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Effective management of emerging medical devices can lead to new insights in healthcare. Thus, human body communication (HBC) is becoming increasingly important. In this paper, we present magnetic resonance (MR) coupling as a promising method for the intra-body network (IBNet). The study reveals that MR coupling can effectively send or receive signals in biological tissue, with a maximum path loss of PL ≤ 33 dB (i.e. at 13.56 MHz), which is lower than other methods (e.g., galvanic, capacitive, or RF) for the same distance (d = 100 cm). The angular orientation of the transmitter and receiver coils at short and long distances also show a minor variation of the path loss (0.19 ≤ ∆PL ≤ 0.62 dB), but more dependency on the distance (0.0547 dB/cm). Additionally, different postures during the MR coupling essentially does not affect path loss ( ∆PL ≤ ± 0.21 dB). In the multi-nodal transmission scenario, the MR coupling demonstrates that two nodes can simultaneously receive signals with -16.77 dBm loss at 60 cm and 100 cm distances, respectively. Such multi-node MR transmission can be utilized for communication, sensing, and powering wearable and implantable devices.

Abstract introduction Odontogenic Keratocysts are benign, developmental, locally aggressive odontogenic cystic lesions with a high risk of recurrence. As such, the most effective treatment modalities remain controversial. The mainstay of treatment remains enucleation with or without decompression. The use of adjunctive therapies is widely reported. Aims To review our experience of OKCs and therefore identify the treatment modality, if any single one, with the lowest rate of recurrence. We also aimed to identify any common themes linking those patients experiencing cystic recurrence. Methods Data was collected on 50 patients treated at UHCW NHS Trust over a 14 year period (2005-2018) via an anonymised database. Surgical pathways were analysed, including details of the location of the cysts and the use of adjunctive therapies, namely; mechanical debridement, cryotherapy, and the use of Carnoy’s solution. Results 56 keratocysts, both primary (91%, n = 51) and recurrent (9%, n = 5) were included. 6% of patients had a pre-existing diagnosis of Gorlin-Goltz Syndrome (n = 3). Enucleation was performed in an approximately 3:1 ratio to decompression with secondary enucleation (n = 41:15). 27% patients had adjunctive therapies (n = 15). There was a 12% recurrence rate (n = 6) found only within the group of primary cysts that had been enucleated alone. Notably, there were no recurrences in those cysts that had undergone adjunctive therapy. None of the cysts that underwent initial decompression or marsupialisation recurred. Following surgical intervention, no tertiary recurrent cysts were detected post-operatively. Conclusions This study demonstrates the advantage of establishing a correct diagnosis prior to definitive treatment. Initial decompression in selected patients followed by enucleation, along with adjunctive therapies show a benefit in reducing recurrences. However, in the absence of high-quality evidence for the most effective management of Odontogenic Keratocysts, finding a common approach will remain controversial.

Infectious endocarditis is associated with substantial in-hospital mortality of 15%-20%. Effective management requires coordination between multiple medical and surgical subspecialties, which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality.The multidisciplinary endocarditis team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching.Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria-definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1, 2014, and June 30, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (P.0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; P = 0.12). Propensity score matching demonstrated similar results.Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the 2 studied cohorts. In conjunction with previous studies demonstrating their effectiveness, these data support the idea that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.

Constipation is a distressing and uncomfortable symptom children experience at end of life. There is a gap in knowledge about how different approaches to hospice care delivery might improve pediatric symptom management of constipation. The purpose of this study was to evaluate the effectiveness of pediatric concurrent hospice versus standard hospice care to manage constipation. Medicaid data (2011-2013) were analyzed. Children who were younger than 21 years enrolled in hospice care and had a hospice enrollment between January 1, 2011, and December 31, 2013, were included. Instrumental variable analysis was used to test the effectiveness of concurrent versus standard hospice care. Among the 18 152 children, approximately 14% of participants were diagnosed or treated for constipation from a nonhospice provider during hospice enrollment. A higher proportion of children received nonhospice care for constipation in concurrent hospice care, compared with standard hospice (19.5% vs 13.2%), although this was not significant (β = .22, P < .05) after adjusting for covariates. The findings demonstrated that concurrent care was no more effective than standard hospice care in managing pediatric constipation. Hospice and nonhospice providers may be doing a sufficient job ordering bowel regimens before constipation becomes a serious problem for children at end of life.

Gout is a form of arthritis, resulting from an inflammatory reaction to the deposition of monosodium urate (MSU) crystals in the synovial fluid of the joint space. It is characterised by periods of acute inflammation in the affected joint, or joints (known as gout flares), separated by asymptomatic periods. There seems to be substantial overlap between environmental triggers of gout flares and common environmental modifiers (diet, pharmaceuticals, and stress) of epigenetic markers (DNA methylation, histone modifications, and ncRNA). Very few studies have looked at whether environment is influencing gout through epigenetic mechanisms. The pathogenesis of gouty inflammation is well understood but understanding the variation of response to hyperuricaemia in terms of gout flare initiation is less well known. In this review, we will examine the potential of epigenomics in understanding how gout flares may occur, both in terms of development of hyperuricaemia and the inflammatory response. Looking at the epigenome and its intersection with lifestyle could help identify new targets and strategies for effective management of gout flares.

Hypercalcemia of malignancy (HCM) is considered an oncologic emergency associated with significant symptom burden and increased comorbid conditions and mortality. Underlying pathologic processes most often stimulate osteoclast-mediated bone resorption. Although long-term control of HCM depends on effective management of the underlying cancer, temporizing management strategies for acute and/or symptomatic HCM include hydration and antiresorptive bone-modifying agents. Although most patients respond well to the antiresorptive therapies available, further investigation into other agents for those who are refractory to both bisphosphonates and denosumab is needed.

