Biological characteristics and clinical management of uveal and conjunctival melanoma

Uveal and conjunctival melanomas are relatively rare tumors;nonetheless,they pose a significant risk of mortality for a large number of affected individuals.The pathogenesis of melanoma at different sites is very similar,however,the prognosis for patients with ocular melanoma remains unfavourable,primarily due to its distinctive genetic profile and tumor microenvironment.Regardless of considerable advances in understanding the genetic characteristics and biological behaviour,the treatment of uveal and conjunctival melanoma remains a formidable challenge.To enhance the prospect of success,collaborative efforts involving medical professionals and researchers in thefields of ocular biology and oncology are essential.Current data show a lack of well-designed randomized clinical trials and limited benefits in current forms of treatment for these tumors.Despite advancements in the development of effective melanoma therapeutic strategies,all current treatments for uveal melanoma(UM)and conjunctival melanoma(CoM)remain unsatisfactory,resulting in a poor long-term prognosis.Ongoing trials offer hope for positive outcomes in advanced and metastatic tumors.A more comprehensive understanding of the genetic and molecular abnormalities involved in the development and progression of ocular melanomas opens the way for the development of personalized therapy,with various potential therapeutic targets currently under consideration.Increased comprehension of the molecular pathogenesis of UM and CoM and their specificities may aid in the development of new and more effective systemic therapeutic agents,with the hope of improving the prognosis for patients with metastatic disease.

Diagnosis of West Nile virus infections:Evaluation of different laboratory methods

BACKGROUND The diagnosis of West Nile virus(WNV)is challenging due to short-term and low-level viremia,flavivirus cross-reactivity,and long immunoglobulin M(IgM)persistence.AIM To evaluate different methods for WNV detection[reverse transcription-polymerase chain reaction(RT-PCR),IgM/IgG antibodies,IgG avidity]in serum,cerebrospinal fluid(CSF),and urine samples of patients with confirmed WNV infection.METHODS The study included patients with confirmed WNV neuroinvasive infection(n=62),asymptomatic WNV seropositive individuals(n=22),and individuals with false-positive WNV IgM antibodies(n=30).WNV RNA was detected using RT-PCR.A commercial ELISA was used to detect WNV IgM/IgG antibodies with confirmation of cross-reactive samples using a virus neutralization test(VNT).IgG-positive samples were tested for IgG avidity.RESULTS The WNV-RNA detection rates were significantly higher in the urine(54.5%)/serum(46.4%)than in CSF(32.2%).According to the sampling time,the WNV-RNA detection rates in urine collected within 7 days/8-14/≥15 days were 29.4/66.6/62.5%(P=0.042).However,these differences were not observed in the CSF.The median RT-PCR cycle threshold values were significantly lower in urine(32.5,IQR=28-34)than in CSF(34.5,IQR=33-36).The frequency of positive WNV IgM and IgG significantly differed according to the sampling time in serum but not in CSF.Positive IgM/IgG antibodies were detected in 84.3/9.3%of serum samples collected within 7 days,100/71.1%of samples collected 8-14,and 100%samples collected after≥15 days.Recent WNV infection was confirmed by low/borderline avidity index(AI)in 13.6%of asymptomatic individuals.A correlation between ELISA and AI was strong negative for IgM and strong positive for IgG.No significant correlation between ELISA IgG and VNT was found.CONCLUSION The frequency of WNV RNA and antibody detection depends on the sampling time and type of clinical samples.IgG avidity could differentiate recent WNV infections from long-persisting IgM antibodies.

