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Objective: This study aims to identify classes based on the trajectory of depressive symptoms and to examine the impact of trajectory classes of depressive symptoms on longitudinal changes in cognitive function in older adults with diabetes. Methods: This is a secondary data analysis of 572 older adults with diabetes using data from the 5th (2014) to 8th (2020) wave of the Korean longitudinal study of aging. Analysis of latent class growth and the effect of trajectories of depressive symptoms on cognitive function was examined using a latent growth curve model. This analysis has been found to be functional in change trajectories and in describing the direction of the trajectory. Results: The trajectory of depressive symptoms was classified into four classes: low‐stable (36.89%), high‐decreasing (20.28%), low‐increasing (18.71%), and high‐persistent (24.13%). Compared with the high‐persistent class, higher initial levels of cognitive function were observed in the high‐decreasing and low‐stable classes. Compared with the high‐persistent class, a slower rate of cognitive decline was observed in the low‐stable class (B = 0.410, p =.021). Conclusions: Continuous monitoring of depressive symptoms and early management of depressive symptoms for community‐dwelling older adults with diabetes can help prevent the cognitive decline and delay the deterioration of cognitive function. [ABSTRACT FROM AUTHOR]

Background: Rapid return to mobilisation and daily function is essential for recovery after an elective and emergency caesarean section, prevention of short- and long-term complications, and mothers' well-being. High pain levels may delay recovery. Considering the biopsychosocial model, recovery is additionally complex and comprises social and psychological aspects. Objective: This study examined the relationships between preoperative expectations, perioperative subjective experience, postoperative pain levels, and postoperative interruption of functioning and recovery. Methods: Overall, 306 women completed a set of questionnaires on the fourth day after a caesarean section regarding their demographic information, levels of expectation matching the caesarean section and the perioperative subjective experience, and the pain levels and interruption to daily activities 24 hours postpartum. Results: Using a structural equation model, a gap between preoperative expectations and perioperative experience related to a poorer perioperative subjective experience was found. This was associated with higher postoperative pain levels that were directly and indirectly related to the interruption of various functions and activities during the initial 24 hours postpartum. The model explained 58% of the variance in postpartum functioning and had good goodness-of-fit (χ2 = 242.74, df = 112, χ2/df = 2.17, NFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06). Additionally, pain levels were higher and daily activities were more severely impaired for women who had undergone emergency caesarean section compared to those who had undergone elective caesarean section. Conclusion: The need for preoperative preparation and setting expectations, perioperative emotional support, continuous communication with the mother, and an efficient postoperative pain management was highlighted. [ABSTRACT FROM AUTHOR]

Background and aims: Studies on cancer incidence and mortality among people with opioid use‐related disorders are lacking. We aimed to measure cancer‐specific incidence, mortality and survival among people diagnosed with opioid use‐related disorders in Norway during 2010–18. Design and setting: This was a cohort study conducted in Norway during 2010–18. Participants: Individuals (n = 20 710) diagnosed with opioid use‐related disorders. Measurements: We conducted a cohort study utilizing a data‐linkage of national health and population registers. Information on opioid use‐related disorders was extracted from specialized healthcare, malignancies from the Cancer Registry of Norway and deaths from Cause of Death Registry. Cancer incidence and mortality were compared with the general population by calculating sex‐specific age‐standardized incidence (SIR) and mortality (SMR) ratios. One‐year survival rates were computed. Findings Compared with the general population, people with opioid use‐related disorders were at an increased risk of developing cancer overall [SIR = 1.2, 95% confidence interval (CI) = 1.1–1.3] with a higher than twofold cancer mortality rate (SMR = 2.3, 95% CI = 2.0–2.7). Excess risk was observed for liver (12.6, 95% CI = 9.1–17.0), larynx (4.7, 95% CI = 1.7–10.2), lung (3.5, 95% CI = 2.8–4.3) and pancreas cancer (2.6, 95% CI = 1.6–4.0), whereas reduced risk was found for melanoma (0.5, 95% CI = 0.3–0.9), breast (0.6, 95% CI = 0.4–0.9) and prostate cancers (0.3, 95% CI = 0.1–0.4). Site‐specific SMRs were significantly elevated for liver (12.3, 95% CI = 8.5–17.2), lung (3.9, 95% CI = 3.0–5.0), pancreas (3.0, 95% CI = 1.7–4.8) and colon cancers (1.9, 95% CI = 1.1–3.1). The average 1‐year survival rate after a cancer diagnosis was low in liver, pancreas and colon cancer, ranging from 10 to 15% less than that of the general population. Conclusions: In Norway, cancer incidence and cancer‐related mortality appear to be elevated among individuals with opioid use‐related disorders. [ABSTRACT FROM AUTHOR]

Introduction: Low cardiorespiratory fitness (CRF) increases the risk of cardiovascular disease by up to eightfold and is one of the strongest predictors of mortality. Some studies demonstrate impaired CRF in people living with type 1 and type 2 diabetes compared with those without diabetes, whereas others demonstrate no diabetes-associated impairment in CRF. Purpose: We aimed to determine whether diabetes can influence CRF and, if so, identify clinical associations underlying diabetes-associated exercise impairments. Methods: Sixty-eight studies were included in the quantitative analysis. Standardized mean difference (SMD) was calculated and meta-analyses and meta-regressions were performed by using a random-effects model. Results: Diabetes is associated with a large negative effect on CRF (SMD = -0.80, P < 0.001)--an effect that is partially mitigated, but still significant, in those with high physical activity levels (SMD = -0.50, P = 0.007). A sedentary lifestyle (SMD = -0.83, P = 0.007) and the presence of clinical complications related to diabetes (SMD = -1.66, P < 0.001) predict a greater magnitude of CRF reduction in people with diabetes compared with controls without diabetes. Both type 1 diabetes and type 2 diabetes are independently associated with impaired CRF compared with controls without diabetes; however, the effect is significantly greater in those type 2 diabetes (SMD = -0.97, P < 0.001).Meta-regression analysis demonstrates the effects of diabetes on CRF are primarily associated with HbA1c levels for type 1 diabetes (B = -0.07, P < 0.001) and body mass index for type 2 diabetes (B = -0.17, P = 0.005). Conclusions: These data demonstrate a negative influence of diabetes on the key risk factor of low CRF and provide critical insight into specific clinical markers of low CRF associated with diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Chronic fatigue is the most common and debilitating symptomin people with multiple sclerosis (PwMS). Recently, exercise has been proven to alleviate chronic fatigue and improve physical functions. Tailoring the training intervention to the potential fatigue causes could optimize the beneficial effects of training on fatigue. The objective of this study was to compare the effectiveness of an individualized (IND) versus a traditional (TRAD) exercise intervention in reducing chronic fatigue. Methods: Twenty-nine PwMS with high chronic fatigue were randomly assigned to 12 wk of either a TRAD or IND exercise intervention. TRAD comprised aerobic and resistance exercises according to the guidelines for PwMS. IND specifically addressed identified individual weaknesses. Participants visited the laboratory before and after training for the following assessments: patient-reported outcomes (fatigue, quality of life, depression questionnaires), incremental cycling test (peak oxygen uptake (...)), and cycling fatigue test (maximal voluntary contraction, rating of perceived exertion). Results: Similar improvements in fatigue, depression, and quality of life were observed between groups (P > 0.05). Compared with TRAD, IND induced a significant greater increase in ... (+21.0% ± 13.9% vs 6.8%± 11.5%, P < 0.05) and a greater reduction in rating of perceived exertion at a given submaximal intensity (-30.3% ± 18.9% vs -12.1% ± 20.4%, P < 0.001), whereas maximal voluntary contraction increased similarly in both groups (P > 0.05). Conclusions: Although tailored exercise improved similarly fatigue and other subjective parameters (depression, quality of life, sleep quality) compared with than traditional exercise intervention, prescribing an individualized intervention led to greater improvement in ... (but not maximal strength) and perception of effort. This may have positive functional consequences for patients. [ABSTRACT FROM AUTHOR]

