Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has...Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has significantly increased morbidity and mortality worldwide is the human immunodeficiency virus(HIV)and acquired immune deficiency syndrome(AIDS)pandemic.HIV has a disproportionately negative impact on key populations.Strong leadership,effective communication,and sound science are necessary for public health emergency(PHE)responses to be successful.These three PHE response pllars are also essential for bridging the HIV response gap among key populations in the setting of restrictive laws.In this review,we explored the importance of these three pillars of successful PHEs responses,and how they are essential to closing the gap in the HIV response among key populations.Leaders must make decisions and instil a sense of authority in the populace during PHEs to foster trust and confidence.Leaders should base their choices on scientific evidence.Effective communication during PHEs should be proactive,polite,imaginative,innovative,and constructive.To address gaps in the HIV response among key populations,leaders must create a supportive environment for effective communication and scientific research,communication should be used to raise awareness of HIV and to dispel stigma and discrimination,while science should provide evidence of efficacy and effectiveness of interventions amongkey populations.展开更多
Objectives This study aimed to analyse the benefits of a gamified clinical supervision strategy during hospital-based training,particularly regarding the development of critical and reflective thinking among undergrad...Objectives This study aimed to analyse the benefits of a gamified clinical supervision strategy during hospital-based training,particularly regarding the development of critical and reflective thinking among undergraduate nursing students.Methods From April to July 2023,second-year nursing students who undertaking a nine-week clinical placement in a cardiology ward in northern Portugal were selected.Following a two-week diagnostic phase,students participated in a six-week gamified supervision programme comprising weekly 60-min sessions:infection-control decision-making;technical-procedural reasoning;guided emotional and ethical reflection;and clinical reasoning quiz on cardiology topics.Students completed weekly Structured Reflection Guide entries;supervisors recorded structured field notes after each session;and,after the intervention,students answered a post-intervention questionnaire and participated in focus groups.Qualitative data(reflections,field notes,open-ended questionnaire items,and focus-group transcripts)were analyzed using Bardin’s content analysis;quantitative questionnaire items were summarized descriptively.Results All seven students completed the six gamified sessions and submitted weekly reflection entries.Five students(71.4%)completed the questionnaire.Across data sources,students reported that gamified activities supported knowledge consolidation,teamwork,and clinical reasoning.Questionnaire data showed that all respondents(n=5,100%)strongly agreed that gamification enhanced their learning and should be maintained in clinical training.Reflections and focus groups revealed recurring themes related to emotional expression,sense of belonging,and difficulties using structured reflection tools,particularly in terms of comprehension and timing.Conclusion The gamified supervision strategy integrated into clinical training provided structured opportunities for practical engagement,collaborative work,and guided reflection.These findings suggest that gamification may support the development of reflective and critical-thinking processes in authentic clinical environments.展开更多
Artificial intelligence(AI)is increasingly recognized as a transformative force in the field of solid organ transplantation.From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosupp...Artificial intelligence(AI)is increasingly recognized as a transformative force in the field of solid organ transplantation.From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosuppressive therapy,AI has the potential to improve both operational efficiency and patient outcomes.Despite these advancements,the perspectives of transplant professionals-those at the forefront of critical decision-making-remain insufficiently explored.To address this gap,this study utilizes a multi-round electronic Delphi approach to gather and analyses insights from global experts involved in organ transplantation.Participants are invited to complete structured surveys capturing demographic data,professional roles,institutional practices,and prior exposure to AI technologies.The survey also explores perceptions of AI’s potential benefits.Quantitative responses are analyzed using descriptive statistics,while open-ended qualitative responses undergo thematic analysis.Preliminary findings indicate a generally positive outlook on AI’s role in enhancing transplantation processes,particularly in areas such as donor matching and post-operative care.These mixed views reflect both optimism and caution among professionals tasked with integrating new technologies into high-stakes clinical workflows.By capturing a wide range of expert opinions,the findings will inform future policy development,regulatory considerations,and institutional readiness frameworks for the integration of AI into organ transplantation.展开更多
Adolescence is a crucial time period with especial vulnerability for development of mental health problems.Growing interest is focusing on the determinants of positive mental health in order to find the key concepts t...Adolescence is a crucial time period with especial vulnerability for development of mental health problems.Growing interest is focusing on the determinants of positive mental health in order to find the key concepts that could be influenced in the promotion of mental well-being of adolescents.In this study we aim to explore the relations between self-esteem,character strengths and experience of social inclusion as determinants of adolescents’positive mental health controlled for selected sociodemographic background factors.The study population(n=195)consisted of comprehensive school students who filled in an electronic questionnaire of adolescent’s mental well-being in Fall 2019.The questionnaire included measures of Warwick-Edinburgh Mental Well-being Scale(WEMWBS),VIA Youth-measure 96,Rosenberg Self-Esteem Scale and Experience of Social Inclusion Scale.The methods included group comparisons and General Linear Model computed by SPSS 24.0.The strongest association was found between positive mental health and self-esteem(β=0.789,p<0.001),followed by character strengths of hope and kindness and experience of social inclusion.Interestingly,family’s socioeconomic factors did not associate significantly with positive mental health in the final statistical model.In terms of our results,it seems that self-esteem,character strengths and experience of social inclusion might have stronger association with adolescents’mental well-being than family’s socioeconomic determinants.Therefore,it should be discussed whether psychological determinants overcome the individual effect of poor socioeconomic status as factors that influence positive mental health.Further studies are needed to establish these results more firmly.展开更多
