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Urine Retention Versus Post-Obstructive Diuresis as a Potential Cause of Acute Hyponatremia: A Case Report
Full text linkAcute urine retention is a common urologic emergency that is frequently seen in the Emergency room (ER). Standard treatment includes placing a urinary catheter or a suprapubic catheter with outpatient urologic follow-up. Urine retention can cause complications, such as hyponatremia and post-obstructive diuresis. It is crucial to diagnose and manage these life-threatening complications appropriately. Herein, we present a case of urine retention-induced hyponatremia. The patient’s urine sodium level and osmolality were consistent with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). In this patient, sodium autocorrection started after a urinary catheter placement. Hypotonic saline was administered to prevent rapid autocorrection. This type of hyponatremia is unique as autocorrection occurs after catheter placement; however, monitoring is needed to ensure fast autocorrection does not occur. Potential fast autocorrection is concerning in those patients. Treating those patients with hypertonic fluids or normal saline can exacerbate the fast autocorrection and lead to severe complications. Hypotonic fluid administration should be considered when developing rapid autocorrection
Clinical Education in Undergraduate Nursing in Ghana: A Gap Analysis
Full text linkBackground: Nursing education comprises theory and practice as two complementary parts. In Ghana, the clinical education space is inundated with many challenges, disrupting the intended purpose of clinical education. The multifactorial challenges include student issues, nurse and educator concerns, management and resource issues. To find solutions, there is a need for a critical analysis of the current clinical educational practices to inform the development of feasible and sustainable approaches for nursing education. This article, therefore, reports on a gap analysis of clinical education in Ghana.
Method: A qualitative descriptive design underpinned the study and was executed through key informant interviews, focus group discussions and document analysis. A total of seventy-three participants, drawn from four nursing education institutions and eight clinical sites located in four administrative regions in Ghana, participated in the study. These participants comprised four principals, four heads of accounts, eight clinical coordinators, eight nurse educators, twelve preceptors, and thirty-seven final-year undergraduate nursing students. Data analysis was done deductively against the Global Pillars for Nursing Education, yielding three themes and eleven sub-themes.
Results: For theme 1, the study revealed a lack of a comprehensive competency-based assessment, ineffective interprofessional communication, and a non-stimulating clinical education climate. For theme 2, disregard for available admission standards and non-integration of interprofessional education into the undergraduate curriculum was found. In the case of theme 3, insufficient clinical experience of nurse educators was detected, financial resources to support clinical activities optimally were insufficient, and nursing schools lacked independence to support nursing education effectively.
Conclusion: This study identified gaps in the clinical education of undergraduate nurses in Ghana when measured against the Global Pillars for Nursing Education. Gaps in clinical education compromise competence at graduation, resulting in nursing graduates who negatively impact health outcomes. Implementing targeted strategies could enhance clinical teaching and learning in undergraduate nursing education in Ghana
Adjuvant Immunotherapy in Microsatellite Instability-High Colon Cancer: A Literature Review on Efficacy, Challenges, and Future Directions
Full text linkColon cancer accounts for nearly 10% of all cancer diagnoses annually. Microsatellite instability-high (MSI-H) colon cancer is a particularly aggressive subtype of colon cancer that is known to have a significant number of genetic mutations. Microsatellite instability (MSI) refers to genetic hypermutability caused by the dysfunction of the DNA mismatch repair (MMR) system, which leads to errors in repetitive DNA sequences and is a hallmark of certain cancers, including MSI-H colon cancer. MSI-H colon cancer acts on the DNA mismatch repair system causing an accumulation of mutations in microsatellite regions of the DNA. These mutations have been linked with increased tumorigenesis and decreased response to conventional forms of chemotherapy for colon cancer. However, this increased tumor burden results in significant production of neoantigens which makes these tumors immunogenic and therefore perfect candidates for pairing with immunotherapy. As a result, adjuvant immunotherapy in MSI-H colon cancer has become a burgeoning field of research, and