Objective: Approximately 20% to 40% of children with hearing loss encounter psychosocial difficulties. This prevalence may be outdated, given the advancements in hearing technology and rehabilitation efforts to enhance the psychosocial well-being of these children. A systematic review of up-to-date literature can help to identify factors that may contribute to the children's psychosocial well-being. Design/Study sample: A systematic review was conducted. Original articles were identified through systematic searches in Embase, Medline, PsychINFO, and Web of Science Core Collection. The quality of the papers was assessed using the Newcastle-Ottawa Quality Assessment Scale and custom Reviewers' Criteria. Results: A search was performed on 20 October 2022. A total of 1561 articles were identified, and 36 were included for review. Critical appraisal led to 24 good to fair quality articles, and 12 poor quality articles. Conclusion: Children with hearing loss have a twofold risk of experiencing psychosocial difficulties compared to normal hearing peers. Estimates for functioning in social interactions, like speech perception (in noise) or language proficiency, have proven to be more adequate predictors for psychosocial difficulties than the degree of hearing loss. Our findings can be useful for identifying children at risk for difficulties and offering them earlier and more elaborate psychological interventions. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis, based on subjective disease state assessment by the treating pediatric rheumatologist. Methods: The cutoff definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, six methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, the Youden index, 90% specificity, maximum agreement, and receiver operating characteristic curve analysis. Sixty percent of the patients were assigned to the definition cohort, and 40% were assigned to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results: The sJADAS10 cutoffs that separated ID from MDA, MDA from MoDA, and MoDA from HDA were ≤2.9, ≤10, and >20.6, respectively. The cutoffs discriminated strongly among different levels of pain, between patients with and without morning stiffness, and among patients whose parents judged their disease status as remission or persistent activity or flare or were satisfied or not satisfied with current illness outcome. Conclusion: The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts and are therefore suitable for use in clinical trials and routine practice. [ABSTRACT FROM AUTHOR]

Roundoff errors often disrupt interpolation methods for time-fractional equations, potentially causing suboptimal convergence or even failure. These issues primarily result from catastrophic cancellations. To address this, we introduce a novel framework for computing coefficients in standard and fast interpolation methods on nonuniform meshes. We propose δ -cancellation and associated threshold conditions to prevent such cancellations. If the thresholds aren't met, a Taylor expansion technique can be applied. Numerical experiments demonstrate our method's accuracy, on par with the Gauss–Kronrod quadrature, but significantly more efficient, allowing for extensive simulations with hundreds of thousands of time steps. [ABSTRACT FROM AUTHOR]

The article describes the case of a 59-year old Japanese man diagnosed with cerebellar cognitive affective syndrome (CCAS) caused by cerebellar atrophy associated with Wallerian degeneration after pontine haemorrhage. The patient demonstrated psychiatric symptoms, slow gait, configuration apraxia, cognitive and motor decline, decline in intelligence quotient and function. Symptoms of CCAS include motor deficits, decreased blood flow in the posterior cerebellar lobes and functional impairment.

Objective: While the number of overdoses in the United States continues to increase, lags in data availability have undermined efforts to monitor, respond to, and prevent drug overdose deaths. We examined the performance of a single-item mandatory radio button implemented into a statewide medical examiner database to identify suspected drug overdose deaths in near-real time. Materials and Methods: The New Jersey Office of the Chief State Medical Examiner operates a statewide mandated case management data system to document deaths that fall under the jurisdiction of a medical examiner office. In 2018, the New Jersey Office of the Chief State Medical Examiner implemented a radio button into the case management data system that requires investigators to report whether a death is a suspected drug overdose death. We examined the performance of this tool by comparing confirmed drug overdose deaths in New Jersey during 2020 with suspected drug overdose deaths identified by investigators using the radio button. To measure performance, we calculated sensitivity, specificity, positive predictive value, negative predictive value, and false-positive and false-negative error rates. Results: During 2020, New Jersey medical examiners investigated 26 527 deaths: 2952 were confirmed by the state medical examiner as a drug overdose death and 3050 were identified by investigators using the radio button as a suspected drug overdose death. Sensitivity was calculated as 96.1% (2837/2952), specificity as 99.1% (23 362/23 575), positive predictive value as 93.0% (2837/3050), negative predictive value as 99.5% (23 362/23 477), false-positive error rate as 7.0% (213/3050), and false-negative error rate as 3.9% (115/2952). Practice Implications: Implementation of a radio button into death investigation databases provides a simple and accurate method for identifying and tracking drug overdose deaths in near-real time. [ABSTRACT FROM AUTHOR]

Summary: Latin America faces a significant public health challenge due to the high prevalence of obesity and its associated diseases. Metabolic and bariatric surgery is effective and safe to treat obesity when other treatments fail; however, its implementation in Latin America remains unsatisfactory. This review explores the current status, challenges, and innovations of metabolic and bariatric surgery in Latin America. We searched peer‐reviewed journals in English and Spanish for relevant articles published between 1998 and 2023. We found that more than 20% of the Latin American population is affected by obesity. Unfortunately, only a limited number of patients have access to metabolic and bariatric surgery due to high cost, limited availability, and shortage of specialists. The review found that ongoing clinical trials are being conducted in Brazil, Mexico, Chile, and Venezuela, indicating some regional progress. However, published studies remain low in number compared with other regions. Furthermore, we summarized the clinical outcomes, risks, and perioperative assessments associated with metabolic and bariatric surgery. We discussed potential strategies to enhance the availability and affordability of this intervention. This review emphasizes the significance of metabolic and bariatric surgery in addressing the obesity pandemic, specifically for Latin America, and proposes directions for future research and innovation. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis. Methods: All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted. Results: Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management. Conclusion: Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis. [ABSTRACT FROM AUTHOR]

