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Envenomation by marine animals poses a significant health concern globally, affecting both local residents and tourists in coastal regions. The primary objective of this review is to critically evaluate the existing scientific literature to determine the most effective first-aid treatment for envenomations caused by marine animals, specifically whether hot-water immersion (HWI) or ice-pack treatment (IPT) provides the best immediate care. This comprehensive review covers a wide range of marine envenomations, from jellyfish stings to stingray injuries. While our focus is primarily on the efficacy of HWI and IPT, we also explore the role of cold-water treatment as a result of its relevance and similarity to ice-pack applications. In addition, we examine other treatments mentioned in the literature, such as medications or vinegar, and highlight their findings where applicable. To provide a clear and structured overview, we summarised the articles in separate tables. These tables categorise the type of research conducted, the marine species studied, the region of origin of the marine species, and the key findings of each study. Our analysis of the available evidence indicates a general consensus in the scientific community on the effectiveness of HWI or IPT for envenomation by marine animals. However, when treating those injuries, it is crucial to consider all factors since there is no universally superior treatment due to the diverse nature of marine habitats.

BackgroundA rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam’s health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. ObjectiveThis study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. MethodsA scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. ResultsOf the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users’ individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. ConclusionsThe use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake.

Following our observation that clofoctol led to Epstein–Barr virus (EBV) lytic gene expression upon activation of the integrated stress response (ISR), we decided to investigate the impact of As2O3 on viral lytic gene expression. As2O3 has also been reported to activate the ISR pathway by its activation of the heme-regulated inhibitor (HRI). Our investigations show that As2O3 treatment leads to eIF2α phosphorylation, upregulation of ATF4 and TRB3 expression, and an increase of EBV Zta gene expression in lymphoid tumor cell lines as well as in naturally infected epithelial cancer cell lines. However, late lytic gene expression and virion production were blocked after arsenic treatment. In comparison, a small molecule HRI activator also led to increased Zta expression but did not block late lytic gene expression, suggesting that As2O3 effects on EBV gene expression are also mediated through other pathways.

Aim of the study : The crisis associated with cancer may contribute to the development of anxiety and depressive disorders. Contemporary psycho-oncology focuses on the psychological determinants of the cancer patientsʼ functioning to find which disease-coping strategies help the healing process, facilitate the establishment of a good therapeutic relationship and the process of adapting to difficult situations. Aim of the study was assess the psychological functioning of patients with cancer of reproductive organs in the cancer-treating process. The practical aim was to develop guidelines for psychological care dedicated to this group of patients. Material and methods : The study was conducted in the Reproductive Organs Cancer Clinic in Institute of Oncology in Warsaw using a questionnaire consisting of: Demographic, Hospital Anxiety and Depression Scale (HADS), Multidimentional Health Locus of Control (MHLC), Cognitive Emotions Regulations Questionaire (CERQ). Results : Seventy-eight patients aged 22 to 82 (average 54) were examined. Investigation of relationships between anxiety and depression and coping strategies showed: positive correlation of anxiety with self blame and rumination, positive correlation of anxiety and depression with catastrophizing, positive correlation of depression with blaming others, negative correlation of anxiety and depression with acceptance and positive refocusing, negative correlation of depression with refocus of planning and putting into perspective. Conclusions : The results of this study indicate that there may be an indirect method of diagnosing anxiety and depression disorders in cancer patients by observing the coping strategies to cope with the difficult situation.

Purpose: The authors sought to determine the value of the audition elective to the overall success of medical students in the match. Method: The authors surveyed 1,335 fourth-year medical students at 10 medical schools in 2013. The study took place over a 2-month period immediately following the match. Medical students were emailed a 14-question survey and asked about audition electives, rank order, and cost of ‘away’ rotations. Results: One hundred percent of students wishing to match in otolaryngology, neurosurgery, plastic surgery, radiation oncology, and urology took the audition electives. The difference by specialty in the proportion of students who took an audition was statistically significant (p

