age Middle-Aged Health Behavior a Matter of Degrees By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Middle-Aged Health Behavior a Matter of DegreesCategory: Health NewsCreated: 8/29/2013 9:35:00 AMLast Editorial Review: 8/29/2013 12:00:00 AM Full Article
age Mellow Music May Help Stave Off Road Rage By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Mellow Music May Help Stave Off Road RageCategory: Health NewsCreated: 8/30/2013 9:35:00 AMLast Editorial Review: 8/30/2013 12:00:00 AM Full Article
age Health Tip: Manage Stress to Keep Diabetes in Check By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Health Tip: Manage Stress to Keep Diabetes in CheckCategory: Health NewsCreated: 8/25/2014 7:35:00 AMLast Editorial Review: 8/25/2014 12:00:00 AM Full Article
age One Part of the Brain Doesn't Age, Study Suggests By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: One Part of the Brain Doesn't Age, Study SuggestsCategory: Health NewsCreated: 8/22/2014 4:36:00 PMLast Editorial Review: 8/25/2014 12:00:00 AM Full Article
age Ban Indoor Use of E-Cigarettes, U.N. Health Agency Says By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Ban Indoor Use of E-Cigarettes, U.N. Health Agency SaysCategory: Health NewsCreated: 8/26/2014 12:35:00 PMLast Editorial Review: 8/27/2014 12:00:00 AM Full Article
age Encouraging Your Baby's Babbling May Speed Language Development By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Encouraging Your Baby's Babbling May Speed Language DevelopmentCategory: Health NewsCreated: 8/29/2014 9:36:00 AMLast Editorial Review: 8/29/2014 12:00:00 AM Full Article
age Liver Damage From Hepatitis C More Widespread Than Thought By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Liver Damage From Hepatitis C More Widespread Than ThoughtCategory: Health NewsCreated: 8/27/2015 12:00:00 AMLast Editorial Review: 8/27/2015 12:00:00 AM Full Article
age Mouse Study Suggests Stem Cells May Reverse Stroke Damage By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Mouse Study Suggests Stem Cells May Reverse Stroke DamageCategory: Health NewsCreated: 8/22/2016 12:00:00 AMLast Editorial Review: 8/23/2016 12:00:00 AM Full Article
age Average Lifespan Longer for Twins By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Average Lifespan Longer for TwinsCategory: Health NewsCreated: 8/23/2016 12:00:00 AMLast Editorial Review: 8/24/2016 12:00:00 AM Full Article
age Health Tip: Avoid Juice Before Age 1 By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Health Tip: Avoid Juice Before Age 1Category: Health NewsCreated: 8/30/2017 12:00:00 AMLast Editorial Review: 8/30/2017 12:00:00 AM Full Article
age Marriage a Blessing for Heart Attack Patients By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Marriage a Blessing for Heart Attack PatientsCategory: Health NewsCreated: 8/29/2017 12:00:00 AMLast Editorial Review: 8/30/2017 12:00:00 AM Full Article
age Study Finds Some Patients With A-Fib Have Hidden Brain Damage By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Study Finds Some Patients With A-Fib Have Hidden Brain DamageCategory: Health NewsCreated: 8/27/2018 12:00:00 AMLast Editorial Review: 8/27/2018 12:00:00 AM Full Article
age Monitoring System for Underage Tobacco Sales Falls Short: Study By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Monitoring System for Underage Tobacco Sales Falls Short: StudyCategory: Health NewsCreated: 8/29/2018 12:00:00 AMLast Editorial Review: 8/30/2018 12:00:00 AM Full Article
age Drug Slows Brain Shrinkage in Progressive MS By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Drug Slows Brain Shrinkage in Progressive MSCategory: Health NewsCreated: 8/29/2018 12:00:00 AMLast Editorial Review: 8/30/2018 12:00:00 AM Full Article
age Vaping May Trigger Lung Damage Like That Seen in Emphysema By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Vaping May Trigger Lung Damage Like That Seen in EmphysemaCategory: Health NewsCreated: 8/26/2019 12:00:00 AMLast Editorial Review: 8/27/2019 12:00:00 AM Full Article
age Even a Little Drinking While Pregnant Ups Miscarriage Odds: Study By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Even a Little Drinking While Pregnant Ups Miscarriage Odds: StudyCategory: Health NewsCreated: 8/27/2019 12:00:00 AMLast Editorial Review: 8/28/2019 12:00:00 AM Full Article
age For Muslim Pilgrimage, Climate Change Poses Health Risks By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: For Muslim Pilgrimage, Climate Change Poses Health RisksCategory: Health NewsCreated: 8/28/2019 12:00:00 AMLast Editorial Review: 8/29/2019 12:00:00 AM Full Article
age Even Age 80 Is Not Too Late to Begin Exercising: Study By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Even Age 80 Is Not Too Late to Begin Exercising: StudyCategory: Health NewsCreated: 8/30/2019 12:00:00 AMLast Editorial Review: 8/30/2019 12:00:00 AM Full Article