Background: The safety and efficacy of robotic liver resection (RLR) for patients with hepatocellular carcinoma (HCC) have been reported worldwide. However, the exact role of RLR in HCC patients with liver cirrhosis is not sufficiently determined. Methods: We conducted a retrospective study on consecutive patients with cirrhosis or non-cirrhosis who received RLR for HCC from 2018 to 2023. Data on patients' demographics and perioperative outcomes were collected and analyzed. Propensity score matching (PSM) analysis was performed. Multivariate logistic regression analysis was performed to determine the risk factors of prolonged postoperative length of stay (LOS) and morbidity. Results: Of the 571 patients included, 364 (64%) had cirrhosis. Among the cirrhotic patients, 48 (13%) were classified as Child–Pugh B. After PSM, the cirrhosis and non-cirrhosis group (n = 183) had similar operative time, estimated blood loss, postoperative blood transfusion, LOS, overall morbidity (p > 0.05). In addition, the intraoperative and postoperative outcomes were similar between the two groups in the subgroup analyses of patients with tumor size ≥ 5 cm, major hepatectomy, and high/expert IWATE difficulty grade. However, patients with Child–Pugh B cirrhosis had longer LOS and more overall morbidity than that of Child–Pugh A. Child–Pugh B cirrhosis, ASA score > 2, longer operative time, and multiple tumors were risk factors of prolonged LOS or morbidity in patients with cirrhosis. Conclusion: The presence of Child–Pugh A cirrhosis didn't significantly influence the difficulty and perioperative outcomes of RLR for selected patients with HCC. However, even in high-volume center, Child–Pugh B cirrhosis was a risk factor for poor postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: An increasing number of reflux patients opt for magnetic sphincter augmentation (MSA) instead of fundoplication. However, few studies compare the medium-term efficacy and safety of the procedures. Methods: We conducted a retrospective single-center analysis of consecutive MSA and Nissen fundoplication cases between 01/2015 and 06/2020. Patients underwent surgery, including hiatoplasty, for medical treatment-resistant reflux due to hiatal hernia. Surgical revision and proton pump inhibitor (PPI) reuptake rates were the primary outcomes. We also compared adverse event rates. Patients with severe preoperative dysphagia/motility disorders were assigned different treatment pathways and excluded from the analysis. We used propensity-score matching to reduce confounding between treatments. Results: Out of 411 eligible patients, 141 patients who underwent MSA and 141 with fundoplication had similar propensity scores and were analyzed. On average, patients were 55 ± 12 years old and overweight (BMI: 28 ± 5). At 3.9 years of mean follow-up, MSA was associated with lower surgical revision risk as compared to fundoplication (1.2% vs 3.0% per year, respectively; HR: 0.38; 95% CI 0.15–0.96; p = 0.04), and similar PPI-reuptake risk (2.6% vs 4.2% per year; HR: 0.59; 95% CI 0.30–1.16; p = 0.12). Adverse event rates during primary stay were similar (MSA vs. fundoplication: 1% vs. 3%, p = 0.68). Fewer patients experienced adverse events in the MSA group after discharge (24% vs. 33%, p = 0.11), driven by higher rates of self-limiting dysphagia (1% vs. 9%, p < 0.01) and gas/bloating (10% vs. 18%, p = 0.06) after fundoplication. Differences between MSA and fundoplication in dysphagia requiring diagnostic endoscopy (11% vs. 8%, p = 0.54) or surgical revision (2% vs. 1%, p = 1.0) were non-significant. The device explantation rate was 4% (5/141). Conclusion: MSA reduces the re-operation risk compared to fundoplication and may decrease adverse event rates after discharge. Randomized head-to-head studies between available surgical options are needed. [ABSTRACT FROM AUTHOR]

Background: Febrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring (RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs. Methods: To assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy. Results: In this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes. Conclusions: In this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs. [ABSTRACT FROM AUTHOR]

Background: Children with nephrotic syndrome are at risk of obesity and growth impairment from repeated steroid treatment. However, incidence and risk factors for obesity and short stature remain uncertain, which is a barrier to preventative care. Our aim was to determine risk, timing, and predictors of obesity and short stature among children with nephrotic syndrome. Methods: We evaluated obesity and longitudinal growth among children (1–18 years) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics. We included children with nephrotic syndrome diagnosed between 1996–2019 from the Greater Toronto Area, Canada, excluding congenital or secondary nephrotic syndrome. Primary outcomes were obesity (body mass index Z-score ≥ + 2) and short stature (height Z-score ≤ -2). We evaluated prevalence of obesity and short stature at enrolment (< 1-year from diagnosis) and incidence during follow-up. Cox proportional hazards models determined the association between nephrotic syndrome classification and new-onset obesity and short stature. Results: We included 531 children with nephrotic syndrome (30% frequently relapsing by 1-year). At enrolment, obesity prevalence was 23.5%, 51.8% were overweight, and 4.9% had short stature. Cumulative incidence of new-onset obesity and short stature over median 4.1-year follow-up was 17.7% and 3.3% respectively. Children with frequently relapsing or steroid dependent nephrotic syndrome within 1-year of diagnosis were at increased risk of new-onset short stature (unadjusted hazard ratio 3.99, 95%CI 1.26–12.62) but not obesity (adjusted hazard ratio 1.56, 95%CI 0.95–2.56). Children with ≥ 7 and ≥ 15 total relapses were more likely to develop obesity and short stature, respectively. Conclusions: Obesity is common among children with nephrotic syndrome early after diagnosis. Although short stature was uncommon overall, children with frequently relapsing or steroid dependent disease are at increased risk of developing short stature. Effective relapse prevention may reduce steroid toxicity and the risk of developing obesity or short stature. [ABSTRACT FROM AUTHOR]

Background: Neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia (HIE + TH) are at risk for acute kidney injury (AKI). The standardized Kidney Disease Improving Global Outcomes (KDIGO) criteria identifies AKI based on a rise in serum creatinine (SCr) or reduced urine output. This definition is challenging to apply in neonates given the physiologic decline in SCr during the first week of life. Gupta et al. proposed alternative neonatal criteria centered on rate of SCr decline. This study aimed to compare the rate of AKI based on KDIGO and Gupta in neonates with HIE and to examine associations with mortality and morbidity. Methods: A retrospective review was performed of neonates with moderate to severe HIE + TH from 2008 to 2020 at a single center. AKI was assessed in the first 7 days after birth by KDIGO and Gupta criteria. Mortality, brain MRI severity of injury, length of stay, and duration of respiratory support were compared between AKI groups. Results: Among 225 neonates, 64 (28%) met KDIGO, 69 (31%) neonates met Gupta but not KDIGO, and 92 (41%) did not meet either definition. Both KDIGO-AKI and GuptaOnly-AKI groups had an increased risk of the composite mortality and/or moderate/severe brain MRI injury along with longer length of stay and prolonged duration of respiratory support compared to those without AKI. Conclusions: AKI in neonates with HIE + TH was common and varied by definition. The Gupta definition based on rate of SCr decline identified additional neonates not captured by KDIGO criteria who are at increased risk for adverse outcomes. Incorporating the rate of SCr decline into the neonatal AKI definition may increase identification of clinically relevant kidney injury in neonates with HIE + TH. [ABSTRACT FROM AUTHOR]