Aim. Assessment of anxiety-depressive disorders in an oncologically ill patient may help in the treatment process and planning psycho-oncological care. The aim of the study was to assess the level of anxiety and depression in cancer patients and their relationship with psychosocial variables. Methods. The study group consisted of adult cancer patients, eligible for causal treatment for at least 6 weeks. The HADS questionnaire was used to examine 537 patients aged 19 to 91 (average age: 53.5). Results. Both during the first oncological treatment and in the relapse of the disease, patients more often show symptoms of anxiety than depression. These conditions occur with greater intensity in women than in men (p = 0.000), moreover, the risk of depressive disorders increases with the patient's age (p = 0.015). The highest intensity of symptoms of depression was observed in patients living in the countryside and in people on disability or retirement pension, and the lowest in small and medium-sized towns and in people who were economically active or on short sick leave. On the other hand, the simultaneous occurrence of anxiety and depression was distinctive for the patients with breast and reproductive organs cancers, which were least frequently reported by patients with urinary tract cancers. Conclusions. Tools for screening the risk of depression and anxiety disorders should be used routinely during regular medical consultations in a patient with cancer. This will allow for early detection of symptoms and initiation of therapeutic measures. [ABSTRACT FROM AUTHOR]

Systemic connective tissue diseases, notably rheumatoid arthritis and systemic lupus erythematosus, frequently affect women of reproductive age. The significant impact of the diseases on the course of pregnancy is well established, and vice versa – the course of systemic connective tissue diseases may be affected by pregnancy. The risk of developing serious pregnancy complications and obstetric failures is markedly higher in the mentioned disease group. The foundation of obstetric success, i.e. giving birth to a healthy child and pregnancy having no effect on the course of a given autoimmune disease, is cooperation between rheumatologists and obstetricians so as to plan procreation at an optimal period and provide accurate pregnancy monitoring. The article delineates recommendations relating to contraception management, obstetric supervision and fetus wellbeing monitoring, from the point of view of the obstetrician.

The antiphospholipid syndrome (APS) is an interdisciplinary condition with a clinical picture in which thrombotic complications and obstetric failures play the most significant role. It has been demonstrated on the basis of multicentre clinical observations that the most common pregnancy-related complications in the course of APS include: recurrent miscarriage in the first trimester of pregnancy, pregnancy loss in the second and third trimester of pregnancy, early preeclampsia and preterm delivery. Any APS female patient planning a pregnancy should be advised about the risk of complications which may occur in the course of pregnancy. The treatment of pregnant APS patients should be conducted by a multidisciplinary team including specialists in rheumatology, obstetrics, and in justified cases also in haematology. The most important element of the pregnant APS patient management is secondary thromboprophylaxis with low dose aspirin and heparins. The introduction of hydroxychloroquine is recommended in patients with systemic lupus erythematosus. The visits should take place every 4 weeks and starting from week 26–28 of pregnancy every 1–2 weeks. The patients should be strictly monitored for signs of preeclampsia and/or thrombosis.

The majority of patients with systemic lupus erythematosus (SLE) are at reproductive age. The mean age of SLE onset is 29 years. In contrast to rheumatoid arthritis, in pregnant patients with SLE the disease is still active or even may be exacerbated. Pregnancy – preparation for it, its course, and the breastfeeding period – is a major therapeutic and organizational challenge for doctors taking care of patients with SLE. The management of pregnancy and puerperium in a patient with SLE requires close cooperation of doctors of various specialities, including in the first place rheumatologists and obstetricians. In the paper the recommendations are presented concerning preparation for pregnancy, treatment of the underlying disease and complications during pregnancy and the breastfeeding period in SLE patients. Particular attention is paid to the treatment according to the recently published recommendations for patients with lupus nephritis.

The peak in incidence of the majority of inflammatory arthropathies (IAs) is observed in the 2 nd –4 th decades of life. Thus the diseases affect patients at reproductive age. The results of population studies have demonstrated that these diseases can exert effects on the fertility of the patients, family planning, course of pregnancy and further development of the baby. It has also been shown that female patients with IAs, compared with healthy women, less frequently decide to have the first and other babies and the interval between successive pregnancies is longer. The aim of pharmacotherapy in a patient with IA who plans to become pregnant is to effectively inhibit the inflammatory activity and to maintain remission/low activity of the disease during pregnancy and after its termination. Disease-modifying drugs suitable for administration in the preconception period and pregnancy include: chloroquine, hydroxychloroquine, sulfasalazine, azathioprine, ciclosporin A, glucocorticosteroids and non-steroidal anti-inflammatory drugs. The following should not be administered: out of the synthetic disease-modifying drugs – methotrexate, leflunomide, cyclophosphamide and mycophenolate mofetil; and out of biological drugs – abatacept, tocilizumab and rituximab.