PURPOSE: To provide an update for postoperative pain control strategies to help ophthalmic surgeons establish a more effective management plan for patients who underwent advanced surface ablation surgeries. METHODS: Google Scholar, Scopus, ScienceDirect, and PubMed were the main resources used to search the medical literature. RESULTS: The postoperative cornea's healing process is accompanied by intense pain as the chief complaint in the first days after the operation. Several strategies were developed to relieve postoperative pain after surface ablation procedures. These strategies included different preoperative, intraoperative, and postoperative methods. Considering the preoperative demographic and emotional factors, underlying dry eye, alternative epithelial removal techniques, bandage contact lenses, and topical or oral therapeutic agents are some examples of postoperative pain treatments after surface ablation procedures. CONCLUSIONS: The current review revealed that despite the development of numerous protocols to relieve postoperative pain following surface ablations, the best approach could be a combination of different strategies. In practice, no validated and standardized strategy is available for total elimination of postoperative pain following advanced surface ablation surgeries. [ J Refract Surg . 2021;37(11):782–790.]

Background and Purpose Fibrocystic disease (FCD) of the breast as a very common health problem in women has estrogen-dependent and proliferative features. No effective management strategy has been validated for this disorder, so far. The anti-hyperglycemic agent metformin has both anti-proliferative and estrogen-suppressing effects. Thus, we investigated metformin as a management strategy for FCD. Methods The study was a double-blind placebo-controlled randomized clinical trial. Premenopausal women with FCD according to history, physical exam and ultrasound, who had measurable microcyst clusters on ultrasound (US) were entered the study. Oral placebo and metformin tablets (500 mg) were used twice daily by participants in the intervention and control groups. Size and number of microcyst clusters on US and the subjective pain score were recorded before and after the intervention. Results 154 participants were randomly allocated into two groups of 77 interventions and 77 controls. The decrease in size of the largest microcyst cluster in each patient and the mean decrease in number of microcyst clusters were not statistically significant (P = 0.310 and P = 0.637, respectively). However, those microcyst clusters which were ≥ 14 mm became significantly smaller after metformin use (P = 0.006). Additionally, in the subset of participants with pain at baseline, a larger proportion in the intervention group experienced at least 50% reduction in pain score (63.8% (30/47) in the intervention vs. 44.2% (19/43) in the placebo groups, P = 0.031). Conclusion Our study showed that metformin might be effective in the management of FCD. Further studies are proposed for confirmation of this subject. Graphical abstract

Cancer is one of the major causes of death in human beings. While traditional cancer treatments kill cancerous cells, they negatively affect normal cells. In addition, the side effects and high medical costs of treatment prevent effective management of cancer. Nonetheless, anticancer peptides have gained popularity over the recent years as potential therapeutic agents that may complement traditional therapies. Compared to conventional wet-lab experiments, computation-based methods provide a promising platform for high-throughput identification of peptides that have anticancer activity. Therefore, this review summarizes the currently available databases for anticancer peptides/proteins. This is a survey of 22 recently published in-silico methods that aim to predict anticancer peptides accurately. More specifically, the article details the benchmark datasets, feature construction, feature selection, machine learning algorithms, assessment criteria, comparison of different methods, and publicly available predictors. We also compare the prediction performance of these predictors to the benchmark dataset. Finally, the study makes several recommendations concerning the future development of databases for anticancer peptides and methods that can be used to predict anticancer peptides.

Background Effective management of trauma patients is dependent on pre-hospital triage systems and proper in-hospital treatment regardless of time of admission. We aim to investigate any differences in adjusted all-cause mortality between day vs. night arrival for adult trauma patients who were transported to the hospital via ground emergency medical services (GEMS) and helicopter emergency medical services (HEMS) and to determine if care/outcomes are inferior when admitted during the night shift as compared to the day shift. Methods Retrospective cohort analysis of adult blunt and penetrating injury patients requiring full team trauma activation at an American College of Surgeons Committee on Trauma (ACSCOT)-verified Level 1 trauma center from 2011 to 2019. Descriptive statistical analyses, chi-square analyses, independent-sample t-tests, and Fisher's exact tests were performed. Primary measurement outcome was adjusted observed/expected (O/E) mortality ratios utilizing TRISS methodology. Results 8370 patients with blunt injuries and 1216 patients with penetrating injuries were analyzed. There were no significant differences in day vs. night O/Es overall (blunt 0.65 vs. 0.59; p = 0.46) (penetrating 0.88 vs. 0.87; p = 0.97). There also were no significant differences when stratified by GEMS (blunt 0.64 vs. 0.55; p = 0.08) (penetrating 0.88 vs. 1.10; p = 0.09) and HEMS admissions (blunt 0.76 vs. 0.75; p = 0.91) (penetrating 0.88 vs. 0.91; p = 0.85). Conclusions At an ACSCOT-verified Level 1 Trauma Center, care/outcomes of patients admitted during the night shift were not inferior to those admitted during the day shift. Trauma Center verification by the ACSCOT and multidisciplinary collaboration may allow for consistent care despite injury type and time of day.

Effective management of the upper nasal vault is based on a thorough preoperative analysis and detailed understanding of the requisite principles and techniques utilized to modify the anatomic structures in this region. The surgeon must equally consider form and function when performing manipulation of the upper nasal vault. Special considerations apply when managing this anatomic region via an endonasal or closed approach. A review of this topic is presented with a focus on techniques as they apply to the endonasal rhinoplasty patient.

