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ABSTRACT Objective Medical personnel show difficulty in differentiating psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES). The purpose of this study was to conduct an initial feasibility assessment of the global dynamic impression (GDI) principle and to evaluate its effectiveness in enabling the diagnosis of epileptic versus psychogenic seizures using video footage of events, even by untrained personnel Methods We based this study on video footage showing five videos of PNES and five ES videos. We asked physicians and nurses from the emergency department, internal medicine department, neurology department, and medical students to classify the videos before and after learning the GDI principle. The GDI principle is a simple clinical tool assuming repetitive movements with minimal dynamics in vector and frequency in motor PNES. A correct answer earned a score of 10 points, and a wrong answer a score of 0. Therefore, the questionnaire score could range from 0 to 100. Results A total of 108 medical personnel participated in the study. A total of 42 participants filled out the questionnaire before training—Group 1, and 36 participants filled out the questionnaire after training—Group 2; 30 participants filled out the questionnaire before and after the training—Group 3. The mean score of Group 1 was 55.23 ± 17.83 versus 75.55 ± 13.61 in Group 2 (p = 0.0000001). The mean score of Group 3 was 53 ± 17.8 compared to 78 ± 12.9, before and after training, respectively (p = 0.000001). Significance A brief training on the GDI principle of various medical teams, even unskilled teams, significantly improves differentiating PNES from ES.

Trained immunity (TI) is the process wherein innate immune cells gain functional memory upon exposure to specific ligands or pathogens, leading to augmented inflammatory responses and pathogen clearance upon secondary exposure. While the differentiation of hematopoietic stem cells (HSCs) and reprogramming of bone marrow (BM) progenitors are well-established mechanisms underpinning durable TI protection, remodeling of the cellular architecture within the tissue during TI remains underexplored. Here, we study the effects of peritoneal Bacillus Calmette–Guérin (BCG) administration to find TI-mediated protection in the spleen against a subsequent heterologous infection by the Gram-negative pathogen Salmonella Typhimurium (S.Tm). Utilizing single cell RNA-sequencing and flow cytometry, we discerned STAT1-regulated genes in TI-associated resident and recruited splenic myeloid populations. The temporal dynamics of TI were further elucidated, revealing both early and delayed myeloid subsets with time-dependent, cell-type-specific STAT1 signatures. Using lineage tracing, we find that tissue-resident red pulp macrophages (RPM), initially depleted by BCG exposure, are restored from both tissue-trained, self-renewing macrophages and from bone marrow-derived progenitors, fostering long lasting local defense. Early inhibition of STAT1 activation, using specific JAK-STAT inhibitors, reduces both RPM loss and recruitment of trained monocytes. Our study suggests a temporal window soon after BCG vaccination, in which STAT1-dependent activation of long-lived resident cells in the tissue mediates localized protection.

Conclusion: The findings underscore the effectiveness of psychiatric hospitalization alternatives yet call for the need to investigate further the effectiveness of technologically guided approaches to psychiatric hospitalization.