One of the more important problems resulting from the specificity of a chronic disease, its treatment and associated adverse effects is a permanent inability or limited ability to initiate and realize the requirements relevant to a given developmental stage of the patient. For women at reproductive age this includes family planning and giving birth to babies. The problem of pregnancy in women with the diagnosis of rheumatic disease is associated not only with physical but also psychological factors. A significant percentage of women with rheumatic diseases make no attempts to conceive. It is caused among other things by lacking knowledge on the possibilities of realization of the motherhood plans and the influence of social stereotypes concerning limitations resulting from disability. Therefore, an important element of influencing the patients’ attitudes is solid education providing information and instrumental support including practical training in precise ways of management of a given situation.

To date, six human coronaviruses have been known, all of which are associated with respiratory infections in humans. With the exception of the highly pathogenic SARS and MERS coronaviruses, human coronaviruses (HCoV-NL63, HCoV-OC43, HCoV-229E, and HCoV-HKU1) circulate worldwide and typically cause the common cold. In most cases, infection with these viruses does not lead to severe disease, although acute infections in infants, the elderly, and immunocompromised patients may progress to severe disease requiring hospitalization. Importantly, no drugs against human coronaviruses exist, and only supportive therapy is available. Previously, we proposed the cationically modified chitosan, N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (HTCC), and its hydrophobically-modified derivative (HM-HTCC) as potent inhibitors of the coronavirus HCoV-NL63. Here, we show that HTCC inhibits interaction of a virus with its receptor and thus blocks the entry. Further, we demonstrate that HTCC polymers with different degrees of substitution act as effective inhibitors of all low-pathogenic human coronaviruses.

Abstract Introduction The resource is designed to familiarize medical students with the special needs and issues of the adolescent patient, including specific components of the adolescent expanded social history. The session emphasizes a combination of didactic and experiential learning and is broken into two parts. Methods The first section consists of a 1-hour didactic lecture discussing the needs of the adolescent patient, the importance of addressing the health needs of adolescents, and important procedural items such as assuring confidentiality and a level of autonomy. Following the lecture, the students report to the clinical skills assessment program section for their standardized patient interaction. Student pairs interview an adolescent using the structured communication adolescent guide. One student is responsible for conducting the interview (20 minutes) while the second student is responsible for observing the interaction and giving feedback along with the adolescent patient instructor (out of character) at the end of the session (10 minutes). The second student can then be the primary interviewer if there are enough adolescent instructors/time available. The encounters are observed by faculty via remote video and there is time set aside for students to debrief with faculty at the end of the session in a small-group setting. Students have a 1-hour didactic lecture discussing the needs of the adolescent patient. Results Students and faculty were surveyed on a quarterly basis in order to facilitate curriculum development. The curricular pieces are graded from poor to excellent based on three criteria, (1) relevance of topic, (2) quality of material presented, and (3) quality of the presentation. Both students and faculty graded the session favorably. Ninety-two percent of students rated the relevance of the lecture as good to excellent. Ninety percent thought the quality of the material is good to excellent, and 87% rated the quality of the presentation as good to excellent. Students also thought highly of the clinical skills section. Ninety percent thought the session increased their understanding and improved their self-assessment skills, and 80% thought the quality of feedback was good to excellent. Discussion A stable pool of recruited adolescents is ideal. Possibilities include outreach to enrichment programs in local high schools or volunteer groups. It is strongly recommend recruiting more students than necessary to anticipate potential absences. Another item to consider is the key importance of preparing the adolescent to feel comfortable to give feedback.