age Age Can Impair a Man's Odds for Fatherhood: Study By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Age Can Impair a Man's Odds for Fatherhood: StudyCategory: Health NewsCreated: 8/23/2021 12:00:00 AMLast Editorial Review: 8/23/2021 12:00:00 AM Full Article
age Expert Panel Lowers Routine Screening Age for Diabetes to 35 By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Expert Panel Lowers Routine Screening Age for Diabetes to 35Category: Health NewsCreated: 8/24/2021 12:00:00 AMLast Editorial Review: 8/25/2021 12:00:00 AM Full Article
age Pain Management By www.medicinenet.com Published On :: Thu, 28 Jul 2022 00:00:00 PDT Title: Pain ManagementCategory: Diseases and ConditionsCreated: 12/7/2006 12:00:00 AMLast Editorial Review: 7/28/2022 12:00:00 AM Full Article
age Cheap, Same-Day Test Could Help Spot Miscarriage Risk By www.medicinenet.com Published On :: Fri, 19 Aug 2022 00:00:00 PDT Title: Cheap, Same-Day Test Could Help Spot Miscarriage RiskCategory: Health NewsCreated: 8/18/2022 12:00:00 AMLast Editorial Review: 8/19/2022 12:00:00 AM Full Article
age What Are the 4 Stages of Congestive Heart Failure? By www.medicinenet.com Published On :: Fri, 26 Aug 2022 00:00:00 PDT Title: What Are the 4 Stages of Congestive Heart Failure?Category: Diseases and ConditionsCreated: 6/24/2020 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
age Cholesterol Management By www.medicinenet.com Published On :: Wed, 6 Jul 2022 00:00:00 PDT Title: Cholesterol ManagementCategory: Diseases and ConditionsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 7/6/2022 12:00:00 AM Full Article
age Scientists Design Skin Patch That Takes Ultrasound Images By www.medicinenet.com Published On :: Fri, 29 Jul 2022 00:00:00 PDT Title: Scientists Design Skin Patch That Takes Ultrasound ImagesCategory: Health NewsCreated: 7/29/2022 12:00:00 AMLast Editorial Review: 7/29/2022 12:00:00 AM Full Article
age How to Manage Menopause Symptoms After Breast Cancer By www.medicinenet.com Published On :: Thu, 7 Jul 2022 00:00:00 PDT Title: How to Manage Menopause Symptoms After Breast CancerCategory: Diseases and ConditionsCreated: 7/7/2022 12:00:00 AMLast Editorial Review: 7/7/2022 12:00:00 AM Full Article
age When Hospital Patient & Doctor Speak Same Language, Outcomes Improve By www.medicinenet.com Published On :: Mon, 11 Jul 2022 00:00:00 PDT Title: When Hospital Patient & Doctor Speak Same Language, Outcomes ImproveCategory: Health NewsCreated: 7/11/2022 12:00:00 AMLast Editorial Review: 7/11/2022 12:00:00 AM Full Article
age Being Social May Be Key to 'Sense of Purpose' as You Age By www.medicinenet.com Published On :: Tue, 12 Jul 2022 00:00:00 PDT Title: Being Social May Be Key to 'Sense of Purpose' as You AgeCategory: Health NewsCreated: 7/12/2022 12:00:00 AMLast Editorial Review: 7/12/2022 12:00:00 AM Full Article
age Evidence-based management of symptoms in serious respiratory illness: what is in our toolbox? By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Extract Living with a respiratory illness requires patients to manage a wide range of symptoms, many of which will worsen as a disease progresses. Breathlessness is a hallmark feature of respiratory conditions, occurring in almost all individuals with COPD and interstitial lung disease (ILD) [1, 2]. Cough is present in 78% of people with ILD and is frequently distressing, with physical, social and emotional impacts [1, 3]. Full Article
age The deadly dance of alveolar macrophages and influenza virus By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Influenza A virus (IAV) is one of the leading causes of respiratory infections. The lack of efficient anti-influenza therapeutics requires a better understanding of how IAV interacts with host cells. Alveolar macrophages are tissue-specific macrophages that play a critical role in lung innate immunity and homeostasis, yet their role during influenza infection remains unclear. First, our review highlights an active IAV replication within alveolar macrophages, despite an abortive viral cycle. Such infection leads to persistent alveolar macrophage inflammation and diminished phagocytic function, alongside direct mitochondrial damage and indirect metabolic shifts in the alveolar micro-environment. We also discuss the "macrophage disappearance reaction", which is a drastic reduction of the alveolar macrophage population observed after influenza infection in mice but debated in humans, with unclear underlying mechanisms. Furthermore, we explore the dual nature of alveolar macrophage responses to IAV infection, questioning whether they are deleterious or protective for the host. While IAV may exploit immuno-evasion strategies and induce alveolar macrophage alteration or depletion, this could potentially reduce excessive inflammation and allow for the replacement of more effective cells. Despite these insights, the pathophysiological role of alveolar macrophages during IAV infection in humans remains understudied, urging further exploration to unravel their precise contributions to disease progression and resolution. Full Article
age Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes. Full Article
age The ageing of people living with cystic fibrosis: what to expect now? By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 The prognosis of people with cystic fibrosis (pwCF) has improved dramatically with the introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators (CFTRm). The ageing of the cystic fibrosis (CF) population is changing the disease landscape with the emergence of different needs and increasing comorbidities related to both age and long-term exposure to multiple treatments including CFTRm. Although the number of pwCF eligible for this treatment is expected to increase, major disparities in care and outcomes still exist in this population. Moreover, the long-term impact of the use of CFTRm is still partly unknown due to the current short follow-up and experience with their use, thus generating some uncertainties. The future spread and initiation of these drugs at an earlier stage of the disease is expected to reduce the systemic burden of systemic inflammation and its consequences on health. However, the prolonged life expectancy is accompanied by an increasing burden of age-related comorbidities, especially in the context of chronic disease. The clinical manifestations of the comorbidities directly or indirectly associated with CFTR dysfunction are changing, along with the disease dynamics and outcomes. Current protocols used to monitor slow disease progression will need continuous updates, including the composition of the multidisciplinary team for CF care, with a greater focus on the needs of the adult population. Full Article
age Cannabis and Pain Management By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Family physicians are fielding questions about cannabis --particularly for the use of cannabis for treatment of pain. Like about every substance ingested to treat medical conditions, cannabis has risks and benefits. But regarding evidence-based practice and practice-based recommendations for patients about cannabis use, the cart is in front of the horse. Cannabis use is still illegal at a federal level and a Schedule 1 drug, but most states have challenged federal law by decriminalizing or legalizing cannabis for a variety of uses. Research is difficult due to this federal status as a Schedule 1 drug since federal funding is not readily available to support research. As a result, physicians have little to no guidance about the clinical usefulness of the product. This article explores what we know and what we are learning about cannabis, and the authors provide clinical guidance for patient care based on this evidence. Full Article
age Be SMART About Asthma Management: Single Maintenance and Reliever Therapy By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Single maintenance and reliever therapy (SMART) is an asthma treatment approach that utilizes combined inhaled corticosteroids and long-acting β-agonists for maintenance and quick relief therapy. Despite the evidence for its benefits in asthma treatment and its adoption into American and international asthma guidelines and recommendations, SMART remains a practice of some debate. This article reviews the available evidence for SMART and offers guidance for its integration into comprehensive asthma management. Overall, short-acting β-agonist-only asthma therapy regimens should be avoided, regardless of condition severity (SOR A Recommendation). Family medicine clinicians should start SMART for patients requiring either GINA Step 3 or 4 therapy, especially if they have signs of poor adherence (SOR B Recommendation). Finally, use budesonide-formoterol over other inhaled corticosteroid/long-acting β-agonist combinations when implementing SMART (SOR B Recommendation). Full Article
age Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge. Objective: To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians. Design: Exploratory, convergent mixed methods. Participants: Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West. Approach: Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics. Results: Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions. Conclusions: While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients’ lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings. Full Article