Coronavirus disease (COVID-19) has been declared as a pandemic by the World Health Organization with rapid spread across 216 countries. COVID-19 pandemic has left its imprints on various health systems globally and caused immense social and economic disruptions. The scientific community across the globe is in a quest for digging the effective treatment for COVID-19 and exploring potential leads from traditional systems of healthcare across the world too. Ayurveda (Indian traditional system of medicine) has a comprehensive aspect of immunity through Rasayana which is a rejuvenation therapy. Here we attempt to generate the potential leads based on the classical text from Ayurveda in general and Rasayana in particular to develop effective antiviral and/or immunomodulator for potential or adjunct therapy in SARS-CoV-2. The Rasayana acts not only by resisting body to restrain or withstand the strength, severity or progression of a disease but also by promoting power of the body to prevent the manifestation of a disease. These Rasayana herbs are common in practice as immunomodulator, antiviral and protectives. The studies on Rasayana can provide an insight into the future course of research for the plausible development of effective management of COVID-19 by the utilization and development of various traditional systems of healthcare. Keeping in view the current pandemic situation, there is an urgent need of developing potential medicines. This study proposes certain prominent medicinal plants which may be further studied for drug development process and also in clinical setup under repurposing of these herbs.

Insomnia is an important but widely ignored health problem in modern society. Despite unequivocal evidence on its large prevalence, health and social impacts, comorbidities, and various pharmacologic and nonpharmacologic (behavioral and device-based) approaches, its effective management is still difficult and often incomplete. This article discusses the role of insomnia in modern societies, newer complicating factors, and its overall social and public health burden. Acute insomnia and sleep difficulties during pandemic and confinement are reviewed. The article also focuses on newer developments accumulating in the field of insomnia and possible future trends.

Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC) has been accepted worldwide as safe and effective. Despite the growing acceptance of AS in the management of low-risk PTMCs, there are barriers to AS in real clinical settings, and it is important to understand and establish appropriate AS protocol from initial evaluation to follow-up. PTMC management strategies should be decided upon after careful consideration of patient and tumor characteristics by a multidisciplinary team of thyroid cancer specialists. Patients should understand the risks and benefits of AS, participate in decision-making and follow structured monitoring strategies. In this review, we discuss clinical outcomes of AS from previous studies, optimal indications and follow-up strategies for AS, and unresolved questions about AS.

Effective management of pain in patients with cancer impacts quality of life and willingness to receive disease-directed treatment. This review focuses on preoperative, intraoperative, and postoperative strategies for management of perioperative pain in the patient with cancer. Managing perioperative pain in special populations, including patients with preoperative opioid use, those with a history of substance abuse, and patients near the end of life are also addressed.

Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects. If there is a contraindication for harvesting a connective tissue graft from the palate or the patient wants to avoid a donor site surgery, adjunctive use of acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be a valuable treatment alternative. For gingival recession defects associated with NCCLs a combined restorative-surgical approach can provide favourable clinical outcomes. If a patient refuses a surgical intervention or there are other contraindications for an invasive approach, gingival conditions should be maintained with preventive measures. This paper gives a concise review on when and how to treat gingival recession defects.

Both prolactinomas and nonfunctioning adenomas (NFAs) can present with hyperprolactinemia. Distinguishing them is critical because prolactinomas are effectively managed with dopamine agonists, whereas compressive NFAs are treated surgically. Current guidelines rely only on serum prolactin (PRL) levels, which are neither sensitive nor specific enough. Recent studies suggest that accounting for tumor volume may improve diagnosis. The objective of this study is to investigate the diagnostic utility of PRL, tumor volume, and imaging features in differentiating prolactinoma and NFA. Adult patients with pathologically confirmed prolactinoma (n = 21) or NFA with hyperprolactinemia (n = 58) between 2013 and 2020 were retrospectively identified. Diagnostic performance of clinical and imaging variables was analyzed using receiver-operating characteristic curves to calculate area under the curve (AUC). Tumor volume and PRL positively correlated for prolactinoma (r = 0.4839, p = 0.0263) but not for NFA (r = 0.0421, p = 0.7536). PRL distinguished prolactinomas from NFAs with an AUC of 0.8892 (p

Purpose of Review The aim of this review is to outline the obesity physician’s role in managing patients with severe obesity with a particular emphasis on bariatric surgery candidates. Recent Findings Obesity is a chronic, relapsing and progressive disease. Scoring systems that evaluate the severity of obesity based on the clinical assessment, rather than the Body Mass Index, are a valuable tool. The clinical assessment should explore the underlying contributors for weight gain and screen for obesity-related complications. Bariatric surgery remains the most effective management approach for severe and complex obesity. Nevertheless, pharmacotherapy and other non-surgical approaches play an important role. Summary The bariatric-metabolic physician’s role is paramount in delivering effective care to patients with obesity. The multiple complications of patients with clinically severe obesity highlight the complexity of their management and reinforce the need for adequate assessment and long-term follow-up to ensure optimal clinical outcomes.

Because of the importance of providing the appropriate fluid consistency for effective management of swallowing problems (dysphagia) in infants, this project sought to determine the effect of three commercially available thickening agents on the resulting thickened consistencies of commonly prescribed, ready-to-feed infant formulas. Nine ready-to-feed infant formulas were thickened with three different thickening agents to nectar and honey consistencies following manufacturer's instructions and their resulting thickness was measured via line spread test (LST). The nine formulas with nothing added to them (thin liquids) and the 27 target-nectar and 27 target-honey samples together created 63 unique samples for comparison. A series of one-way analysis of variance analyses were conducted to determine if the resulting thickness (as measured by LST values) for target categories of nectar and honey consistencies was significantly influenced by the type of thickening agent used. The achieved thickness of the formula samples as measured by LST values was statistically significantly different for the three different types of thickening agents used to achieve a target nectar consistency, F (2, 24) = 15.55, p η p 2 = .709. Additionally, the achieved thickness of the formula samples was statistically significantly different for the three different types of thickening agents used to achieve a target honey consistency, F (2, 24) = 16.18, p η p 2 = .709. The results of this study reveal that the choice of thickening agent impacts the resulting thickness of ready-to-feed infant formula.

ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

Given the critical physiological role of potassium, it is understandable that the development of severe hyperkalaemia requires effective management to reduce its effects, which include muscle weakness, paralysis and cardiac arrhythmias. Hyperkalaemia most often results from the failure of renal adaptation to potassium imbalance. Patients who are most susceptible to the development of hyperkalaemia include those with chronic kidney disease and those with heart failure. These patients are often treated with renin–angiotensin–aldosterone system (RAAS) inhibitors, such as angiotensin-converting enzyme inhibitors and angiotensin II-receptor blockers, but the development of hyperkalaemia can require down-titration or cessation of RAAS inhibitors. This presents a significant challenge to nephrologists, cardiologists and healthcare professionals treating these patients as this can prevent them from receiving maximum guideline-directed RAAS inhibitor therapy. Panellists in this roundtable discussion shared their clinical experiences of using potassium binders to manage hyperkalaemia in patients with chronic kidney disease and patients with heart failure (illustrated with case studies) in Northern Ireland and considered recommendations for the implementation and maintenance of chronic potassium-lowering treatment.

Highlights • Self-collected saliva and buccal swab results show moderate agreement with those of nasopharyngeal swabs (NPS). • A combined strategy is recommended. • Primary screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be performed with a saliva test or buccal swab. • A negative test should warrant a confirmatory NPS test to avoid false-negatives. • This minimizes discomfort and reduces the risk of spread to the community and healthcare workers., Background Effective management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires large-scale testing to identify and isolate infectious carriers. Self-administered buccal swab and saliva collection are convenient, painless, and safe alternatives to the current healthcare worker (HCW)-collected nasopharyngeal swab (NPS). Methods A cross-sectional single-centre study was conducted on 42 participants who had tested positive for SARS-CoV-2 via an NPS within the past 7 days. Real-time polymerase chain reaction (RT-PCR) was performed and cycle threshold (Ct) values were obtained for each test. The positive percent agreement (PPA), negative percent agreement (NPA), and overall agreement (OA) were calculated for the saliva samples and buccal swabs, and compared with NPS. Results Among the 42 participants, 73.8% (31/42) tested positive by any one of the three tests. With reference to NPS, the saliva test had PPA 66.7%, NPA 91.7%, and OA 69.0%; the buccal swab had PPA 56.7%, NPA 100%, and OA 73.8%. Conclusion Self-collected saliva tests and buccal swabs showed only moderate agreement with HCW-collected NPS. Primary screening for SARS-CoV-2 may be performed with a saliva test or buccal swab, with a negative test warranting a confirmatory NPS to avoid false-negatives, minimize discomfort, and reduce the risk of spread to the community and HCWs.

Effective management of acute post surgical pain is one of the cornerstones of successful perioperative care. The principal objectives of post surgical pain management include relief of patient suf...

Background Prenatal diagnosis of placenta percreta (PP) is important to be able to provide effective management and a multidisciplinary approach to minimize the complications. Purpose To evaluate the role of shear-wave elastography (SWE) in the prenatal diagnosis of PP. Material and Methods A total of 18 women with PP and 20 pregnant women with normal placenta in the second or third trimesters were included in this prospective study. SWE was used to determine the elasticities of the placenta (in the maternal edge of the placenta) and myometrium. The obstetric data regarding grayscale and Doppler ultrasonography, and perinatal outcomes were reviewed. A mean placental SW velocity (SWV) cut-off value was determined to predict the presence of placental adherence. Results The SWV values of the PP group in the maternal edge of the placenta were significantly higher than those of the control group (1.95 ± 0.19 m/s and 1.69 ± 0.23 m/s; P = 0.001). Myometrial SWV was also higher in the PP group compared to the control group (2.25 ± 0.39 m/s and 1.90 ± 0.71 m/s; P = 0.002). A receiver operating characteristic (ROC) curve analysis was performed and the best cut-off value of placental SWV was determined as 1.92 m/s with sensitivity of 58% and specificity of 80%, to predict the placental adherence in patients with PP. Conclusion Placental stiffness was significantly higher in patients with PP than in pregnant women with normally localized placenta. Thus, we thought that SWE of the placenta might be used as an alternative method in the diagnosis of PP.

Objective:The 2019 coronavirus disease (COVID-19) is a global pandemic with no therapy, and pharmacists being a part of the health care system have a vital role in the management of COVID-19. The purpose of this study is to assess the knowledge, attitude, and practices of community pharmacists (CPs) regarding COVID-19.Method:An online survey was conducted among 393 CPs in 2 provinces of Pakistan during the lockdown period. A validated questionnaire (Cronbach’s alpha, 0.745) was used for data collection. All statistical analyses were analyzed by using SPSS, version 21 (IBM Corp, Armonk, NY).Results:Among 393 participants, 71.5% (n = 281) had good knowledge, 44% (n = 175) had a positive attitude, and 57.3% (n = 225) had good practices regarding COVID-19. Social media (45.29%, n = 178) were reported as the main source to seek information of COVID-19. Good knowledge, age ≥ 26 years, and a PhD degree level were the substantial determinants (P= < 0.05) of a good attitude. Similarly, a CP with experience of > 5 years, a PhD degree, good knowledge, and a good attitude has higher odds of having good practices as compared with reference categories (P= < 0.05).Conclusion:In short, a majority of the CPs had good knowledge but had a poor attitude and practice toward the management of COVID-19. Standard-structured educational and counseling programs for CPs regarding COVID-19 are needed for effective management.

