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In May 1988 the World Health Assembly set to World Health Organization (WHO) the goal to achieve a global eradication of poliomyelitis by the year 2000. Surveillance of the acute flaccid paralysis (AFP) remains the ‘gold standard’ for the detection of polio. The criterion of sensitivity of the surveillance system is the incidence from non-polio related AFP, in children under 15 years of age. The aim is to detect more than 1 case of AFP, per 100,000 children. In 2019, WHO announced the eradication of wild poliovirus 3, and poliovirus 2 was eradicated in 2015. Wild poliovirus 1 continues to circulate. The main goals of the WHO Polio Eradication Strategy for the period 2022-2026 are: permanently interrupt all poliovirus transmission in endemic countries (Afghanistan and Pakistan), stop cVDPV (circulating vaccine-derived poliovirus) transmission and prevent outbreaks in non-endemic countries.

Lydia Cassard,1 Noelle Seraly,2 Maureen Riegert,3 Aditi Patel,4 Anthony P Fernandez5 1Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA; 2Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA; 3Department of Dermatology, Rush University, Chicago, IL, USA; 4Department of Rheumatology, Cleveland Clinic, Cleveland, OH, USA; 5Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH, USACorrespondence: Anthony P Fernandez, Departments of Dermatology and Pathology, Cleveland Clinic, 9500 Euclid Avenue; A61, Cleveland, OH, 44195, USA, Email fernana6@ccf.orgAbstract: Dermatomyositis is a heterogeneous idiopathic inflammatory myopathy associated with various cutaneous manifestations and variable presence of myositis, interstitial lung disease, and other visceral organ involvement. An accurate diagnosis of dermatomyositis requires correlating clinical examination findings with serological and histological findings. Familiarity with pathognomonic and common cutaneous manifestations of dermatomyositis, which are highlighted here, can be especially helpful in making an accurate diagnosis. Additionally, evaluating patients for presence of myositis-specific autoantibodies can further support or refute a dermatomyositis diagnosis. When present, myositis-specific autoantibodies can also help guide workups for various dermatomyositis-associated manifestations, as each is associated with relatively distinct clinical characteristics. Evaluating patients for various systemic manifestations often relies on expert opinion recommendations; however, societal guideline statements concerning the evaluation of some manifestations have recently been described. Although malignancy-associated dermatomyositis is a well-accepted subtype, there is limited evidence to support extensive malignancy screening has a favorable benefit–risk ratio in most dermatomyositis patients. However, recent research has uncovered novel associations between dermatomyositis and malignancy, suggesting the possibility of identifying high-risk subsets of dermatomyositis patients in whom malignancy screening may have a high value. Treatment for dermatomyositis has remained largely unchanged over the past several decades. Although many dermatomyositis patients can be effectively treated with current options, either as monotherapy or with combination regimens, there is a need for more targeted and effective DM therapies, in general, and for MDA5(+) dermatomyositis-associated rapidly progressive interstitial lung disease. Fortunately, significant current and emerging research activities evaluating various novel medications for dermatomyositis provide hope for exciting future advances in patients with this intriguing immune-mediated disease.Keywords: idiopathic inflammatory myopathy, myositis, autoantibody, malignancy, MDA-5, treatment

Timothy Deer,1 Ankur A Patel,2 Dawood Sayed,3 Ashley Bailey-Classen,4 Ashley Comer,1 Benjamin Gill,5 Kiran Patel,6 Alaa Abd-Elsayed,7 Natalie Strand,8 Jonathan M Hagedorn,9 Zohra Hussaini,3 Nasir Khatri,10 Ryan Budwany,1 Melissa Murphy,11 Dan Nguyen,12 Vwaire Orhurhu,13 Morteza Rabii,14 Douglas Beall,15 Stephen Hochschuler,16 Michael E Schatman,17,18 Timothy Lubenow,19 Richard Guyer,16,20 Ahmed M Raslan21 1The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 2Weill Cornell Tri-Institutional Pain Medicine Program, Department of Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA; 3Department of Anesthesiology and Pain Medicine, the University of Kansas Medical Center, Kansas City, KS, USA; 4Trinity Pain Medicine Associates, Fort Worth, TX, USA; 5Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA; 6Lenox Hill Hospital, Northwell Health, New York, NY, USA; 7Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 8Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA; 9Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 10Novant Health Spine Specialists, Charlotte, NC, USA; 11North Texas Orthopedics and Spine Center, Grapevine, TX, USA; 12Neuroradiology and Pain Solutions of Oklahoma, Oklahoma City, OK, USA; 13Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, PA, USA; 14Crimson Pain Management, Overland Park, Kansas, KS, USA; 15Comprehensive Specialty Care, Edmond, OK, USA; 16Texas Back Institute, Plano, TX, USA; 17Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 18Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA; 19Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA; 20Department of Orthopedic Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA; 21Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, USACorrespondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email dsayed@kumc.eduIntroduction: The evolution of treatment options for painful spinal disorders in diverse settings has produced a variety of approaches to patient care among clinicians from multiple professional backgrounds. The American Society of Pain and Neuroscience (ASPN) Best Practice group identified a need for a multidisciplinary guideline regarding appropriate and effective informed consent processes for spine procedures.Objective: The ASPN Informed Consent Guideline was developed to provide clinicians with a comprehensive evaluation of patient consent practices during the treatment of spine pathology.Methods: After a needs assessment, ASPN determined that best practice regarding proper informed consent for spinal procedures was needed and a process of selecting faculty was developed based on expertise, diversity, and knowledge of the subject matter. A comprehensive literature search was conducted and when appropriate, evidence grading was performed. Recommendations were based on evidence when available, and when limited, based on consensus opinion.Results: Following a comprehensive review and analysis of the available evidence, the ASPN Informed Consent Guideline group rated the literature to assist with specification of best practice regarding patient consent during the management of spine disorders.Conclusion: Careful attention to informed consent is critical in achieving an optimal outcome and properly educating patients. This process involves a discussion of risks, advantages, and alternatives to treatment. As the field of interventional pain and spine continues to grow, it is imperative that clinicians effectively educate patients and obtain comprehensive informed consent for invasive procedures. This consent should be tailored to the patient’s specific needs to ensure an essential recognition of patient autonomy and reasonable expectations of treatment.Keywords: informed consent, best practice, clinical guideline, pain medicine, spine intervention, spine surgery

