This study assessed the differences in swabbing rates, vaccine uptake, COVID-19 infection, hospitalization rates and outcomes in patients suffering from inflammatory bowel disease (IBD) on ...immunomodulation and patients diagnosed with irritable bowel syndrome (IBS).
A population consisting of 250 IBD and 250 IBS patients was randomly selected from the local database. Apart from demographic data, the following data was collected: number of COVID-19 swabs taken, vaccination rates, type of vaccine administered, infection secondary to COVID-19, hospitalization and outcomes.
IBD patients performed significantly more swabs tests for SARS-CoV-2 detection compared with IBS patients in both phases of the study. Whilst the IBS cohort recorded a larger number of COVID-19 infection and less hospitalisations whilst infected, IBD patients had a better outcome whilst infected since hospitalisation reason in the latter was not related to COVID-19 infection. IBD patients had a larger uptake of COVID-19 vaccines.
This study was the first of its nature locally and internationally as it compared two unrelated cohorts of patients followed up in gastroenterology. Vaccination rates in both cohorts were higher than those reported internationally. In concordance with international studies, IBD patients are not at an increased risk of worse outcomes from COVID-19 infection compared to non-IBD cohorts.
We present the case of a man in his early 50s who presented with a history of fever, malaise and jaundice. Initial investigations showed liver and renal dysfunction with no discernible cause for the ...septic process. On starting intravenous antibiotics, the patient developed a septic-shock-like reaction requiring transfer to intensive care. A diagnosis of leptospirosis was eventually established through an extensive and thorough history leading to a stepwise approach to investigations. Treatment targeting leptospirosis was delivered with noticeable clinical improvement.
Ethics is a significant topic within medical and other healthcare undergraduate curricula. Advances in technology, changes within our population, e.g. an increasing ageing population, those living ...with disabilities and chronic conditions, and increasing demands on resources have resulted in an increase in the ethical dilemmas experienced within healthcare practice. The globalisation of medicine and the increased mobility of students and professionals has resulted in a need to explore their understanding of ethical issues inherent to the clinical area. This research seeks to address how Malaysian medical students on a partner medical school programme understand the ethical dimensions of practice, by focusing on the processes through which this understanding develops, the factors that influence this and what the participants’ understand by the ethical dimensions of practice. A qualitative approach to the study was adopted, as it concerns itself with the feelings and personal experiences. An interpretive methodology was applied as this paradigm is concerned with understanding the world from the participants’ perspective, and how “human beings make sense of their subjective reality and attach meaning to it” (Weber 1964). A purposive sample of 16 Malaysian medical students in the final year of a partner medical school programme participated. Data was collected using a mixture of semi-structured focus groups and individual interviews. Interviews were transcribed and analysed using a descriptive phenomenological analysis based on an adaptation of Hycner’s (1985) model of thematic analysis. Key findings reveal that students develop their understanding through observed practices and patient interactions. The unique experiences offered by the partner medical school programme, such as placements in two distinct settings, influence the development of their ethical understanding. Students exhibited uncertainty and cognitive anxiety when ethical issues arose in practice. The relationship between the factors which influence the understanding of the ethical dimensions of healthcare and cognitive anxiety creates a cycle of reflexivity, leading to students developing their ethical sensitivity. Existing literature suggests that ethical sensitivity is related to achieving ethical competence and a reduction in moral distress amongst clinicians, as well as enhancing patient wellbeing. Within the current globalization of medical education, and the increase in international students and workforce, there is a fundamental need to explore the students’ experiences and perspectives on how they develop their ethical understanding whilst undertaking a partner medical school programme, as there is currently a lack of research in this area. The findings reveal the development of ethical sensitivity through the interrelationship between factors influencing students’ understanding of the ethical dimensions of practice and the cognitive anxiety they experience during this process.
Laboratory mouse studies are paramount for understanding basic biological phenomena but also have limitations. These include conflicting results caused by divergent microbiota and limited ...translational research value. To address both shortcomings, we transferred C57BL/6 embryos into wild mice, creating "wildlings." These mice have a natural microbiota and pathogens at all body sites and the tractable genetics of C57BL/6 mice. The bacterial microbiome, mycobiome, and virome of wildlings affect the immune landscape of multiple organs. Their gut microbiota outcompete laboratory microbiota and demonstrate resilience to environmental challenges. Wildlings, but not conventional laboratory mice, phenocopied human immune responses in two preclinical studies. A combined natural microbiota- and pathogen-based model may enhance the reproducibility of biomedical studies and increase the bench-to-bedside safety and success of immunological studies.
