Origin of the H1N1 (Russian influenza) pandemic of 1977-A risk assessment using the modified Grunow-Finke tool (mGFT).

In 1977, the Soviet Union (Union of Soviet Socialist Republics [USSR]) notified the World Health Organization (WHO) about an outbreak of H1N1 influenza, which later spread to many countries. The H1N1 strain of 1977 reappeared after being absent from the world for over 20 years. This pandemic simultaneously spread to several cities in the USSR and China. Many theories have been postulated to account for the emergence of this pandemic, including natural and unnatural origins. The purpose of this study was to use the modified Grunow-Finke risk assessment tool (modified Grunow-Finke tool [mGFT]) to investigate the origin of the 1977 H1N1 pandemic. Data was collected from WHO archives and published documents. The assessment of the pandemic's origin involved the utilization of a modified version of the original Grunow-Finke risk assessment tool (GFT). Using the mGFT, the final score was 37 out of 60 points (probability: 62%), indicating a high likelihood that the Russian influenza pandemic of 1977 was of unnatural origin. Several variables supported this finding, including the sudden re-emergence of a previously extinct strain, a genetic signature of laboratory modification for vaccine development, and unusual epidemiology. Inter-rater reliability was moderate to high. By applying the mGFT to the 1977 Russian influenza pandemic, we established a high probability that this pandemic was of unnatural origin. Although this is not definitive, it is consistent with the possibility that it originated from an incompletely attenuated live influenza vaccine. The mGFT is a useful risk analysis tool to evaluate the origin of epidemics.

Use of a risk assessment tool to determine the origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is contentious. Most studies have focused on a zoonotic origin, but definitive evidence such as an intermediary animal host is lacking. We used an established risk analysis tool for differentiating natural and unnatural epidemics, the modified Grunow-Finke assessment tool (mGFT) to study the origin of SARS-COV-2. The mGFT scores 11 criteria to provide a likelihood of natural or unnatural origin. Using published literature and publicly available sources of information, we applied the mGFT to the origin of SARS-CoV-2. The mGFT scored 41/60 points (68%), with high inter-rater reliability (100%), indicating a greater likelihood of an unnatural than natural origin of SARS-CoV-2. This risk assessment cannot prove the origin of SARS-CoV-2 but shows that the possibility of a laboratory origin cannot be easily dismissed.

Vedolizumab in the treatment of Crohn's disease: A promising therapeutic approach.

Crohn's disease (CD) is a chronic and debilitating inflammatory bowel disease that affects millions of individuals worldwide. Despite the availability of various treatment options, a significant number of patients do not achieve remission or experience adverse effects with conventional therapies. Vedolizumab, a novel therapeutic agent, has emerged as a promising approach in the management of CD. Despite improvements in treatment choices, there is still a demand for medicines that are efficient and well-tolerated. Vedolizumab, a monoclonal antibody targeting α4ß7 integrin, has emerged as a promising therapeutic approach for the treatment of CD. The review aims to provide a summary of vedolizumab, current treatment options, impact of vedolizumab on the patient's quality of life, mechanism of action, clinical effectiveness, safety and efficacy of vedolizumab, potential side effects or risks associated with vedolizumab therapy, and potential predictors. Furthermore, we investigate limitations and challenges associated with vedolizumab and possible future developments and medical implications. This review provides a comprehensive examination of the present data supporting vedolizumab as a possible treatment option for CD, highlighting its benefits and outlining prospective directions for future study and clinical practice improvement.

Assessment of the Zulfiqar Frailty Scale (ZFS) in Primary Healthcare.