Nuclear factor kappa B (NF-κB) family plays a central role in the human immune system. Heterozygous variants in NFKB2 typically cause immunodeficiency with various degrees of central adrenal insufficiency, autoimmunity, and ectodermal dysplasia. No reported case has presented kidney failure as an initial symptom. Moreover, documentation of kidney involvement of this disease is limited. Case diagnosis: A 2-year-old female who presented with dyspnea and hypertensive emergency in the setting of new-onset nephrotic syndrome with acute-on chronic kidney injury with resultant chronic kidney disease (CKD) was found to have a novel heterozygous N-terminal variant in NFKB2 (c.880del: p. Tyr294Ilefs*4) with mild hypogammaglobulinemia, but no adrenal insufficiency or ectodermal dysplasia. She became dialysis-dependent during her initial hospitalization and developed CKD stage 5D, requiring continued peritoneal dialysis. She is currently awaiting kidney transplantation. Conclusions: Whether nephrotic syndrome or kidney injury or failure is the primary symptom of this variant or secondary to some event remains unknown. Further case accumulation is warranted. [ABSTRACT FROM AUTHOR]

The incidence of rare diseases is expected to be comparatively higher in the Middle East and North Africa (MENA) region than in other parts of the world, attributed to the high prevalence of consanguinity. Most MENA countries share social and economic statuses, cultural relativism, religious beliefs, and healthcare policies. Polycystic kidney diseases (PKDs) are the most common genetic causes of kidney failure, accounting for nearly 8.0% of dialysis cases. The development of PKDs is linked to variants in several genes, including PKD1, PKD2, PKHD1, DZIP1L, and CYS1. Autosomal recessive PKD (ARPKD) is the less common yet aggressive form of PKD. ARPKD has an estimated incidence between 1:10,000 and 1:40,000. Most patients with ARPKD require kidney replacement therapy earlier than patients with autosomal dominant polycystic kidney disease (ADPKD), often in their early years of life. This review gathered data from published research studies and reviews of ARPKD, highlighting the epidemiology, phenotypic presentation, investigations, genetic analysis, outcomes, and management. Although limited data are available, the published literature suggests that the incidence of ARPKD may be higher in the MENA region due to consanguineous marriages. Patients with ARPKD from the MENA region usually present at a later disease stage and have a relatively short time to progress to kidney failure. Limited data are available regarding the management practice in the region, which warrants further investigations. [ABSTRACT FROM AUTHOR]

Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the follow-up rates of non-normal cervical screening samples between Denmark and Flanders (Belgium) to illuminate whether organizational differences between the health systems might affect the follow-up rates, e.g. sending of reminders in Denmark since 2012 compared to Flanders with no such system in place. Methods: The study population included 48,082 Danish women and 22,271 Flemish women who received abnormal or inadequate primary screening results from 2014 to 2016. The participants were followed for 24 months, and the timeliness and appropriateness of the recommended follow-up, according to national guidelines, were evaluated. Results: After 18 months over 90% of the Danish women had received some form of follow-up, while in Flanders, this level is achieved only for those who test positive for human papillomavirus. The analysis also revealed that 10–28% of follow-ups were performed too early, with Danish women showing the highest proportions. In both regions, general practitioners (GPs) exhibited better follow-up rates compared to gynaecologists, with gynaecologists displaying a tendency towards earlier re-testing than recommended. Conclusions: An important factor influencing the follow-up rate may be the sending of reminders in Denmark since 2012, as the follow-up rates in general were higher in this period. It is noteworthy that a reminder system is currently being implemented in Flanders and further studies on the potential effects should be studied. Additionally, the organization of the health system might influence the follow-up rate, as engaging the GP for screening in Denmark may have had a positive effect. [ABSTRACT FROM AUTHOR]

Purpose: Vascular injuries are rarely associated with severe knee injuries; nonetheless, it is imperative to efficiently detect this condition and plan for either immediate or definitive treatment at later stages. The diagnosis and management of multiligament knee injuries still present unresolved issues, particularly in the early detection of vascular issues and the sequential stabilisation of ligaments. High-energy trauma is a frequently encountered cause, however, even low-energy trauma in those who are morbidly obese might pose a significant risk. Advancements in detection and management methods have greatly decreased the occurrence of vascular complications and amputation rates over time. MLKIs after transient knee dislocations are frequently misdiagnosed for vascular injuries, underscoring the necessity for improved diagnostic techniques to avoid avoidable amputations. Methods: This article is a new conceptual review of vascular injuries associated with MLKIs. It provides a full overview of these conditions and includes a review of the most recent literature. We have included pertinent citations from the literature, together with suggestions derived from the latest studies. This review article had additional evaluation by proficient specialists with commendable outcomes and more than a decade of expertise in surgical techniques. Results: This article offers a detailed overview of orthopaedic management, including new definitions and summaries of the causes, evaluation of patients, clinical assessment, identification of vascular injuries, and initial management in patients with vascular impairment following major limb and joint injuries (MLKIs). Conclusion: MLKIs (patients with lower limb ischaemia) who have vascular damage necessitate meticulous physical assessment and sophisticated treatments in order to decrease amputation rates. Prompt identification and timely treatment of vascular lesions, namely in the popliteal artery, can substantially reduce the occurrence of amputations. Emerging research suggests that there is a heightened risk in low-energy situations, particularly amongst individuals who are extremely obese. Progress in vascular intervention has led to a reduction in amputation rates, whilst the implementation of new guidelines has enhanced identification. Thorough patient assessment is essential, utilising physical examinations and imaging techniques such as Computed tomography angiography, magnetic resonance angiography (CTA or MRA) to guide treatment decisions. MRA, in particular, is capable of identifying both vascular and knee structural damage. Level of Evidence: Level IV, Literature reviews. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age. Methods: Fifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated. Results: Fifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications—dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively). Conclusion: Closed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: The relationship between spontaneous osteonecrosis of the knee (SONK) and ipsilateral meniscus tear remains to be established, and the possible causes are clarified and summarized. Methods: We conducted a search in Pubmed, Web of Science, Embase, and the Cochrane Library to include all English articles published from the establishment of the database until April 2023. The odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the relationship between SONK and ipsilateral meniscus lesions. Results: A total of 405 patients were included in eight articles, including 157 males and 248 females, with an average age of 63.94 years and an average BMI of 26.36 kg/m2. In patients with medial SONK, the prevalence of ipsilateral meniscus tear was 0.8982, 95% CI (0.7389, 0.9648), and the prevalence of ipsilateral posterior root tear was 0.6198, 95% CI (0.5169, 0.7118). The prevalence of ipsilateral meniscus tears in patients with lateral SONK was 0.2188, 95% CI (0.1150, 0.3711), and the prevalence of ipsilateral posterior root tears was 0.1667, 95% CI (0.1071, 0.2424). Conclusions: SONK is significantly associated with meniscus or root tears, which limit meniscus function and lead to changes in the stress environment between the knee and the tibiofemur, increasing the chance of incomplete fracture. We suggest that the expression of SONK can be replaced with subchondral insufficiency fracture of the knee. [ABSTRACT FROM AUTHOR]

