Jacobs Institute of Women's Health
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Using Electroencephalography to Assess Coma Etiology in Children with Retinopathy-Negative Cerebral Malaria
No full textAutopsy studies of children dying of cerebral malaria (CM) have revealed that those with malarial retinopathy exhibited high levels of sequestration in the cerebral vasculature, whereas children with retinopathy-negative CM exhibited lower sequestration levels and possible nonmalarial causes of death. This suggests that children dying of retinopathy-negative CM have nonmalarial coma etiologies with concomitant incidental parasitemia, which is common in high malaria transmission areas. Subsequent studies have challenged this assertion, positing that retinopathy-negative CM and retinopathy-positive CM are variants of the same disease pathophysiology or host biology, both caused by acute malaria infection. We recently determined that electroencephalography (EEG) can be used to discriminate between a malarial coma (CM) and a nonmalarial coma. To better understand the contribution of acute malaria infection in the pathophysiology of retinopathy-negative CM, we compared qualitative and quantitative EEG findings from 30-minute EEG recordings of Malawian children aged 3 months to 14 years hospitalized at Queen Elizabeth Central Hospital with retinopathy-negative CM, retinopathy-positive CM, and nonmalarial coma. Neither qualitative nor quantitative EEG interpretation methods allow for the discrimination between children with retinopathy-positive CM and those with retinopathy-negative CM. Conversely, quantitative EEG readily differentiated children with retinopathy-negative CM from those with nonmalarial coma (area under the receiving operating characteristic [AUROC] curve of 0.83). When combining qualitative and quantitative EEG interpretation methods, the ability of EEG to distinguish retinopathy-negative CM from nonmalarial EEG increases (AUROC of 0.87). The EEGs of children with retinopathy-negative CM are similar to those of children with retinopathy-positive CM and significantly different from those of children with nonmalarial coma, supporting the hypothesis that acute malarial infection is pathophysiologically important in retinopathy-negative CM
Untangling the multifaceted VTA responses to stress
No full textStress has profound impacts on the ventral tegmental area (VTA). However, the complex and opposing effects of stress on the VTA have limited our ability to reach a clear understanding of how adaptation of the VTA can drive behavior following stress. In this review we provide an overview of VTA responses to acute and chronic stress, with a primary focus on studies in mice and rats. We propose that divergent responses to stress arise from the heterogeneity of VTA neurons, the multidimensional nature of stress, and interactive effects between cumulative stressors. We suggest that the robust and varied plasticity of the VTA in response to stress indicates a role for the VTA as an integrator of homeostatic and affective information during stress to drive flexible and nuanced adjustments in behavioral adaptation
Stem cell-derived pancreatic beta cells: a step closer to functional diabetes treatment?
No full textABSTRACT: Diabetes remains one of the significant health struggles worldwide, leading to disability and mortality. There are several types, with Types 1 and 2 representing the majority of cases. Pancreatic beta cells play a key role in glucose control through the secretion of insulin. Insulin, a key player, is under-secreted in diabetes due to autoimmune destruction of the beta cells in type 1 diabetes and exhaustion of beta cell secretion in type 2. Hence, insulin plays a central role in the management of both conditions. Lifestyle modifications and pharmacological agents are significant components of managing diabetes, although they come with limitations; hence, the exploration of stem cells in diabetes management. A thorough literature search was conducted across several databases, identifying randomized and non-randomized controlled trials that utilized stem cells in patients with diabetes. The intervention details, primary and secondary outcomes, key findings, and safety profiles were documented and discussed. We explored key protocols and methods for generating pancreatic beta-like cells from stem cells, as well as the role of specific molecules and pathways in stem cell differentiation. In this paper, we also discuss preclinical animal studies, explore the challenges of immunogenicity, and address ethical concerns that limit the implementation of stem cells in clinical practice. A comparative analysis was conducted to evaluate conventional insulin therapy, islet transplantation, and stem cell-based approaches. Although stem cells represent a potentially valuable direction, their application clinically remains mainly experimental, and future studies should incorporate larger cohorts, diverse populations with varying comorbidities, and extended follow-up periods to better ascertain their long-term efficacy and safety. CLINICAL TRIAL NUMBER: Not applicabl
Translation of clinical practice to research: the VETS and ETHOS epidemiologic prospective cohorts
