Hasil untuk "Medicine (General)"

Alicia Rodriguez-Pla

As we conclude this Special Issue of <i>Diagnostics</i>, “Advances in the Diagnosis and Management of Vasculitis,” we reflect on a vibrant collection of eleven articles that span the globe from Spain and Poland to the USA, Germany, Romania, and Turkey [...]

Sylvain Diop, Elie Fadel, Thibaut Genty et al.

Objectives: Cardiac surgery is associated with an increased dioxygen (O2) consumption (VO2) following cardiopulmonary bypass (CPB). But data on intraoperative VO2 variation during pulmonary endarterectomy (PEA) are scarce. We aimed to assess the variation of VO2 and O2 delivery (DO2) between the induction of general anesthesia and the weaning off CPB in patients undergoing PEA. Methods: A prospective single center observational study was conducted from May to November 2023 in patients that underwent PEA. Hemodynamic and biological data were collected from arterial and venous blood gas after the induction of general anesthesia and after CPB weaning. Results: Forty-nine patients were included in the final analysis. The mean age was 57 (±14.3) years, and 30 (61%) patients were male. There was no significant change in VO2 and DO2 (O2 delivery) after CPB weaning (VO2=104.5 (±45.9) vs 110.5 (±30.4) ml of O2/min/m2; p=0.33; DO2=426.1 (±166.3) vs 398.1 (±109.4) ml of O2/min/m2; p=0.18 respectively). There was a weak correlation between CPB duration and VO2 following CPB weaning (R=0.41; p=0.008). No correlation between the duration of aortic cross clamp time, the duration of circulatory arrest, and post CPB VO2 were found (R=0.22; p=0.14 and R=0.22; p=0.10, respectively). Conclusion: There was no significant increase in VO2 and DO2 after deep hypothermic circulatory arrest PEA surgery.

Hameed Byju, Hegde Maitreyi, Raveendran Natarajan et al.

Background Wetlands, globally, face significant threats from human activities, and waterbirds, as key indicators of wetland health, are essential to maintaining ecological balance. Any long-term conservation measures should prioritize coordinated habitat preservation, wetland restoration, and sustainable management practices involving local communities. Monitoring and analyzing waterbird population trends are critical for understanding restoration, conservation, and management practices. Methods The present study was carried out in five bird sanctuaries Chitrangudi, Kanjirankulam (Ramsar sites), Therthangal, Sakkarakottai, and Mel-Kel Selvanoor of Tamil Nadu, Southeast coast of India, over one year (April 2022 to March 2023). Monthly surveys using direct and block methods, with additional fortnightly visits during the breeding season, were conducted from vantage points to record species diversity, nesting activity, and conservation threats. Assessments of the residential status, national status (SOIB), and Convention for Migratory species (CMS) status were done along with the alpha and beta biodiversity profiles, principal component analysis, Pearson correlation and other statistical methods performed to assess breeding waterbirds community structure. Threats to the breeding waterbirds were categorised into high, medium, and low impacts based on degree of severity and irreversibility. Results The avifaunal checklist revealed a diversity of waterbird species utilizing the sanctuaries for breeding. Notable findings include two Near-Threatened species like, Asian Woolly-necked Stork Ciconia episcopus, and Spot-billed Pelican Pelecanus philippensis, where Asian Woolly-necked Stork recorded only in Therthangal Bird Sanctuary. Avifauna of each sanctuary with breeding waterbirds in parenthesis is as follows: Chitragundi 122 (13); Mel-Kel Selvanoor 117 (19); Therthangal 96 (23); Sakkarakottai 116 (17) and Kanjirankulam 123 (14). The breeding activity (incubation in nests) was from November to February except for Glossy Ibis and Oriental Darter whose breeding started in December; Spot-billed Duck and Knob-billed Duck breed only during January and February. Among the 131 species recorded from all the sanctuaries, 78% were resident birds; 27% were breeding waterbirds, and 21% were Winter visitors. The SOIB and CMS statuses underscore the necessity of implementing effective conservation measures to protect breeding habitats amid anthropogenic pressures. Water unavailability and nest tree unavailability in the sanctuaries are found to be the high degree threats to breeding waterbirds than others. This research provides critical baseline data for the forest department’s future wetland management plans.