INTRODUCTION: The primary aim of the study was to validate the Zulfiqar Frailty Scale (ZFS) and examine its concordance with the modified Short Emergency Geriatric Assessment (mSEGA) scale, Part A. METHODS: A prospective observational study was conducted in Guadeloupe (France) over a two-month duration (from 20 February to 20 April 2024), involving elderly individuals aged 65 and older, deemed self-sufficient with an ADL (Activities of Daily Living) score exceeding four out of six. RESULTS: Within this community cohort of 98 individuals, averaging 75 years in age, frailty according to the modified SEGA criteria was prevalent in 29%. Frailty according to the "ZFS" score was prevalent in 40%. Key predictors of frailty identified in our study included age, comorbidity (Charlson score), polypharmacy (total number of medications and therapeutic classes), and functional ability (ADL scores). Notably, experiences of falls and hospitalizations within the past six months significantly influenced the classification of frailty according to both ZFS and SEGA scales. Significant associations with the presence of home care aides (p < 0.0001), monopodal support test results (p < 0.0001), memory impairments (p < 0.0001), and recent hospitalizations (p = 0.0054) underscored the multidimensional impact of frailty. The Pearson correlation coefficient and its 95% confidence interval between the SEGA and Zulfiqar Frailty Scales stood at 0.73 [0.61: 0.81]. The discernment threshold for frailty was set at three out of six criteria, showcasing a sensitivity of 64% and a negative predictive value of 80%. The area under the curve (AUC) for the Zulfiqar Frailty Scale was reported as 0.8. CONCLUSION: The "ZFS" tool allows for the detection of frailty with a highly satisfactory sensitivity and negative predictive value.

Salt intake across the hypertension care cascade in the Bangladeshi adult population: a nationally representative cross-sectional study.

OBJECTIVES: This study aimed to examine the distribution of daily salt intake across the hypertension care cascade and assess the proportional distribution of these care cascade categories across various salt consumption level. DESIGN: A population-based national cross-sectional study. SETTINGS: Data from the Bangladesh STEPS 2018 survey were used, encompassing both urban and rural strata within all eight divisions. National estimates were generated from weighted data. PARTICIPANTS: A diverse population of 6754 men and women aged 18-69 years was included in the study. OUTCOME MEASURES: Daily salt consumption was estimated using the spot urine sodium concentration following Tanaka equation. Distribution of salt intake among different categories of hypertension care cascade, including hypertensives, aware of hypertension status, on treatment and under control, was assessed. RESULTS: Individuals with hypertension consume more salt on average (9.18 g/day, 95% CI 9.02 to 9.33) than those without hypertension (8.95 g/day, 95% CI 8.84 to 9.05) (p<0.02). No significant differences were found in salt intake when comparing aware versus unaware, treated versus untreated and controlled versus uncontrolled hypertension. In the overall population, 2.7% (95% CI 2.1% to 3.6%) of individuals without hypertension adhered to the recommended salt intake (<5 g/day) while 1.6% (95% CI 1.0% to 2.4%) with hypertension did so (p<0.03). Among individuals with hypertension, 2.4% (95% CI 1.4% to 4.0%) of those aware followed the guideline while only 0.8% (95% CI 0.4% to 1.9%) of those unaware adhered (p<0.03). Additionally, no significant differences were observed in adherence between the treated versus untreated and controlled versus uncontrolled hypertension. CONCLUSIONS: Individuals with hypertension consume significantly more salt than those without, with no significant variations in salt intake based on aware, treated and controlled hypertension. Adhering to WHO salt intake guidelines aids better blood pressure management. By addressing salt consumption across hypertension care cascade, substantial progress can be made in better blood pressure control.

[Diabetes and frailty in the elderly: a cross-sectional study of an outpatient population]. / Diabète et fragilité chez la personne âgée, étude transversale d'une population ambulatoire.

Screening for frailty syndrome, a marker of mortality risk, dependence, and institutionalization, is currently recommended in primary care to prevent its consequences effectively. Elderly diabetic individuals represent a significant and growing proportion of general practitioners' patient population, but their frailty status compared to the non-diabetic population is poorly understood. To study the relationship between diabetes and frailty in individuals aged 75 and older in general medicine. A total of 309 patients were included, among them 64 were diabetic patients, with a male/female ratio of 0.72. The proportion of frail elderly people was comparable between diabetics (24 %) and non-diabetics (27.6 %), as was the mean Fried score (1.78 vs. 1.56; not significant). Subgroup analysis revealed a significant difference in the risk of frailty, which was multiplied by 2.14 in diabetics without complications compared with non-diabetics, [95 % CI=2.03 to 2.25, p<2e(-16)]. Larger-scale studies at multiple outpatient sites should be conducted in general medicine among subjects aged over 75. Frailty management should be continued and carried out in patients whether they are diabetic or not.

