Diagnostic Yield of head Computed Tomography in Patients with Syncope: Sex Differences.

BACKGROUND: Syncope is responsible for approximately 1-3% of all emergency department (ED) visits and up to 6% of all hospital admissions in the United States. Although often of no long-term consequence, syncope can be the first presentation of a range of serious conditions such as strokes, tumors, or subarachnoid hemorrhages. Head computed tomography (CT) scanning is therefore commonly ordered in the ED for patients presenting with syncope to rule out any of these conditions, which may present without other associated physical or neurological findings on initial examination. However, the diagnostic yield of head CTs in patients presenting with syncope is unclear. OBJECTIVES: To determine the diagnostic yield of head CT in the ED in patients with syncope. METHODS: We conducted an observational analytical retrospective cross-sectional study on 360 patients diagnosed with syncope who underwent a head CT to determine the diagnostic yield of syncope to determine whether head CT is necessary for every patient presenting with syncope to the ED. RESULTS: The total of new CT findings was 11.4%. Percentages varied between men (12.8%) and women (9.7%), P = 0.353. There were no significant differences between sexes regarding the findings in head CT, yet the incidence increased, especially among elderly males. CONCLUSIONS: Age had a more significant impact on diagnostic yield of syncope than head CT. The use of a head CT scan as a routine diagnosis tool in patients with syncope is unjustifiable unless there is an indication based on medical history or physical examination.

Volume Measurement of the Cavum Septi Pellucidi: Normative Values Between 20 and 40 Weeks of Gestation.

BACKGROUND: The cavum septi pellucidi (CSP) is a brain-enclosed cavity located on the midline between the two leaflets of the septum pellucidum that separates the lateral ventricles. This structure develops in the fetus from week 18 and can be seen up to week 37 in almost all cases and then begins to disappear. OBJECTIVES: To measure and determine the normative values of the CSP volume in fetuses between 20 to 40 weeks of gestation. METHODS: The study comprised 161 consecutive pregnant women between 20 to 40 weeks of gestation with single viable fetuses. All patients had normal, disease-free pregnancies. Transvaginal or transabdominal ultrasound was used according to the fetal presentation. The fetal head was assessed in mid-sagittal sections. Once the CSP was visualized, its volume was measured using three-dimensional ultrasound with Virtual Organ Computer-aided Analysis software. The width of the CSP was also measured at the biparietal diameter (BPD) plane. RESULTS: Of the 161 fetuses, the CSP volume was measured in 158. In three patients the CSP was not identified. The CSP volume correlated poorly with gestational age (r=0.229) and with the BPD (r=0.295). The mean CSP volume was 0.508 ± 0.372 ml (range: 0.03-1.78 ml). The simple measurement of the CSP width correlated better with gestational age (r=0.535) and the BPD (r=0.484). CONCLUSIONS: The CSP volume had a poor correlation with gestational age; however, the volume did not exceed 2 ml regardless of gestational age. This information can be used to assess pathologies involving the CSP.

Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review.

An emerging outbreak of monkeypox infection is quickly spreading worldwide, being currently reported in more than 30 countries, with slightly less than 1000 cases. In the present preliminary report, we collected and synthesized early data concerning epidemiological trends and clinical features of the ongoing outbreak and we compared them with those of previous outbreaks. Data were pooled from six clusters in Italy, Australia, the Czech Republic, Portugal, and the United Kingdom, totaling 124 cases (for 35 of which it was possible to retrieve detailed information). The ongoing epidemic differs from previous outbreaks in terms of age (54.29% of individuals in their thirties), sex/gender (most cases being males), risk factors, and transmission route, with sexual transmission being highly likely. Also, the clinical presentation is atypical and unusual, being characterized by anogenital lesions and rashes that relatively spare the face and extremities. The most prevalent sign/symptom reported was fever (in 54.29% of cases) followed by inguinal lymphadenopathy (45.71%) and exanthema (40.00%). Asthenia, fatigue, and headache were described in 22.86% and 25.71% of the subjects, respectively. Myalgia was present in 17.14% of the cases. Both genital and anal lesions (ulcers and vesicles) were reported in 31.43% of the cases. Finally, cervical lymphadenopathy was described in 11.43% of the sample, while the least commonly reported symptoms were diarrhea and axillary lymphadenopathy (5.71% of the case series for both symptoms). Some preliminary risk factors can be identified (being a young male, having sex with other men, engaging in risky behaviors and activities, including condomless sex, human immunodeficiency virus positivity (54.29% of the sample analyzed), and a story of previous sexually transmitted infections, including syphilis). On the other hand, being fully virally suppressed and undetectable may protect against a more severe infectious course. However, further research in the field is urgently needed.