Aim: We aimed to review the importance of the natural products and herbs used in the management of diabetes mellitus (DM) as medicinal agents. Background: Naturally occuring phytoactive compounds and herbs are very important because they are found to be effective against several diseases. DM is a commonly occurring endocrinological disorder, with the incidences increased four times in the last 34 years. There are several oral hypoglycemic agents available in the market, which in the long term, may lead to a high risk of secondary failure rate. Objectives: This review focuses on natural products and herbs application for effective management of diabetic conditions, and natural products that can be utilized as alternative therapy. Methods: We searched the various online databases (PubMed, Bentham, ScienceDirect) and scientific publications from the library using a qualitative systematic review. The criteria of the review were based on natural products and herbs application for possessing medicinal value against diabetes and the literature of previous thirty years has been searched. The inclusion criteria of materials were based on the quality and relevancy with our aim. Results: We observed that owing to the potential of natural products and herbs, different research groups are searching for the potent natural antidiabetic agents with minimal side effects. Recent research showed that there is a decline in a number of new molecules that fail in clinical trials because of toxicity thus, natural products and herbs are considered as the alternative. Currently, some of the natural products and herbs like coixol, andrographolide, Tinospora cordifolia, polypeptide p, charantin, Annona squamosa, and Nigella are being explored for their potential to be used successfully for the management of type 2 diabetes. Conclusion: The significance of natural products and herbs in the anticipation of diabetes and allied complications are being described herein. We observed that a huge amount of work is being done to explore the natural products and herbs to manage the diabetes and this review gives the highlights of them.

Plants are the central source of food for humans around the world. Unfortunately, plants can be negatively affected by diverse kinds of diseases that are responsible for major economic losses worldwide. Thus, monitoring plant health and early detection of pathogens are essential to reduce disease spread and facilitate effective management practices. Various detection approaches are currently practiced. These methods mainly include visual inspection and laboratory tests. Nonetheless, these methods are labor-intensive, time-consuming, expensive, and inefficient in the early stages of infection. Thus, it is extremely important to detect diseases at the early stages of the epidemic. Here, we would like to present a fast, sensitive, and reliable electrochemical sensing platform for the detection of airborne soybean rust spores. The suspected airborne soybean rust spores are first collected and trapped inside a carbon 3D electrode matrix by high-capacity air-sampling means. Then, a specific biotinylated aptamer, suitable to target specific sites of soybean rust spores is applied. This aptamer agent binds to the surface of the collected spores on the electrode. Finally, spore-bound aptamer units are incubated with a streptavidin–alkaline phosphatase agent leading to the enzymatic formation of p-nitrophenol, which is characterized by its unique electrochemical properties. Our method allows for the rapid (ca. 2 min), selective, and sensitive collection and detection of soybean rust spores (down to the limit of 100–200 collected spores per cm2 of electrode area). This method could be further optimized for its sensitivity and applied to the future multiplex early detection of various airborne plant diseases.

Pain is a highly personal experience that can be challenging to define. In addition, evidence has indicated that the assessment of pain by healthcare professionals is often suboptimal and its severity often underestimated. In clinical practice, the use of language can be a significant influencing factor in the effective management of pain, with terms such as pain, discomfort and comfort used interchangeably. This article explores how language can both act as a barrier to, and assist, nurses to understand the patient's pain experience.

In recent years, nanotechnology has led to significant scientific and technological advances in diverse fields, specifically within the field of medicine. Owing to the revolutionary implications in drug delivery, nanotechnology-based drug delivery systems have gained an increasing research interest in the current medical field. A variety of nanomaterials with unique physical, chemical and biological properties have been engineered to develop new drug delivery systems for the local, sustained and targeted delivery of drugs with improved therapeutic efficiency and less or no toxicity, representing a very promising approach for the effective management of diseases. The utility of nanotechnology, particularly in the field of orthopedics, is a topic of extensive research. Nanotechnology has a great potential to revolutionize treatment, diagnostics, and research in the field of orthopedics. Nanophase drug delivery has shown great promise in their ability to deliver drugs at nanoscale for a variety of orthopedic applications. In this review, we discuss recent advances in the field of nanostructured drug delivery systems for orthopedic applications.

Aim Investigate changes in alcohol use and related harm using the first multisite, controlled, longitudinal study of Managed Alcohol Programs (MAPs). MAPs provide regular doses of alcohol, accommodation, social supports and healthcare to unstably housed people with alcohol dependence. Methods A multisite, quasi-experimental, longitudinal study was conducted in day centres, shelters and residential programs for unstably housed people. There were 59 MAP participants from six Canadian cities and 116 local controls. Self-reported alcohol consumption and harms were assessed at 0-2, 6 and 12 months. Liver function test results were accessed for MAP participants. Results Both groups had similar reductions in mean drinks per day (MAP: -8.11; controls: -8.54 controls, P < 0.001) and days drinking per month (MAP: -2.51 days, P < 0.05; control: -4.81 days, P = 0.0001) over 6–-12 months. Both reduced non-beverage alcohol consumption. MAP participants reported significantly fewer harms at both 0-2 and 6 months than controls. MAP participants had similar total consumption to controls, but spread out over more days (25.41 versus 19.64 days per month, P = 0.001). After leaving a MAP, participants’ liver status deteriorated, with increases in both aspartate transaminase and bilirubin levels. MAP sites with effective policies on outside drinking drank less and had fewer harms. Conclusion MAP participants drank less hazardously than controls, especially with effective management of non-MAP drinking. Reductions in alcohol use and harms occurred for both groups, although MAP participants reported fewer harms at 0-6 months. Departing an MAP was associated with deterioration in liver status. Although providing stable housing, MAPs did not worsen health or increase alcohol use.

Orthopedic device related infections (ODRI's) represent a difficult to treat situation owing to their biofilm based nature. Biofilm infections once established are difficult to eradicate even with an aggressive treatment regimen due to their recalcitrance towards antibiotics and immune attack. The involvement of antibiotic resistant pathogens as the etiological agent further worsens the overall clinical picture, pressing on the need to look into alternative treatment strategies. The present review highlightes the microbiological challenges associated with treatment of ODRI's due to biofilm formation on the implant surface. Further, it details the newer anti-infective modalities that work either by preventing biofilm formation and/or through effective disruption of the mature biofilms formed on the medical implant. The study, therefore aims to provide a comprehensive insight into the newer anti-biofilm interventions (non-antibiotic approaches) and a better understanding of their mechanism of action essential for improved management of orthopedic implant infections.