The COVID-19 pandemic has dramatically impacted cancer care worldwide. Disruptions have been seen across all facets of care. While the long-term impact of COVID-19 remains unclear, the immediate ...impacts on patients, their carers and the healthcare workforce are increasingly evident. This study describes disruptions and reorganisation of cancer services in Australia since the onset of COVID-19, from the perspectives of people affected by cancer and healthcare workers. Two separate online cross-sectional surveys were completed by: a) cancer patients, survivors, carers, family members or friends (n = 852) and b) healthcare workers (n = 150). Descriptive analyses of quantitative survey data were conducted, followed by inductive thematic content analyses of qualitative survey responses relating to cancer care disruption and perceptions of telehealth. Overall, 42% of cancer patients and survivors reported experiencing some level of care disruption. A further 43% of healthcare workers reported atypical delays in delivering cancer care, and 50% agreed that patient access to research and clinical trials had been reduced. Almost three quarters (73%) of patients and carers reported using telehealth following the onset of COVID-19, with high overall satisfaction. However, gaps were identified in provision of psychological support and 20% of participants reported that they were unlikely to use telehealth again. The reorganisation of cancer care increased the psychological and practical burden on carers, with hospital visitation restrictions and appointment changes reducing their ability to provide essential support. COVID-19 has exacerbated a stressful and uncertain time for people affected by cancer and healthcare workers. Service reconfiguration and the adoption of telehealth have been essential adaptations for the pandemic response, offering long-term value. However, our findings highlight the need to better integrate psychosocial support and the important role of carers into evolving pandemic response measures. Learnings from this study could inform service improvements that would benefit patients and carers longer-term.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Professional dance is a physically demanding career path with a high injury prevalence, yet an ingrained culture of hiding or pushing through injuries. Developing better knowledge surrounding the ...cultural beliefs and behaviors related to injury reporting is critical to understand their incidence and burden. Therefore, the aim of this study was to investigate injury fear and injury reporting behaviors in professional dancers in Australia.
This study utilized data collected in a cross-sectional survey of professional dancers in Australia. Descriptive analysis of injury fear and reporting stigma are presented with comparisons between subgroups (full-time versus part-time dancers; men versus women) conducted using two-sided Fisher's exact tests.
A total of 146 professional dancers were included. Over half (63%) of the respondents reported that they fear sustaining a dance-related injury, that they believe there is still a stigma surrounding injuries in dance (62%), and that this stigma has led to a delay in reporting or seeking care for an injury (51%). A lower proportion of part-time than full-time dancers reported that they would usually tell someone within their dance employment about an injury (35.1% vs. 59.6%, p = 0.006).
Professional dancers are at risk of losing contracts or roles if they are injured, and therefore, it is common to dance through their occurrence. Many dancers, particularly those dancing part-time, are unwilling to tell their employers about their injuries. Action is required to improve this culture regarding injury reporting and help seeking for more effective injury understanding, prevention, and management in dance.
Alzheimer's disease and Parkinson's disease are neurodegenerative disorders characterised by the misfolding of proteins into soluble prefibrillar aggregates. These aggregate complexes disrupt ...mitochondrial function, initiating a pathophysiological cascade leading to synaptic and neuronal degeneration. In order to explore the interaction of amyloid aggregates with mitochondrial membranes, we made use of two in vitro model systems, namely: (i) lipid vesicles with defined membrane compositions that mimic those of mitochondrial membranes, and (ii) respiring mitochondria isolated from neuronal SH-SY5Y cells. External application of soluble prefibrillar forms, but not monomers, of amyloid-beta (Aβ42 peptide), wild-type α-synuclein (α-syn), mutant α-syn (A30P and A53T) and tau-441 proteins induced a robust permeabilisation of mitochondrial-like vesicles, and triggered cytochrome c release (CCR) from isolated mitochondrial organelles. Importantly, the effect on mitochondria was shown to be dependent upon cardiolipin, an anionic phospholipid unique to mitochondria and a well-known key player in mitochondrial apoptosis. Pharmacological modulators of mitochondrial ion channels failed to inhibit CCR. Thus, we propose a generic mechanism of thrilling mitochondria in which soluble amyloid aggregates have the intrinsic capacity to permeabilise mitochondrial membranes, without the need of any other protein. Finally, six small-molecule compounds and black tea extract were tested for their ability to inhibit permeation of mitochondrial membranes by Aβ42, α-syn and tau aggregate complexes. We found that black tea extract and rosmarinic acid were the most potent mito-protectants, and may thus represent important drug leads to alleviate mitochondrial dysfunction in neurodegenerative diseases.
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•Prefibrillar amyloid aggregates efficiently permeabilise mitochondrial membranes.•Tau and mutant synuclein aggregates are most damaging to mitochondrial membranes.•Cardiolipin affinity for amyloid aggregates has pathophysiological implications.•Cyto c release from mitochondria most likely involves a pore-forming mechanism.•Polyphenols protect mitochondrial membranes against insult by amyloid aggregates.
Coronavirus disease 2019 convalescent plasma (CCP) has emerged as a potential treatment of COVID-19. However, meta-analysis data and recommendations are limited. The Association for the Advancement ...of Blood and Biotherapies (AABB) developed clinical practice guidelines for the appropriate use of CCP.
These guidelines are based on 2 living systematic reviews of randomized controlled trials (RCTs) evaluating CCP from 1 January 2019 to 26 January 2022. There were 33 RCTs assessing 21 916 participants. The results were summarized using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. An expert panel reviewed the data using the GRADE framework to formulate recommendations.
The AABB suggests CCP transfusion in addition to the usual standard of care for outpatients with COVID-19 who are at high risk for disease progression (weak recommendation, moderate-certainty evidence).
The AABB recommends against CCP transfusion for unselected hospitalized persons with moderate or severe disease (strong recommendation, high-certainty evidence). This recommendation does not apply to immunosuppressed patients or those who lack antibodies against SARS-CoV-2.
The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 who do not have SARS-CoV-2 antibodies detected at admission (weak recommendation, low-certainty evidence).
The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 and preexisting immunosuppression (weak recommendation, low-certainty evidence).
The AABB suggests against prophylactic CCP transfusion for uninfected persons with close contact exposure to a person with COVID-19 (weak recommendation, low-certainty evidence).
CCP is most effective when transfused with high neutralizing titers to infected patients early after symptom onset.
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