Objective: This commentary seeks to evaluate existing knowledge about the relationship between brain injury (BI) and overdose (OD), to unify distant bodies of literature, and to enhance prevention and treatment for opioid OD among individuals with BI. Background: There is a hidden epidemic of undiagnosed BI in the United States. Due to lack of screening, the vast majority of BI sufferers do not know they have a BI. Not only are those with BI at elevated risk for opioid use, misuse, and opioid use disorder, but also they are at elevated risk for OD. Conversely, those with OUD and those who experienced an OD, are more likely to sustain BI. Key Findings/Conclusions: The existing literature suggests that primary strategies to reduce ABI (Acquired Brain Injury)/TBI (Traumatic Brain Injury) harms involve addressing: screening, stigma, racial disparities, and popular misconceptions about OD. The association between TBI and OD is an underexamined public health issue, exacerbated by the bidirectional nature of the relationship. Not only is TBI a risk factor for opioid OD; opioid OD was also found to be a major cause of ABI, which can have lifelong effects similar to Alzheimer's disease. Screening tools for BI were underutilized and inconsistently implemented across reviewed studies. Enhanced screening population wide is a promising intervention, complemented with expanded treatment and research. Black individuals face worse outcomes in BI and treatment outcomes. Anti-racist strategies must fight inequity while addressing social and structural drivers of overdose and BI within the opioid and opioid overdose crises. [ABSTRACT FROM AUTHOR]

Background: Infertility is globally prevalent and India accounts for 25% of the global burden, but it is still a neglected reproductive health issue. To estimate the prevalence of infertility, its determinants, perception and challenges faced by couples from the peri-urban area of Ahmedabad City. Materials and Methods: A community-based cross-sectional study was conducted in peri-urban areas of Ahmedabad City. For quantitative data collection, 689 couples were selected through probability proportion-based sampling (PPBS). Data was collected through a questionnaire during (1) phase I for socio-demographic details of the community and identification of eligible couples, (2) phase II for assessing the presence of infertility and its risk factors along with the assessment of depression and anxiety, and (3) phase III for Clinicosocial profiling of all infertile couples (detected during second phase). Some of these women were involved in qualitative components to know the perceptions, challenges, etc. faced while seeking infertility treatment. Result: Study population of 917 families (n = 3891) yielded 689 women of reproductive age group (RAG) with a period prevalence of 7.4% (5.5%-9.4%); separately being 3.5% and 3.9% for primary and secondary type respectively. Socio-demographic determinants like age, education, occupation, addiction, and lifestyle-related illnesses like diabetes and hypertension exhibited no significant association with infertility. However, asthma, mental illnesses, and hormonal diseases like polycystic ovarian disease (PCOD) were associated and exhibited a significant association with infertility. Preventable risk factors like reproductive tract/sexually transmitted infections (RTI/STI) showed a significantly positive association with infertility. Conclusion: The period prevalence of infertility was 7.4%, with the secondary type being more common. Asthma, mental illness, RTI/STI and age at menarche showed significant association. Screening and treatment for RTI/STI can prevent complications like infertility. Stigma associated with infertility and lack of treatment facilities in the government sector makes it difficult to deal with and neglected health problems. [ABSTRACT FROM AUTHOR]

This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. This was a cross-sectional study. Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk. [ABSTRACT FROM AUTHOR]

The article focuses on defining clinical criteria for identifying limbic-predominant amnestic neurodegenerative syndrome (LANS) in older patients and the use of imaging and clinical features to differentiate LANS from Alzheimer's disease.

Summary: In this large population-based matched cohort study, patients with primary aldosteronism were at increased risk of hip fracture, particularly subgroups traditionally considered at higher risk of osteoporosis such as women, patients older than 56 years at diagnosis, patients with established cardiovascular disease at diagnosis, and patients treated with MRA. Purpose: Previous studies suggest that primary aldosteronism (PA) is associated with dysregulated bone homeostasis. The aim of this study was to evaluate the incidence of hip fractures in patients with PA. Methods: We studied a nationwide cohort of 2419 patients with PA (1997–2019) and 24 187 age and sex matched controls from the general population. Hip fractures were identified by ICD codes in the Swedish National Patient Register. We estimated hazard ratios (HRs) for incident hip fractures, adjusted for prior fractures, socioeconomic factors, diabetes, osteoporosis, hyperparathyroidism, and cardiovascular disease (CVD). Pairwise subgroup comparisons were performed by age (18–56 and > 56 years), sex, CVD at baseline, and treatment for PA. Results: During a mean follow up of 8 ± 5 years, 64 (2.6%) patients had a hip fracture after being diagnosed with PA, compared to 401 (1.7%) controls. After adjustments, PA was associated with a 55% increased risk of hip fracture compared to controls (HR 1.55 [1.18–2.03]). HRs were increased in women (HR 1.76 [95% CI 1.24–2.52]), patients aged > 56 years (HR 1.62 [95% CI 1.21–2.17]), and patients with CVD at diagnosis (HR 2.15 [95% CI 1.37–3.37]). PA patients treated with adrenalectomy did not have higher risk than controls (HR 0.84 [95% CI 0.35–2.0]), while patients treated with mineralocorticoid receptor antagonists (MRA) retained a greater risk (HR 1.84 [95% CI 1.20–2.83]). Conclusion: PA is associated with increased hip fracture risk, especially in women, patients diagnosed after the age of 56 years and patients with established CVD at diagnosis. Also, patients treated with MRA seem to have an increased risk of hip fractures, while adrenalectomy may be protective. [ABSTRACT FROM AUTHOR]