[SEGA frailty scale in emergency: back to basics]. / Échelle de fragilité SEGA aux urgences : retour aux sources.

Can the SEGA scale, implemented in the emergency department, effectively predict morbidity and mortality? A prospective study was conducted from January 30, 2018, to July 16, 2018, at the Emergency Department of Chaumont Hospital. Patients aged over 65 were included, while those under 65, in palliative care, or in a life-threatening emergency were excluded. The SEGAm score was calculated for each included patient, and their outcomes were assessed at the end of the emergency department visit and one year later. A total of 278 subjects were included. Vital status at one year was known for all subjects, with no loss to follow-up or censoring. At one year, 56 patients out of 278 (20.1%, 95% CI 15.6% to 25.3%) had died, with less than half of these deaths (n = 25) occurring after readmission to the emergency department or during the emergency visit. The average age was 82 ± 8.2 years, with 158 women and 120 men. Regarding living arrangements, 130 (46.8%) lived at home without caregivers, 100 (36%) lived at home with caregivers, and 48 (17.3%) lived in nursing homes. The average Charlson Comorbidity Index was 5.49 ± 1.99, with an average number of medications of 7.52. The primary methods of referral were as follows: C15 for 144 patients (51.8%), general practitioner for 59 patients (21.2%), spontaneous consultation for 58 patients (20.9%), and family referral for 8 patients (2.9%). The main reasons for admission were falls for 55 patients (19.8%), dyspnea for 33 patients (11.9%), and other reasons for 60 patients (21.6%). Post-emergency department disposition included hospitalization for 167 patients (60.1%) and discharge for 111 patients (39.9%), with no deaths occurring during this period. The SEGAm frailty score (grid A) had an average completion time of 8.18 min ± 3.64. A score of ≤ 8 was found for 85 patients (30.6%), a score between 9 and 11 for 51 patients (18.3%), and a score ≥ 12 for 142 patients (51.1%). In this geriatric population, the risk of death at 12 months was estimated at 31% (95% CI 23.5% to 39.3%) for subjects with a SEGA score exceeding 12, compared to approximately 10% for those with lower SEGA scores. The risk of death or readmission was 52.8% (95% CI 44.3% to 61.2%) for subjects with a SEGA score exceeding 12, compared to 20% to 30% for those with lower SEGA scores. The SEGA score provides valuable prognostic information that is not fully captured by the Charlson score or reason for hospitalization.

Optimization and utilization of emerging waste (fly ash) for growth performance of chickpea (Cicer arietinum L.) plant and mitigation of root-knot nematode (Meloidogyne incognita) stress.

The sustainable management of large amounts of fly ash (FA) is a concern for researchers, and we aim to determine the FA application in plant development and nematicidal activity in the current study. A pot study is therefore performed to assess the effects of adding different, FA-concentrations to soil (w/w) on the infection of chickpea plants with the root-knot nematode Meloidogyne incognita. Sequence characteristic amplified region (SCAR) and internal transcribed spacer (ITS) region-based-markers were used to molecularly confirm M. incognita. With better plant growth and chickpea yield performance, FA enhanced the nutritious components of the soil. When compared with untreated, uninoculated control (UUC) plants, the inoculation of M. incognita dramatically reduced chickpea plant growth, yield biomass, and metabolism. The findings showed that the potential of FA to lessen the root-knot nematode illness in respect of galls, egg-masses, and reproductive attributes may be used to explain the mitigating effect of FA. Fascinatingly, compared with the untreated, inoculated control (UIC) plants, the FA treatment, primarily at 20%, considerably (p ≤ 0.05) boosted plant growth, yield biomass, and pigment content. Additionally, when the amounts of FA rose, the activity of antioxidants like superoxide dismutase-SOD, catalase-CAT, and peroxidase-POX as well as osmo-protectants like proline gradually increased. Therefore, our findings imply that 20% FA can be successfully applied as a potential strategy to increase biomass yield and plant growth while simultaneously reducing M. incognita infection in chickpea plants.

Prevalence of influenza and other acute respiratory illnesses in patients with acute myocardial infarction in Bangladesh: A cross-sectional study.