age Colorectal Cancer Screening: A Multicomponent Intervention to Increase Uptake in Patients Aged 45-49 By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Purpose: Colorectal cancer (CRC) screening is recommended starting at age 45, but there has been little research on strategies to promote screening among patients younger than 50. This study assessed the effect of a multicomponent intervention on screening completion in this age group. Methods: The intervention consisted of outreach to patients aged 45 to 49 (n = 3,873) via mailed fecal immunochemical test (FIT) (sent to 46%), text (84%), e-mail (53%), and the extension to this age group of an existing standing order protocol allowing primary care nurses and medical assistants to order FIT at primary care clinics in an urban safety-net system. We used segmented linear regression to assess changes in CRC screening completion trends. Patients aged 51 to 55 were included as a comparison group (n = 3,943). Data were extracted from the EHR. Results: The percentage of patients aged 45 to 49 who were up-to-date with CRC screening (colonoscopy in 10 years or FIT in last year) increased an average of 0.4% (95% CI 0.3, 0.6)) every 30 days before intervention rollout and 2.8% (95% CI 2.5, 3.1) after (slope difference 2.3% [95% CI 2.0, 2.7]). This difference persisted after accounting for small changes in the outcome observed in the comparison group (slope difference 1.7% [95% CI 1.2, 2.2]). Conclusions: These results suggest that the intervention increased CRC screening completion among patients 45 to 49. Health care systems seeking to improve CRC screening participation among patients aged 45 to 49 should consider implementing similar interventions. Full Article
age A Review of Artificial Intelligence and Machine Learning in Product Life Cycle Management By journal.pda.org Published On :: 2024-10-22T08:20:35-07:00 The pursuit of harnessing data for knowledge creation has been an enduring quest, with the advent of machine learning (ML) and artificial intelligence (AI) marking significant milestones in this journey. ML, a subset of AI, emerged as the practice of employing mathematical models to enable computers to learn and improve autonomously based on their experiences. In the pharmaceutical and biopharmaceutical sectors, a significant portion of manufacturing data remains untapped or insufficient for practical use. Recognizing the potential advantages of leveraging the available data for process design and optimization, manufacturers face the daunting challenge of data utilization. Diverse proprietary data formats and parallel data generation systems compound the complexity. The transition to Pharma 4.0 necessitates a paradigm shift in data capture, storage, and accessibility for manufacturing and process operations. This paper highlights the pivotal role of AI in converting process data into actionable knowledge to support critical functions throughout the whole product life cycle. Furthermore, it underscores the importance of maintaining compliance with data integrity guidelines, as mandated by regulatory bodies globally. Embracing AI-driven transformations is a crucial step toward shaping the future of the pharmaceutical industry, ensuring its competitiveness and resilience in an evolving landscape. Full Article
age Degradation of Obidoxime Chloride Solution for Injection upon Long-Term Storage under Field Conditions of Mediterranean Climate vs the Controlled Environment By journal.pda.org Published On :: 2024-10-22T08:20:35-07:00 Obidoxime chloride is an antidote for nerve gas intoxication. As an emergency medicine, it is being stored by the Israel Defense Forces (IDF) scattered throughout Israel in depots without a controlled environment (field conditions), thus being exposed to high and fluctuating temperatures. These conditions do not meet the manufacturer’s requirements. In addition, due to possible supply shortages, the utilization of expired batches was suggested. The current work investigated these matters. Long-term (15 years) storage under different conditions was initiated. Chemical stability and toxicity in rats were assessed. No difference was found between field conditions vs the controlled environment. The obidoxime assay remained >95% for 5 years and >90% for 7 years. The pH remained above the lower specification limit for 7–8 years. The major degradation product, 4-pyridinealdoxime, surpassed the allowed limit at 5 years. The content of total unknown impurities reached its maximum allowed by the IDF limit at 4–5 years. Threefold higher than clinically utilized doses of valid-to-date Toxogonin batches administered to rats did not cause any abnormality. However, expired batches produced significant toxic effects. Although no difference was found between storage of obidoxime ampoules when adhering to manufacturer’s recommendations vs field conditions, accumulation of degradants over the limit allowed by the IDF at 4–5 years of storage and the toxicity of the expired batches observed in rats led the IDF to a decision to shorten the shelf-life of this product from 5 to 4 years when stored in an uncontrolled environment of the Mediterranean climate. Full Article