Objectives The aim of this study was to analyze the psychometric properties(reliability and validity)of the Social Isolation Scale(SIS)in a sample of Portuguese community-dwelling older adults.Methods A transversal de...Objectives The aim of this study was to analyze the psychometric properties(reliability and validity)of the Social Isolation Scale(SIS)in a sample of Portuguese community-dwelling older adults.Methods A transversal descriptive study was carried out with a convenience sample of 250 community-dwelling older adults(≥65 years).The survey comprised a sociodemographic questionnaire,SIS,Geriatric Depression Scale-4(GDS-4),6-item Lubben Social Network Scale(LSNS-6),a loneliness self-assessment question,and Satisfaction with Life Scale(SWLS).Construct validity(confirmatory factor analysis)and convergent validity were analyzed,and ISI internal reliability(composite reliability),external reliability(test-retest,intraclass correlation coefficient)and inter-rater reliability(Cohen’s kappa coefficient)were evaluated.Results Confirmatory factor analysis showed a two-factor model with an excellent index of fit.The SIS showed significant correlations with LSNS-6(rs=0.47),SWLS(rs=0.26),the loneliness self-assessment question(rs=0.35),and GDS-4(rs=−0.16).SIS composite reliability was good(0.708).The inter-class correlation coefficient varied from 0.84 to 0.98.The Cohen’s kappa coefficient ranged from 0.936 to 1.Conclusions SIS has been shown to be a valid and reliable instrument for assessing social isolation among Portuguese community-dwelling older adults.Healthcare professionals,particularly nurses working in community settings,can use SIS to assess social isolation in older adults to design,implement,and evaluate interventions.展开更多
Background:Recognition and treatment of emotional distress,which affects 20 to 40%of outpatients with type 1 or type 2 diabetes,are important because of its association with worse diabetes self-care,poor glycemic cont...Background:Recognition and treatment of emotional distress,which affects 20 to 40%of outpatients with type 1 or type 2 diabetes,are important because of its association with worse diabetes self-care,poor glycemic control,increased rates of mortality and diabetes-related complications,and a rise in healthcare expenditure.However,although the symptoms of emotional distress improve in diabetic patients after psychological and pharmacological interventions,evidence of benefits in glycemic control is still uncertain.Objective:The aim of this study was to assess the metabolic control in diabetic patients with emotional distress attending primary mental care clinics(PMCC)in the Eastern Province of Saudi Arabia.Method:This study was a single group pretest-posttest design conducted on adult diabetic patients with emotional distress attending PMCC.Out of 194 attendees,62 patients who fulfilled the selection criteria were studied.Data were collected from the patients’records using a worksheet designed for the study.Metabolic parameters including BMI,BP,FBS,HbA1c and lipid profile were recorded before and after the management of emotional distress.Socio-demographic characteristics,complications related to diabetes and co-morbidities were also recorded.Paired t-test was used appropriately to compare continuous variables.A p-value of less than 0.05 was considered significant in all statistical analysis.Results:The majority of the patients had type 2 DM(98.2%)and the presence of co-morbidities was high(83.9%).A comparison of the metabolic parameters before and after management of emotional distress,showed a significant reduction in HbA1c(p=0.020)and elevation in HDL(p=0.010).No differences in BMI,BP,FBS,TC,TG or LDL were found.Conclusions:Treating emotional distress in diabetic patients is associated with an improvement in HbA1c and HDL.展开更多
Air quality was measured inside 628 United Arab Emirates (UAE) personal residences. Weekly average concentrations of carbon monoxide (CO), formaldehyde (HCHO), hydrogen sulfide (H2S), nitrogen dioxide (NO2), sulfur di...Air quality was measured inside 628 United Arab Emirates (UAE) personal residences. Weekly average concentrations of carbon monoxide (CO), formaldehyde (HCHO), hydrogen sulfide (H2S), nitrogen dioxide (NO2), sulfur dioxide (SO2), and three size fractions of particulate matter (PM2.5, PMc, and PM10) were determined in each home. In a subset of the homes, measurements of outdoor air quality, ultrafine PM concentrations, and elemental PM concentrations were also made. Questionnaires were administered to obtain information on housing demographics and lifestyle habits. Air measurements were performed using simple and cost effective passive samplers. The 90th percentiles of indoor CO, HCHO, H2S, NO2, and SO2 were 1.55 ppm, 0.05 ppm, 0.12 ppm, 0.01 ppm, and 0.05 ppm, respectively. Median indoor PM2.5, PMc, and PM10, concentrations were 5.73 μg/m3, 29.4 μg/m3, and 35.2 μg/m3, respectively. The median indoor concentration of ultrafine PM was 3.62 × 1010 particles/m3. Indoor/outdoor ratios for PM were 0.44, 0.41, and 0.38 for ultrafine PM, PM2.5, and PM10, respectively. These values fall within the range of other indoor air studies findings conducted in developing countries. Air conditioning, smoking, and attached kitchens were significantly correlated with indoor levels of carbon monoxide. In addition, indoor concentrations of PM2.5 and PM10 were significantly correlated with vehicles parked within five meters of the home, central air conditioning, and having attached kitchens. This is the first robust indoor air quality data set developed for the UAE. This study demonstrates that screening level tools are a good initial step for assessing air quality when logistical issues (distance, language, cultural, training) and intrusion into personal lives need to be minimized.展开更多
Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extra...Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.展开更多
This frontier will highlight the principles of diagnosis and management of earthquake crush syndrome and related acute kidney injury(AKI)based on our two recently published highly accessed collective review articles.C...This frontier will highlight the principles of diagnosis and management of earthquake crush syndrome and related acute kidney injury(AKI)based on our two recently published highly accessed collective review articles.Continuous prolonged pressure of the rubble on injured muscles following earthquakes may cause crush injuries.When the patient is extricated and the compressed muscles are relieved,an ischemia–reperfusion injury,with systematic serious metabolic disturbances,occurs.This includes hyperkalemia,rhabdomyolysis,and AKI.AKI is caused by three mechanisms.Prerenal factors include:(1)Hypovolemia due to bleeding;(2)Dehydration due to lack of water;(3)Ischaemia-reperfusion injury;and(4)Cardiac depression caused by released toxins.Renal factors include the nephrotoxic effects of the uric acid and bilirubin,tubular casts obstructing the tubules,or the direct deposition of phosphorus and calcium inside the kidneys.Pelvic fractures may cause urethral rupture with postrenal obstruction.The ma-nagement principles of crush syndrome and AKI include:(1)Proper fluid therapy to maintain adequate urine output;(2)Preventing and treating hyperkalemia;and(3)Renal replacement therapy when indicated in cases of severe hyperkalemia,severe acidemia,volume overload,or severe uremia.Recognizing these condi-tions and treating them timely and properly will save many patients.展开更多
Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, inc...Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions.Methods The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates.Results The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases.Conclusions The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.展开更多
Background:Diabetes mellitus(DM),a metabolic disorder that leads to chronic hyperglycemia,is one of the topmost global public health concerns according to the International Diabetes Federation.Adropin is a peptide hor...Background:Diabetes mellitus(DM),a metabolic disorder that leads to chronic hyperglycemia,is one of the topmost global public health concerns according to the International Diabetes Federation.Adropin is a peptide hormone that is primarily involved in energy homeostasis,but its involvement in other biological activities such as lowering hyperlipidemia,and diminishing insulin resistance has also been reported.In this study,we aimed to explore additional effects of adropin on oxidative stress,inflammation,and cell proliferation in an animal model of type 1 DM.Methods:To achieve our aim,normal and diabetic Wistar rats were treated with adropin(2.1μg/kg/day)for a period of 10 days.Pancreatic tissue samples were collected for histomorphological analysis and inflammation assay,while blood was collected for oxidative stress assay.Results:Our results showed that diabetes induction stimulated cell proliferation in both exocrine and endocrine pancreas,and adropin dramatically attenuated this effect in pancreatic exocrine tissue,but not in the islet of Langerhans.In addition,adropin significantly increased glutathione reductase expression in pancreatic tissue,and augmented serum total glutathione in the diabetic rats compared to diabetic untreated rats.Conclusion:Our study indicates the potential role of adropin in alleviating oxidative stress in DM.展开更多
Bartter and Gitelman syndromes(BS and GS) are inherited disorders resulting in defects in renal tubularhandling of sodium,potassium and chloride.Previously considered as genotypic and phenotypic heterogeneous diseases...Bartter and Gitelman syndromes(BS and GS) are inherited disorders resulting in defects in renal tubularhandling of sodium,potassium and chloride.Previously considered as genotypic and phenotypic heterogeneous diseases,recent evidence suggests that they constitute a spectrum of disease caused by different genetic mutations with the molecular defects of chloride reabsorption originating at different sites of the nephron in each condition.Although they share some characteristic metabolic abnormalities such as hypokalemia,metabolic alkalosis,hyperplasia of the juxtaglomerular apparatus with hyperreninemia,hyperaldosteronism,the clinical and laboratory manifestations may not always allow distinction between them.Diuretics tests,measuring the changes in urinary fractional excretion of chloride from baseline after administration of either hydrochlorothiazide or furosemide show very little change(< 2.3%) in the fractional excretion of chloride from baseline in GS when compared with BS,except when BS is associated with KCNJ1 mutations where a good response to both diuretics exists.The diuretic test is not recommended for infants or young children with suspected BS because of a higher risk of volume depletion in such children.Clinical symptoms and biochemical markers of GS and classic form of BS(type III) may overlap and thus genetic analysis may specify the real cause of symptoms.However,although genetic analysis is available,its use remains limited because of limited availability,large gene dimensions,lack of hot-spot mutations,heavy workup time and costs involved.Furthermore,considerable overlap exists between the different genotypes and phenotypes.Although BS and GS usually have distinct presentations and are associated with specific gene mutations,there remains considerable overlap between their phenotypes and genotypes.Thus,they are better described as a spectrum of clinical manifestations caused by different gene mutations.展开更多
Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretic...Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible.展开更多
The fact that the acidsecreting parietal cells undergo continuous renewal has been ignored by many gastroenterologists and cell biologists. In the past, it was thought that these cells were static. However, by using 3...The fact that the acidsecreting parietal cells undergo continuous renewal has been ignored by many gastroenterologists and cell biologists. In the past, it was thought that these cells were static. However, by using 3Hthymidine radioautography in combination with electron microscopy, it was possible to demonstrate that parietal cells belong to a continuously renewing epithelial cell lineage. In the gastric glands, stem cells anchored in the isthmus region are responsible for the production of parietal cells. The stem cells give rise to three main progenitors: prepit, preneck and preparietal cells. Parietal cells develop either directly from the noncycling preparietal cells or less commonly via differentiation of the cycling prepit and preneck cell progenitors. The formation of a parietal cell is a sequential process which involves diminishment of glycocalyx, production of cytoplasmic tubulovesicles, an increase in number and length of microvilli, an increase in number and size of mitochondria, and fi nally, expansion and invagination of the apical membrane with the formation of an intracellular canalicular system. Little is known about the genetic counterparts of these morphological events. However, the time dimension of parietal cell production and the consequences of its alteration on the biological features of the gastric gland are well documented. The production of a new parietal cell takes about 2 d. However, mature parietal cells have a long lifespan during which they migrate bidirectionally while their functional activity for acid secretion gradually diminishes. Following an average lifespan of about 54 d, in mice, old parietal cells undergo degeneration and elimination. Various approaches for genetic alteration of the development of parietal cells have provided evidence in support of their role as governors of the stem/progenitor cell proliferation and differentiation programs. Revealing the dynamic features and the various roles of parietal cells would help in a better understanding of the biological features of the gastric glands and would hopefully help in providing a basis for the development of new strategies for prevention, early detection and/or therapy of various gastric disorders in which parietal cells are involved, such as atrophic gastritis, peptic ulcer disease and gastric cancer.展开更多
Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold...Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold and warm shock and to select the appropriate inotropic and vasoactive medications is fraught with errors. Semiquantitative and quantitative assessment of the preload,contractility and afterload using non-invasive tools has been suggested,in conjunction with clinical and laboratory assessment,to direct shock management and select between vasopressors,vasodilators and inotropes or a combination of these drugs. This review aims to describe non-invasive tools to assess the hemodynamic status in septic shock including echocardiography,trans-thoracic/trans-esophageal Doppler and electrical cardiometry. As septic shock is a dynamic condition that changes markedly overtime,frequent or continuous measurement of the cardiac output(CO),systemic vascular resistance(SVR) and other hemodynamic parameters using the above-mentioned tools is essential to personalize the treatment and adapt it over time. The different combinations of blood pressure,CO and SVR serve as a pathophysiological framework to manage fl-uid therapy and titrate inotropic and vasoactive drugs. Near infrared spectroscopy is introduced as a noninvasive method to measure end organ perfusion and assess the response to treatment.展开更多
Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD...Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not include longterm patient oriented outcomes.Multicenter,randomized,outcome trials are needed to determine whether NAVA is effective in avoiding intubation,facilitating extubation,decreasing time of ventilation,reducing the incidence ofCLD,decreasing length of stay,and improving long-term outcomes such as the duration of ventilation,length of hospital stay,rate of pneumothorax,CLD and other major complications of prematurity.In order to prevent barotrauma,next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA.They should also include an upper limit to the inspiratory time as in conventional ventilation.The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants.Newly developed ventilators should also include leak compensation and high frequency ventilation.A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA.展开更多
AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospectiv...AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for bronchiolitis.Clinical outcomes included disease severity,duration of hospital stay,admission to pediatric intensive care unit,or death.They also included complications of thrombocytosis,including thromboembolic complications such as cerebrovascular accident,acute coronary syndrome,deep venous thrombosis,pulmonary embolus,mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding(spontaneous hemorrhage in the skin,mucous membranes,gastrointestinal,respiratory,or genitourinary tracts).RESULTS The median age was 4.7 mo and 179 were males(59%).Respiratory syncytial virus was isolated in 268(84%),adenovirus in 23(7%) and influenza virus A or B in 13(4%).Thrombocytosis(platelet count > 500 × 109/L) occurred in 88(29%;95%CI:24%-34%),more commonly in younger infants with the platelet count declining with age.There was no significant association with the duration of illness,temperature on admission,white blood cell count,serum C-reactive protein concentration,length of hospital stay or admission to the intensive care unit.No death,thrombotic or hemorrhagic events occurred.CONCLUSION Thrombocytosis is common in children under two years of age admitted with bronchiolitis.It is not associated with disease severity or thromboembolic complications.展开更多
Hepatitis E virus(HEV)and hepatitis C virus(HCV)are both RNA viruses with a tropism for liver parenchyma but are also capable of extrahepatic manifestations.Hepatitis E is usually a viral acute fecal-oral transmitted ...Hepatitis E virus(HEV)and hepatitis C virus(HCV)are both RNA viruses with a tropism for liver parenchyma but are also capable of extrahepatic manifestations.Hepatitis E is usually a viral acute fecal-oral transmitted and self-limiting disease presenting with malaise,jaundice,nausea and vomiting.Rarely,HEV causes a chronic infection in immunocompromised persons and severe fulminant hepatitis in pregnant women.Parenteral HCV infection is typically asymptomatic for decades until chronic complications,such as cirrhosis and cancer,occur.Despite being two very different viruses in terms of phylogenetic and clinical presentations,HEV and HCV show many similarities regarding possible transmission through organ transplantation and blood transfusion,pathogenesis(production of antinuclear antibodies and cryoglobulins)and response to treatment with some direct-acting antiviral drugs.Although both HEV and HCV are well studied individually,there is a lack of knowledge about coinfection and its consequences.The aim of this review is to analyze current literature by evaluating original articles and case reports and to hypothesize some interactions that can be useful for research and clinical practice.展开更多
Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine.Despite these advances,the growth of survivors does not reach the ideal target...Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine.Despite these advances,the growth of survivors does not reach the ideal target level of the normal fetus of the same gestational age.Postnatal weight gain is often not achieved because extrauterine growth has higher energy requirements than intrauterine growth,due to the intensive care environment,illness and inadequate nutrition.Although many other factors influence infant brain development,including family socioeconomic and educational background,the role of nutrition is considerable and fortunately,amenable to intervention.In the preterm neonate,the brain is the most metabolically demanding organ,consuming the largest proportions of energy and nutrient intake for its function and programmed growth and maturation.Weight gain,linear and head circumference growth are all markers of nutritional status and are independently associated with long-term neurodevelopment.Brain development is not only the result of nutrients intake,but in addition,of the interaction with growth factors which depend on adequate nutrient supply and overall health status.This explains why conditions such as sepsis,necrotizing enterocolitis and chronic lung disease alter the distribution and accretion of nutrients thereby suppressing growth factor synthesis.In this review,we will focus on the direct role of nutrition on neurodevelopment,emphasizing why it should be started without delay.The nutritional requirements of the preterm infant will be discussed,followed by the effects of general nutritional interventions and specific nutrients,as well as the role of nutritional supplements on neurodevelopment.The primordial role of human breast milk,breast milk fortifiers and human milk oligosaccharides will be discussed in detail.We will also examine the role of nutrition in preventing neonatal complications which can affect neurodevelopment in their own right.展开更多
Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such...Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through in-fections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to fnd a safer, effective and acceptable alter-native. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vacci-nium Macrocarpon （cranberry）, commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus （LA-5） and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli （E. coli ） 83972 has resulted in subjective beneft and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interven-tions.展开更多
文摘Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has significantly increased morbidity and mortality worldwide is the human immunodeficiency virus(HIV)and acquired immune deficiency syndrome(AIDS)pandemic.HIV has a disproportionately negative impact on key populations.Strong leadership,effective communication,and sound science are necessary for public health emergency(PHE)responses to be successful.These three PHE response pllars are also essential for bridging the HIV response gap among key populations in the setting of restrictive laws.In this review,we explored the importance of these three pillars of successful PHEs responses,and how they are essential to closing the gap in the HIV response among key populations.Leaders must make decisions and instil a sense of authority in the populace during PHEs to foster trust and confidence.Leaders should base their choices on scientific evidence.Effective communication during PHEs should be proactive,polite,imaginative,innovative,and constructive.To address gaps in the HIV response among key populations,leaders must create a supportive environment for effective communication and scientific research,communication should be used to raise awareness of HIV and to dispel stigma and discrimination,while science should provide evidence of efficacy and effectiveness of interventions amongkey populations.
文摘Objectives This study aimed to analyse the benefits of a gamified clinical supervision strategy during hospital-based training,particularly regarding the development of critical and reflective thinking among undergraduate nursing students.Methods From April to July 2023,second-year nursing students who undertaking a nine-week clinical placement in a cardiology ward in northern Portugal were selected.Following a two-week diagnostic phase,students participated in a six-week gamified supervision programme comprising weekly 60-min sessions:infection-control decision-making;technical-procedural reasoning;guided emotional and ethical reflection;and clinical reasoning quiz on cardiology topics.Students completed weekly Structured Reflection Guide entries;supervisors recorded structured field notes after each session;and,after the intervention,students answered a post-intervention questionnaire and participated in focus groups.Qualitative data(reflections,field notes,open-ended questionnaire items,and focus-group transcripts)were analyzed using Bardin’s content analysis;quantitative questionnaire items were summarized descriptively.Results All seven students completed the six gamified sessions and submitted weekly reflection entries.Five students(71.4%)completed the questionnaire.Across data sources,students reported that gamified activities supported knowledge consolidation,teamwork,and clinical reasoning.Questionnaire data showed that all respondents(n=5,100%)strongly agreed that gamification enhanced their learning and should be maintained in clinical training.Reflections and focus groups revealed recurring themes related to emotional expression,sense of belonging,and difficulties using structured reflection tools,particularly in terms of comprehension and timing.Conclusion The gamified supervision strategy integrated into clinical training provided structured opportunities for practical engagement,collaborative work,and guided reflection.These findings suggest that gamification may support the development of reflective and critical-thinking processes in authentic clinical environments.
文摘Artificial intelligence(AI)is increasingly recognized as a transformative force in the field of solid organ transplantation.From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosuppressive therapy,AI has the potential to improve both operational efficiency and patient outcomes.Despite these advancements,the perspectives of transplant professionals-those at the forefront of critical decision-making-remain insufficiently explored.To address this gap,this study utilizes a multi-round electronic Delphi approach to gather and analyses insights from global experts involved in organ transplantation.Participants are invited to complete structured surveys capturing demographic data,professional roles,institutional practices,and prior exposure to AI technologies.The survey also explores perceptions of AI’s potential benefits.Quantitative responses are analyzed using descriptive statistics,while open-ended qualitative responses undergo thematic analysis.Preliminary findings indicate a generally positive outlook on AI’s role in enhancing transplantation processes,particularly in areas such as donor matching and post-operative care.These mixed views reflect both optimism and caution among professionals tasked with integrating new technologies into high-stakes clinical workflows.By capturing a wide range of expert opinions,the findings will inform future policy development,regulatory considerations,and institutional readiness frameworks for the integration of AI into organ transplantation.
文摘Adolescence is a crucial time period with especial vulnerability for development of mental health problems.Growing interest is focusing on the determinants of positive mental health in order to find the key concepts that could be influenced in the promotion of mental well-being of adolescents.In this study we aim to explore the relations between self-esteem,character strengths and experience of social inclusion as determinants of adolescents’positive mental health controlled for selected sociodemographic background factors.The study population(n=195)consisted of comprehensive school students who filled in an electronic questionnaire of adolescent’s mental well-being in Fall 2019.The questionnaire included measures of Warwick-Edinburgh Mental Well-being Scale(WEMWBS),VIA Youth-measure 96,Rosenberg Self-Esteem Scale and Experience of Social Inclusion Scale.The methods included group comparisons and General Linear Model computed by SPSS 24.0.The strongest association was found between positive mental health and self-esteem(β=0.789,p<0.001),followed by character strengths of hope and kindness and experience of social inclusion.Interestingly,family’s socioeconomic factors did not associate significantly with positive mental health in the final statistical model.In terms of our results,it seems that self-esteem,character strengths and experience of social inclusion might have stronger association with adolescents’mental well-being than family’s socioeconomic determinants.Therefore,it should be discussed whether psychological determinants overcome the individual effect of poor socioeconomic status as factors that influence positive mental health.Further studies are needed to establish these results more firmly.