Respiratory virus infections are related to over 80% of childhood asthma exacerbations. They enhance pro-inflammatory mediator release, especially for sensitized individuals exposed to pollens/molds. Using a time-series study design, we investigated possible effect modification by respiratory virus infections of the associations between aeroallergens/PM2.5 and asthma exacerbation rates. Outpatient, emergency department (ED), and inpatient visits for asthma exacerbation among children with asthma (28,540/24,444 [warm/cold season]), as well as viral infection counts were obtained from electronic health records of the Children's Hospital of Philadelphia from 2011 to 2016. Rate ratios (RRs, 90th percentile vs. 0) for late-season grass pollen were 1.00 (0.85–1.17), 1.04 (0.95–1.15), and 1.12 (0.96–1.32), respectively, for respiratory syncytial virus (RSV) counts within each tertile. However, similar trends were not observed for weed pollens/molds or PM2.5. Overall, our study provides little evidence supporting effect modification by respiratory viral infections. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is an etiological factor of tinea pedis (TP) which can increase the risk of diabetes-related foot complications. There is scarce research investigating the epidemiology of TP among patients with diabetes and this study contributed to filling this gap. Objective: To identify the prevalence and the associated factors of TP among patients with diabetes in Jordan. Methods: A total of 375 patients with diabetes were recruited in a cross-sectional study at the National Centre for Diabetes, Endocrinology and Genetics in Amman, Jordan. TP was examined by a specimen culture and microscopic study. Several independent variables were collected, including sociodemographic, clinical, and foot self-care variables. Multivariant logistic regression was conducted to test independent factors associated with the prevalence of TP. Results: Positive TP was present in 211 participants with a prevalence of 56.3%. Multiple logistic regression resulted in four significant associated factors; being highly educated (β = 1.69, p = 0.03), presence of onychomycosis (β = 4.48, p < 0.01), wearing socks as a daily habit (β = 2.30, p < 0.01), and frequency of feet washing (1–2 times\day) (β = 2.54, p = 0.04). Conclusion: Patients with diabetes in Jordan have a high prevalence of TP. Factors including educational level, onychomycosis infection, and self-care activities (i.e., socks wearing habits and foot hygiene) were found to be associated with the prevalence of TP. [ABSTRACT FROM AUTHOR]

Objective: Diabetes is an important risk factor for cardiovascular disease. The purpose of this study was to explore the role of diabetes and prediabetes in the risk of cardiovascular disease. Methods: This prospective study was performed on three groups of non-diabetic (n = 7291), prediabetic (n = 438), and diabetic (n = 1713) in the age range of 40–70 years in Kharameh (Iran) in 2014–2021. The participants were followed for 4 years. Demographic information, chronic disease history, behavioral habits, and laboratory parameters were examined. Initially, the incidence density was calculated and the difference between the risk of cardiovascular disease in the three groups was examined using the log-rank test. The Cox regression model was performed to investigate the association between prediabetes and diabetes with the risk of cardiovascular disease. Results: The mean age of the participants was 51.47 years. The density incidence in the three groups of non-diabetic, prediabetic, and diabetic individuals was estimated to be 1.5, 1.5, and 3.9 cases per 100,000 person-days, respectively. There was no statistically significant relationship between prediabetes and the incidence of cardiovascular disease. However, the incidence of cardiovascular disease in diabetics was 2.55, 2.16, and 2 times higher than in non-diabetics in the simple, adjusted for age and sex, and in multiple Cox regression, respectively. Conclusion: Due to the independent role of diabetes in the incidence of cardiovascular disease, diabetic individuals should be screened periodically for cardiovascular conditions. Furthermore, it is very important for these individuals to control the important risk factors that contribute to the incidence of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objective: Although many studies have shown the relationship between type 1 diabetes mellitus (T1DM) and autoimmune thyroid diseases, few studies have conducted a morphological evaluation of the thyroid gland in T1DM without thyroid disease. This study aimed to compare thyroid ultrasonography findings of the healthy control group with the T1DM group without thyroid disease and examine the relationship between β-cell autoantibodies and the presence of thyroid nodules. Methods: This cross-sectional study included 119 patients with T1DM and 105 healthy controls. Thyroid function tests, thyroid volume, and presence of thyroid nodules were compared between the two groups. Patients with T1DM were divided into two groups according to the presence of thyroid nodules, and risk factors that may affect the development of thyroid nodules were tried to be determined. Results: No significant difference was found between the control group and the T1DM group in terms of thyroid function tests, thyroid volume, and presence of thyroid nodules. In the T1DM group, the number of female patients and the islet cell antibody (ICA) positivity rate were higher in the presence of thyroid nodules. As a result of regression analysis, ICA positivity in the T1DM group increased threefold the risk of having thyroid nodules. Conclusion: A relationship was observed between ICA positivity and thyroid nodules in T1DM. Thus, cases with ICA positivity may have a higher probability of nodules in the thyroid gland, and neck examinations should be performed more frequently. [ABSTRACT FROM AUTHOR]

Objective: We studied the presence of psychological stress in patients with type 2 diabetes (T2D) and if could be attributed to the consumption of a pro-inflammatory diet. We evaluated the inflammatory potential of the habitual Mexican diet, addressed by tools with an approach to collecting information on e-Health. Methods: In this cross-sectional analytic study of 238 Mexican adults with T2D, the profile of the inflammatory diet was obtained by the Dietary Inflammatory Index (DII), and the presence of psychological stress by the Diabetes Distress Scale-17 (DSS) was assessed. Multivariable logistic regression analysis was performed to estimate the association between diabetes stress and DII score. Sensitivity analysis was performed by Energy–Density Dietary Inflammatory Index (E-DII). Results: We demonstrated that there is an association between a profile of stress and high-inflammatory values of the DII score after adjustment for potential confounders (OR 2.40, 95% CI 1.2, 4.6). Conclusion: Using e-Health through web-based tools to collect information showed benefits of the application as a method of dietary assessment. We provide evidence showing that better values of the DII score and physical activity may play a protective role against the presence of psychological stress; DII and E-DII scores qualify and label habitual diet into pro and anti-inflammatory and are associated with psychological stress in T2D. [ABSTRACT FROM AUTHOR]

Objective: Tropical diabetic hand syndrome (TDHS) is rarely described and recognized in the literature as a complication in people with diabetes, and Mexico has high incidence rates of diabetes mellitus II (DMII). The minor or major amputation of the arm represents a physically and economically significant morbidity problem in patients. To optimize the diagnosis and treatment, in this work, we identify prognostic factors and their association with the severity of TDHS and the need for amputation in patients with diabetes mellitus and hand tissue infection. Methods: A total of 55 patients with a confirmed diagnosis of DMII with soft tissue infection in the hand referred to the plastic and reconstructive surgery department were studied for their evaluation and treatment. We analyze sociodemographic and clinical factors and follow-up of remission and recovery in limb functions. Results: In our study, we identified factors associated with amputation such as schooling under 6 years (OR: 21.98, confidence interval (CI): 1.21–3.98, p = 0.003), body mass index ≥ 20 (OR: 0.07, CI = 0.003–1.41, p = 0.031), and history of amputation (no upper limb) (OR: 5.9, CI = 1.11–32.1, p = 0.032). Furthermore, people with TDHS requiring amputation had slightly higher glycated hemoglobin (Hb1Ac) ≥ 10% (OR: 2.36, CI = 0.62–8.98, p = 0.338), and the risk of death was also increased (OR: 3.4, CI = 0.355–32.6, p = 0.288), although these outcomes did not reach statistical significance. Conclusions: Risk factors for amputation as a treatment of THDS are directly linked to lower schooling status, poor nutrition/low weight, as well as previous amputation procedures in patients. These data will help to establish a timelier evaluation and management in patients with suspected THDS. [ABSTRACT FROM AUTHOR]