The Impact of Generative Conversational Artificial Intelligence on the Lesbian, Gay, Bisexual, Transgender, and Queer Community: Scoping Review.

BACKGROUND: Despite recent significant strides toward acceptance, inclusion, and equality, members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community still face alarming mental health disparities, being almost 3 times more likely to experience depression, anxiety, and suicidal thoughts than their heterosexual counterparts. These unique psychological challenges are due to discrimination, stigmatization, and identity-related struggles and can potentially benefit from generative conversational artificial intelligence (AI). As the latest advancement in AI, conversational agents and chatbots can imitate human conversation and support mental health, fostering diversity and inclusivity, combating stigma, and countering discrimination. In contrast, if not properly designed, they can perpetuate exclusion and inequities. OBJECTIVE: This study aims to examine the impact of generative conversational AI on the LGBTQ community. METHODS: This study was designed as a scoping review. Four electronic scholarly databases (Scopus, Embase, Web of Science, and MEDLINE via PubMed) and gray literature (Google Scholar) were consulted from inception without any language restrictions. Original studies focusing on the LGBTQ community or counselors working with this community exposed to chatbots and AI-enhanced internet-based platforms and exploring the feasibility, acceptance, or effectiveness of AI-enhanced tools were deemed eligible. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS: Seven applications (HIVST-Chatbot, TelePrEP Navigator, Amanda Selfie, Crisis Contact Simulator, REALbot, Tough Talks, and Queer AI) were included and reviewed. The chatbots and internet-based assistants identified served various purposes: (1) to identify LGBTQ individuals at risk of suicide or contracting HIV or other sexually transmitted infections, (2) to provide resources to LGBTQ youth from underserved areas, (3) facilitate HIV status disclosure to sex partners, and (4) develop training role-play personas encompassing the diverse experiences and intersecting identities of LGBTQ youth to educate counselors. The use of generative conversational AI for the LGBTQ community is still in its early stages. Initial studies have found that deploying chatbots is feasible and well received, with high ratings for usability and user satisfaction. However, there is room for improvement in terms of the content provided and making conversations more engaging and interactive. Many of these studies used small sample sizes and short-term interventions measuring limited outcomes. CONCLUSIONS: Generative conversational AI holds promise, but further development and formal evaluation are needed, including studies with larger samples, longer interventions, and randomized trials to compare different content, delivery methods, and dissemination platforms. In addition, a focus on engagement with behavioral objectives is essential to advance this field. The findings have broad practical implications, highlighting that AI's impact spans various aspects of people's lives. Assessing AI's impact on diverse communities and adopting diversity-aware and intersectional approaches can help shape AI's positive impact on society as a whole.

Knowledge of Human Papillomavirus (HPV), Attitudes, and Practices Towards Anti-HPV Vaccination Among Israeli Nurses.