age YY1 knockout in pro-B cells impairs lineage commitment, enabling unusual hematopoietic lineage plasticity [Research Papers] By genesdev.cshlp.org Published On :: 2024-10-16T07:18:56-07:00 During B-cell development, cells progress through multiple developmental stages, with the pro-B-cell stage defining commitment to the B-cell lineage. YY1 is a ubiquitous transcription factor that is capable of both activation and repression functions. We found here that knockout of YY1 at the pro-B-cell stage eliminates B lineage commitment. YY1 knockout pro-B cells can generate T lineage cells in vitro using the OP9-DL4 feeder system and in vivo after injection into sublethally irradiated Rag1–/– mice. These T lineage-like cells lose their B lineage transcript profile and gain a T-cell lineage profile. Single-cell RNA-seq experiments showed that as YY1 knockout pro-B cells transition into T lineage cells in vitro, various cell clusters adopt transcript profiles representing a multiplicity of hematopoietic lineages, indicating unusual lineage plasticity. In addition, YY1 KO pro-B cells in vivo can give rise to other hematopoietic lineages in vivo. Evaluation of RNA-seq, scRNA-seq, ChIP-seq, and scATAC-seq data indicates that YY1 controls numerous chromatin-modifying proteins leading to increased accessibility of alternative lineage genes in YY1 knockout pro-B cells. Given the ubiquitous nature of YY1 and its dual activation and repression functions, YY1 may regulate commitment in multiple cell lineages. Full Article
age A worldwide perspective of long COVID management: how can we END-COVID? By beta.openres.ersjournals.com Published On :: 2024-11-11T01:50:25-08:00 Extract As of 15 May 2024, >775 million confirmed cases of COVID-19 and >7 million deaths have been reported to the World Health Organization [1]. Although most patients with COVID-19 survive, survivors are at risk of long COVID, the sequelae of the viral infection affecting multiple organ systems [2]. Long COVID poses a substantial burden to individuals and society, even with a conservative estimate of 10% prevalence among COVID-19 survivors [3–5]. However, as the symptoms of long COVID vary substantially, ranging from respiratory symptoms, such as dyspnoea and cough, to fatigue and cognitive impairment [6], developing a standard set of investigations and management protocols for patients with long COVID is challenging. Full Article
age A worldwide look into long COVID-19 management: an END-COVID survey By beta.openres.ersjournals.com Published On :: 2024-11-11T01:50:25-08:00 Background Long COVID is a heterogeneous clinical syndrome characterised by a variety of reported symptoms and signs. Its clinical management is expected to differ significantly worldwide. Methods A survey-based study investigating long COVID-related standard operating procedures (SOPs) has been conducted by the European Respiratory Society (ERS) END-COVID clinical research collaboration with the support of other international societies (ALAT, APSR, CHEST, ESCMID and PATS). A global analysis of the results is provided here, alongside sub-population analysis based on continents, national income levels, type of involved healthcare professional and inclusion or exclusion of paediatric patients. Findings 1015 healthcare professionals from 110 different countries worldwide participated in this study, the majority of them being respiratory physicians (60.6%). A dedicated long COVID programme was present in 55.4% of the investigated institutions, with hospital admission during the acute infection being the main inclusion criteria to access them. Consistent differences in long COVID-related procedures were identified among centres, mainly regarding the multidisciplinary approach, the availability of telemedicine and psychological support, the type of requested exams and the total amount of visits in the centre. Interpretation Long COVID management shows important differences related to geographical areas and national income levels. SOPs were significantly different when centres were managed by a pulmonologist or when paediatric patients were included. Full Article
age Ensuring availability of respiratory medicines in times of European drug shortages By erj.ersjournals.com Published On :: 2024-11-07T00:35:56-08:00 Extract It is of utmost importance that medicines are available at all times for our patients. Historically, medication unavailability has typically, if not exclusively, affected low- and middle-income countries [1]. More recently however, drug shortages have also been reported in high-income European countries [2]. Drug shortages have negative health consequences for patients [3], and a profound economic impact, with the need to resort to more expensive alternatives and demands on healthcare professionals’ time to find, prescribe and dispense alternatives [4]. Full Article