synthesizing information regarding the efficacy of these immunotherapies is the goal of this literature review. Pembrolizumab, a monoclonal antibody targeting programmed cell death protein 1 (PD-1), was among the first to receive approval for the treatment of MSI-H colon cancer and was observed to have significant efficacy versus traditional chemotherapy with statistically significant improvements in metrics such as progression-free survival (PFS), overall response (OR), and disease-free survival (DFS). Similarly, Nivolumab, another PD-1 inhibitor, and the combination of nivolumab and ipilimumab (a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor) were granted Food and Drug Administration (FDA) approval for the treatment of MSI-H colon cancer and have also shown the ability to outperform traditional chemotherapy with a higher overall response rate (ORR), mean PFS, and overall survival rates. Off-label uses of existing adjuvant immunotherapies such as Atezolizumab (a programmed death-ligand 1 (PD-L1) inhibitor) and Durvalumab (a PD-L1 inhibitor) have shown promise with preliminary results showing higher DFS and recurrence-free survival but need further data collection. Emerging immunotherapy targets such as lymphocyte activation gene 3 (LAG-3) and T-cell immunoreceptor with immunoglobin and Immunoreceptor Tyrosine-based Inhibitory Motif domains (TIGIT) inhibitors show preliminary promise and may one day become a part of the approach to the treatment of MSI-H colon cancer. This review highlights current advancements, challenges, and emerging trends in the application of immunotherapy for MSI-H colon cancer, with a focus on improving patient outcomes
Google Trends Shows Increased Public Interest in Platelet-Rich Plasma Injections in All Joints: Shoulder and Knee Show Greatest Increase
Full text linkPurpose: To assess search term frequency of platelet-rich plasma (PRP) in multiple joints, including the shoulder, elbow, hip, knee, ankle, and foot, using Google Trends.
Methods: The following joints included were (1) shoulder, (2) elbow, (3) hip, (4) knee, (5) ankle, and (6) foot. Google Trends was utilized to obtain search trends from 2010 to 2023 for each joint. The search combinations “PRP” + “shoulder,” “elbow,” “hip,” “knee,” “ankle,” and “foot” were used, and a linear regression model was applied. Analysis of variance and post hoc Tukey honest significant difference analyses were performed to determine specific comparisons between joints.
Results: There was an increasing trend in Google queries for PRP and shoulder (R2 = 0.669, P \u3c .001), elbow (R2 = 0.284, P \u3c .001), hip (R2 = 0.648, P \u3c .001), knee (R2 = 0.802, P \u3c .001), ankle (R2 = 0.240, P \u3c .001), and foot (R2 = 0.040, P = .009). The shoulder showed the greatest rate of growth, shown by the slope in the linear regression model, followed by the knee (0.422 and 0.421, respectively). Within the lens of percent increase, PRP in the ankle had the highest magnitude of growth, followed by the knee (1,251.27% and 163.95%, respectively). The knee joint held the highest average relative search volume of 66.38 as of 2023.
Conclusions: Each of the search terms for PRP in the shoulder, elbow, hip, knee, ankle, and foot had statistically significant trends of increasing search volume. PRP for the shoulder and knee exhibited the highest rate of growth, whereas PRP for the foot exhibited the slowest increase.
Clinical Relevance: There appears to be substantial patient interest in PRP injections. The information in this study can be used by clinicians to better understand which joint injections patients may generally be interested in discussing during clinic visits. They can provide evidence-based materials to educate patients about PRP joint injections
Effects of Meeting Exercise Guidelines on Depression and Anxiety in Multiple Sclerosis – A Systematic Review and Meta-analysis
Full text linkBackground: Depression and anxiety are common in multiple sclerosis (MS), significantly affecting quality of life. Previous studies on exercise interventions for mental health in persons with MS (PwMS) have shown mixed results, partly due to inconsistent adherence to the Physical Activity Guidelines for Multiple Sclerosis (PAG-MS).
Objective: This study aimed to evaluate the effects of PAG-MS-compliant exercise on depression and anxiety outcomes in PwMS.
Methods: A systematic search was performed in EMBASE, PsycINFO, Web of Science, SPORTDiscuss, PubMed, Scopus, and CINAHL through October 2024 to identify randomized controlled trials (RCTs). Eligible studies involved adults with MS and focused on exercise regimens compliant with PAG-MS. Comparisons were made with non-PAG-MS exercise regimens or no exercise at all. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. Depression and anxiety outcomes were analyzed using meta-analyses, incorporating minimal clinically important difference (MCID) thresholds to determine clinical significance.