Background: Depression is present in individuals with type 2 diabetes mellitus. Objective : We evaluated the sociodemographic, anthropometric, and clinical features of Mexican individuals with clinical depressive symptoms in order to identify predictors for depression symptoms; finally, we evaluated if HbA1c levels could be used as a probable diagnostic of depressive symptoms in individuals with type 2 diabetes mellitus. Methods: The population studied consisted of 376 Mexicans with diabetes who were interviewed to collect information about comorbidities and habits. The evaluation of depressive symptoms was performed using the Hamilton scale. For a possible clinical association between HbA1c levels and depressive symptoms, we performed chi-square tests (χ2)/ t tests. A multivariate logistic regression model with the backward conditional method was used to identify predictors of depressive symptoms. An ROC curve was plotted to assess the possible role of HbA1c as a diagnostic predictive test of depression symptoms. Results: A total of 42.8% (n = 161) individuals showed clinical depressive symptoms. When comparing individuals with and without depression symptoms, those with depression symptoms showed higher levels of glucose and HbA1c; additionally, gender (p = 0.04), age (p = 0.006), HbA1c (p < 0.01), and complications related to diabetes were predictive factors for clinical depressive symptoms (p < 0.01). However, HbA1c showed a low diagnostic accuracy for depressive symptoms, with an area under the ROC curve of 0.59. Conclusions: Our findings provided evidence of the sex, age, HbA1c levels, and medical complications as predictors of clinical depressive symptoms in individuals with diabetes mellitus. Nevertheless, HbA1c levels are not useful as a diagnostic instrument for depressive symptom severity in these Mexican individuals. [ABSTRACT FROM AUTHOR]

Background: Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. Aim: To explore the impact of EM on TBI‐related pneumonia in the neurosurgical intensive care unit (NICU). Study Design: This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI‐related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. Results: After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p <.001). Multivariate logistic regression showed that EM was an independent risk factor for TBI‐related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p =.017) and higher GCS at discharge (12 vs. 11, p =.010). Conclusion: EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. Relevance to Clinical Practice: Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application. [ABSTRACT FROM AUTHOR]

This paper examines the stability of the à trous algorithm under arbitrary iteration in the context of a more general study of shift-invariant filter banks. The main results describe sufficient conditions on the associated filters under which an infinitely iterated shift-invariant filter bank is stable. Moreover, it is shown that the stability of an infinitely iterated shift-invariant filter bank guarantees that of any associated finitely iterated shift-invariant filter bank, with uniform bounds. The reverse implication is shown to hold under an additional assumption on the low-pass filter. Finally, it is also shown that the separable product of stable one-dimensional shift-invariant filter banks produces a stable two-dimensional shift-invariant filter bank. [ABSTRACT FROM AUTHOR]

The article presents a neonatal case where cardiac tamponade developed as a complication of a peripherally inserted central catheter (PICC). Topics discussed include the potential risks associated with PICC placement, the management of pericardial effusion, and the importance of timely detection and intervention to prevent severe outcomes.

The article provides a comprehensive overview of acne vulgaris, focusing on its pathophysiology and management strategies. Topics discussed include factors influencing acne such as androgen activity and genetic variants, the impact of lifestyle and dietary behaviors, and current treatment options ranging from topical and oral medications to isotretinoin.

The article presents a case study of an 18-year-old male with adrenal insufficiency, characterized by dizziness, shortness of breath, and weight loss. Topics discussed include the diagnosis of primary adrenal insufficiency, treatment with glucocorticoids and mineralocorticoids, and the importance of screening for additional autoimmune endocrine disorders.

Following mild traumatic brain injury (mTBI), children show reduced processing speed (PS). Evidence suggests that slowed PS after TBI is associated with working memory deficits. Our aim was to investigate several forms of PS and to examine its impact on working and episodic memory performance in children after mTBI. We included data of 64 children after mTBI and 57 healthy control children aged 8–16 years. PS (Color Naming, Coding, Symbol Search, Alertness) was compared between groups 1 week (T1) and 3–6 months (T2) after the injury; working and episodic memory outcome was compared between groups at T2. Alertness at T1 and Color Naming at T1 and T2 were significantly reduced following mTBI compared to controls, although most group differences in PS disappeared when patients with previous impairments and mTBI were excluded. PS was predictive for episodic and working memory performance 3–6 months after injury, whereas group was a significant predictor of working memory. Compared to healthy controls, children after mTBI showed reduced performance in verbal PS, which was associated with working memory. In children who are symptomatic after mTBI, diagnostic screening of PS could be helpful in identifying patients that could profit from speed-improving strategies. [ABSTRACT FROM AUTHOR]

Cognitive impairment is a severe complication of acute respiratory distress syndrome (ARDS). Emerging studies have revealed the effects of pyrrolidine dithiocarbamate (PDTC) on improving surgery-induced cognitive impairment. The major aim of the study was to investigate whether PDTC protected against ARDS-induced cognitive dysfunction and to identify the underlying mechanisms involved. The rat model of ARDS was established by intratracheal instillation of lipopolysaccharide (LPS), followed by treatment with PDTC. The cognitive function of rats was analyzed by the Morris Water Maze, and pro-inflammatory cytokines were assessed by quantitative real-time PCR, enzyme-linked immunosorbent assay, and western blot assays. A dual-luciferase reporter gene assay was performed to identify the relationship between miR-181c and its target gene, TAK1 binding protein 2 (TAB2). The results showed that PDTC improved cognitive impairment and alleviated neuroinflammation in the hippocampus in LPS-induced ARDS model. Furthermore, we demonstrated that miR-181c expression was downregulated in the hippocampus of the ARDS rats, which was restored by PDTC treatment. In vitro studies showed that miR-181c alleviated LPS-induced pro-inflammatory response by inhibiting TAB2, a critical molecule in the nuclear factor (NF)-κB signaling pathway. PDTC improves cognitive impairment in LPS-induced ARDS by regulating miR-181c/NF-κB axis-mediated neuroinflammation, providing a potential opportunity for the treatment of this disease. [ABSTRACT FROM AUTHOR]