Background Rotator cuff tears (RCTs) are a common cause of shoulder disability, yet both conservative and surgical treatment strategies can lead to poor results in some patient populations. Enhanced understanding of the genetic processes associated with RCTs can assist in the development of more effective management options and help predict individual responses to surgical treatment. This systematic review analyzes the current literature on the genetic footprint associated with RCTs and interprets these findings to enhance the current understanding of RCT pathogenesis, potential treatment regimens, and prognostic biomarkers of outcomes after surgical repair. Methods A systematic search of the Embase, PubMed, and Web of Science electronic databases was performed. Medical Subject Headings (MeSH) and Emtree index terms were formulated from the concept terms “rotator cuff tear,” “genetics,” and “human,” and synonyms of these concepts were applied to the Web of Science search. Articles were screened against predefined inclusion and exclusion criteria. Eligible studies compared gene expression patterns and genetic polymorphisms between cases (with RCTs) and controls (without RCTs). Quality assessment was performed with studies being rated as high, moderate, or poor quality. A modified best-evidence synthesis was applied, and studies were determined to be of strong, moderate, or limited evidence. Results The search identified 259 articles. Of these studies, 26 were eligible for review. Two studies were considered poor quality; 15 studies, moderate quality; and 9 studies, high quality. Analysis of these articles found that RCTs were associated with alterations in genes that code for the extracellular matrix, cell apoptosis, immune and inflammatory responses, and growth factor pathways. In particular, there was strong evidence of a significant association between RCTs and the genes MMP3, TNC, and ESRRB. Strong evidence of an association between BMP5 upregulation and successful healing after surgical repair was also found. Conclusion This review provides strong evidence of an genetic association with RCTs. The genotype and gene expression patterns detailed within this review can assist in deciphering the biological mechanisms resulting in RCTs, as well as predicting an individual's response to surgical repair. Future research could investigate whether manipulating these genes—or their associated signaling pathways—could assist in RCT healing and whether genetic biomarkers could be used clinically to predict patient outcomes after surgical repair of RCTs.

Perianal Crohn’s disease (CD) is a complex manifestation of CD that affects approximately 10% of patients. The spectrum of disease is quite variable, ranging from relatively mild disease to severe, aggressive manifestations that result in frequent hospitalizations, multiple surgeries, and poor quality of life. Despite significant recent advances in surgical and medical management, treatment remains challenging and frequently requires a multidisciplinary medical-surgical approach. The goal of this article is to review the current literature regarding the work-up, treatment, and future directions of therapy. Crucial features of effective management include the precise identification of manifestations, control of sepsis, limiting rectal inflammation, frequently with use of antitumor necrosis factor agents, and avoidance of extensive surgery.

ObjectiveThis study aimed to evaluate the benefits of betahistine or vestibular rehabilitation (Tetrax biofeedback) on the quality of life and fall risk in patients with Ménière's disease.MethodsSixty-six patients with Ménière's disease were randomly divided into three groups: betahistine, Tetrax and control groups. Patients’ Dizziness Handicap Index and Tetrax fall index scores were obtained before and after treatment.ResultsPatients in the betahistine and Tetrax groups showed significant improvements in Dizziness Handicap Index and fall index scores after treatment versus before treatment (p < 0.05). The improvements in the Tetrax group were significantly greater than those in the betahistine group (p < 0.05).ConclusionsBetahistine and vestibular rehabilitation (Tetrax biofeedback) improve the quality of life and reduce the risk of falling in patients with Ménière's disease. Vestibular rehabilitation (Tetrax biofeedback) is an effective management method for Ménière's disease.

"Home noninvasive ventilation (NIV) is indicated for numerous conditions including neuromuscular disease, thoracic cage disorders, chronic obstructive pulmonary disease, and hypoventilation syndromes. Effective management of patients on home NIV requires clinicians to interpret data downloads from NIV devices. Clinicians must first look at adherence and factors that may impact this including mask comfort and fit. Next, leak assessment is undertaken. Once these are addressed, such information as apnea-hypopnea index, exhaled tidal volume, and percent triggered breaths help clinicians troubleshoot setting changes. Finally, overnight oximetry and transcutaneous CO2 monitoring are useful adjuncts to the data download to optimize NIV settings."

The coronavirus SARS-CoV-2 pandemic has and continues to create a huge number of challenges to the global economy and its associated healthcare systems, including dentistry. In the early stages, we have had to rely on mathematical modelling and plans developed from previous healthcare emergencies. As the emergency develops, it is vitally important that policymakers understand the difference between the science and the real-world evidence so that policy can adapt rapidly to the changing environment. Effective management of future crises will require open channels of communication across the whole profession, not only to collect, clean, curate and evaluate data but also to assess the benefits and harms of any policy change., Key points The effects of the COVID-19 pandemic are not evenly spread throughout the population.Errors in pandemic modelling are due to a combination of biased assumptions, and an underestimation of the variance and noise in real-world data.Scientific research must be backed up by real-world evidence before it can be considered valid.As evidence accumulates, policymakers should rapidly update guidance by keeping channels of communication open and frequently updated.