Abstract Introduction The online Occupational Medicine Tutorial prepares students to diagnose occupational diseases in their patients. The material is comprehensive enough to allow faculty who do not specialize in occupational medicine to run this activity. Methods The tutorial is broken into three sections and is designed to take approximately 30-minutes to complete. The first section includes an overview of the importance of taking an occupational history, a list of common occupations, exposures and resultant diseases, and a methodology for obtaining a problem-focused occupational history. The second section asks the students to complete their own personal occupational history using the framework outlined in the previous section. The third section allows the student to work through one of two clinical vignettes. Results Both students and faculty graded the online tutorial favorably. Eighty-one percent of students rated the relevance of the online tutorial as good to excellent. Seventy-four percent thought the quality of the material is good to excellent and seventy percent rated the quality of the presentation as good to excellent. Faculty respondents were much more enthusiastic with 92.8% judging the relevance, quality of content, and presentation within the good to excellent range. Discussion After completing the tutorial students appreciated the range of occupational exposures and the importance of taking an occupational history. Because the tutorial encourages the students to take their own occupational histories, they are more familiar with the tools available to determine if a patient's workplace exposures could be associated with their presenting symptoms and illness.

Background: To support informal dementia carers, the World Health Organization (WHO) developed 'iSupport for Dementia' online skills training program, culturally adaptable to local contexts. Several WHO Member States are adapting the program. This study was conducted to draw lessons about iSupport adaptation in Australia, Brazil, Indonesia, New Zealand, and Qatar. Method: A short questionnaire regarding modifications made to the WHO iSupport adaptation methodology, changes made to the WHO iSupport manual, and the enablers of and barriers to the iSupport adaptation process was sent to the iSupport adaptation research teams in the five countries. Data were analysed thematically. Result: Countries modified the WHO adaptation methodology, undertaking more focus group discussions (FGDs) than recommended. Prior to the FGDs, iSupport manual was divided into smaller, more manageable sections. Individual participants only reviewed a section rather than the entire manual to reduce burden. Common adaptation includes changes to language and terminology used in the manual to be more empathetic and person‐centred. In Australia, and later New Zealand, an additional module was added about person‐centred care principles and access to formal care services. In Brazil, additional topics such as fall prevention were suggested. Four countries identified short video clips as a method to increase usability of and real‐time access to the iSupport manual. In Australia, scenarios from the Australian adapted iSupport manual were translated into scripts then storyboards and 50 animations were produced via an iterative, ongoing stakeholder feedback process. Themes emerged include an emphasis on carers understanding of the disease, validating their experiences and emotions and creating authentic content that genuinely reflects caring for someone with dementia. In New Zealand and Indonesia, Australian animations were used and adjusted to suit the local contexts through modifications to terminology and animation characters. Qatar developed five short videos, each reflecting a module of the iSupport, to encourage carers to seek further information in the adapted iSupport program. Conclusion: Modifications of the current WHO iSupport Adaptation and Implementation Guidelines are needed. There is a need to improve the accessibility and usability of the iSupport online program, with the inclusion of short video clips being one possible solution. [ABSTRACT FROM AUTHOR]

Purpose Health-related quality of life (HRQoL) evaluations are being increasingly used for clinical assessment of cancer treatment outcomes. For a patient, not only is life expectancy important, but also a general sense of sustained global health. Intuitively, the more disfiguring the treatment, the more pronounced could be the deterioration in the QoL. We aimed to compare various aspects of QoL in three groups of patients surgically treated for penile cancer by local excision, partial penectomy, or total penectomy. Methods HRQoL was assessed in 51 patients surgically treated for penile cancer. Total penectomy, partial penectomy, or wide local excision was performed in 11, 27, and 13 patients, respectively. The EORTC QLQ-C30 questionnaire was used for HRQoL assessment. Relations between the patients and their partners were also assessed. Results Statistically significant negative correlation was found between aggressiveness of the surgical procedure and both, assessment of global health status ( p = 0.04) and physical functioning ( p = 0.047). The more aggressive the surgery, the lower was the patients' assessment of their QoL. Among the patients who maintained their partner relations postsurgery, 58.9% declared that their relations postoperatively were not inferior compared to those preoperatively. There was no statistically significant effect of the surgery type on relations with female partners ( p = 0.619). Conclusion The magnitude of disfigurement caused by surgical treatment of penile cancer had a significant impact on the selected QoL domains assessed by the EORTC QLQ C-30 questionnaire. There was no correlation between the scope of surgical intervention and partner relations. [ABSTRACT FROM AUTHOR]