age Multidisciplinary management of adult patients with chylothorax: a consensus statement By erj.ersjournals.com Published On :: 2024-11-07T00:35:55-08:00 The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and four specialties (pulmonary, interventional radiology, thoracic surgery and nutrition) with experience and expertise in managing adult patients with chylothorax. We performed a literature and internet search for reports addressing seven clinically relevant PICO (Patient, Intervention, Comparison and Outcome) questions pertaining to the management of adult patients with chylothorax. This consensus statement, consisting of best practice statements based on expert consensus addressing these seven PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with provider experience. Panel members participated in the development of the final best practice statements using the modified Delphi technique. Our consensus statement aims to offer guidance in clinical decision making when managing patients with chylothorax while also identifying gaps in knowledge and informing future research. Full Article
age Reassessing Halm's clinical stability criteria in community-acquired pneumonia management By erj.ersjournals.com Published On :: 2024-11-07T00:35:55-08:00 Background Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary real-world setting. Methods This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017 and 2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan–Meier survival curves were used to analyse these outcomes, considering competing risks. Results The study population primarily comprised elderly individuals (median age 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders and 17.3% (276/1595) among the rest. Conclusion Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this ageing population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders. Full Article
age Investigations into the Concentrations and Metabolite Profiles of Doping Agents and Antidepressants in Human Seminal Fluid Using Liquid Chromatography-Mass Spectrometry [Articles] By dmd.aspetjournals.org Published On :: 2024-10-16T09:02:03-07:00 Exogenous substances, including drugs and chemicals, can transfer into human seminal fluid and influence male fertility and reproduction. In addition, substances relevant in the context of sports drug testing programs, can be transferred into the urine of a female athlete (after unprotected sexual intercourse) and trigger a so-called adverse analytical finding. Here, the question arises as to whether it is possible to distinguish analytically between intentional doping offenses and unintentional contamination of urine by seminal fluid. To this end, 480 seminal fluids from nonathletes were analyzed to identify concentration ranges and metabolite profiles of therapeutic drugs that are also classified as doping agents. Therefore, a screening procedure was developed using liquid chromatography connected to a triple quadrupole mass spectrometer, and suspect samples (i.e., samples indicating the presence of relevant compounds) were further subjected to liquid chromatography-high-resolution accurate mass (tandem) mass spectrometry. The screening method yielded 90 findings (including aromatase inhibitors, selective estrogen receptor modulators, diuretics, stimulants, glucocorticoids, beta-blockers, antidepressants, and the nonapproved proliferator-activated receptor delta agonist GW1516) in a total of 81 samples, with 91% of these suspected cases being verified by the confirmation method. In addition to the intact drug, phase-I and -II metabolites were also occasionally observed in the seminal fluid. This study demonstrated that various drugs including those categorized as doping agents partition into seminal fluid. Monitoring substances and metabolites may contribute to a better understanding of the distribution and metabolism of exogenous substances in seminal fluid that may be responsible for the impairment of male fertility. SIGNIFICANCE STATEMENT This study demonstrates that doping agents as well as clinically relevant substances are transferred/eliminated into seminal fluid to a substantial extent and that knowledge about drug levels (and potential consequences for the male fertility and female exposure) is limited. The herein generated new dataset provides new insights into an important and yet little explored area of drug deposition and elimination, and hereby a basis for the assessment of contamination cases by seminal fluid in sports drug testing. Full Article