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) affect gastrointestinal motility, slowing gastric emptying and colonic transit. GLP-1RAs have an impact on gastric residue before endoscopy, but only limited data are available regarding its effect on the adequacy of colonic preparation. We investigated the association between GLP-1RA use and inadequate bowel preparation (IBP) for colonoscopy. Methods We performed a multicenter retrospective study with GLP-1RA cases matched with controls (using propensity scores for age, sex, diabetes mellitus [DM], obesity, and co-morbidities). Data on demographics, medication use, procedural indications, and colonoscopy findings were collected. IBP ("poor preparation" on Aronchik scale or Boston Bowel preparation scale <5) was the primary outcome. Results 4876 patients treated with GLP-1RAs were included in the analysis and compared with 4876 controls selected from 333 648 patients without GLP-1RA use. Among the GLP-1RA patients, 10% (n = 487) had IBP compared with 197 (4%) of the control group (P <0.001). Subgroup analysis showed a higher rate of IBP among diabetic patients treated with GLP-1RA (284/2364 [12%]) than among diabetic patients without GLP-1RA treatment (118/2364 [5%]; P <0.001). Additionally, 203/2512 nondiabetic patients treated with GLP-1RAs had IBP (8%) compared with 79 of the nondiabetic non-GLP-1RA group (3%; P <0.001). On multivariate analysis, diabetes and GLP-1RA use were both found to be independent risk factors for IBP (odds ratio [OR] 1.4 and OR 2.7, respectively; both P <0.001). Conclusion Our findings highlight the necessity for special attention and tailored recommendations for both diabetic and nondiabetic patients treated with GLP-1RAs in terms of colonic preparation prior to colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Home rehabilitation improves patient satisfaction and reduces the need for specialist consultations. Hemodialysis is a costly post-ICU service that requires frequent monitoring. Previous studies have demonstrated the feasibility and accuracy of patients self-scanning their lungs with an ultrasound device within the hospital. Methods: In this single-center, prospective pilot study, we compared the quality of high-risk elderly patient-generated lung ultrasound images against physician-generated images as our primary outcome. The secondary outcome assessed image quality and B-line quantification between a home device and a gold standard device, when operated by the same clinician. Results: We enrolled nine participants (66% male, median age 76 years [IQR 66,79]). Analysis included 402 ultrasound clips (163 patient-generated, 239 physician-generated, and 237 in-clinic gold standard clips). Patient-generated images demonstrated high reliability (92% highly reliable or reliable) and were non-inferior to physician-generated images (p < 0.001). There was substantial agreement in B-line classification (Kw = 0.64, 95% CI: 0.46–0.82). The home device, when operated by the same physician, showed non-inferiority to the gold standard device (p < 0.001) with substantial B-line classification agreement (Kw = 0.64, 95% CI: 0.51–0.78). Conclusions: High-risk elderly patients can successfully generate self-scanned lung ultrasound images comparable to those produced by physicians. These promising results warrant further investigation through larger-scale and long-term studies. [ABSTRACT FROM AUTHOR]

Purpose: Apixaban, a direct oral anticoagulant is administered for stroke prevention in atrial fibrillation patients. Dosing adjustment is guided by renal function, age, and body weight. However, no data exist on its pharmacokinetics in patients with a body mass index (BMI) ≥ 35 kg/m2. The aim was to investigate the effects of BMI ≥ 35 kg/m2 on trough plasma concentrations of apixaban in patients with atrial fibrillation. Methods: This prospective study compared steady-state trough concentrations of apixaban in patients with a BMI ≥ 35 kg/m2 and patients with a BMI < 35 kg/m2. Results: Sixty patients were included. In patients receiving 5 mg apixaban twice daily, the median trough plasma concentration was 29% lower in patients with a BMI ≥ 35 kg/m2 than in those with a BMI < 35 kg/m2 (148.9 ng/ml, interquartile range [IQR] 94.5–205.6, compared to 209.1 ng/ml, IQR 167–266.8 ng/ml, respectively; P = 0.044). However, median trough concentrations fell within the manufacturer's predicted range for effective steady-state apixaban exposure. A similar trend was observed with 2.5 mg apixaban twice daily, although statistical significance was not reached. Multivariate analysis revealed no correlation between BMI values and trough concentrations. Conclusion: BMI ≥ 35 kg/m2 patients exhibited lower apixaban trough concentrations, while remaining within the manufacturer's established range for effective steady-state apixaban, suggesting that dose adjustment is unnecessary for this specific patient group. [ABSTRACT FROM AUTHOR]

