Stenosis in single coronary artery originating from right sinus of valsalva: asymptomatic upto sixth decade of life

Among all coronary anomalies, the prevalence of single coronary artery (SCA) originating from right sinus of Valsalva is 1.3%. Here, we report a rare case of a 60-years-old male serendipitously diagnosed with SCA originating from right aortic sinus with pre-pulmonic course of anomalous left coronary artery (LCA). His angiogram revealed 90% stenosis in distal right coronary artery with normal anomalous LCA. Thus, the patient was treated with percutaneous coronary intervention using a stent and was found stable post-procedure

Oral adverse effects of drugs:taste disorders

Objective: Oral healthcare professionals are frequently confronted with patients using drugs on a daily basis. These drugs can cause taste disorders as adverse effect. The literature that discusses drug-induced taste disorders is fragmented. This article aims to support oral healthcare professionals in their decision making whether a taste disorder can be due to use of drugs by providing a comprehensive overview of drugs with taste disorders as an adverse effect. Materials and methods: The national drug information database for Dutch pharmacists, based on scientific drug information, guidelines, and summaries of product characteristics, was analyzed for drug-induced taste disorders. “MedDRA classification” and “Anatomic Therapeutical Chemical codes” were used to categorize the results. Results: Of the 1,645 drugs registered in the database, 282 (17%) were documented with “dysgeusia” and 61 (3.7%) with “hypogeusia.” Drug-induced taste disorders are reported in all drug categories, but predominantly in “antineoplastic and immunomodulating agents,” “antiinfectives for systemic use,” and “nervous system.” In ~45%, “dry mouth” coincided as adverse effect with taste disorders. Conclusion: Healthcare professionals are frequently confronted with drugs reported to cause taste disorders. This article provides an overview of these drugs to support clinicians in their awareness, diagnosis, and treatment of drug-induced taste disorders

Endophthalmitis due to Brevibacterium Casei

Endophthalmitis is a serious post-traumatic ocular complication that can lead to loss of vision. We report a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an unusual organism, Brevibacterium casei. The patient was successfully treated with intravitreal antibiotics like ceftazidime and vancomycin, along with topical cefazolin and tobramycin. Brevibacterium casei can be added to the list of rare bacteria causing endophthalmitis and should be kept in mind by clinicians as a potential source of pathology

Are Survival Outcomes Different for Young and Old Patients with Oral and Oropharyngeal Squamous Cell Carcinoma? A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aims to address whether age can be a determinant of overall survival (OS), disease-free survival (DFS), recurrence, distant metastasis (DM) and second primary (SP) in surgically treated oral and oropharyngeal squamous cell carcinoma (OOPSCC). A total of 4981 cases and 44254 controls from 25 comparative observational studies were included in the analysis. A significantly better OS (matched subgroup analysis: OR 1.64; 95% CI 1.31–2.04, overall analysis: OR 1.48; 95% CI 1.09–2.01) was observed in young patients compared to older adults, with heterogeneity ranging from moderate to severe. Worse DFS (unmatched subgroup analysis OR 0.43; 95% CI 0.27–0.68) was observed in young patients compared to older adults with minimal to moderate heterogeneity. The frequency of recurrence (OR 1.49; 95% CI 1.10–2.02) and DM (OR 1.83; 95% CI 1.10–3.03) was significantly higher in the young patients, as found in unmatched and matched subgroup analysis, with the least heterogeneities. Young age can be considered as an independent prognostic factor for recurrence and distant metastases in OOP-SCC. Larger and methodologically robust observational studies with longer follow-up are needed to establish the definitive role of age as an independent prognostic factor on OS and DFS in OOPSCC.</jats:p

Top tips for interprofessional education and collaborative practice research: a guide for students and early career researchers.