Maternal choledochal cysts in pregnancy:A systematic review of case reports and case series

BACKGROUND Choledochal cysts(CC)are cystic dilatations of the biliary tract,usually diagnosed during childhood,with an estimated incidence in the general population of 1:100000.Complications related to CC include rupture,biliary obstruction,and cholangitis.Maternal CC in pregnancy are rarely reported,and there are no guidelines on optimal management.AIM To systematically review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC,the mode of treatment and delivery,and maternal outcomes.METHODS A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed,Web of Science,Google Scholar,and Embase.There were no restrictions on language or publication year.Databases were lastly accessed on September 1,2022.RESULTS Overall,71 publications met the inclusion criteria,reporting 97 cases.Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium.The most common symptoms were abdominal pain(81.2%)and jaundice(60.4%).Interventions for CC complications were required in 52.5%of the cases,and 34%of pregnancies were induced.Urgent cesarean section(CS)was done in 24.7%.The maternal mortality was 7.2%,while fetal mortality was inconsistently reported.Cholangitis,CC>15 cm,and bilirubin levels>80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC.Bilirubin levels positively correlated with CC size.There was no correlation between age and cyst dimension,gestational age at cyst discovery,and CC size.CONCLUSION Although rare,maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain.Symptomatology and clinical course are variable,and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS.While most cases were managed by conservative measures or drainage procedures,CC>15 cm and progressive cholangitis carry the risk of CC rupture and septic complications,which may increase the rates of unfavorable maternal and fetal outcomes.Therefore,such cases require specific surgical and obstetric interventions.

Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation

BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.

Spontaneous gastric hematoma as a rare cause of acute abdomen:A case report

BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.

Helicobacter pylori:Future perspectives in therapy reflecting three decades of experience

The rising prevalence of antibiotic resistance has created a need to reassess the established Helicobacter pylori(H.pylori)eradication protocols,and to develop new ones.Various bacterial and host factors are evaluated,and their contribution to eradication failure is estimated.For a long time being considered the cornerstone eradication scheme,the standard triple therapy has been replaced with novel,more efficient regimens,namely sequential and concomitant,along with the emergence of a new design of bismuth quadruple therapy.A rescue levofloxacin based regimen has overcome the fear of therapy failure due to higher prevalence of dual resistant(clarithromycin and metronidazole)H.pylori.Culture-free and efficient susceptibility test are reestablishing the concept of tailored therapy,making eradication success close to originally desirable rates.Alleviating therapy side effects and improving patient compliance are as important as choosing appropriate eradication schemes,so various probiotic compound supplements are taken into consideration.Finally,we summarize the emerging efforts and obstacles in creating efficientH.pylori vaccine.

Epidemiology of hepatitis C in Croatia in the European context

We analyzed prevalence, risk factors and hepatitis C virus(HCV) genotype distribution in different population groups in Croatia in the context of HCV epidemiology in Europe, with the aim to gather all existing information on HCV infection in Croatia which will be used to advise upon preventive measures. It is estimated that 35000-45000 of the Croatian population is chronically infected with HCV. Like in other European countries, there have been changes in the HCV epidemiology in Croatia over the past few decades. In some risk groups(polytransfused and hemodialysis patients), a significant decrease in the HCV prevalence was observed after the introduction of routine HCV screening of blood/blood products in 1992. Injecting drug users(IDUs) still represent a group with the highest risk for HCV infection with prevalence ranging from 29% to 65%. Compared to the prevalence in theCroatian general population(0.9%), higher prevalence rates were found in prison populations(8.3%-44%), human immunodeficiency virus-infected patients(15%), persons with high-risk sexual behavior(4.6%) and alcohol abusers(2.4%). Low/very low prevalence was reported in children and adolescents(0.3%) as well as in blood donors(0%-0.009%). In addition, distribution of HCV genotypes has changed due to different routes of transmission. In the general population, genotypes 1 and 3 are most widely distributed(60.4%-79.8% and 12.9%-47.9%, respectively). The similar genotype distribution is found in groups with high-risk sexual behavior. Genotype 3 is predominant in Croatian IDUs(60.5%-83.9%) while in the prison population genotypes 3 and 1 are equally distributed(52.4% and 47.6%). Data on HCV prevalence and risk factors for transmission are useful for implementation of preventive measures and HCV screening.