age Ghrelin Modulates Voltage-Gated Ca2+ Channels through Voltage-Dependent and Voltage-Independent Pathways in Rat Gastric Vagal Afferent Neurons [Article] By molpharm.aspetjournals.org Published On :: 2024-10-17T05:12:59-07:00 The orexigenic gut peptide ghrelin is an endogenous ligand for the growth hormone secretagogue receptor type 1a (GHSR1a). Systemic ghrelin administration has previously been shown to increase gastric motility and emptying. While these effects are known to be mediated by the vagus nerve, the cellular mechanism underlying these effects remains unclear. Therefore, the purpose of the present study was to investigate the signaling mechanism by which GHSR1a inhibits voltage-gated Ca2+ channels in isolated rat gastric vagal afferent neurons using whole-cell patch-clamp electrophysiology. The ghrelin pharmacological profile indicated that Ca2+ currents were inhibited with a log (Ic50) = –2.10 ± 0.44 and a maximal inhibition of 42.8 ± 5.0%. Exposure to the GHSR1a receptor antagonist (D-Lys3)-GHRP-6 reduced ghrelin-mediated Ca2+ channel inhibition (29.4 ± 16.7% vs. 1.9 ± 2.5%, n = 6, P = 0.0064). Interestingly, we observed that activation of GHSR1a inhibited Ca2+ currents through both voltage-dependent and voltage-independent pathways. We also treated the gastric neurons with either pertussis toxin (PTX) or YM-254890 to examine whether the Ca2+ current inhibition was mediated by the Gαi/o or Gαq/11 family of subunits. Treatment with both PTX (Ca2+ current inhibition = 15.7 ± 10.6%, n = 8, P = 0.0327) and YM-254890 (15.2 ± 11.9%, n = 8, P = 0.0269) blocked ghrelin’s effects on Ca2+ currents, as compared with control neurons (34.3 ± 18.9%, n = 8). These results indicate GHSR1a can couple to both Gαi/o and Gαq/11 in gastric vagal afferent neurons. Overall, our findings suggest GHSR1a-mediated inhibition of Ca2+ currents occurs through two distinct pathways, offering necessary insights into the cellular mechanisms underlying ghrelin’s regulation of gastric vagal afferents. SIGNIFICANCE STATEMENT This study demonstrated that in gastric vagal afferent neurons, activation of GHSR1a by ghrelin inhibits voltage-gated Ca2+ channels through both voltage-dependent and voltage-independent signaling pathways. These results provide necessary insights into the cellular mechanism underlying ghrelin regulation of gastric vagal afferent activity, which may benefit future studies investigating ghrelin mimetics to treat gastric motility disorders. Full Article
age Maturity Assessment of the Health Information System Using Stages of Continuous Improvement Methodology: Results From Serbia By ghspjournal.org Published On :: 2024-10-29T12:28:39-07:00 ABSTRACTIntroduction:Since the health information system (HIS) in public health care services in Serbia was introduced in 2009, it has gradually expanded. However, it is unclear how well the HIS components have developed and the whole system’s stage of maturity.Method:In June–September 2021, a maturity assessment of the Serbian HIS was conducted for the first time using the HIS Stages of Continuous Improvement (SOCI) toolkit. The toolkit measures HIS status across 5 HIS domains: leadership and governance, management and workforce, information and communication technology (ICT), standards and interoperability, and data quality and use. The domains were further divided into 13 components and 39 subcomponents whose maturity stage was assessed on a 5-point Likert scale, indicating the level of development: (1) emerging/ad hoc; (2) repeatable; (3) defined; (4) managed; and (5) optimized. The toolkit was applied in a working group of 32 professionals and experts who were engaged in developing the new national eHealth strategy and action plan.Results:The overall maturity score of the Serbian HIS was 1.6, which indicates a low level. The highest baseline score (2) was given to the standards and interoperability domain, and the lowest (1.1) was given to ICT infrastructure. The remaining 3 domains (leadership and governance, Management and Workforce, and Data Quality and Use) were similarly rated (1.7, 1.7, and 1.6, respectively).Conclusion:A baseline assessment of the maturity level of Serbian HIS indicates that the majority of components are between the emerging/ad hoc stage and repeatable, which represent isolated, ad hoc efforts, with some basic processes in place and existing and accessible policies. This exercise provided an opportunity to address identified weaknesses in the upcoming national eHealth strategy. Full Article
age Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries By ghspjournal.org Published On :: 2024-10-29T12:28:39-07:00 ABSTRACTIntroduction:Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.Methods:Implementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.Results:Implementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).Conclusion:Systematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial. Full Article