P. García Piqueras, D. Vírseda González, K. Soledad Encalada Luna et al.

Bareqa Salah, Diana Shahin, Momen Sarhan et al.

Anis Ernawati

Introduction: Children with special needs are often considered to be cursed. They are frequently ostracized from society thus making them feel lonely. This paper aims to help patients, especially children with special needs, find good friends through the review of current studies. Methods: This study used a descriptive quantitative method and data that was retrieved from Child and Adolescence Psychiatric Outpatients Daycare, Dr. Soetomo General Academic Hospital, Surabaya with 80 children with ADHD and 160 children with ASD. Results: A common intervention used in Indonesia is applied behavior analysis (ABA), a method that trains children to have social skills such as how to communicate, interact, and express themselves in social settings. Besides personal intervention, the need for integrated care for children with special needs such as pharmacological therapy, speech and behavioral therapy, occupational therapy, and special education, is needed to support them in helping them make friends. Conclusion: To help children with special needs make friends, we can give support, appreciation, and motivation. However, children with special needs need different treatment from their peers, so special attention and understanding are needed so that children with special needs can socialize and make friends well. Keywords: Children, Special Needs, Friends, Mental Health, Loneliness

Pengsheng Hui, Yu Jiang, Jie Wang et al.

BackgroundParkinson’s disease (PD) is a prevalent neurodegenerative disorder that significantly benefits from early diagnosis for effective disease management and intervention. Despite advancements in medical technology, there remains a critical gap in the early and non-invasive detection of PD. Current diagnostic methods are often invasive, expensive, or late in identifying the disease, leading to missed opportunities for early intervention.ObjectiveThe goal of this study is to explore the efficiency and accuracy of combining fNIRS technology with machine learning algorithms in diagnosing early-stage PD patients and to evaluate the feasibility of this approach in clinical practice.MethodsUsing an ETG-4000 type near-infrared brain function imaging instrument, data was collected from 120 PD patients and 60 healthy controls. This cross-sectional study employed a multi-channel mode to monitor cerebral blood oxygen changes. The collected data were processed using a general linear model and β values were extracted. Subsequently, four types of machine learning models were developed for analysis: Support vector machine (SVM), K-nearest neighbors (K-NN), random forest (RF), and logistic regression (LR). Additionally, SHapley Additive exPlanations (SHAP) technology was applied to enhance model interpretability.ResultsThe SVM model demonstrated higher accuracy in differentiating between PD patients and control group (accuracy of 85%, f1 score of 0.85, and an area under the ROC curve of 0.95). SHAP analysis identified the four most contributory channels (CH) as CH01, CH04, CH05, and CH08.ConclusionThe model based on the SVM algorithm exhibited good diagnostic performance in the early detection of PD patients. Future early diagnosis of PD should focus on the Frontopolar Cortex (FPC) region.

Jose Manuel PINILLOS RUBIO, Minerva VIGUERA MORENO

This project develops a cloud-based solution for securely managing clinical data and patient-reported outcomes (PROMs) for multiple sclerosis (MS) patients. Utilizing REDCap for data collection, we incorporated clinical outcomes and PROMs from 300 MS patients over 18 months, supporting a machine learning (ML) based clinical decision support system. Our cloud architecture, featuring segregated data handling and enhanced security protocols using AWS, ensures robust data integrity and confidentiality. Key improvements include streamlined data ETL processes and an interactive online-based dashboard that facilitates the visualization of clinical data and PROMs, crucial for effective clinical decision-making. Initial results indicate a successful implementation in enhancing data management, with implications for personalized and predictive medicine. This framework not only elevates clinical data handling efficiency but also integrates PROMs into clinical practice effectively.

Mochamad Yusuf Alsagaff, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Dr Soetomo General Hospital, Surabaya, Indonesia, Hendri Susilo et al.

Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors' offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians' skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED.

Andrea Steuwe, Birte Valentin, Oliver T. Bethge et al.