基金supported by national funds through FCT-Fundaçao para a Ciencia e a Tecnologia,I.P.,within CINTESIS R&D Unit(UIDB/4255/2020 and UIDP/4255/2020)within the scope of the project RISE(LA/P/0053/2020).
文摘Objectives The aim of this study was to analyze the psychometric properties(reliability and validity)of the Social Isolation Scale(SIS)in a sample of Portuguese community-dwelling older adults.Methods A transversal descriptive study was carried out with a convenience sample of 250 community-dwelling older adults(≥65 years).The survey comprised a sociodemographic questionnaire,SIS,Geriatric Depression Scale-4(GDS-4),6-item Lubben Social Network Scale(LSNS-6),a loneliness self-assessment question,and Satisfaction with Life Scale(SWLS).Construct validity(confirmatory factor analysis)and convergent validity were analyzed,and ISI internal reliability(composite reliability),external reliability(test-retest,intraclass correlation coefficient)and inter-rater reliability(Cohen’s kappa coefficient)were evaluated.Results Confirmatory factor analysis showed a two-factor model with an excellent index of fit.The SIS showed significant correlations with LSNS-6(rs=0.47),SWLS(rs=0.26),the loneliness self-assessment question(rs=0.35),and GDS-4(rs=−0.16).SIS composite reliability was good(0.708).The inter-class correlation coefficient varied from 0.84 to 0.98.The Cohen’s kappa coefficient ranged from 0.936 to 1.Conclusions SIS has been shown to be a valid and reliable instrument for assessing social isolation among Portuguese community-dwelling older adults.Healthcare professionals,particularly nurses working in community settings,can use SIS to assess social isolation in older adults to design,implement,and evaluate interventions.
文摘Background:Recognition and treatment of emotional distress,which affects 20 to 40%of outpatients with type 1 or type 2 diabetes,are important because of its association with worse diabetes self-care,poor glycemic control,increased rates of mortality and diabetes-related complications,and a rise in healthcare expenditure.However,although the symptoms of emotional distress improve in diabetic patients after psychological and pharmacological interventions,evidence of benefits in glycemic control is still uncertain.Objective:The aim of this study was to assess the metabolic control in diabetic patients with emotional distress attending primary mental care clinics(PMCC)in the Eastern Province of Saudi Arabia.Method:This study was a single group pretest-posttest design conducted on adult diabetic patients with emotional distress attending PMCC.Out of 194 attendees,62 patients who fulfilled the selection criteria were studied.Data were collected from the patients’records using a worksheet designed for the study.Metabolic parameters including BMI,BP,FBS,HbA1c and lipid profile were recorded before and after the management of emotional distress.Socio-demographic characteristics,complications related to diabetes and co-morbidities were also recorded.Paired t-test was used appropriately to compare continuous variables.A p-value of less than 0.05 was considered significant in all statistical analysis.Results:The majority of the patients had type 2 DM(98.2%)and the presence of co-morbidities was high(83.9%).A comparison of the metabolic parameters before and after management of emotional distress,showed a significant reduction in HbA1c(p=0.020)and elevation in HDL(p=0.010).No differences in BMI,BP,FBS,TC,TG or LDL were found.Conclusions:Treating emotional distress in diabetic patients is associated with an improvement in HbA1c and HDL.
文摘Air quality was measured inside 628 United Arab Emirates (UAE) personal residences. Weekly average concentrations of carbon monoxide (CO), formaldehyde (HCHO), hydrogen sulfide (H2S), nitrogen dioxide (NO2), sulfur dioxide (SO2), and three size fractions of particulate matter (PM2.5, PMc, and PM10) were determined in each home. In a subset of the homes, measurements of outdoor air quality, ultrafine PM concentrations, and elemental PM concentrations were also made. Questionnaires were administered to obtain information on housing demographics and lifestyle habits. Air measurements were performed using simple and cost effective passive samplers. The 90th percentiles of indoor CO, HCHO, H2S, NO2, and SO2 were 1.55 ppm, 0.05 ppm, 0.12 ppm, 0.01 ppm, and 0.05 ppm, respectively. Median indoor PM2.5, PMc, and PM10, concentrations were 5.73 μg/m3, 29.4 μg/m3, and 35.2 μg/m3, respectively. The median indoor concentration of ultrafine PM was 3.62 × 1010 particles/m3. Indoor/outdoor ratios for PM were 0.44, 0.41, and 0.38 for ultrafine PM, PM2.5, and PM10, respectively. These values fall within the range of other indoor air studies findings conducted in developing countries. Air conditioning, smoking, and attached kitchens were significantly correlated with indoor levels of carbon monoxide. In addition, indoor concentrations of PM2.5 and PM10 were significantly correlated with vehicles parked within five meters of the home, central air conditioning, and having attached kitchens. This is the first robust indoor air quality data set developed for the UAE. This study demonstrates that screening level tools are a good initial step for assessing air quality when logistical issues (distance, language, cultural, training) and intrusion into personal lives need to be minimized.
基金United Arab Emirates University,Grant/Award Number:12R104 and 12R121。
文摘Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.