Pre-and intraoperative predictors of acute kidney injury after liver transplantation

BACKGROUND Acute kidney injury(AKI)after liver transplantation(LT)is a frequent and multifactorial event related to increased morbidity and mortality.Risk factors for AKI after LT still need to be clarified.AIM To identify the predictors of acute kidney injury after liver transplantation.METHODS The frequency and pre-and intraoperative predictors of AKI within the first 7 d after LT were evaluated in adult liver transplant candidates in a single LT center in Croatia.AKI was defined according to the Kidney Disease:Improving Global Outcomes criteria.RESULTS Out of 205 patients(mean age 57±10 years;73.7%males,52.7%with alcoholrelated liver disease)93(45.36%)developed AKI,and the majority of them(58.06%)had stage 1.Only 5.38%of patients required renal replacement therapy after LT.The majority of patients(82.8%)developed AKI within the first two days after the procedure.Multivariate logistic regression identified pre-LT body mass index(OR=1.1,95%CI:1.05-1.24)and red blood cell transfusion(OR=1.66,95%CI:1.09-2.53)as independent predictors of early post-LT AKI occurrence.30-d survival after LT was significantly better for patients without AKI(P=0.01).CONCLUSION Early AKI after LT is a frequent event that negatively impacts short-term survival.The pathogenesis of AKI is multifactorial,but pre-LT BMI and intraoperative volume shifts are major contributors.

Current practice variations in the management of anterior cruciate ligament injuries in Croatia

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament(ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants(95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach(67% vs 33%). Suspensory fixation was the most common graft fixation method(62%) for the femoral side, followed by the cross-pin(33%) and bioabsorbable interference screw(5%). Almost all respondents(97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.

Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

The significance of hepatitis E virus(HEV)as an important public health problem is rising.Until a decade ago,cases of HEV infection in Eur-ope were mainly confined to returning travelers,but nowadays,hepatitis E represents an emerging zoonotic infection in many European countries.The aim of this manuscript is to perform a systematic review of the published literature on hepatitis E distribution in humans,animals and environmental samples("One Health"concept)in the South-Eastern European countries.Comparison of the available data showed that the anti-HEV seroprevalence in the South-Eastern Europe varies greatly,depending on the population studied,geographical area and methods used.The IgG seroprevalence rates in different population groups were found to be 1.1%-24.5%in Croatia,up to 20.9%in Bulgaria,5.9-%17.1%in Romania,15%in Serbia,up to 9.7%in Greece and 2%-9.7%in Albania.Among possible risk factors,older age was the most significant predictor for HEV seropositivity in most studies.Higher seroprevalence rates were found in animals.HEV IgG antibodies in domestic pigs were detected in 20%-54.5%,29.2%-50%,38.94%-50%and 31.1%-91.7%in Serbia,Bulgaria,Romania and Croatia,respectively.In wild boars seroprevalence rates were up to 10.3%,30.3%and 31.1%in Romania,Slovenia and Croatia,respectively.A high HEV RNA prevalence in wild boars in some countries(Croatia and Romania)indicated that wild boars may have a key role in the HEV epidemiology.There are very few data on HEV prevalence in environmental samples.HEV RNA was detected in 3.3%and 16.7%surface waters in Slovenia and Serbia,respectively.There is no evidence of HEV RNA in sewage systems in this region.The available data on genetic characterization show that human,animal and environmental HEV strains mainly belong to the genotype 3.

Exploring new treatment options for polycystic ovary syndrome: Review of a novel antidiabetic agent SGLT2 inhibitor

Polycystic ovary syndrome(PCOS)is the most common endocrinopathy in women of reproductive age associated with long-term metabolic and cardiovascular consequences.A plethora of symptoms and their severity differentiate on an individual level,giving the syndrome numerous phenotypes.Due to menstrual cycle abnormalities,women suffer from irregular menstrual bleeding,difficulty in conception,and infertility.Furthermore,the risk of pregnancy complications such as gestational diabetes mellitus,hypertensive disorders of pregnancy,and preterm birth are higher in women with PCOS than in the general population.Often,women with PCOS have comorbidities such as dyslipidemia,obesity,glucose intolerance or diabetes type 2,non-alcoholic fatty liver disease,and metabolic syndrome,which all influence the treatment plan.Historic insulinsensitizing agents,although good for some of the metabolic derangements,do not offer long-term cardiovascular benefits;therefore,new treatment options are of paramount importance.Sodium-glucose co-transporter-2(SGLT-2)inhibitors,a new class of antidiabetic agents with beneficial cardiovascular,bodyweight,and antihyperglycemic effects,although not approved for the treatment of PCOS,might be an attractive therapeutic addition in the PCOS armamentarium.Namely,recent studies with SGLT-2 inhibitors showed promising improvements in anthropometric parameters and body composition in patients with PCOS.It is important to further explore the SGLT-2 inhibitors potential as an early therapeutic option because of the PCOS-related risk of metabolic,reproductive,and psychological consequences.