Human papillomavirus (HPV) is a small, non-enveloped, double-stranded DNA virus, belonging to the family of Papillomaviridae. It is a highly common infectious agent, which causes one of the most widespread sexually transmitted infections (STIs), involving approximately 20% of sexually active female adolescents and up to 80% of female adults aged 50 years. There exist two major preventative strategies: namely, anti-HPV vaccination and cervical screening. Healthcare providers, including nurses, can play a crucial role in HPV immunization campaigns, counteracting vaccine hesitancy and doing advocacy and counseling. To explore the overall knowledge of HPV and HPV-related issues, as well as the attitudes and practices of Israeli nurses, a modified and adapted, previously validated knowledge, attitudes, and practices (KAP) questionnaire was administered to a sample of 565 participants, 481 female (85.1%) and 84 male (14.9%). Most of them were married (n = 428, 75.8%), with more than 5 years of experience (n = 405, 71.7%), working in the general/internal medicine ward (n = 432, 76.5%), and Jewish (n = 352, 62.3%). Only 87 nurses (15.4%) got vaccinated against HPV. Forty-four (9.1%) of the female nurses never underwent a Pap smear. Higher percentages of right replies were reported only for the item related to available preventative strategies for cervical cancer (82.1% versus 17.9%). Higher percentages of wrong replies were reported for items related to body regions that can be infected by HPV (60.5% versus 39.5%), percentage of girls aged 15-18 years being sexually active (68.0% versus 32.0%). Similar percentages of right and wrong replies were reported for items related to whom the Pap test is recommended (52.7% versus 47.3%), Israeli Ministry of Health's guidelines for anti-HPV vaccination (50.4% versus 49.6%), and percentage of boys aged 15-18 years being sexually active (44.4% versus 55.6%). Concerning the reliability of the third section of the questionnaire, Cronbach's alpha was deemed to be acceptable (α = 0.64). Statistically significant determinants of reporting lower scores in HPV-related attitudes and practices were religion (OR 1.44 [95%CI 1.02-2.04]), and male offspring (OR 1.22 [1.03-1.44]). This study has important implications for policy- and decision-makers in that they should be aware of the overall poor and unsatisfactory level of HPV-related knowledge among Israeli nurses and implement multipronged HPV vaccine promotion programs, taking into account the challenges of a multicultural and diverse society like Israel.

Ensuring equitable, inclusive and meaningful gender identity- and sexual orientation-related data collection in the healthcare sector: insights from a critical, pragmatic systematic review of the literature.

In several countries, no gender identity- and sexual orientation-related data is routinely collected, if not for specific health or administrative/social purposes. Implementing and ensuring equitable and inclusive socio-demographic data collection is of paramount importance, given that the LGBTI community suffers from a disproportionate burden in terms of both communicable and non-communicable diseases. To the best of the authors' knowledge, there exists no systematic review addressing the methods that can be implemented in capturing gender identity- and sexual orientation-related data in the healthcare sector. A systematic literature review was conducted for filling in this gap of knowledge. Twenty-three articles were retained and analysed: two focussed on self-reported data, two on structured/semi-structured data, seven on text-mining, natural language processing, and other emerging artificial intelligence-based techniques, two on challenges in capturing sexual and gender-diverse populations, eight on the willingness to disclose gender identity and sexual orientation, and, finally, two on integrating structured and unstructured data. Our systematic literature review found that, despite the importance of collecting gender identity- and sexual orientation-related data and its increasing societal acceptance from the LGBTI community, several issues have to be addressed yet. Transgender, non-binary identities, and also intersex individuals remain often invisible and marginalized. In the last decades, there has been an increasing adoption of structured data. However, exploiting unstructured data seems to overperform in identifying LGBTI members, especially integrating structured and unstructured data. Self-declared/self-perceived/self-disclosed definitions, while being respectful of one's perception, may not completely be aligned with sexual behaviours and activities. Incorporating different levels of information (biological, socio-demographic, behavioural, and clinical) would enable overcoming this pitfall. A shift from a rigid/static nomenclature towards a more nuanced, dynamic, 'fuzzy' concept of a 'computable phenotype' has been proposed in the literature to capture the complexity of sexual identities and trajectories. On the other hand, excessive fragmentation has to be avoided considering that: (i) a full list of options including all gender identities and sexual orientations will never be available; (ii) these options should be easily understood by the general population, and (iii) these options should be consistent in such a way that can be compared among various studies and surveys. Only in this way, data collection can be clinically meaningful: that is to say, to impact clinical outcomes at the individual and population level, and to promote further research in the field.

Inflammatory Markers in the Diagnosis of Fibromyalgia.

BACKGROUND: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain accompanied by various additional symptoms. The prevalence of FMS ranges between 2-8% of the population. The exact pathophysiology of the disease remains unknown, and under certain circumstances it is difficult for the physician to diagnose. Previous studies have shown a correlation between inflammatory biomarkers such as C-reactive protein (CRP) and FMS activity, suggesting that an inflammatory component may play a role in this disease pathogenesis. OBJECTIVES: To investigate the role of certain new inflammatory biomarkers in the diagnosis of patients with FMS. METHODS: In this study data were collected from FMS patients who were admitted to Ziv Medical Center during the period 2013 to 2019 in an attempt to find a connection between inflammatory markers detectable by a traditional complete blood count (CBC) tests such as neutrophil-lymphocytes ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet value (MPV), red cell distribution width (RDW), and C-reactive protein (CRP) and FMS. RESULTS: We found significantly higher CRP levels, MPV, and PLR and lower lymphocyte count in the FMS group compared to the control group. CONCLUSIONS: FMS has certain inflammatory components that may be useful in disease diagnosis.