Deep-learning (DL) noise reduction techniques in computed tomography (CT) are expected to reduce the image noise while maintaining the clinically relevant information in reduced dose acquisitions. This study aimed to assess the size, attenuation, and objective image quality of reno-ureteric stones denoised using DL-software in comparison to traditionally reconstructed low-dose abdominal CT-images and evaluated its clinical impact. In this institutional review-board-approved retrospective study, 45 patients with renal and/or ureteral stones were included. All patients had undergone abdominal CT between August 2019 and October 2019. CT-images were reconstructed using the following three methods: filtered back-projection, iterative reconstruction, and PixelShine (DL-software) with both sharp and soft kernels. Stone size, CT attenuation, and objective image quality (signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) were evaluated and compared using Bonferroni-corrected Friedman tests. Objective image quality was measured in six regions-of-interest. Stone size ranged between 4.4 × 3.1–4.4 × 3.2 mm (sharp kernel) and 5.1 × 3.8–5.6 × 4.2 mm (soft kernel). Mean attenuation ranged between 704–717 Hounsfield Units (HU) (soft kernel) and 915–1047 HU (sharp kernel). Differences in measured stone sizes were ≤1.3 mm. DL-processed images resulted in significantly higher CNR and SNR values (<i>p <</i> 0.001) by decreasing image noise significantly (<i>p <</i> 0.001). DL-software significantly improved objective image quality while maintaining both correct stone size and CT-attenuation values. Therefore, the clinical impact of stone assessment in denoised image data sets remains unchanged. Through the relevant noise suppression, the software additionally offers the potential to further reduce radiation exposure.

Turgut Ekingen, Cynthia Sob, Christina Hartmann et al.

Abstract Background Whole-body hydration status is associated with several health outcomes, such as dehydration, edema and hypertension, but little is known about the nonclinical determinants. Therefore, we studied the associations of sex, age, body composition, nutrition, and physical activity on several body hydration measures. Methods We assessed sociodemographic variables, dietary habits, and physical activity by questionnaire and body composition by bioelectric impedance analysis (BIA). We compared determinants between the sexes and calculated associations between determinants and BIVA hydration measures by multivariable linear regressions. Results A total of 242 adults from the general population (age 18–94, 47% women) were included. Women were younger, smaller, lighter, and had a smaller BMI (kg/m2) than men (p < 0.05). Women had less muscle mass, less visceral fat mass and less extracellular and intracellular water than men (p < 0.001). Women showed less intracellular water per extracellular water than men, while men showed higher phase angle values than women (both p < 0.001). Men had a stronger association of hydration measures with physical activity than women. Both sexes showed a decrease in hydration measures with age. Conclusions Sex, age, body composition, and physical activity influence body hydration. There seem to be differences in body water regulation between the sexes. Especially interesting are factors susceptible to preventive measures such as physical activity.

Simon M. Glynn, Jack M. Parent

Benjamin Vipler, Ami DeWaters

Jane Sandra Afriyie‐Mensah, Felix Razak Awindaogo, Emmanuella Naa Deeidei Tagoe et al.

Abstract The clinical presentation of cardiac sarcoidosis is variable. We report two cases of cardiac sarcoidosis to highlight the varied clinical presentations and diagnostic challenges in our setting, and encourage the consideration of sarcoidosis as a differential in unexplained arrhythmias and heart failure.

Thomas B. Brunner, Dominik Bettinger, Dominik Bettinger et al.

The aim of this prospective observational trial was to evaluate the efficacy, toxicity and quality of life after stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to assess the results of this treatment in comparison to trans-arterial chemoembolization (TACE). Patients with HCC, treated with TACE or SBRT, over a period of 12 months, enrolled in the study. The primary endpoint was feasibility; secondary endpoints were toxicity, quality of life (QOL), local progression (LP) and overall survival (OS). Between 06/2016 and 06/2017, 19 patients received TACE and 20 SBRT, 2 of whom were excluded due to progression. The median follow-up was 31 months. The QOL remained stable before and after treatment and was comparable in both treatment groups. Five patients developed grade ≥ 3 toxicities in the TACE group and 3 in the SBRT group. The cumulative incidence of LP after 1-, 2- and 3-years was 6, 6, 6% in the SBRT group and 28, 39, and 65% in the TACE group (p = 0.02). The 1- and 2- years OS rates were 84% and 47% in the TACE group and 44% and 39% in the SBRT group (p = 0.20). In conclusion, SBRT is a well-tolerated local treatment with a high local control rates and can be safely delivered, while preserving the QOL of HCC patients.