Considering that diagnostic decisions about mTBI are often predicated on clinical symptom criteria, it is imperative to determine which initial presentation features of mTBI have prognostic significance for identifying those at high risk for long-term functional impairment. Zoom interview Participants: Male, former NCAA Division I, and professional-level National Football League (NFL) athletes (n = 177) between the ages of 27 and 85 (M = 54.1, SD = 14.7). Cross-sectional case-control. Main Measures: History of mild TBI, history of loss of consciousness (LOC), depression symptoms, insomnia, neurobehavioral symptoms. Number of mTBI exposures did not predict neurobehavioral symptoms (B = 0.21, SE = 0.18, p = 0.23), but number of mTBI + LOC events did (B = 2.27, SE = 0.64, p = <.001). Further analysis revealed that the number of mTBI + LOC events predicted neurobehavioral symptoms indirectly through both depression (B = 0.85, 95% CI = [0.27, 1.52) and insomnia (B = 0.81, 95% CI = [0.3, 1.4]). Further, the direct effect of mTBI + LOC events on neurobehavioral symptoms became non-significant when depression and insomnia were added to the model (B = 0.78, SE = 0.45, p = 0.08). Findings support LOC at time of injury as an important predictor of long-term outcomes. Additionally, results suggest depression and insomnia as potential mediators in the association between mTBI + LOC and neurobehavioral symptoms. These findings provide justification for early depression and insomnia symptom monitoring following mTBI + LOC. [ABSTRACT FROM AUTHOR]

Hyperoxia has been suggested as a mechanism for secondary injury following adult traumatic brain injury (TBI), but its effects have not been well described in pediatric patients. Pediatric (≤18yo) TBI patients were identified in a prospective institutional registry from October 2008 to April 2022. The first, highest, and the Area Under the Curve (AUC) PaO2 in the first 24 hours were collected and calculated for each patient from arterial blood gas reports after admission to the ICU. Neurological outcome after 6 months was measured using dichotomized modified Rankin Scale (mRS) and Glasgow Outcome Scale – Extended (GOS-E). Multivariable logistic regression models were used to determine if the three measurements for hyperoxia predicted an unfavorable outcome after controlling for well-established clinical and imaging predictors of outcome. We identified 98 pediatric patients with severe accidental TBI during the study period. Hyperoxia (PaO2 > 300 mmHg) occurred in 33% of the patients. The presence of elevated PaO2 values, determined by all three evaluations of hyperoxia, was not associated with unfavorable outcome after 6 months. Utilizing multiple methods to assess exposure, hyperoxia was present in a substantial number of patients with severe TBI but was not associated with an unfavorable outcome. [ABSTRACT FROM AUTHOR]

To establish the prevalence of tinnitus in adults who have sustained non-blast related traumatic brain injury (TBI), as well as the prevalence of tinnitus following TBI in the absence of hearing loss. A systematic search was carried out using MEDLINE, EMBASE, PsycINFO, CINAHL from January 1st 1990 to August 14th 2023. TBI, tinnitus and auditory findings were extracted from all eligible studies, and a descriptive synthesis performed. This systematic review was registered with PROSPERO (Registration number: CRD42022377637). Based on the Oxford Centre of Evidence-Based Medicine (OCEBM) (2011) criteria, the highest quality evidence identified was at Level 2b, with the bulk of the included studies predominantly populating the lower evidence tiers. While there was a substantial variability in the methods used to establish and report the presence of tinnitus, its occurrence following TBI was evident in adults with and without hearing loss. The need for prospective, longitudinal research into tinnitus following non-blast related TBI is evident. Such comprehensive studies hold the potential to inform and enhance the clinical diagnosis and management of this patient population. [ABSTRACT FROM AUTHOR]

Post-COVID conditions (long COVID) are defined as COVID symptoms persisting 28 days post-initial infection. The limited research available on the prevalence and experiences of post-COVID conditions among persons with HIV (PWH) indicates potential increased risk for post-COVID conditions. The purpose of this study was to characterize prevalence, symptom clustering, impact, and potential risk factors of post-COVID conditions among PWH. Data come from the COVID-19 survey, conducted as a sub-study of the DC Cohort Longitudinal HIV Study, an ongoing study of over 12,000 PWH living in Washington, DC. Survey data were matched to electronic medical record data. Prevalence estimates and multivariable logistic regression analyses were calculated comparing those with and without post-COVID conditions. The prevalence of post-COVID conditions among PWH was 46% with no significant differences among demographic or HIV measures. Those with history of asthma were more likely to report post-COVID conditions symptoms. Among those with post-COVID conditions, 81% reported three or more initial COVID symptoms. Retired/disabled PWH were more likely to report post-COVID conditions compared to employed (aOR = 2.37, 95% CI = 1.06, 5.33). Post-COVID conditions significantly limited activities of daily living. Programs are needed to address the long-term impact of post-COVID conditions on activities of daily living among PWH. [ABSTRACT FROM AUTHOR]

Sexual dysfunction is a common and significant issue for patients with multiple sclerosis (MS), adversely affecting their overall quality of life. Proper sexual counseling can be beneficial for these women. This study aimed to evaluate the impact of a counseling intervention based on the PLISSIT model on family functioning and sexual quality of life in women with MS. This interventional study was conducted in 2020 at the largest center for special diseases in southeast Iran. Sixty women with MS were selected through convenience sampling and randomly assigned to either an intervention group or a control group. The intervention group participated in four 90-minute individual counseling sessions based on the PLISSIT model over four weeks, while the control group received routine training. Data were collected using a demographic information form and questionnaires on family functioning and sexual quality of life, both before and after the intervention. Results showed no significant differences between the two groups in terms of family functioning and sexual quality of life scores before the intervention (p > 0.05). However, after the intervention, the intervention group exhibited significant improvements in both family functioning and sexual quality of life scores (P < 0.0001). Specifically, there was a notable increase in the mean scores for family functioning and sexual quality of life in the intervention group post-intervention (P = 0.001 and P = 0.0001, respectively). In contrast, the control group showed no significant change in family functioning (P = 0.79) and a significant decrease in sexual quality of life (P = 0.014) during the second assessment. The results suggest that sexual counseling based on the PLISSIT model can effectively enhance family functioning and sexual quality of life in women with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Female infertility is a major public health concern, and viral infections have been suggested as a potential cause. The recent emergence of coronaviruses, such as SARS-CoV-2, has raised concerns about their potential impact on female fertility. This systematic review aimed to evaluate the existing literature on the relationship between female infertility and viral diseases, with a particular focus on coronaviruses. A systematic review was conducted using relevant databases, including PubMed, Scopus, Web of Science, and Google Scholar. Studies published between 2009 and 2023 were included. The Critical Appraisal Skills Program (CASP) tool was used to assess the quality of the studies. Data extraction and synthesis was carried out to summarize the findings. 13 studies met the inclusion criteria and were included in the review. The review demonstrated that many type viruses including human papillomavirus (HPV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and coronaviruses van affect female reproductive system. Moreover, findings revealed that some viral infections such as HPV and HIV may be associated with female infertility. However, evidence on the effect of coronaviruses on female infertility was limited and inconclusive. [ABSTRACT FROM AUTHOR]