In this report, we describe the case of an 81-year-old male with reactivation tuberculosis following local radiation therapy for prostate cancer. The patient was asymptomatic except for an unintentional 20-pound weight loss and was incidentally found to have a pulmonary infiltrate in the right upper lobe on imaging for shoulder pain. The medical history was notable for recently treated prostate cancer. After further investigation, the patient was determined to have Mycobacterium tuberculosis infection. It is important to have a high level of suspicion for reactivation tuberculosis in patients with a pulmonary infiltrate following radiation therapy due to the impact of radiation on the host's immune system. We will review the literature on reactivation tuberculosis following radiation therapy and explore the mechanism of immunosuppression in this process. To our knowledge, this is the first reported case of tuberculosis reactivation following local radiation therapy for prostate cancer. [ABSTRACT FROM AUTHOR]

Abstract: The aim of our study was to evaluate the effects of long-life severe growth hormone deficiency on bone mineral density (BMD) and bone scintigraphy in adult patients with childhood onset (CO) hypopituitarism never treated with growth hormone. Our studies included 22 adult patients with CO hypopituitarism never treated with growth hormone (13 males and 9 females, aged 25–66yr). The patients received replacement therapy with thyroxine, sex steroid hormones, and patients with secondary adrenocortical deficiency, hydrocortisone, but none of the patients had ever received GH treatment. In 22 patients, the total body with regional distribution of BMD, the lumbar spine L2–L4, and radial (33% site) BMD were determined by dual energy X-ray absorptiometry (DXA). In addition, 12 patients had the femoral neck BMD examined. In 10 cases, bone scintigraphy using 99-technetium labeled methylene diphosphonate was performed. Our studies revealed abnormalities, not yet described, in the regional distribution of BMD and bone scintigraphy in adults with CO hypopituitarism never treated with GH. In all patients, the results obtained from the total body showed definite disproportion in the regional distribution of BMD with a significantly advanced bone mineral deficit in the legs and a moderate deficit in the arms and total body. Local BMD measured at the radial (33% site) and lumbar spine L2–L4 revealed also a more pronounced bone mineral deficit in the cortical bone (33% distal radius) than in the trabecular bone (spine L2–L4). Bone scintigraphy showed a decrease in tracer accumulation in the shafts of the long bones but normal uptake in the spine, ribs, sternum, skull, and periarticular areas, indicating suppressed skeletal metabolism of cortical bone. Our studies indicate that long-life growth hormone deficiency leads to deficient and abnormal distribution of bone mineralization, a more pronounced deficit of BMD at the cortical bone, mainly expressed in the shafts of the long bones of the legs and arms, and moderately reduced BMD at the trabecular bone. Bone scans displaying low diphosphonates uptake in the shafts of the long bones point to greatly suppressed skeletal metabolism of the cortical bone in the patients with CO hypopituitarism never treated with GH. [Copyright &y& Elsevier]

Envenomation by marine animals poses a significant health concern globally, affecting both local residents and tourists in coastal regions. The primary objective of this review is to critically evaluate the existing scientific literature to determine the most effective first-aid treatment for envenomations caused by marine animals, specifically whether hot-water immersion (HWI) or ice-pack treatment (IPT) provides the best immediate care. This comprehensive review covers a wide range of marine envenomations, from jellyfish stings to stingray injuries. While our focus is primarily on the efficacy of HWI and IPT, we also explore the role of cold-water treatment as a result of its relevance and similarity to ice-pack applications. In addition, we examine other treatments mentioned in the literature, such as medications or vinegar, and highlight their findings where applicable. To provide a clear and structured overview, we summarised the articles in separate tables. These tables categorise the type of research conducted, the marine species studied, the region of origin of the marine species, and the key findings of each study. Our analysis of the available evidence indicates a general consensus in the scientific community on the effectiveness of HWI or IPT for envenomation by marine animals. However, when treating those injuries, it is crucial to consider all factors since there is no universally superior treatment due to the diverse nature of marine habitats.