Yayoi Aizawa, Atsushi Watanabe, Atsushi Watanabe et al.

In recent years, genetic counseling has started playing a major role in the field of genomic medicine. There are currently about 7,000 genetic counselors in more than 28 countries, with 267 certified genetic counselors in Japan alone (about 2 per million population, as of April 2020). While the rapid advancement of genomic medicine has expanded this field, the challenges genetic counselors face are also evolving. This article aims to provide an overview of the institutional and social issues surrounding genetic counselors in Japan and discuss implications for the global community. In Japan, with the rapid changes in genomic medicine and the establishment of a delivery mechanism within the healthcare system, several issues need to be discussed. First, many genetic testing, counseling, and preventive healthcare programs are not covered by public health insurance. Second, reducing human resource shortages for genetic counseling is an urgent issue. Third, the lack of a national qualification in the profession is critically important issue in the field. Fourth, research on the role and value of genetic counselors is still limited. To address these issues, discussions among relevant stakeholders, including genetic counselors, professionals in genomic medicine, and lawmakers, are necessary. Additionally, we believe that research by genetic counselors to evaluate and improve their practice and examine institutional and social issues is crucial for developing their profession’s activities and delivering high-quality healthcare to many people. To establish the position and role of the relatively new profession of genetic counselor, sharing information and collaborating on institutional and social challenges faced by genetic counselors globally will be beneficial.

Maya S. Iyer, David P. Way, Daniel J. Schumacher et al.

The Accreditation Council for Graduate Medical Education (ACGME) requires General Pediatricians (GPeds) to learn thirteen procedures during training. However, GPeds infrequently perform these procedures in practice. We sought to determine:1) how GPeds learned procedures, 2) if GPeds self-reported achieving competence in the required ACGME procedures during training, and 3) if GPeds maintained these skills into practice. We conducted this mixed methods study from 2019–2020. 51 GPeds from central Ohio and the American Board of Pediatrics General Examination Committee were recruited via email or snowball sampling and participated in semi-structured recorded phone interviews probing procedural performance during training and current practice. Participants represented varied geographic regions and clinical settings. We employed Sawyer’s ‘Learn, See, Practice, Prove, Do, Maintain’ mastery learning pedagogical framework as a lens for thematic analysis. Participants did not demonstrate competence in all ACGME required procedures during training, nor sustain procedural skills in practice. Most participants learned procedures through a ‘see one, do one’ apprenticeship model. GPeds reported never being formally assessed on procedural competence during residency. All GPeds referred out at least one procedure. GPeds also believed that skill maintenance was unwarranted for procedures irrelevant to their current practice. GPeds did not sufficiently demonstrate competence in all ACGME required procedures during training, partially suggesting why they infrequently perform some procedures. Alternatively, these required procedures may not be relevant to their practice. Pediatric residency procedures education might consider using mastery learning for practice-specific procedures and surface-level methods (learning without mastery) for other skills.

Nick Maguire

Kristiina Häyrinen

Nicola Luigi Bragazzi, Guglielmo Dini, Alessandra Toletone et al.

This article reports data concerning silicosis-related web-activities using Google Trends (GT) capturing the Internet behavior in the USA for the period 2004–2010. GT-generated data were then compared with the most recent available epidemiological data of silicosis mortality obtained from the Centers for Disease Control and Prevention for the same study period. Statistically significant correlations with epidemiological data of silicosis (r=0.805, p-value <0.05) and other related web searches were found. The temporal trend well correlated with the epidemiological data, as well as the geospatial distribution of the web-activities with the geographic epidemiology of silicosis.