Arthroscopic removal as an effective treatment option for intraarticular osteoid osteoma of the knee

BACKGROUND Intra-articular osteoid osteoma(iaOO)can be found in 5.2%up to 10%of cases.They may cause non-specific symptoms,mimicking degenerative or traumatic pathologies.If iaOO is left untreated,it may lead to severe muscle atrophy,tenderness,swelling,and limited range of motion.Therefore,surgical treatment is recommended.The main goal of surgical treatment is complete removal or destruction of iaOO.AIM To evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature.METHODS Analysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed.All patients had a diagnosis of iaOO confirmed by histopathologic analysis.Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made.All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method.RESULTS The average age of patients included in our study was 23.2(range 16-37)years.The average duration of the symptoms prior to surgery was 14.2(range 6-24)months.All of the patients had persistent knee pain.Three patients reported worsening of pain during the night,while two reported worsening of pain during activity.Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs(NSAIDs),while one patient reported partial alleviation of pain on NSAIDs.No intraoperative complications were noted,and the postoperative period was uneventful in all patients.The patients reported immediate pain relief in the postoperative period.No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo.The literature review revealed 14 cases with an average age of 27.6(range 16-48)years and onset of symptoms 27.7(range 6-108)months prior to surgery,with recurrence of the disease noted in a single case.CONCLUSION Arthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive,thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.

Expression of adipokine ghrelin and ghrelin receptor in human colorectal adenoma and correlation with the grade of dysplasia

BACKGROUNDGhrelin is an adipokine that plays an important role in energy balance. Expressionof ghrelin and ghrelin receptor has been investigated in different tissues andtumors. Studies regarding expression of ghrelin and ghrelin receptor in colorectaltumors are scarce and no data on expression of ghrelin and its receptor incolorectal adenomas has been published. Ghrelin and ghrelin receptor werehighly expressed in colon carcinoma cells while expression was decreased in lessdifferentiated tumors, presuming that ghrelin might be important in early phasesof tumorigenesis.AIMTo investigate the expression of ghrelin and ghrelin receptor in human colorectaladenomas and adjacent colorectal tissue.METHODSIn this prospective study (conducted from June 2015 until May 2019) we included92 patients (64 male and 28 female) who underwent polypectomy for colorectaladenomas in the Department of Gastroenterology and Hepatology, “Sestre milosrdnice” Clinical Hospital Center in Zagreb, Croatia. After endoscopicremoval of colorectal adenoma, an additional sample of colon mucosa in theproximity of the adenoma was collected for pathohistological analysis. Adenomaswere graded according to the stage of dysplasia, and ghrelin and ghrelin receptorexpression were determined immunohistochemically in both adenoma andadjacent colon tissue using the polyclonal antibody for ghrelin (ab150514,ABCAM Inc, Cambridge, United States) and ghrelin receptor (ab48285, ABCAMInc, Cambridge, United States). Categorical and nominal variables were describedthrough frequencies and proportions and the difference between specific groupswere analyzed with Fisher’s and Fisher-Freeman-Halton’s method respectively.Spearman's rank correlation coefficient was determined for correlation ofexpression of ghrelin and ghrelin receptor in adenoma and adjacent colon tissuewith the grade of adenoma dysplasia.RESULTSAmong 92 patients with colorectal adenoma 43 had adenomas with high-gradedysplasia (46.7%). High expression of ghrelin was 7 times more common in highgradeadenoma compared to low-grade adenomas (13.95% to 2.04%, P = 0.048),while the expression of ghrelin in adjacent colon tissue was low. We found nocorrelation between ghrelin receptor expression in adenoma and adjacent colontissue and the grade of colorectal adenoma dysplasia. The most significantcorrelation was found between ghrelin and ghrelin receptor expression inadenomas with high-grade dysplasia (rho = 0.519, P < 0.001).CONCLUSIONGhrelin and ghrelin receptor are expressed in colorectal adenoma and adjacenttissue with ghrelin expression being more pronounced in high grade dysplasia asa possible consequence of increased local synthesis.

Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.

Field evaluation of COVID-19 rapid antigen test:Are rapid antigen tests less reliable among the elderly?

BACKGROUND The global outbreak of coronavirus disease 2019(COVID-19)leads to the development of accessible and cost-effective rapid antigen-detection tests(RATs),as quick and accurate diagnosis is crucial to curb the pandemic.AIM To evaluate the Humasis COVID-19 Ag Test(Humasis Co.,Ltd.,Gyeonggi-do,Republic of Korea)in the diagnosis of severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).METHODS This retrospective study was carried out at the Croatian Institute of Public Health and included patients with clinical symptoms of COVID-19 lasting no longer than 5 d prior to testing,whose nasopharyngeal swabs were primarily tested with RAT.Negative RAT samples underwent confirmatory real-time reverse transcription-polymerase chain reaction(RT-PCR).Diagnostic efficacy was determined compared to RT-PCR.The patients were divided into three age groups(<18,19-65,>65 years).Statistical analysis was performed with the significance level set at P<0.05.RESULTSIn total,2490 symptomatic patients were tested;953 samples were positive on RAT,and 1537 werenegative.All negative RAT samples were subjected to RT-PCR;266 samples were positive andmarked as false-negative results on RAT.The calculated negative predictive value as a measure ofRAT efficacy was 82.69%.The χ^(2) test and Kruskal-Wallis test showed a significant difference in theproportion of false negatives(P<0.001)and RT-PCR cycle(Ct)values for false-negative RATs(P=0.012)among the age groups.The young age group was significantly less likely to be falsenegative,whereas the false negatives from the elderly group experienced significantly lower Ctvalues than the other two age groups.CONCLUSIONEvaluated RAT demonstrated satisfactory performance with more reliable results in youngerpatients.Humasis COVID-19 Ag RAT is potentially a valuable tool in areas where access tomolecular methods is limited;however,RT-PCR remains a gold standard for SARS-CoV-2detection.

Fear of hypoglycemia,a game changer during physical activity in type 1 diabetes mellitus patients

Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus(T1DM).Fear of hypoglycemia(FoH)is a significant psychosocial consequence that negatively impacts the willingness of T1DM patients to engage in and profit from the health benefits of regular physical activity(e.g.,cardiometabolic health,improved body composition,cardiovascular fitness,quality of life).Technological advances,improved insulin regimens,and a better understanding of the physiology of various types of exercise could help ameliorate FoH.This narrative review summarizes the available literature on FoH in children and adults and tools to avoid it.

Hepatitis E virus in professionally exposed: A reason for concern?

The zoonotic risk of hepatitis E virus(HEV)is well established.The HEV seroprevalence rates vary according to geographical region,assays used,and study cohorts.HEV infection is still underdiagnosed,implying the need to evaluate the disease's burden in the general population and specific risk groups,such as professionally exposed.Close contact with various animal reservoirs such as pigs,rabbits,sheep,dogs,wild boars,and deer has been associated with higher anti-HEV seroprevalence as a part of occupational exposure.While exact transmission routes remain to be determined,some general preventive measures such as proper hand hygiene,the usage of personal protective equipment,and the thermal processing of food before consumption should be followed.A“One-Health”multisectoral approach should be implemented to achieve optimal health and well-being outcomes,recognizing the interconnections between humans,animals,plants,and their shared environment,in which a vaccine against the zoonotic genotypes 3 and 4 and swine vaccination should be considered as a possible public health measure.This opinion review comprehensively addresses the HEV burden of professional exposure for butchers,slaughterhouse workers,veterinarians,farmers,hunters,and forestry workers delineates the current limits of protective work measures,and tackles future directions.