No full textFor \u3e30 years, the Exercise Testing and Health Outcomes Study (ETHOS) and the Veterans Exercise Testing Study (VETS) cohorts have contributed significantly to the understanding of the association between cardiorespiratory fitness (CRF), health outcomes, and the prevention of chronic disease. Multiple reports from these studies have consistently shown an inverse and graded association between higher CRF and the incidence of chronic conditions including cardiovascular disease, site-specific cancers, chronic kidney disease, rhythm disturbances, and neurological conditions. In addition, higher CRF is inversely related to health care costs. Among individuals whose CRF level improves over periods of time ranging from 5 to 7 years, improvements in health outcomes have been observed, and the converse is true among those who decrease CRF over time. The Veterans Administration Health Care System (VAHCS) has pioneered electronic medical records that have facilitated epidemiologic research and have provided the foundation for the ETHOS and VETS cohorts. The VAHCS is particularly suited for epidemiologic studies because patients can be accurately traced through VAHCS benefits services. These studies have helped formulate guidelines on exercise testing as well as recommendations from national and international health organizations on physical activity. In addition, they have provided strong support for efforts to reduce sedentary behavior, promote physical activity, and enhance CRF by public health organizations and healthcare systems in order to reduce the risk of chronic disease. This paper outlines the development of the ETHOS and VETS cohorts and highlights key studies contributing to our understanding of CRF as a critical health determinant
In-hospital outcomes of non-elective transapical transcatheter versus surgical aortic valve replacement
No full textWhen transfemoral (TF) access is not available during transcatheter aortic valve replacement (TAVR), transapical (TA)-TAVR can be performed. However, TA-TAVR is associated with significantly higher risk, and it is unclear whether it provides more benefit than surgical aortic valve replacement (SAVR) in non-elective cases. This study aimed to compare the in-hospital outcomes of non-elective TA-TAVR and SAVR by conducting a population-based analysis using a national registry. Patients who underwent non-elective TA-TAVR and SAVR were selected from National Inpatient Sample from Q4 2015 to 2021. Exclusion criteria included age \u3c 18 years and concomitant procedures. Demographics, socioeconomic status, comorbidities, relevant diagnosis, transfer-in status, and hospital characteristics were matched between patients who underwent TA-TAVR and SAVR using a 1:3 propensity-score matching. In-hospital outcomes were compared. There were 130 and 10,487 patients who underwent TA-TAVR and SAVR, respectively. After the propensity-score matching, all TA-TAVR patients were matched to 341 SAVR patients. TA-TAVR and SAVR patients had comparable in-hospital mortality (7.69% vs. 7.33%, p = 0.85), myocardial infarction (3.85% vs. 4.4%, p = 1.00), stroke (0.77% vs. 1.76%, p = 0.69), respiratory complications (15.38% vs. 17.6%, p = 0.68), cardiogenic shock (14.62% vs. 12.61%, p = 0.55), and pacemaker implantation (10% vs. 7.33%, p = 0.35). However, TA-TAVR patients had lower hemorrhage/hematoma (38.46% vs. 68.33%, p \u3c 0.01), lower transfer out rate (33.08% vs. 44.87%, p = 0.02), and shorter length of stay (p = 0.04). All other in-hospital outcomes were comparable. Among eligible TAVR candidates in non-elective cases and when TF access is not available, both TA-TAVR and SAVR may be equally alternative approaches considering their comparable in-hospital outcomes. Further studies should compare the long-term outcomes between TA-TAVR and SAVR
Higher risks of thirty-day mortality and thromboembolism in disseminated cancer patients undergoing carotid endarterectomy: A perspective from the ACS-NSQIP database from 2011 to 2022
No full textBackgroundAtherosclerosis in carotid arteries can lead to carotid stenosis, where carotid endarterectomy (CEA) is the first-line intervention. Malignancy has a two-way relationship with atherosclerosis, where they share common molecular pathways in their pathophysiology. However, the postoperative outcomes of CEA in patients with disseminated cancer remain unclear. This study aimed to examine the 30-day outcomes of CEA in patients with disseminated cancer.MethodsPatients with and without disseminated cancer who underwent CEA were identified in the ACS-NSQIP targeted database from 2011 to 2022. Patients with age \u3c18 years were excluded. A 1:5 propensity-score matching was used to address preoperative differences between the cohorts. Thirty postoperative outcomes were examined.ResultsThere were 148 (0.37%) patients with disseminated cancer who went under CEA. Meanwhile, 40,028 patients without disseminated cancer underwent CEA, where 740 of them were matched to those with disseminated cancer. After 1:5 propensity-score matching, disseminated cancer patients had higher risks of 30-day mortality (4.73% vs 1.62%, p = .03), and deep vein thrombosis (3.38% vs 0.68%, p = .01), while stroke, transient ischemic attacks, and other 30-day outcomes were comparable between the groups.ConclusionPatients with disseminated cancer had higher thromboembolism and mortality after CEA. Given the prevalence of cancer-related thrombosis and its associated increased mortality risk, effective prophylaxis and treatment for venous thromboembolism, such as low molecular weight heparin administration, should be essential in patients with disseminated cancer. These findings can also be valuable for preoperative risk stratification and in determining the surgical candidacy of patients with disseminated cancer in CEA. CEA for asymptomatic patients with disseminated cancer may require further justification given their elevated perioperative risk