Psoriasis is a chronic disease that has negative effects on quality of life. Understanding the illness perception of psoriasis is important for effective management of the disease and improving quality of life. The aim of this study was to determine the relationship between illness perception and quality of life in psoriasis patients. This cross-sectional study was performed with 306 patients who applied to a psoriasis outpatient clinic of a university hospital in Istanbul, Turkey. Data were collected using a sociodemographic characteristics and disease information form, the Dermatology Life Quality Index (DLQI), the Revised Illness Perception Questionnaire (IPQ-R) and the Psoriasis Area Severity Index (PASI) score. Data were analyzed using descriptive statistics, Kruskal-Wallis test and Mann-Whitney U test, Spearman correlation analysis, and multiple regression analysis. A positive relationship was found between scores on the DLQI and scores on the IPQ-R subscales of Illness identity, Consequences, Emotional representations, Time (cyclic), Personal attributions, External attributions, and Chance. A negative correlation was determined between DLQI scores and scores on the IPQ-R subscales of Treatment control and Illness coherence. Furthermore, there was a positive correlation between the PASI score and the DLQI scores and scores on the IPQ-R subscales of Consequences and Emotional representation. Multiple regression analysis showed that illness identity, PASI scores, treatment control, illness coherence, consequences, and personal attributions were significantly associated with quality of life (R2 = 0.365, p 0.01). The quality of life of the psoriasis patients who associated their symptoms with the disease, who had a high PASI score, thought that they were adversely affected by the disease, and who saw personal attributions as the cause of the disease was negatively affected. The quality of life of patients who thought that their disease could be kept under control and who understood their disease was positively affected.

Coronavirus disease 2019 has emerged as a global pandemic, affecting millions of people across the globe. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the human cell after binding to the Angiotensin-Converting Enzyme 2 receptors, that are present in various organs. The involvement of the respiratory system is common and may progress to acute respiratory distress syndrome. Besides the involvement of respiratory system other systems like cardiovascular, renal, gastrointestinal and central nervous are not uncommon. In-depth understanding of the pathophysiological basis of organs and systems involvement and disease progression aids in the safe and effective management of the COVID-19 patients. It also helps to guide future well-designed clinical trials, which is the need of time. This review aims to explore the current understanding of pathophysiological basis of various organ system involvement in patients with COVID-19, that can have relevance for patient management and future research. We reviewed the articles in various databases to assemble the current evidences. Keywords: Coronavirus disease 2019; COVID-19; pathophysiology; severe acute respiratory syndrome coronavirus 2

Fangcang shelter (Cabin) hospitals were set up in order to cope with the rapid growth of confirmed cases of coronavirus disease 2019 (COVID‐19) in Wuhan, China at a time when there were insufficient beds in designated hospitals. This paper describes the layout and functioning of a typical Fangcang shelter hospital, Wuhan Dongxihu Fangcang shelter Hospital, where the author has worked, the working mechanism, experience and effectiveness. A set of patient management protocols was employed for daily practice, which included preset criteria and procedure for admission, examination, medication treatment, referral and discharge. WeChat platform with different groups was used for communication, ward round, test appointments and patient data communication. All these procedures and mechanisms of working enabled the effective management of a larger number of patients with relatively few doctors. As a result, 442 mild or moderate COVID‐19 patients in Hall C were successfully managed by a team of 40 doctors, with 246 (56%) patients were cured and discharged from the Fangcang shelter hospital while the remaining 196 (44%) patients were referred on to designated hospitals for further treatment. The reasons for referral included poor resolution in computerized tomography (CT) scan (59%), persistently positive severe acute respiratory syndrome coronavirus 2 by PCR after 9 days of admission (16%), deterioration in CT image (4%), development of dyspnoea (1%) and other (4%) or unclear reasons (16%) due to no record of reasons for referral on the document. There were no deaths and no complaints from the patients in Hall C. In summary, the Fangcang shelter hospital could be run successfully with a set of patient management protocols under conditions of limited facilities and medical staff. It was effective and safe in isolating patients, providing basic medical care and early identification of potential severe cases. This experience may provide a successful example of a working mechanism for the prevention and control of the COVID‐19 pandemic worldwide.

The neuropsychiatric illnesses have been enigmatic, with no effective treatment to date. The complexity and heterogeneity of psychiatric disorders are daunting for the development of novel treatment modalities. The conventional treatment approaches are less effective and are associated with several side effects, thus creating the need for the development of more innovative strategies. Since psychiatric disorders are known to exhibit genetic linkage, gene therapy has created an interest among the researchers worldwide. The delivery of nucleic acids is a complex process requiring the transport of genetic material across various intracellular and extracellular barriers to reach the target cells eliciting the transfection process. Therefore, the identification or development of the delivery system for nucleic acid delivery still remains the challenge. Viral vectors are quite effective but are associated with toxicity and side effects. With the rapid advancement in the field of nanotechnology, nanosized materials were identified to be the perfect candidate for nonviral vectors in gene delivery. The biggest advantage of nanoparticles is that their surface can be engineered in many possible ways to deliver the drugs directly to the target site. Although gene therapy has already been established as an innovative treatment modality for several neurological diseases, its use in psychiatry still warrants more investigations for its translation into clinical use. The present manuscript discusses the prospects of gene therapy in psychiatric disorders, their benefits, and pitfalls. The review embarks upon the importance of nanoparticle-based gene therapy for effective management of psychiatric disorders.

Background: Viral hemorrhagic fevers (VHF) refers to a group of febrile illnesses caused by different viruses that result in high mortality in animals and humans. Many risk factors like increased human-animal interactions, climate change, increased mobility of people and limited diagnostic facility have contributed to the rapid spread of VHF. Materials: The history of VHFs in the Saudi Arabian Peninsula has been documented since the 19th century, in which many outbreaks have been reported from the southwestern region of Saudi Arabia. Despite presence of regional network of experts and technical organizations, which expedite support and respond during outbreaks, there are some more challenges that need to be addressed immediately. Gaps in funding, exhaustive and inclusive response plans and improved surveillance systems are some areas of concern in the region which can be dealt productively. This review primarily focusses on the hem- orrhagic fevers that are caused by three most common viruses namely, the Alkhurma hemorrhagic fever virus, Rift valley fever virus, and Dengue fever virus. Conclusion: In summary, effective vector control, health education, possible use of vaccine and concerted synchronized efforts between different government organizations and private research institutions will help in planning effective out- break-prevention and response strategies in future. Keywords: Viral fever; hemorrhagic fever (VHF); Saudi Arabia; challenges; management; future considerations.