Winghan J Kwong,1 Syed Numan,2 Tina D Hunter,3 Dalila Alves,3 Anish Patel,4 Satish Shanbhag5 1Daiichi Sankyo, Inc, Basking Ridge, NJ, USA; 2American Regent, Norristown, PA, USA; 3CTI Clinical Trial & Consulting Services, Covington, KY, USA; 4Brooke Army Medical Center, San Antonio, TX, USA; 5Cancer Specialists of North Florida, Jacksonville, FL, USACorrespondence: Tina D Hunter, CTI Clinical Trial & Consulting Services 100 E. Rivercenter Blvd, Covington, KY, 41011, USA, Tel +1 513-598-9290, Fax +1 859-261-3757, Email thunter@ctifacts.comBackground: Iron deficiency anemia (IDA) is a common cause of fatigue and impaired quality of life. The present study aimed to evaluate the impact of intravenous iron supplementation with ferric carboxymaltose (FCM) on fatigue, physical function, and general health among patients with IDA attending routine clinical care.Methods: This was a prospective, single arm, observational study of adult patients prescribed with intravenous FCM for the treatment of IDA during routine clinical care. We used Patient-Reported Outcomes Measurement Information System (PROMIS) instruments to evaluate fatigue (PROMIS Short Form v1.0 13a [FACIT-Fatigue]), general health status (PROMIS Scale v1.2), and physical function (PROMIS Short Form v2.0 4a) before and at 3 and 6 months after FCM treatment.Results: A total of 152 patients were enrolled. Mean age was 47.4 ± 16.0 years and 82.2% were female. Mean serum hemoglobin was 10.2 ± 1.4 g/dL at baseline. All patients were treated with at least one FCM dose at baseline, with 77.6% receiving a two-dose treatment course. The mean baseline FACIT-Fatigue score was 61.0 ± 9.0, improving significantly to 50.2 ± 9.5 at 3 months after FCM treatment. A minimum 5-point improvement, pre-defined as clinically meaningful, was seen in the FACIT-Fatigue, PROMIS Global Physical Health, Global Mental Health and PROMIS Physical Function scores for 72.7%, 52.8%, 41.7% and 39.8% of patients at 3 months (p < 0.0001 for each change from baseline), with statistically significant improvement continuing at 6 months. Mean serum hemoglobin was significantly increased at both 3 and 6 months (12.8 g/dL [N = 44] and 12.4 g/dL [N = 54], respectively).Conclusion: IDA patients attending routine clinical practice reported substantial levels of fatigue and impairments in physical function and global health prior to intravenous iron treatment. Patients experienced significant improvements in fatigue symptoms, physical function, and global health at 3 months after treatment with FCM, which were sustained at 6 months.Keywords: iron deficiency anemia, quality of life, patient-reported outcomes, ferric carboxymaltose, intravenous iron

Jillian A Maloney,1 Ryan S D’Souza,2 Skye A Buckner Petty,3 Michal J Turkiewicz,4 Debarshi Sinha,4 Ajay Patel,5 Natalie H Strand1 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA; 2Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; 3Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA; 4Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 5Department of Rehabilitation & Regenerative Medicine (Patel), New York-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, NY, USACorrespondence: Jillian A Maloney, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA, Email Maloney.jillian@mayo.eduPurpose: Data are lacking on the factors that contribute to job satisfaction among pain medicine physicians. We sought to determine how sociodemographic and professional characteristics relate to job satisfaction among pain medicine physicians.Methods: In this nationwide, multicenter, cross-sectional observational study, an electronic questionnaire related to job satisfaction was emailed in 2021 to pain medicine physicians who were members of the American Society of Anesthesiologists or the American Society of Pain and Neuroscience. The 28-item questionnaire asked physicians about sociodemographic and professional factors. Eight questions related to job satisfaction were based on a 10-point Likert scale, and 1 question was a binary (yes/no) variable. Differences in responses based on sociodemographic and professional factors were assessed with the Kruskal–Wallis rank sum test for Likert scale questions and with the Pearson χ2 test for yes/no questions.Results: We determined that several variables, including gender, parental status, geographic location, specialty, years of practice, and volume of patients, are associated with pain medicine physicians’ outlook on job satisfaction. Overall, 74.9% of respondents surveyed would choose pain medicine as a specialty again.Conclusion: High rates of poor job satisfaction persist among pain medicine physicians. This survey study identified several sociodemographic and professional factors that are associated with job satisfaction among pain medicine physicians. By identifying physicians at high risk for poor job satisfaction, healthcare leadership and occupational health agencies can aim to protect physicians’ well-being, enhance working conditions, and raise awareness about burnout.Keywords: economics, outcomes, pain management