age Proteomic Analysis of Signaling Pathways Modulated by Fatty Acid Binding Protein 5 (FABP5) in Macrophages [Special Section: Cannabinoid Signaling in Human Health and Disease] By jpet.aspetjournals.org Published On :: 2024-10-18T07:04:15-07:00 Although acute inflammation serves essential functions in maintaining tissue homeostasis, chronic inflammation is causally linked to many diseases. Macrophages are a major cell type that orchestrates inflammatory processes. During inflammation, macrophages undergo polarization and activation, thereby mobilizing pro-inflammatory and anti-inflammatory transcriptional programs that regulate ensuing macrophage functions. Fatty acid binding protein 5 (FABP5) is a lipid chaperone highly expressed in macrophages. FABP5 deletion is implicated in driving macrophages toward an anti-inflammatory phenotype, yet signaling pathways regulated by macrophage-FABP5 have not been systematically profiled. We leveraged proteomic and phosphoproteomic approaches to characterize pathways modulated by FABP5 in M1 and M2 polarized bone marrow-derived macrophages (BMDMs). Stable isotope labeling by amino acids-based analysis of M1 and M2 polarized wild-type and FABP5 knockout BMDMs revealed numerous differentially regulated proteins and phosphoproteins. FABP5 deletion impacted downstream pathways associated with inflammation, cytokine production, oxidative stress, and kinase activity. Toll-like receptor 2 (TLR2) emerged as a novel target of FABP5 and pharmacological FABP5 inhibition blunted TLR2-mediated activation of downstream pathways, ascribing a novel role for FABP5 in TLR2 signaling. This study represents a comprehensive characterization of the impact of FABP5 deletion on the proteomic and phosphoproteomic landscape of M1 and M2 polarized BMDMs. Loss of FABP5 altered pathways implicated in inflammatory responses, macrophage function, and TLR2 signaling. This work provides a foundation for future studies seeking to investigate the therapeutic potential of FABP5 inhibition in pathophysiological states resulting from dysregulated inflammatory signaling. SIGNIFICANCE STATEMENT This research offers a comprehensive analysis of fatty acid binding protein 5 (FABP5) in macrophages during inflammatory response. The authors employed quantitative proteomic and phosphoproteomic approaches to investigate this utilizing bone marrow-derived macrophages that were M1 and M2 polarized using lipopolysaccharide with interferon and interleukin-4, respectively. This revealed multiple pathways related to inflammation that were differentially regulated due to the absence of FABP5. These findings underscore the potential therapeutic significance of macrophage-FABP5 as a candidate for addressing inflammatory-related diseases. Full Article
age Cannabinoid 2 Receptor Activation Protects against Diabetic Cardiomyopathy through Inhibition of AGE/RAGE-Induced Oxidative Stress, Fibrosis, and Inflammasome Activation [Special Section: Cannabinoid Signaling in Human Health and Disease] By jpet.aspetjournals.org Published On :: 2024-10-18T07:04:15-07:00 Oxidative stress, fibrosis, and inflammasome activation from advanced glycation end product (AGE)–receptor of advanced glycation end product (RAGE) interaction contribute to diabetic cardiomyopathy (DCM) formation and progression. Our study revealed the impact of β-caryophyllene (BCP) on activating cannabinoid type 2 receptors (CB2Rs) against diabetic complication, mainly cardiomyopathy and investigated the underlying cell signaling pathways in mice. The murine model of DCM was developed by feeding a high-fat diet with streptozotocin injections. After the development of diabetes, the animals received a 12-week oral BCP treatment at a dose of 50 mg/kg/body weight. BCP treatment showed significant improvement in glucose tolerance and insulin resistance and enhanced serum insulin levels in diabetic animals. BCP treatment effectively reversed the heart remodeling and restored the phosphorylated troponin I and sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a expression. Ultrastructural examination showed reduced myocardial cell injury in DCM mice treated with BCP. The preserved myocytes were found to be associated with reduced expression of AGE/RAGE in DCM mice hearts. BCP treatment mitigated oxidative stress by inhibiting expression of NADPH oxidase 4 and activating phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/nuclear factor erythroid 2–related factor 2 (Nrf2) signaling. Also, BCP suppressed cardiac fibrosis and endothelial-to-mesenchymal transition in DCM mice by inhibiting transforming growth factor β (TGF-β)/suppressor of mothers against decapentaplegic (Smad) signaling. Further, BCP treatment suppressed nucleotide-binding domain, leucine-rich–containing family, pyrin domain–containing-3 (NLRP3) inflammasome activation in DCM mice and alleviated cellular injury to the pancreatic tissues evidenced by significant elevation of the number of insulin-positive cells. To demonstrate a CB2R-dependent mechanism of BCP, another group of DCM mice were pretreated with AM630, a CB2R antagonist. AM630 was observed to abrogate the beneficial effects of BCP in DCM mice. Taken together, BCP demonstrated the potential to protect the myocardium and pancreas of DCM mice mediating CB2R-dependent mechanisms. SIGNIFICANCE STATEMENT BCP, a CB2R agonist, shows protection against DCM. BCP attenuates oxidative stress, inflammation, and fibrosis in DCM via activating CB2Rs. BCP mediating CB2R activation favorably modulates AGE/RAGE, PI3K/AKT/Nrf2β and TGF-β/Smad and (NLRP3) inflammasome in diabetic cardiomyopathy. Full Article