Introduction: Although community mental healthcare has been rapidly developing, hospital‐based psychiatric admissions are still highly prevalent worldwide. Aims: In this study, we aimed to assess the long‐term effectiveness of two novel alternatives to psychiatric admission: Soteria homes and technologically assisted intensive home treatment (TAIHT) compared to hospital admission. Method: A three‐center, open‐label, longitudinal ecological study was employed in the Sheba psychiatric wards, the Sheba TAIHT, and Soteria houses. Patients (N = 214) were measured for distress, anxiety, depression, quality of life, level of functioning, and psychotic symptoms at admission, discharge, and 3‐ and 6‐month postdischarge. A multilevel modeling (MLM) approach was utilized to assess differences in changes from pre‐ to posttreatment. Outcome measures included symptom distress (Outcome Questionnaire‐45 (OQ‐45)), anxiety and depression symptoms (Hopkins Symptoms Checklist‐11 (HSCL‐11)), psychotic symptoms (Positive and Negative Syndrome Scale‐6 (PANSS‐6)), quality of life (Manchester Short Assessment of Quality of Life (MANSA)), and functioning (Global Assessment of Functioning (GAF)). Results: Patients in the psychiatric ward demonstrated significantly greater reductions of distress compared to those treated with TAIHT (b = −5.18, p = 0.042) but showed similar levels to Soteria. Soteria exhibited significantly greater improvement of psychotic symptoms compared to TAIHT (b = −2.057, p = 0.0076) but not compared to the psychiatric ward. The psychiatric ward (b = 3.49, p = 0.0068) and Soteria (b = 5.35, p < 0.0001) both demonstrated significantly greater improvements in functioning compared to TAIHT, with no significant differences between them. Conclusion: The findings underscore the effectiveness of psychiatric hospitalization alternatives yet call for the need to investigate further the effectiveness of technologically guided approaches to psychiatric hospitalization. Trial Registration: ClinicalTrials.gov identifier: NCT05431231 [ABSTRACT FROM AUTHOR]

Background: COPD exacerbations are a major cause of morbidity and mortality. Although inhaled corticosteroids (ICS) have a role as long-term treatment, their efficacy in exacerbations, particularly as an adjunct to systemic steroids, remains unclear. Methods: In this retrospective observational study, we analyzed data from 870 subjects admitted with COPD exacerbations to a tertiary medical center in Israel from January 2018–January 2023. We investigated the impact of adding ICS to standard systemic steroid treatment on hospital length of stay, intubation rates, and 30-d mortality using propensity score matching to account for confounders. Results: The cohort, after matching, included 354 subjects treated with systemic steroids and ICS and 121 treated with systemic steroids alone. All characteristics were similar between the groups. Our analysis showed no differences in 30-d mortality (7.1% vs 5.8%, P =.63) or secondary outcomes (intubation, hospital length of stay, and readmission rates) between the groups. Subgroup analyses based on different eosinophil levels did not alter these findings. In multivariate analysis among the general cohort, eosinophil count <150 cells/μL (adjusted odds ratio 0.45 [95% CI 0.21–0.87], P =.02) and high Charlson score (adjusted odds ratio 1.19 [95% CI 1.02–1.37], P =.02) were independent predictors for 30-d mortality. Conclusions: Despite the known benefits of ICS in managing chronic COPD, we did not find an added value of ICS to systemic steroids in exacerbations. These results underscore the necessity for individualized treatment strategies and further research into the role of ICS in COPD exacerbations. [ABSTRACT FROM AUTHOR]

Newborn screening (NBS) for isovaleric acidemia (IVA) reduces mortality and morbidity; however, it has also resulted in the detection of individuals with an asymptomatic or mild presentation for which early detection via newborn screening has not been proven to alter neurological outcome. We reevaluated biochemical and molecular data for newborns flagged positive for IVA in aim of developing a new screening algorithm to exclude the latter from positive screening. Among 2 794 365 newborns underwent routine newborn screening in Israel, 412 flagged positive for IVA, of which, 371 were false positives on recall sample testing and 41 positive newborns were referred to the clinic. 38/41 have biochemical and molecular confirmation in keeping with IVA. Among the 38 patients, 32% (12/38) were classified as symptomatic while, 68% (26/38) were classified as asymptomatic. 69% of the latter group harbor the known variant associated with mild potentially asymptomatic phenotype, c.932C>T; p. Ala311Val. Among asymptomatic patients, only 46% (12/26) are currently treated. Two novel variants have been detected in the IVD gene: c.487G>A; p. Ala163Thr and c.985A>G; p. Met329Val. Cut-off recalculation, of referred newborns' initial biochemical results, after classifying the referred patients to two binary groups of symptomatic and asymptomatic, resulted in an improved NBS algorithm comprising of C5 >5 μM and C5/C2>0.2 and C5/C3>4 flagging only those likely to have the classic symptomatic phenotype., (© 2024 SSIEM.)