Aurora Rodriguez,1 Caitlin Kelley,1 Anjali Patel,1 Aparna Ramasubramanian2 1School of Medicine, Creighton University, Phoenix, AZ, USA; 2Ophthalmology Department, Phoenix Children’s Hospital, Phoenix, AZ, USACorrespondence: Aparna Ramasubramanian, Ophthalmology Department, Phoenix Children’s Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA, Tel +1 602-933-3937, Fax +1 602-933-2409, Email aramasubramanian@phoenixchildrens.comPurpose: The objective of this review is to explore the prenatal diagnosis of retinoblastoma and the recommended screening practices.Patients and Methods: An electronic literature search on prenatal diagnosis of retinoblastoma was conducted on the PubMed database. Publications within the last 20 years that matched the inclusion criteria were selected. The literature search included the following keywords: retinoblastoma, prenatal, diagnosis, screening, and associated synonyms to increase search sensitivity. Nine studies were included for investigation and extracted to identify prenatal diagnostic and screening techniques for retinoblastoma, their associated impact, and the target population that should receive prenatal screening for retinoblastoma.Results: Familial retinoblastoma has an autosomal inheritance pattern and 90% penetrance. Therefore, future parents with a family history of retinoblastoma are strongly advised to get tested for retinoblastoma (Rb) gene mutations; if one of the parents is positive for a mutated allele of the RB1 gene, there is a 45% chance that their child will inherit a mutated allele of the retinoblastoma gene, rendering the allele non-functional in all of the cells of the individual and predisposing the child to a higher risk of developing retinoblastoma as well as other secondary cancers. Thus, prenatal screening and diagnosis of retinoblastoma is crucial for early diagnosis and optimal treatment.Conclusion: Prenatal testing for retinoblastoma in high-risk families is important for everyone in the family. For the parents, prenatal screening has been shown to improve their family planning decisions and psychological well-being as they can mentally prepare beforehand and make informed decisions. More importantly, these practices have shown to yield better treatment and vision outcomes in the newborn.Keywords: retinoblastoma, prenatal, diagnosis, screening, imaging

Background: Earlier research on Andrographis paniculata focused on documenting their bioactive compounds profiles and traditional use. Before making a drug-like substance prediction using information from in silico experimental models, the current work aimed to examine and analyze the ADMET properties. This study assessed the drug-likeness and ADMET characteristics of bioactive compounds from A. paniculata.Materials and Methods: The current study will be the first to use the free online tool Swiss ADME to report the ADME characteristics of A. paniculata. The ADME properties of 10 bioactive compounds from A. paniculata were screened, and the results were evaluated. Results: Six bioactive compounds were identified to have good gastrointestinal absorption and can penetrate the brain. These compounds include andrographolide, 14-Acetylandrographolide, Drf3188, Neoandrographolide, Isoandrographolide, and 3,19-O-diacetyl andrographolide. On the other hand, three of the bioactive compounds were found to show Ames mutagenicity: 19-O-Acetylandrographolide, 3,19-isopropylideneandrographolide, and 14-glycinylandrographolide hydrochloride. Except 5-Hydroxy-7,8-dimethoxyflavone, most of these substances do not serve as substrates for both P-glycoprotein (P-gp) and Cytochrome P-450 isoenzymes (CYP). Furthermore, all the compounds were found to pass the Lipinski rule of five, indicating their potential suitability as drug candidates. Conclusion: Swiss ADME has proven to be an effective, dependable, and straightforward method for determining the ADME characteristics of the bioactive compounds in A. paniculata. Based on the information, it was predicted that A. panicluata would be effective in managing the disease. To validate these findings, it is advisable to conduct further controlled experimental research exploring the bioactive compounds’ pharmacological effects.

In this study, we show with the help of a simple model that an increase of the retirement age has a negative impact on the distribution of pension benefits in the Bismarckian as well in the Beveridgean pension system. In both systems, the distribution of pension benefits will change in favour of high-income earners. Additionally, we show that the increasing gap in the life expectancies of low and high-income earners will increase inequality. Both results are a consequence of the positive relationship between the socio-economic status and life expectancy of a person. These important insights are often ignored by the promoters of pension reforms.