文摘This frontier will highlight the principles of diagnosis and management of earthquake crush syndrome and related acute kidney injury(AKI)based on our two recently published highly accessed collective review articles.Continuous prolonged pressure of the rubble on injured muscles following earthquakes may cause crush injuries.When the patient is extricated and the compressed muscles are relieved,an ischemia–reperfusion injury,with systematic serious metabolic disturbances,occurs.This includes hyperkalemia,rhabdomyolysis,and AKI.AKI is caused by three mechanisms.Prerenal factors include:(1)Hypovolemia due to bleeding;(2)Dehydration due to lack of water;(3)Ischaemia-reperfusion injury;and(4)Cardiac depression caused by released toxins.Renal factors include the nephrotoxic effects of the uric acid and bilirubin,tubular casts obstructing the tubules,or the direct deposition of phosphorus and calcium inside the kidneys.Pelvic fractures may cause urethral rupture with postrenal obstruction.The ma-nagement principles of crush syndrome and AKI include:(1)Proper fluid therapy to maintain adequate urine output;(2)Preventing and treating hyperkalemia;and(3)Renal replacement therapy when indicated in cases of severe hyperkalemia,severe acidemia,volume overload,or severe uremia.Recognizing these condi-tions and treating them timely and properly will save many patients.
文摘Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions.Methods The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates.Results The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases.Conclusions The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.
基金supported by research grants from the United Arab Emirates University[Grant#:G00003388,G00002809,G00003627,31M374].
文摘Background:Diabetes mellitus(DM),a metabolic disorder that leads to chronic hyperglycemia,is one of the topmost global public health concerns according to the International Diabetes Federation.Adropin is a peptide hormone that is primarily involved in energy homeostasis,but its involvement in other biological activities such as lowering hyperlipidemia,and diminishing insulin resistance has also been reported.In this study,we aimed to explore additional effects of adropin on oxidative stress,inflammation,and cell proliferation in an animal model of type 1 DM.Methods:To achieve our aim,normal and diabetic Wistar rats were treated with adropin(2.1μg/kg/day)for a period of 10 days.Pancreatic tissue samples were collected for histomorphological analysis and inflammation assay,while blood was collected for oxidative stress assay.Results:Our results showed that diabetes induction stimulated cell proliferation in both exocrine and endocrine pancreas,and adropin dramatically attenuated this effect in pancreatic exocrine tissue,but not in the islet of Langerhans.In addition,adropin significantly increased glutathione reductase expression in pancreatic tissue,and augmented serum total glutathione in the diabetic rats compared to diabetic untreated rats.Conclusion:Our study indicates the potential role of adropin in alleviating oxidative stress in DM.
文摘Bartter and Gitelman syndromes(BS and GS) are inherited disorders resulting in defects in renal tubularhandling of sodium,potassium and chloride.Previously considered as genotypic and phenotypic heterogeneous diseases,recent evidence suggests that they constitute a spectrum of disease caused by different genetic mutations with the molecular defects of chloride reabsorption originating at different sites of the nephron in each condition.Although they share some characteristic metabolic abnormalities such as hypokalemia,metabolic alkalosis,hyperplasia of the juxtaglomerular apparatus with hyperreninemia,hyperaldosteronism,the clinical and laboratory manifestations may not always allow distinction between them.Diuretics tests,measuring the changes in urinary fractional excretion of chloride from baseline after administration of either hydrochlorothiazide or furosemide show very little change(< 2.3%) in the fractional excretion of chloride from baseline in GS when compared with BS,except when BS is associated with KCNJ1 mutations where a good response to both diuretics exists.The diuretic test is not recommended for infants or young children with suspected BS because of a higher risk of volume depletion in such children.Clinical symptoms and biochemical markers of GS and classic form of BS(type III) may overlap and thus genetic analysis may specify the real cause of symptoms.However,although genetic analysis is available,its use remains limited because of limited availability,large gene dimensions,lack of hot-spot mutations,heavy workup time and costs involved.Furthermore,considerable overlap exists between the different genotypes and phenotypes.Although BS and GS usually have distinct presentations and are associated with specific gene mutations,there remains considerable overlap between their phenotypes and genotypes.Thus,they are better described as a spectrum of clinical manifestations caused by different gene mutations.
文摘Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible.
基金Supported by Terry Fox Fund for Cancer Research and UAE University
文摘The fact that the acidsecreting parietal cells undergo continuous renewal has been ignored by many gastroenterologists and cell biologists. In the past, it was thought that these cells were static. However, by using 3Hthymidine radioautography in combination with electron microscopy, it was possible to demonstrate that parietal cells belong to a continuously renewing epithelial cell lineage. In the gastric glands, stem cells anchored in the isthmus region are responsible for the production of parietal cells. The stem cells give rise to three main progenitors: prepit, preneck and preparietal cells. Parietal cells develop either directly from the noncycling preparietal cells or less commonly via differentiation of the cycling prepit and preneck cell progenitors. The formation of a parietal cell is a sequential process which involves diminishment of glycocalyx, production of cytoplasmic tubulovesicles, an increase in number and length of microvilli, an increase in number and size of mitochondria, and fi nally, expansion and invagination of the apical membrane with the formation of an intracellular canalicular system. Little is known about the genetic counterparts of these morphological events. However, the time dimension of parietal cell production and the consequences of its alteration on the biological features of the gastric gland are well documented. The production of a new parietal cell takes about 2 d. However, mature parietal cells have a long lifespan during which they migrate bidirectionally while their functional activity for acid secretion gradually diminishes. Following an average lifespan of about 54 d, in mice, old parietal cells undergo degeneration and elimination. Various approaches for genetic alteration of the development of parietal cells have provided evidence in support of their role as governors of the stem/progenitor cell proliferation and differentiation programs. Revealing the dynamic features and the various roles of parietal cells would help in a better understanding of the biological features of the gastric glands and would hopefully help in providing a basis for the development of new strategies for prevention, early detection and/or therapy of various gastric disorders in which parietal cells are involved, such as atrophic gastritis, peptic ulcer disease and gastric cancer.