Quadricuspid aortic valve and right ventricular type of myocardial bridging in an asymptomatic middle-aged woman:A case report

BACKGROUND Quadricuspid aortic valve(QAV)is a very rare congenital cardiac defect with the incidence of 0.0125%-0.033%(<0.05%)predominantly causing aortic regurgitation.A certain number of patients(nearly one-half)have abnormal function and often require surgery,commonly in their fifth or sixth decade.QAV usually appears as an isolated anomaly but may also be associated with other cardiac congenital defects.Echocardiography is considered the main diagnostic method although more and more importance is given to computed tomography(CT)and magnetic resonance imaging(MRI)as complementary methods.CASE SUMMARY A 60-year-old female patient was referred for transthoracic ultrasound of the heart as part of a routine examination in the treatment of arterial hypertension.She did not have any significant symptoms.QAV was confirmed and there were no elements of valve stenosis with moderate aortic regurgitation.At first,it seemed that in the projection of the presumed left coronary cusp,there were two smaller and equally large cusps along with two larger and normally developed cusps.Cardiac CT imaging was performed to obtain an even more precise valve morphology and it showed that the location of the supernumerary cusp is between the right and left coronary cusp,with visible central malcoaptation of the cusps.Also,coronary computed angiography confirmed the right-type of myocardial bridging at the distal segment of the left anterior descending coronary artery.Significant valve dysfunction often occurs in middle-aged patients and results in surgical treatment,therefore,a 1-year transthoracic echocardiogram control examination and follow-up was recommended to our patient.CONCLUSION This case highlights the importance of diagnosing QAV since it leads to progressive valve dysfunction and can be associated with other congenital heart defects which is important to detect,emphasizing the role of cardiac CT and MRI.

Prehabilitation of overweight and obese patients with dysglycemia awaiting bariatric surgery: Predicting the success of obesity treatment

Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment.In cases with additional hyperglycemia,the burden of surgery can be even higher and alter both shortterm and long-term outcomes.Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission,weight loss results are lower than for obese patients without diabetes.Different multimodal programs,usually including interventions related to patients’performance,nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course.However,there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients’health.In this minireview,we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.

Clinical Effect and Tolerance Analysis of Photodynamic/Electroion in the Treatment of Skin Cancer and Precancerous Lesions

The study was dedicated to explore the clinical efficacy and tolerability of photodynamic/electroion therapy of skin cancer and precancerous lesions.Firstly,a total of 60 patients with skin cancer and precancerous lesions,who were admitted to the Dermatology Department of the Fifth Affiliated Hospital of Zhengzhou University from November 2013 to November 2016,were selected and divided into observation group and control group according to the random number table,with 30 patients in each group.Observation group adopted the photodynamic/electroion therapy,and control group adopted photodynamic therapy(PDT).Two groups of patients were last follow-up to December 2018,and loss of follow-up and death were taken as the end point events of follow-up.The frequency of treatment,clinical efficacy and severity of adverse reactions of the two groups were calculated,and Kaplan-Meier curves were plotted to compare the progression free survival(PFS)of the two groups.The results showed that the number of treatment times per capita in the observation group was 3.6±1.1 times,which was lower than that of in the control group(4.1±1.1 times),but the difference was not statistically significant(t=1.760,P=0.083).The total effective rate in the observation group(100.00%)was higher than that of in the control group(80.00%),and the difference was significant(P<0.05).In addition,during the treatment,both groups had adverse reactions such as burning,pain,redness,swelling and exudation of different degrees,but there was no significant difference in the severity score of adverse reactions(P>0.05).There was no statistically significant difference in the follow-up time and PFS between the two groups(P>0.05),but the recurrence rate of the observation group was significantly lower than that of the control group(P<0.05).Therefore,the clinical efficacy of photodynamic/electroion treatment in patients with skin cancer and precancerous lesions was superior to that of PDT alone,which increased the risk of tolerance.So,it is worthy of clinical promotion.