Background and Aims: Several studies imply that influenza and other respiratory illnesses could lead to acute myocardial infarction (AMI), but data from low-income countries are scarce. We investigated the prevalence of recent respiratory illnesses and confirmed influenza in AMI patients, while also exploring their relationship with infarction severity as defined by ST-elevation MI (STEMI) or high troponin levels. Methods: This cross-sectional study, held at a Dhaka tertiary hospital from May 2017 to October 2018, involved AMI inpatients. The study examined self-reported clinical respiratory illnesses (CRI) in the week before AMI onset and confirmed influenza using baseline real-time reverse transcription polymerase chain reaction (qRT-PCR). Results: Of 744 patients, 11.3% reported a recent CRI, most prominently during the 2017 influenza season (35.7%). qRT-PCR testing found evidence of influenza in 1.5% of 546 patients, with all positives among STEMI cases. Frequencies of CRI were higher in patients with STEMI and in those with high troponin levels, although these relationships were not statistically significant after adjusting for other variables. The risk of STEMI was significantly greater during influenza seasons in the unadjusted analysis (relative risk: 1.09, 95% confidence interval [CI]: 1.02-1.18), however, this relationship was not significant in the adjusted analysis (adjusted relative risk: 1.03, 95% CI: 0.91-1.16). Conclusion: In Bangladesh, many AMI patients had a recent respiratory illness history, with some showing evidence of influenza. However, these illnesses showed no significant relationship to AMI severity. Further research is needed to understand these relationships better and to investigate the potential benefits of infection control measures and influenza vaccinations in reducing AMI incidence.

Factors Influencing Prostate Cancer Screening Intentions in Lebanese Men.

OBJECTIVE: The objective of this study is to investigate the perceived obstacles and willingness of Lebanese men aged 40 and above to undergo screening for prostate cancer. MATERIAL AND METHOD: A cross-sectional research design was employed. The study utilized a survey questionnaire to collect data on various factors influencing screening behaviors. The research instrument consisted of a comprehensive survey questionnaire that incorporated validated scales to assess barriers to prostate cancer screening, intention to screen, and the International Prostate Symptom Score (IPSS). RESULTS: The study found that the 120 participants had an average IPSS score of 7.20 ± 2.23, most people (70%) had mild symptoms of prostate cancer, whereas others had moderate (20%) or severe symptoms (10%). The majority of the men indicated a low to moderate inclination to undergo screening through Prostate-specific antigen testing, or digital rectal examination (DRE) (PSA), with 76% considering DRE and 70% considering PSA. The main barriers to screening included the dread of receiving distressing outcomes (48%) and a lack of understanding about the screening procedure (54%). The study identified key factors affecting the intention to undergo a prostate cancer screening. Regarding DREs, these factors included the perceived danger of the illness and prior information from doctors about prostate conditions. When it came to the intention to undergo screening through the prostate-specific antigen test (PSA), determinants included the perceived threat of the disease, one's general health perception, and prior information from doctors about prostate-related issues. Additionally, a significant proportion of participants believed that prostate cancer was not a serious illness (56%) and 57% thought DRE was embarrassing. CONCLUSIONS: The participants displayed a low willingness to get screened for prostate cancer. Implementing interventions that focus on increasing awareness of the disease and its associated risks could potentially reduce the barriers and boost participation in prostate cancer screening.

Analyzing Depressive Symptoms Among Elderly Cancer Patients: A Comprehensive Examination of Demographic and Medical Correlates.

OBJECTIVE: This study aimed to explore the relationship between depressive symptoms and demographic as well as health-related variables in elderly individuals diagnosed with cancer. METHODS: A cohort of 50 elderly cancer patients participated in the study. Data collection involved the completion of surveys and assessments encompassing demographic characteristics, medical profiles, levels of depression, cognitive functioning, activities of daily living, and perceived social support. RESULTS: Findings revealed that among the elderly participants, 45% experienced mild depression, 20% exhibited moderate depression, and 5% showed severe depression. Depression levels were found to be linked to marital status (P = 0.03), with widowed individuals reporting the highest depression rates (80%) and single individuals reporting the lowest (4%). Living arrangements were significantly associated with depression (P = 0.012), with participants cohabiting with their partner and children showing lower depression rates (6%) compared to those living solely with their children (40%). Additionally, depression showed a significant correlation with income (P = 0.01), as individuals reporting insufficient income for living expenses displayed higher levels of depression (58%). Furthermore, depression was notably linked to chronic health conditions like diabetes and respiratory ailments (P = .023), with individuals grappling with respiratory issues reporting the highest depression scores. CONCLUSION: Recognizing and addressing factors such as marital status, living situation, income level, and the presence of chronic illnesses hold the potential for healthcare professionals to tailor interventions effectively to meet the specific requirements of this vulnerable demographic. This tailored approach has the capability to contribute significantly to enhancing the overall well-being and mental health outcomes of elderly cancer patients.

Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial.

BACKGROUND: The World Health Organization (WHO) promotes the HEARTS technical package for improving hypertension control worldwide, but its effectiveness has not been rigorously evaluated. OBJECTIVE: To compare hypertension outcomes in clinics implementing HEARTS versus clinics continuing usual hypertension care in rural Bangladesh. METHODS: A matched-pair cluster quasi-experimental trial in Upazila Health Complexes (UHCs; primary healthcare facilities) was conducted in rural Bangladesh. A total of 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure (BP) ≥140/90 mm Hg regardless of treatment history) were enrolled: 1950 patients from 7 HEARTS UHCs and 1985 patients from 7 matched usual care UHCs. The primary outcome was systolic BP at 6 months measured at the patient's home; secondary outcomes were diastolic BP, hypertension control rate (<140/90 mm Hg) and loss to follow-up. Multivariable mixed-effects linear and Poisson models were conducted. RESULTS: Baseline mean systolic BP was 158.4 mm Hg in the intervention group and 158.8 mm Hg in the usual care group. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention significantly lowered systolic BP (-23.7 mm Hg vs -20.0 mm Hg; net difference -3.7 mm Hg (95% CI -5.1 to -2.2)) and diastolic BP (-10.2 mm Hg vs -8.3 mm Hg; net difference -1.9 mm Hg (95% CI -2.7 to -1.1)) and improved hypertension control (62.0% vs 49.7%, net difference 12.3% (95% CI 9.0 to 16.8)). Rate of missed clinic visits was lower in the intervention group (8.8% vs 39.3%, p<0.001). CONCLUSIONS: After WHO-HEARTS package implementation in rural Bangladesh, BP was lowered and hypertension control improved significantly compared with usual care. TRIAL REGISTRATION NUMBER: NCT04992039.

Hemofilia adquirida como manifestación inicial de recidiva de adenocarcinoma colorrectal / Acquired hemophilia as the initial manifestation of colorectal cancer's recurrence

Resumen Presentamos el caso de un varón de 86 años con un hematoma espontáneo en el músculo ilíaco izquierdo y diagnóstico previo de cáncer de colon en 1998 (estadio pT3N0M0), tratado quirúrgicamente mediante colectomía transversal, considerado en remisión completa. Tras realización de estudios complementarios se demostró la presencia de autoanticuerpos inhibidores del Factor VIII que confirmaron el diagnóstico de hemofilia adquirida. Durante el ingreso el paciente presentó un sangrado digestivo bajo que conllevó al descubrimiento de recidiva del adenocarcinoma colorrectal tratado previamente. Respondió de forma favorable a la terapia inicial con corticoides sistémicos y el complejo coagulante anti inhibidor que incluye el Factor VII activado [FEIBA].

Abstract We report the case of an 86-year-old man presenting with a spontaneous hematoma in the left iliac muscle and previous diagnosis of colon cancer in 1998 (stage pT3N0M0) treated with transverse colectomy and considered in complete remission. After a complete study, it was possible to identify the presence of Factor VIII inhibitors antibodies that confirmed the presence of acquired hemophilia. During hospitalization the patient presented a lower gastrointestinal bleeding leading to the diagnosis of recurrence of a previously treated colorectal adenocarcinoma. He responded to initial therapy with systemic corticoids and anti-inhibitory coagulant complex which includes activated VII Factor [FEIBA].

Hipervitaminosis B12: Nuestra experiencia y una revisión / Hypervitaminosis B12. Our experience and a review

Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.