inclusive announcements, movies, politics, and the economy. This growth has led to an increase in the breadth of topics covered. This emotion analysis includes many aspects. Arabic and OMCD survey big data were integrated with data from Twitter to inform this study. Different word embedding methods were implemented, such as Spacy (W2V), FastText, and Arabic Bidirectional Encoder Representation (AraBERT). In the context of sentiment analysis models, convolutional neural network (CNN), long short-term memory (LSTM), and recurrent neural network (RNN) were employed. The evaluation of model performance was based on accuracy. Deep learning (DL) methods using the AST (Arabic sentiment Twitter) dataset yielded 72% and 95% model accuracy rates. The accuracy rates for the OMCD (Offensive Moroccan Comments Dataset) is a dataset containing offensive comments in the Moroccan dialect. dataset fell within the range of 54% to 84%.

Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to 2023 and identify risk factors for pouchitis. Secondary objectives included evaluating the effectiveness of biological therapy in chronic antibiotic-refractory pouchitis (CARP), Crohn’s disease of the pouch (CDP), and Crohn’s-like inflammation of the pouch (CDLPI), and assessing risk factors for pouch failure. Methods: This retrospective, observational study included 109 patients whose data were collected from medical records. Univariate logistic regression was used to analyze associations between preoperative and postoperative factors and outcomes such as acute pouchitis and pouch failure. The effectiveness of biological therapy was assessed by measuring changes in the Pouchitis Disease Activity Index (PDAI) and the Modified Pouchitis Disease Activity Index (mPDAI) over a 12-month treatment period. Results: Univariate logistic regression revealed significant associations between preoperative extraintestinal manifestations (OR 3.569, 95% CI 1.240–10.720), previous diagnosis of Crohn’s disease (OR 10.675, 95% CI 1.265–90.089), and transmural inflammation at cross-sectional imaging before surgery (OR 3.453, 95% CI 1.193–9.991) with an acute pouchitis risk. Pouch failure was significantly associated with a previous diagnosis of Crohn’s disease (OR 9.500, 95% CI 1.821–49.571) and post-surgical fistulas (OR 41.597, 95% CI 4.022–430.172). Biological therapy led to a significant reduction in the PDAI score in patients with CARP, decreasing from a median of 10 to 4 (p = 0.006). Similarly, in patients with CDP or CDLPI, the mPDAI score was significantly reduced from a median of 9 to 1 (p = 0.034), with remission achieved in 5/6 (83.3%) of these patients. Conclusions: This study provides valuable insights into the management of IPAA patients and highlights the importance of early identification and treatment of risk factors for pouchitis and failure. Biological therapy demonstrated significant effectiveness in reducing disease activity in patients with CARP, CDP, and CDLPI, suggesting its role as a crucial component in managing these complications.

Lina Naseralallah,1 Dima Nasrallah,2 Somaya Koraysh,1 Shimaa Aboelbaha,3 Tarteel Ali Hussain3 1Pharmacy Department, Hamad Medical Corporation, Doha, Qatar; 2College of Medicine, QU Health, Qatar University, Doha, Qatar; 3College of Pharmacy, QU Health, Qatar University, Doha, QatarCorrespondence: Lina Naseralallah, Department of Pharmacy, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, Email LNaseralallah@hamad.qaBackground: Heparin and its derivates, including unfractionated heparin (UFH) and low molecular weight heparin (LMWH), are among the most commonly used anticoagulants. Nonetheless, their use has been associated with hyperkalemia.Objective: To determine and compare the incidence, magnitude, and potential risk factors of hyperkalemia in patients receiving UFH versus LMWH in a real-world clinical setting.Methods: A retrospective observational study was conducted involving all adult hospitalized patients who received UFH, dalteparin or enoxaparin. Electronic medical records were reviewed over a 12-month period, collecting data on demographic, laboratory, comorbidity, and medication-related variables. Data were analyzed using multivariate logistic regression.Results: A total of 929 patients met the eligibility criteria, with a mean age of over 40 years across all groups. Of these, 56.3%, 17.2%, and 15.7% experienced hyperkalemia with UFH, dalteparin and enoxaparin, respectively. The incidence of hyperkalemia was significantly higher with UFH compared to enoxaparin and dalteparin (p< 0.001). Diabetes mellitus was associated with a higher incidence of hyperkalemia (OR 1.79, 95% CI 1.241– 2.581, p=0.002), as was the concomitant use of co-trimoxazole (OR 2.244, 95% CI 1.137– 4.426, p=0.02). Whilst chronic kidney disease and the use of two or more hyperkalemia-inducing agents were not statistically significant, they were retained in the model as they were associated with more than a 10% increase in the odds of hyperkalemia.Conclusion: Heparin (UFH, LMWH) administration was associated with a risk of hyperkalemia particularly in patients with diabetes mellitus and those concurrently receiving co-trimoxazole.Keywords: unfractionated heparin, low molecular weight heparin, hyperkalemia, adverse drug reactions, risk factors

OBJECTIVE: Despite interest in optimizing the electronic health record (EHR) to facilitate chronic disease care for conditions like rheumatoid arthritis (RA), progress in this area has been slow. EHR sidecar applications offer one solution, but little guidance exists to facilitate their successful development, deployment, and maintenance in the healthcare setting. We aimed to provide a roadmap for how to develop and deploy an EHR sidecar application based on our experience building a new EHR-integrated, patient-facing visualization tool that displayed disease outcomes to RA patients during a clinical visit (the RA PRO dashboard) in a large academic health center. METHODS: We describe the technical design and implementation of the RA PRO dashboard; report clinic workflow adaptations to incorporate this new technology; and discuss the resources required and challenges encountered in maintaining this application. RESULTS: The RA PRO dashboard required extensive human-centered design work, regulatory approvals, software development, user testing, integration with Epic-based workflows, and maintenance. Key requirements were prioritized based on the anticipated effects on usefulness and ease of use. Implementation science strategies were used to improve use of the dashboard in clinic and included education for patients, staff, and clinicians; reports of actual use of the dashboard and data quality; and regular meetings between the research team and clinicians to discuss and address barriers to use. CONCLUSION: Successful development and deployment of an EHR-integrated application are resource-intensive and require technical, operational, and educational innovations. The roadmap presented in this study can serve as a resource for future developers.

Appropriate oral hygiene significantly reduces the possibility of oral infections. However, dental caries and periodontal diseases are major oral health issues causing chronic diseases due to poor oral health. Recently, herbal compounds have gained interest in maintaining oral health. Extracts of burdock root (Arctium), noni fruit (Morinda citrifolia), and neem leaf (Azadirachta indica) are now used as intracanal medicaments in endodontics and periodontics. Plectranthus amboinicus species and other plants produces essential oil like β-caryophyllene, p-cymene, and γ-terpinene can exhibit antibacterial activity; highlighting phytoconstituents plays a vital role in oral health. The COVID-19 pandemic highlighted the importance of hygiene and sanitization, to curb SARS-CoV-2. Oral cavity is among the gateways for virus entry into saliva. Saliva is a potential reservoir of SARS-CoV-2, and there is an increased risk of infection if there is any fissure in the mouth. This enables entry of virus into the vascular system through gingival or periodontal pocket, possibly reaching lung periphery then to lung vessels by interacting with endothelial surface receptors triggering pulmonary vasoconstriction and lung damage due to endothelial dysfunction. This review aims to draw attention to the possible route of SARS-CoV-2 infection via the oral cavity and the importance of oral hygiene against COVID-19.