The role of neutrophil-lymphocyte ratio, and mean platelet volume in detecting patients with acute venous thromboembolism.

BACKGROUND: Acute venous thromboembolism (VTE) refers to deep venous thrombosis (DVT) of the extremities or pulmonary embolism (PE), or to both. Reliable imaging is not always available making a serologic diagnosis, or biomarker, highly desirable. OBJECTIVE: This study aimed to examine the role of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) in detection patients with acute VTE. METHODS: A total of 327 patients with initial diagnosis of acute VTE who were admitted to Ziv hospital were evaluated. Of them, 272 patients with definitive diagnosis of VTE, and 55 patients without VTE were used as control group. Complete blood count (CBC), measurements of NLR, MPV, and PLR were determined at admission. RESULTS: Patients with VTE were older than controls (62 ± 18.9 vs 55.4 ± 15.1 years, respectively, P = .03). Female gender was predominant in the two groups. In the study group, 178/272 (66%) had DVT, 84/272 (31%) had pulmonary embolism (PE), and the rest had DVT and PE. NLR, MPV, and PLR were found to be significantly elevated in acute VTE compared to control (P < .001, P = .008, P = .014, respectively). A ROC curve analysis of NLR and MPV for predicting acute VTE was performed which found a cut-off value of 5.3 for NLR, an area under curve of (0.67 (0.60-0.75), P < .001, with a sensitivity of 69% and specificity of 57%. and a cut-off value of 8.6 for MPV, an area under curve of (0.61 [0.53-0.68], P = .014, with a sensitivity of 52% and specificity of 67%. Multivariate logistic regression model found that NLR (OR 1.2, 95% CI [1.01-1.4], P = .041) and MPV (OR 1.5, 95%CI [1.07-2.12], P = .5) were associated with acute VTE. CONCLUSIONS: Neutrophil-lymphocyte ratio and MPV could be beneficial predictors for the early detection of potential acute VTE.

Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes.

BACKGROUND AND AIM: Chronic inflammation has an important role in the development and progression of type 2 diabetes through immunologic inflammatory mechanisms. Simple new inexpensive inflammatory markers may contribute to the detection of microalbuminuria. Aim of our study is to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and red blood cell distribution width (RDW) for microalbuminuria in type 2 diabetic patients for possible application as prognostic factors for the prediction of microalbuminuria and the progression of disease in patients with diabetes. METHODS: A total of 168 patients with type 2 diabetes mellitus were classified into gender- and BMI-matched three groups according to hemoglobin A1c and microalbuminuria: Group A: 53 patients with controlled diabetes, Group B: 57 patients with uncontrolled diabetes, both without microalbuminuria, and Group C: 58 patients with uncontrolled diabetes with microalbuminuria. Levels of NLR, MPV, and RDW between the study groups were examined and compared. RESULTS: A significant difference in NLR was found between Group C and groups A and B (P < .001, P = .005, respectively). A statistically significant difference in RDW was found between groups B and C (P = .014). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction showed an area under curve (AUC) of 0.675 for NLR (CI 0.58-0.76, P < .001) and 0.614 for RDW (CI 0.52-0.70, P = .013). NLR value of 2.54 has 39.7% sensitivity, 78.8% specificity, and 45% positive predictive value (PPV). RDW value of 14.44 has 37.9% sensitivity, 76% specificity, and 41.5% PPV. CONCLUSIONS: Neutrophil-to-lymphocyte ratio and RDW have PPV for microalbuminuria in diabetic patients.

The Prognostic Value of Inflammatory Markers in Clostridium difficile-associated Diarrhea.