Results: Twelve RCTs involving 458 participants we included. Depression outcomes showed significant improvement (MD: -4.46 [95% CI: -6.90, -2.01], P ˂ 0.01), exceeding the MCID threshold of 3.00 points on the Beck Depression Inventory scale. Anxiety outcomes, analyzed from two RCTs, showed non-significant improvement (SMD: -0.87 [95% CI: -2.46, 0.72], p = .29). Overall, 58.33% of studies had a high risk of bias.
Conclusion: Interventions that meet PAG-MS demonstrate clinically meaningful improvements in depression, supporting their use as a non-pharmacological treatment strategy. However, given the limited data on anxiety outcomes, further research is needed to clarify the potential benefits in this domain
Biomarkers of Exposure to Tobacco-Related Toxicants among Adult Nicotine Pouch Users
No full textIntroduction: Nicotine pouches (NPs) are an emerging nicotine delivery system. Understanding nicotine and toxicant exposure among NP users compared with users of other tobacco products and non-users is critical for informing public health strategies.
Methods: Data (n = 4527) were drawn from the Population Assessment of Tobacco and Health Study Wave 7 (2022-2023). Participants were classified into four mutually exclusive groups: non- tobacco users, exclusive NP users, exclusive e-cigarette users, and exclusive cigarette smokers. Geometric mean concentrations of biomarkers from urinary nicotine metabolites, minor tobacco alkaloids, and heavy metals were compared across groups using general linear model adjusted for demographics and current marijuana use.
Results: Despite having higher levels of nicotine metabolites than non-tobacco users (e.g., cotinine, 2137.2 vs. 0.2 ng/mg creatinine, p\u3c.0001), exclusive NP users showed no significant differences in levels of metals or minor tobacco alkaloids (p\u3e.05). Exclusive NP users had comparable levels of nicotine metabolites to exclusive cigarette smokers (p\u3e.05), but significantly higher concentrations of certain nicotine metabolites than exclusive e-cigarette users (e.g., TNE-2: 27.3 vs. 7.0, p=.02). Meanwhile, exclusive NP users exhibited lower levels of anabasine (0.6 vs. 9.3 ng/mg creatinine, p\u3c.0001), anatabine (0.4 vs. 14.7 ng/mg creatinine, p\u3c.0001), and lead (0.2 vs. 0.4 ng/mg creatinine, p=.003) than exclusive cigarette smokers and lower levels of lead (p=.02) than exclusive e-cigarette users.
Conclusions: NP users have substantially elevated nicotine exposure without a corresponding rise in selected tobacco alkaloids or metals. Findings from objective biomarker measures could inform harm reduction strategies and shape regulatory policies concerning emerging nicotine products.
Implications: Nicotine pouches are gaining popularity in the United States. The long-term health effects of nicotine pouch use remain unknown, and this national study offered early evidence into the scope of toxicant exposure associated with nicotine pouch use. Exclusive nicotine pouch users exhibited higher levels of nicotine metabolites but lower concentrations of anabasine and lead compared to cigarette smokers, indicating that nicotine pouches may serve as a potential harm-reduction strategy for combustible cigarette smokers. Findings from this study add to the current field of tobacco regulatory science and may inform future efforts to evaluate their effectiveness in smoking cessation or substitution
Anxiety as a Mediator on the Relationship Between Self-Talk and Sports Performance
No full textMental health is a key component of youth development, with anxiety and depression being common among adolescents. Participation in organized sports can promote resilience but may also introduce performance-related anxiety. Psychological skills such as self-talk have been shown to support confidence, reduce anxiety, and improve skill acquisition. This study examined the impact of a self-talk intervention on anxiety and performance in adolescent baseball and softball athletes aged 10 to 18. Using a within-subjects design, participants were randomly assigned to intervention or control groups. The intervention group received psychoeducation on self-talk and applied it during batting trials. Performance was measured by batting average, and anxiety was assessed using the short-form State-Trait Anxiety Inventory (STAI). Results indicated that anxiety did not mediate the relationship between self-talk and performance. However, participants in the self-talk group demonstrated significantly higher batting averages compared to the control group. Anxiety levels decreased over time in both groups, suggesting task familiarity may reduce anxiety regardless of intervention. These findings support the use of self-talk to enhance performance and highlight the importance of psychological skills training in youth sports. Further research is needed to explore how self-talk and emotional regulation interact across sport contexts
Correction: Otolaryngological Presentations of Klippel-Feil Syndrome: A Systematic Review
No full text[This corrects the article DOI: 10.7759/cureus.73986.]