Trends of female authorship in speech-language pathology publications over the last decade
No full textOBJECTIVES: The purpose of this study was to analyse the speech-language pathology (SLP) literature from 2012 to 2022 and evaluate authorship trends and factors associated with gender disparities. DESIGN AND OUTCOME MEASURES: Authorship across journals published by the American Speech-Language-Hearing Association (ASHA) was evaluated. Outcomes collected from each article included the gender of the first and senior authors, author department affiliations, study type, reported funding source and the country of origin. Three sets of linear regression models were explored to determine the probability of male first authorship, of male senior authorship, and of a study being funded. RESULTS: A total of 2754 articles were identified for inclusion. The majority of the literature was authored by females, with 77% of first authors and 68% of senior authors being female. Studies with a male senior author were shown to be 4.05-4.67 times more likely to have a male first author than with a female senior author. Male senior authors were over-represented relative to their proportion of ASHA membership compared with female senior authors. Male authorship was associated with certain subtopics, including voice, stuttering and motor speech. Funding probability decreased for all authors regardless of gender between 2012 and 2022. CONCLUSIONS: Implicit gender bias and societal gender stereotypes lead to a greater number of women in the field of SLP; the same biases and stereotypes often limit the research productivity and academic leadership potential of women in the field. Addressing these biases and stereotypes is vital to move towards gender equity in the field
EMBRACE Study: Outcomes of a Randomized, Mindfulness-Based Intervention for Adults with Congenital Heart Disease
No full textAdults with congenital heart disease (ACHD) have high rates of anxiety and depression. Strategies to manage the stress of having a chronic disease, improve coping skills and resilience can reduce these rates. To examine the effectiveness of an ACHD-specific, real-time virtual mindfulness-based behavioral intervention (MBBI) on mental health and resilience. A randomized wait-list control study was conducted, testing a virtual MBBI for 90 min once weekly × 6 weeks compared to standard of care (SOC) control. Primary outcomes of anxiety and depression were assessed through the Hospital and Anxiety and Depression Scale (HADS-A/HADS-D), while secondary outcomes of resilience and mindfulness were assessed through the Brief Resilience Scale (BRS) and Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), respectively. Outcomes were assessed pre-post-intervention and 3-month post-intervention. Forty-one participants were recruited. Thirty-one participants (average age = 39.7 + 12.6 years, 64.5% female) completed the study, attending an average of 5 sessions. While the randomization groups did not show differences in changes in any outcomes, participants did show meaningful improvements after the EMBRACE intervention in anxiety [60.9% with decreased HADS-A (95% CI 43.8-76.8%)]; depression [48.4% with decreased HADS-D (95% CI 31.6-65.5%)]; resilience [43.6% with increased BRS score (95% CI 26.9-61.0%)]; and mindfulness [69.4% with increased CAMS-R-score (95% CI 52.3-84.0%)] scores. Satisfaction surveys revealed that 97% found the program effective. Major qualitative themes included community connections, focus on self-care and self-management. The EMBRACE study demonstrates the effectiveness of a virtual intervention to improve mental health, resilience, and coping skills. Further study is needed to evaluate the long-term benefits and sustainability for ACHD patients
Advocacy in Psychiatry
No full textAdvocacy is a fundamental responsibility of all physicians, and psychiatrists are uniquely positioned as advocates because of their expertise in understanding the intersection between mental health, social determinants, and systemic barriers. Defined as giving voice to advance patient and population health, physician advocacy spans a continuum of activities, including micro-level efforts focused on individual patients, meso-level initiatives targeting organizational and community improvements, and macro-level interventions addressing systemic changes. Advocacy training enhances competence in these domains, but significant gaps persist in advocacy integration into medical education. Although insufficient institutional support, lack of formalized requirements, and limited recognition in academic or career promotion hinder advocacy skill development, professional organizations provide opportunities to develop and refine advocacy competencies, obtain mentorship, and identify avenues for engaging with policy makers. Through advocacy, psychiatrists have made significant contributions at individual, community, and national levels-and continue to be essential in driving systemic change to improve health