BACKGROUND: The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing and is associated with significant morbidity and mortality. Therefore, there is a need to find new tools to determine the severity of the disease. OBJECTIVES: To investigate the prognostic values of inflammatory markers such as mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), and C-reactive protein (CRP) in patients with CDAD. METHODS: The study comprised of 100 patients diagnosed with CDAD. The study included an additional control group of 69 patients with diarrhea who were negative for C. difficile toxin. The control group was age- and sex-matched and hospitalized at the same time period. NLR and MPV were obtained from complete blood count results. Serum CRP levels were measured by the latex particle enhanced immunoturbidimetric assay. Blood samples for all inflammatory markers were collected at time of diagnosis and prior to initiating the antibiotic therapy. Demographic, clinical, laboratory, and prognostic data were collected from medical records for a period of 90 days from the initial diagnosis of CDAD. RESULTS: The mean age of the CDAD group was 68.6 ± 21.5 years compared to 65.6 ± 24.5 in the control group (P = 0.29). Our findings show that patients with CDAD had significantly higher NLR, MPV and serum CRP levels compared to the control group (P < 0.001)). Moreover, significantly higher levels were observed when CDAD was fatal (P < 0.001). CONCLUSIONS: Elevated NLR, MPV, and serum CRP levels may serve as biomarkers for prediction of recurrence and mortality in patients with CDAD.

A link between platelet to lymphocyte ratio and Helicobacter pylori infection.

PURPOSE: Chronic Helicobacter pylori gastritis affects two-thirds of the world's population and is one of the most common chronic inflammatory disorders of humans, the infection clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. Some studies showed that there was a correlation between low-grade inflammation as CRP and HP infection. The purpose of this study was to investigate the relationship between the presence of HP infection and platelet/lymphocyte ratio (PLR). METHOD: A total of 200 patients who met the HP criteria and 180 age- and gender-matched control subjects were included in this randomized controlled trial. Patients were diagnosed to have HP according stomach biopsy and urea breath test, PLR was calculated from complete blood count at time of diagnosis and before initiating the treatment. RESULTS: Patients with HP infection had significantly higher PLR compared to those without HP. Moreover, the patients with symptomatic HP had higher PLR than those with asymptomatic HP. While PLR increased as the severity of HP symptoms increased (r=.452, P<.001). CONCLUSION: Our study indicated, for the first time, a significant association between HP infection and symptoms based on PLR, a simple and reliable indicator of inflammation. Furthermore, there an increase in PLR as the severity of HP increases.

Consecutive Measures of CRP Correlate with Length of Hospital Stay in Patients with Community-Acquired Pneumonia.

BACKGROUND: Accurate diagnosis of community acquired pneumonia (CAP) is crucial to its proper management and to combating antibiotic resistance. Levels of C-reactive protein (CRP) have been shown to distinguish pneumonia from other pathological conditions and can be used to control the severity of infection during admission. OBJECTIVES: To investigate an association between consecutive measurements of CRP and the severity of CAP in hospitalized patients. METHODS: A total of 500 patients with CAP were admitted to the hospital. Traditional markers of inflammation including CRP, leukocyte count, body temperature, were measured on the first, second, and fifth days of hospitalization. Correlations between these measures and the length of the hospital stay were calculated. RESULTS: Mean levels of CRP, body temperature, and leukocyte count were significantly lower on the second day after hospital admission and even lower on the fifth day. A positive correlation of medium strength was found between the level of CRP on the second day of hospitalization and the length of hospital stay (P < 0.001, rs = 0.447), and a negative correlation was noted between the decrease in CRP level from the first to second day and the length of hospital stay. CONCLUSIONS: CRP levels correlated with body temperature and leukocyte count, traditional markers of inflammation. A greater decrease in CRP level between the first and second day of hospitalization was associated with shorter hospital stay and rapid improvement. These findings support the use of CRP as a marker for the severity and complication of CAP.

Common Laboratory Parameters for Differentiating Between Community-Acquired and Healthcare-Associated Pneumonia.