文摘Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold and warm shock and to select the appropriate inotropic and vasoactive medications is fraught with errors. Semiquantitative and quantitative assessment of the preload,contractility and afterload using non-invasive tools has been suggested,in conjunction with clinical and laboratory assessment,to direct shock management and select between vasopressors,vasodilators and inotropes or a combination of these drugs. This review aims to describe non-invasive tools to assess the hemodynamic status in septic shock including echocardiography,trans-thoracic/trans-esophageal Doppler and electrical cardiometry. As septic shock is a dynamic condition that changes markedly overtime,frequent or continuous measurement of the cardiac output(CO),systemic vascular resistance(SVR) and other hemodynamic parameters using the above-mentioned tools is essential to personalize the treatment and adapt it over time. The different combinations of blood pressure,CO and SVR serve as a pathophysiological framework to manage fl-uid therapy and titrate inotropic and vasoactive drugs. Near infrared spectroscopy is introduced as a noninvasive method to measure end organ perfusion and assess the response to treatment.
文摘Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not include longterm patient oriented outcomes.Multicenter,randomized,outcome trials are needed to determine whether NAVA is effective in avoiding intubation,facilitating extubation,decreasing time of ventilation,reducing the incidence ofCLD,decreasing length of stay,and improving long-term outcomes such as the duration of ventilation,length of hospital stay,rate of pneumothorax,CLD and other major complications of prematurity.In order to prevent barotrauma,next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA.They should also include an upper limit to the inspiratory time as in conventional ventilation.The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants.Newly developed ventilators should also include leak compensation and high frequency ventilation.A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA.
文摘AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for bronchiolitis.Clinical outcomes included disease severity,duration of hospital stay,admission to pediatric intensive care unit,or death.They also included complications of thrombocytosis,including thromboembolic complications such as cerebrovascular accident,acute coronary syndrome,deep venous thrombosis,pulmonary embolus,mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding(spontaneous hemorrhage in the skin,mucous membranes,gastrointestinal,respiratory,or genitourinary tracts).RESULTS The median age was 4.7 mo and 179 were males(59%).Respiratory syncytial virus was isolated in 268(84%),adenovirus in 23(7%) and influenza virus A or B in 13(4%).Thrombocytosis(platelet count > 500 × 109/L) occurred in 88(29%;95%CI:24%-34%),more commonly in younger infants with the platelet count declining with age.There was no significant association with the duration of illness,temperature on admission,white blood cell count,serum C-reactive protein concentration,length of hospital stay or admission to the intensive care unit.No death,thrombotic or hemorrhagic events occurred.CONCLUSION Thrombocytosis is common in children under two years of age admitted with bronchiolitis.It is not associated with disease severity or thromboembolic complications.
基金Supported by PON Research and Innovation 2014-2020(Nadia Marascio),Attraction and International Mobility programmeNo.Proposal Code_Activity AIM1879147_1。
文摘Hepatitis E virus(HEV)and hepatitis C virus(HCV)are both RNA viruses with a tropism for liver parenchyma but are also capable of extrahepatic manifestations.Hepatitis E is usually a viral acute fecal-oral transmitted and self-limiting disease presenting with malaise,jaundice,nausea and vomiting.Rarely,HEV causes a chronic infection in immunocompromised persons and severe fulminant hepatitis in pregnant women.Parenteral HCV infection is typically asymptomatic for decades until chronic complications,such as cirrhosis and cancer,occur.Despite being two very different viruses in terms of phylogenetic and clinical presentations,HEV and HCV show many similarities regarding possible transmission through organ transplantation and blood transfusion,pathogenesis(production of antinuclear antibodies and cryoglobulins)and response to treatment with some direct-acting antiviral drugs.Although both HEV and HCV are well studied individually,there is a lack of knowledge about coinfection and its consequences.The aim of this review is to analyze current literature by evaluating original articles and case reports and to hypothesize some interactions that can be useful for research and clinical practice.
文摘Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine.Despite these advances,the growth of survivors does not reach the ideal target level of the normal fetus of the same gestational age.Postnatal weight gain is often not achieved because extrauterine growth has higher energy requirements than intrauterine growth,due to the intensive care environment,illness and inadequate nutrition.Although many other factors influence infant brain development,including family socioeconomic and educational background,the role of nutrition is considerable and fortunately,amenable to intervention.In the preterm neonate,the brain is the most metabolically demanding organ,consuming the largest proportions of energy and nutrient intake for its function and programmed growth and maturation.Weight gain,linear and head circumference growth are all markers of nutritional status and are independently associated with long-term neurodevelopment.Brain development is not only the result of nutrients intake,but in addition,of the interaction with growth factors which depend on adequate nutrient supply and overall health status.This explains why conditions such as sepsis,necrotizing enterocolitis and chronic lung disease alter the distribution and accretion of nutrients thereby suppressing growth factor synthesis.In this review,we will focus on the direct role of nutrition on neurodevelopment,emphasizing why it should be started without delay.The nutritional requirements of the preterm infant will be discussed,followed by the effects of general nutritional interventions and specific nutrients,as well as the role of nutritional supplements on neurodevelopment.The primordial role of human breast milk,breast milk fortifiers and human milk oligosaccharides will be discussed in detail.We will also examine the role of nutrition in preventing neonatal complications which can affect neurodevelopment in their own right.
文摘Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through in-fections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to fnd a safer, effective and acceptable alter-native. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vacci-nium Macrocarpon （cranberry）, commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus （LA-5） and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli （E. coli ） 83972 has resulted in subjective beneft and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interven-tions.