Vulvodynia is chronic perineal pain in women. Repercussions of this disorder can have a negative effect on women's health and lifestyle. The origin is often multifactorial, including pelvic and lower extremity somatic dysfunctions. If left untreated, these somatic dysfunctions can directly alter ligamentous tension on the pelvic floor and surrounding regions, resulting in perineal pain. Management of vulvodynia must be individualized due to the multifactorial etiology and complicated structure and function of the pelvic floor muscles. The authors present a case of vulvodynia in which osteopathic manipulative treatment was an effective management technique.

Echocardiography has always been a journey from scientific observation to clinical application. Whether in theranostics, understanding the performance of the systemic right ventricle, or uncovering the predictive power of echocardiographic data in congenital heart disease, the author's experiences highlight how echocardiographers at the frontier of scientific inquiry making observations today are inundated with data. It becomes apparent that new clinical applications, if they are to be successful, depend more than ever on effective management of the information we collect. In light of this realization, the 21st Feigenbaum lecture explores analytic intelligence-one path echocardiography might now take on its march from observation to application.

The COVID-19 pandemic has emerged as a serious global threat causing a large number of fatalities and putting enormous strain on the health care resources across the world. This has resulted in preferentially triaging the coronavirus infected patients and placing others, especially cardiovascular patients at increased risk for adverse complications. The effective management of cardiac patients in the hospital environment during this COVID-19 pandemic has emerged as a real challenge. We try to address this issue and also highlight the interplay between COVID-19 and cardiovascular diseases. We hereby review the available literature and emerging guidelines about cardiovascular implications related to COVID-19 which will have a bearing on the patient care, health care professionals and cardiac centres.

Background Neonatal hyperbilirubinemia is a significant health problem in Myanmar, and the rate of kernicterus is also higher than in developed countries. Non-invasive methods for early detection and treatment of hyperbilirubinemia are urgently needed. In this study, we used transcutaneous bilirubin (TcB) measurements to develop an hour-specific TcB nomogram for the effective management of hyperbilirubinemia in Myanmar newborns. Methods The bilirubin levels of neonates born in Central Women Hospital in Yangon, Myanmar were measured three times a day within 72 h after birth using a transcutaneous bilirubinometer. An hour-specific TcB nomogram was created based on the data. Results Participants were 512 infants (287 boys, 225 girls) born in Central Women's Hospital in Yangon. The mean (±SD) gestational age was 38.4 ± 1.2 weeks; birthweight was 3078 ± 412 g. A total of 3,039 plots were obtained, and the TcB nomogram was created with smoothed percentile curves (97.5th, 50th, and 2.5th percentiles) for 0-72 h after birth. Conclusions An hour-specific TcB nomogram was successfully created to manage hyperbilirubinemia in Myanmar newborns.

We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960

Gout is an important cause of disability among Filipinos, despite measures for effective management. This study aims to determine attainment of target serum uric acid level (SUA ≤ 6 mg/dl) among patients with gout given urate-lowering therapy (ULT) over 6-12 months.This is a single-center, prospective cohort study conducted in one adult Arthritis Clinic at the University of the Philippines-Philippine General Hospital which included 138 patients with gout (1977 ACR criteria), SUA ≥ 6 mg/dl prior to ULT, initiated on ULT (allopurinol or febuxostat), with six months minimum follow-up and with SUA determination post-treatment.37.7% (52/138) and 36.2% (50/138), achieved target SUA at 6 and 12 months. The factors associated with achieving target SUA in 6 months are BMI 25 kg/mTarget SUA level was not achieved at 6 and 12 months of ULT in most of this cohort. This mirrors the deficient control of gout and should urge health professionals to fully study and address the problem.

Occupational stress is a major problem for healthcare providers, with some professionals experiencing higher numbers of stressful situations than others. Although it is difficult to eliminate stress in professionals' daily lives, providing social support can lower psychological distress symptoms. This study aims to investigate the relationship between occupational stress and social support, and the effects of social support on psychological distress symptoms of healthcare professionals. A cross-sectional descriptive design was utilized. Self-administered questionnaires were completed by a convenience sample of 211 participants (physicians, nurses, and pharmacists) from a Jordanian hospital. Bivariate analyses were used to examine the relationships between the study variables. Multiple regression analyses were used to determine if occupational stress, demographic characteristics, and social support predict depression, anxiety, and stress. Results showed that healthcare professionals with more social support showed less depression than those with a lower score of social support. Females had higher scores of depression and anxiety than males. Pharmacists had significantly higher occupational stress than both nurses and physicians. Occupational stress negatively influences healthcare professionals' mental health. To improve the productivity and psychological wellbeing of healthcare professionals, occupational stress should be diminished by implementing effective management approaches to facilitate social support for healthcare professionals.

Immune checkpoint inhibitors (ICIs) have now been approved in numerous and diverse cancer types and combination regimens. Effective recognition and treatment of ICI toxicities, which might occur acutely, affect any organ system, and produce many distinct clinical syndromes, have emerged as essential goals of ICI management. Thus, developing robust diagnostic and management approaches for ICI toxicity across the health-care system is an urgent and unmet clinical need. In this Personal View, we describe barriers to high-quality care that have constrained the most effective management of patients with cancer receiving ICI treatment. We review education initiatives to enhance patient and physician awareness, which is necessary given the broad spectrum of ICI toxicities often experienced by patients, and assess various systems-based approaches that maximise the chances of appropriate management. In addition, we describe research pipelines that broaden evidence-based approaches and the pathobiology of these novel events. Developing effective, systematic approaches for the recognition and treatment of ICI toxicities will continue to grow in importance as these agents proliferate in cancer care.