BACKGROUND AND OBJECTIVES: The correct diagnosis of healthcare-associated pneumonia (HCAP) as opposed to community-acquired pneumonia is essential for the selection of a correct empirical antimicrobial approach, reserving the broad-spectrum or highly potent antimicrobial therapies for resistant strains most commonly present in HCAP, whereas treating the less resistant strains, most commonly associated with community and long-term care facility-acquired infections, with a more targeted empirical approach. The standard approach today is to differentiate between the two based on the medical history of the past 90 days prior to admission. Measurable, quantitative assessment may be able to assist in this decision. The objective of this study is to find a measurable method of differentiating between community-acquired and healthcare-associated pneumonias. MATERIALS AND METHODS: The records of 126 patients admitted with a diagnosis of pneumonia were divided into two groups based on the probable cause of their disease, in accordance with common practice. The routine laboratory work taken upon admittance was analyzed using logistical regression and Student's t-test. RESULTS: We have found that the red blood cell distribution width and the neutrophil-to-lymphocyte ratio, both routine parameters obtained in a simple blood count, can each assist in differentiating between community-acquired and healthcare-associated pneumonias. CONCLUSION: We have found two statistically significant parameters that may be used as adjuncts to the medical history, chest radiography and other parameters in forming an immediate clinical impression of a patient presenting with pneumonia.

[SURVIVAL OF PATIENTS WITH WORSENING CHRONIC OBSTRUCTIVE PULMONARY DISEASE].

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD), a common disease worldwide, refers to two frequently coexisting lung diseases, chronic bronchitis and emphysema. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. A sharp worsening obstructive pulmonary disease with respiratory acidosis leads to repeated hospitalizations and high mortality rates. OBJECTIVE: This study examined patients with COPD during hospitalization. Parameters included: the number of patients admitted for a defined period of time, the time of ventilation, the average length of hospitalization, the treatment modality, the mortality rate and the percentage of returning patients. METHODS: We chose 260 admissions with worsening chronic obstructive pulmonary disease during a six month period in internal medicine departments and the intensive care unit. We selected patients who met the criteria and collected demographic data, complete blood tests including blood gases and checking the ventilator during hospitalization. We checked the relationship between the indices for hospitalization, and the mechanical ventilation. RESULTS: A total of 255 admissions were enrolled in the study; 13 patients were excluded. Data was collected from 242 hospitalizations; 242 admissions included 71 patients hospitalized more than once. Patients' age ranged from 34 to 97 years with a median age of 66.6 years. During hospitalization, 194 patients (80%) were admitted to the internal medicine departments and 48 patients (19.8%) needed mechanical ventilation in intensive care. Most patients (60.7%) were hospitalized for 2 to 4 days, but 50% of the group of patients were hospitalized for almost one week. CONCLUSION: Although the results were almost identical to those found in the literature we found other factors related to the aggravation of the disease e.g. smoking, ischemic heart disease and malignancy, which are more common in this group of diseases.

Association of neutrophil to lymphocyte ratio with presence and severity of gastritis due to Helicobacter pylori infection.

OBJECTIVE: Infection with the bacterial pathogen Helicobacter pylori (HP) clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. Some studies have shown that there was a correlation between low-grade inflammation as C-reactive protein (CRP) and HP infection. The aim of this study was to investigate the relationship between the presence of gastritis due to HP infection and neutrophil/lymphocyte ratio (NLR), a simple and reliable indicator of inflammation. DESIGN: Fifty patients met the HP criteria and half of them have had severe symptoms and upper endoscopy showed atrophic gastritis, and fifty age- and sex-matched control subjects with gastritis without HP infection were included in this randomized controlled trial. Patients were diagnosed to have HP according to the use of urea breath testing (UBT) and multiple biopsies. NLR was calculated from complete blood count at the time of diagnosis and before initiating the treatment to all groups. RESULTS: Patients with HP infection had significantly higher NLR compared to those without HP. Moreover, the patients with symptomatic HP and grade 4 gastritis had higher NLR than those asymptomatic with past history of peptic disease (P 0.007 and P 0.068, respectively). Although NLR increased as the severity of gastritis and HP symptoms increased (r = 0.564, P < 0.001), Receiver operating characteristic (ROC) Curve analysis was performed. The cut-off level for NLR with optimal sensitivity and specificity was calculated as 1.82 (area under curve [AUC] = 0.825 [0.753-0.884], P < 0.001). CONCLUSION: The present study indicated, for the first time, a significant correlation between HP infection and inflammation on the basis of NLR, a simple and reliable indicator of inflammation. Furthermore, there is an increase in NLR as the severity of gastritis with HP increases. This elevated ratio gets normalized with treatment.

Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview.

In the biomedical field, the differentiation between sex and gender is crucial for enhancing the understanding of human health and personalizing medical treatments, particularly within the domain of orthopedics. This distinction, often overlooked or misunderstood, is vital for dissecting and treating musculoskeletal conditions effectively. This review delves into the sex- and gender-specific physiology of bones, cartilage, ligaments, and tendons, highlighting how hormonal differences impact the musculoskeletal system's structure and function, and exploring the physiopathology of orthopedic conditions from an epidemiological, molecular, and clinical perspective, shedding light on the discrepancies in disease manifestation across sexes. Examples such as the higher rates of deformities (adolescent idiopathic and adult degenerative scoliosis and hallux valgus) in females and osteoporosis in postmenopausal women illustrate the critical role of sex and gender in orthopedic health. Additionally, the review addresses the morbidity-mortality paradox, where women, despite appearing less healthy on frailty indexes, show lower mortality rates, highlighting the complex interplay between biological and social determinants of health. Injuries and chronic orthopedic conditions such osteoarthritis exhibit gender- and sex-specific prevalence and progression patterns, necessitating a nuanced approach to treatment that considers these differences to optimize outcomes. Moreover, the review underscores the importance of recognizing the unique needs of sexual minority and gender-diverse individuals in orthopedic care, emphasizing the impact of gender-affirming hormone therapy on aspects like bone health and perioperative risks. To foster advancements in sex- and gender-specific orthopedics, we advocate for the strategic disaggregation of data by sex and gender and the inclusion of "Sexual Orientation and Gender Identity" (SOGI) data in research and clinical practice. Such measures can enrich clinical insights, ensure tailored patient care, and promote inclusivity within orthopedic treatments, ultimately enhancing the precision and effectiveness of care for diverse patient populations. Integrating sex and gender considerations into orthopedic research and practice is paramount for addressing the complex and varied needs of patients. By embracing this comprehensive approach, orthopedic medicine can move towards more personalized, effective, and inclusive treatment strategies, thereby improving patient outcomes and advancing the field.

Epidemiological and Clinical Characteristics of Mpox in Cisgender and Transgender Women and Non-Binary Individuals Assigned to the Female Sex at Birth: A Comprehensive, Critical Global Perspective.

The 2022-2023 Mpox multi-country outbreak, identified in over 110 WHO Member States, revealed a predominant impact on cisgender men, particularly those engaging in sex with men, while less frequently affecting women. This disparity prompted a focused investigation into the gender-specific characteristics of Mpox infections, particularly among women, to address a notable knowledge gap. This review systematically gathers and analyzes the scientific literature and case reports concerning Mpox infections in women, covering a broad geographical spectrum including regions such as Argentina, Brazil, Colombia, Nigeria, Europe, Vietnam, and the United States. The analysis delves into various aspects of Mpox in women, including clinical features, epidemiology, psychological impacts, preparedness strategies, and case studies, with particular attention to pregnant women and those with underlying health conditions. Empirical data from multiple studies underscore the unique epidemiological and clinical patterns of Mpox in women. In the United States, a small percentage of Mpox cases were reported among cisgender women, with a notable portion involving non-Hispanic Black or African American, non-Hispanic White, and Hispanic or Latino ethnicities. The primary transmission route was identified as sexual or close intimate contact, with the virus predominantly manifesting on the legs, arms, and genital areas. Further, a study in Spain highlighted significant disparities in diagnosis delays, transmission modes, and clinical manifestations between genders, indicating a different risk profile and disease progression in women. Additionally, a case from Vietnam, linked to a new Mpox sub-lineage in women, emphasized the role of women in the transmission dynamics and the importance of genomic monitoring. This review emphasizes the necessity for inclusive surveillance and research to fully understand Mpox dynamics across diverse population groups, including women. Highlighting gender and sexual orientation in public health responses is crucial for an effective approach to managing the spread and impact of this disease. The findings advocate for a gender-diverse assessment in health services and further research to explore the nuances of Mpox transmission, behavior, and progression among different groups, thereby enhancing the global response to Mpox and similar public health challenges.