Interprofessional research within the contexts of education and health and social care practice has grown exponentially within the past three decades. To maintain the momentum of high-quality research, it is important that early career researchers embarking on their first research journey and new to interprofessional education or interprofessional collaborative practice feel supported in making their contribution to the field. This guide, developed by the Center for the Advancement of Interprofessional Education (CAIPE) Research Group, has been written with these groups in mind who are embarking on their first research journey, and new to the interprofessional field. It aims to raise awareness of academic resources and share practical advice from those who have previously experienced problems when undertaking interprofessional research in education or health and social care practice

The United States COVID-19 Forecast Hub dataset

Academic researchers, government agencies, industry groups, and individuals have produced forecasts at an unprecedented scale during the COVID-19 pandemic. To leverage these forecasts, the United States Centers for Disease Control and Prevention (CDC) partnered with an academic research lab at the University of Massachusetts Amherst to create the US COVID-19 Forecast Hub. Launched in April 2020, the Forecast Hub is a dataset with point and probabilistic forecasts of incident cases, incident hospitalizations, incident deaths, and cumulative deaths due to COVID-19 at county, state, and national, levels in the United States. Included forecasts represent a variety of modeling approaches, data sources, and assumptions regarding the spread of COVID-19. The goal of this dataset is to establish a standardized and comparable set of short-term forecasts from modeling teams. These data can be used to develop ensemble models, communicate forecasts to the public, create visualizations, compare models, and inform policies regarding COVID-19 mitigation. These open-source data are available via download from GitHub, through an online API, and through R packages

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

SMARThealth pregnancy: the development & evaluation of a complex intervention using mobile clinical decision support to screen, refer and manage pregnant women at high risk of future cardiometabolic disorders in rural India

India has witnessed a rapid rise in cardiometabolic diseases (CMDs), and women with high-risk pregnancy conditions including hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are at increased risk. In rural India, Community Health Workers (CHWs) deliver antenatal care, and are ideally placed to screen at-risk women in their villages. The aims of my thesis were to design, develop and evaluate a contextually-relevant, theory-informed complex intervention to enable CHWs to screen, refer and counsel pregnant women at high risk of future CMDs during their transition between antenatal, postnatal and ongoing healthcare services. Guided by the MRC conceptual framework for complex interventions, my study was conducted in three phases. In phase 1, I reviewed the evidence for the associations between high-risk pregnancy conditions and CMDs; community-level interventions for high-risk pregnant women (including mobile technologies), and the integration of non-communicable disease programmes into antenatal care platforms. Qualitative methods were then used to explore the context of maternal healthcare in rural districts of two diverse States in India. In-depth interviews and focus group discussions with key stakeholders (n=71), were thematically analysed. The study revealed three local priority conditions (anaemia, HDP and GDM), the need for improving local understanding of long-term sequelae of high-risk pregnancies, and highlighted important socio-cultural practices impacting intervention design. In phase 2, using behaviour change theory (COM-B/Behaviour Change wheel and Theoretical Domains Framework), the target behaviours, intervention functions and policy categories to be addressed through a complex intervention were identified, using data from the contextual study. A total of 15 Behaviour Change Techniques (the ‘active ingredients’) were embedded into intervention design, and the proposed mechanisms of action of SMARThealth Pregnancy were articulated in a logic model. The final intervention included: a) a village awareness programme; b) targeted training for CHWs to screen, refer and counsel women on the three priority high-risk pregnancy conditions and to conduct point-of-care testing for anaemia and blood pressure, and community-based GDM screening, and; c) mobile clinical decision support (App) to enable CHWs to deliver guideline-based care for women at home, at three timepoints: last trimester of pregnancy, week 1 and week 6 postpartum. In phase 3, feasibility and acceptability of the intervention was evaluated in a pilot cluster randomised controlled trial (n=4 primary health centre clusters), and a qualitative process evaluation using Normalisation Process Theory. A total of 200 pregnant women were randomised equally to the SMARThealth Pregnancy intervention or control. Recruitment was timely (4.5 months), with minimal loss to follow-up (2%). The intervention became embedded and integrated into the daily work of CHWs, who experienced increased social and professional recognition, with women perceiving improved quality of care. SMARThealth Pregnancy was feasible and acceptable as a model of task-sharing for CHWs to deliver integrated home-based care for women at high risk of future CMDs, in the context of rural India.</p