Comparison of the risk for dementia between physicians and the general population: a nationwide population-based cohort study.

BACKGROUND: Physicians have better medical knowledge, which may decrease the risk of dementia; however, this issue remains unclear. This study was performed to clarify it. METHODS: We conducted a nationwide population-based study that recruited 29,388 physicians, 50,000 participants from the general population, and 30,446 other healthcare professionals (HCPs; excluding physicians) for this study. The prevalence of dementia was compared among the three groups and physician subgroups by tracing their medical histories from 2006 to 2012. RESULTS: Physicians had a lower prevalence of dementia than the general population after adjusting for age, sex, head trauma, hypothyroidism, hypertension, diabetes mellitus, stroke, vascular disease, atrial fibrillation, hypercholesterolemia, depression, and alcoholism [adjusted odds ratio (AOR) 0.56; 95% confidence interval (CI) 0.47-0.67]. Other HCPs also had a lower prevalence for dementia than the general population (AOR 0.46; 95% CI 0.36-0.60). Compared with other HCPs, physicians had no difference in the prevalence for dementia (AOR 0.98 95% CI 0.71-1.36). Physicians who were older, specialized in pediatrics and worked at local hospitals and clinics had a higher prevalence for dementia than their counterparts did. CONCLUSIONS: Physicians had a lower prevalence for dementia than the general population. The prevalence for dementia in specific subgroups of physicians was higher, which needs to be clarified by further studies.

An overview of occupational noise-induced hearing loss among workers: epidemiology, pathogenesis, and preventive measures.

Occupational noise-induced hearing loss (ONIHL) is the most prevalent occupational disease in the world. The goal of this study was to review the epidemiology, pathogenesis, and preventive measures of ONIHL among workers and provide evidence for the implementation of control measures. Literature studies were identified from the MEDLINE, PubMed, Embase, Web of Science, and Google Scholar using the search terms "noise-induced hearing loss" "prevalence", "pathogenesis", and "preventive measures". The articles reviewed in this report were limited from 2000 to 2020. Articles that were not published in the English language, manuscripts without an abstract, and opinion articles were excluded. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the current status of ONIHL among workers. The mechanism of ONIHL among workers is a complex interaction between environmental and host factors (both genetic and acquired factors). The outcomes of noise exposure are different among individual subjects. Clinical trials are currently underway to evaluate the treatment effect of antioxidants on ONIHL. Noise exposure may contribute to temporary or permanent threshold shifts; however, even temporary threshold shifts may predispose an individual to eventual permanent hearing loss. Noise prevention programs are an important preventive measure in reducing the morbidity of ONIHL among workers.

Exposure Duration and History of Hypertension Predicted Neurological Sequelae in Patients with Carbon Monoxide Poisoning.

BACKGROUND: Carbon monoxide poisoning (COP) accounts for a large number of emergency department visits worldwide and is fatal in many cases. In surviving patients, neurological sequelae (NS) attributable to cerebral hypoxia are the most devastating outcome, but reliable predictors are limited. Therefore, we conducted a study to identify predictors of NS in patients with COP and evaluate their effects. METHODS: In this retrospective case-control study, we identified patients with COP in a medical center in Southern Taiwan between January 2005 and December 2014. Cases were patients with NS, and controls were patients without NS. We obtained information on potential predictors of NS from medical records and evaluated their association with NS, including demographic characteristics, exposure source, suicide attempts, duration of exposure (by tertile), histories, symptoms, signs, laboratory data, treatment, and the length of hospital stay. RESULTS: We included 371 patients with COP. Of them, 93 developed NS, and their mean ages (41.4 ± 14.7 years vs. 39.7 ± 14.2 years) and proportions of males (59.1% vs. 58.6%) were similar to those in the 298 controls. Multivariate logistic regression showed that a history of hypertension (adjusted odds ratio = 2.1; 95% confidence interval = 1.0, 4.5) and a longer duration of carbon monoxide exposure (adjusted odds ratio = 1.7; 95% confidence interval = 1.1, 2.8; the longest tertile [>5 hours] vs. the other two tertiles [≤5 hours]) were independent predictors for NS, but not the level of carboxyhemoglobin. CONCLUSIONS: This study identified two independent predictors for NS that may be useful for public healthcare workers and physicians in predicting outcomes and deciding on treatment strategies for COP patients.

Risk for cervical herniated intervertebral disc in dentists: a nationwide population-based study.

BACKGROUND: Prolonged static postures (PSPs) may predispose dentists to develop cervical herniated intervertebral disc (C-HIVD); however, there is limited evidence supporting this in the literature thus far. We conducted this study to fit the data gap. METHODS: We conducted a retrospective nationwide population-based study using the Taiwan National Health Insurance Research Database to identify 10,930 dentists, an identical number of age- and sex-matched participants from the general population, and 73,718 other health care providers (HCPs, non-dentists). Comparisons for the risk of developing C-HIVD between dentists and the general population, and between dentists and other HCPs were performed by tracing their medical histories between 2007 and 2011. RESULTS: Dentists had a cumulative incidence rate of 1.1% for C-HIVD during the 5-year follow-up period. Overall, there was no difference of the risk for C-HIVD between dentists and the general population after adjusting for hypertension, hyperlipidemia, liver disease, mental disorders, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, malignancy, stroke, and renal disease (adjusted odds ratio [AOR]: 1.2, 95% confidence interval [CI]: 0.9-1.6). However, stratified analysis showed that younger dentists (≤ 34 years) had a trend of higher risk for C-HIVD than members of the younger general population (AOR: 1.9, 95% CI: 0.9-4.1). There was no difference found between dentists and other HCPs (AOR: 0.9, 95% CI: 0.8-1.1). CONCLUSION: Younger dentists had a trend of higher risk of developing C-HIVD than members of the general population.

The Risk of Stroke in Physicians: A Population-based Cohort Study in Taiwan.

BACKGROUND: Physicians in Taiwan work in stressful workplaces and have heavy workloads, both of which may contribute to the occurrence of a stroke. However, it is not clear whether they have a higher risk of stroke. Therefore, we conducted a population-based cohort study to compare the risks of stroke between physicians and the general population and among subgroups of physicians in Taiwan. METHODS: In the National Health Insurance Research Database of Taiwan, we identified 28,062 physicians and selected 84,186 age- and sex-matched nonmedical staff beneficiaries as the references. Using conditional logistic regression, we compared the prevalence of stroke between physicians and references. In addition, we made comparisons among subgroup of physicians defined by age, sex, comorbidity, specialty, and the level of hospital. RESULTS: During the study period, physicians had higher prevalence rates of hypertension (23.6% vs. 19.1%), hyperlipidemia (21.4% vs. 12.9%), and coronary artery disease (CAD) (6.4% vs. 5.7%) than the referent group, but they had a lower risk of stroke with an odds ratio of 0.61 (95% confidence interval = 0.55, 0.66) after adjusting for hypertension, diabetes, hyperlipidemia, CAD, and active worker. Among physicians, the risks were higher in those who were older or had hypertension, diabetes, hyperlipidemia, or CAD. CONCLUSIONS: Despite having higher prevalence rates of hypertension, hyperlipidemia, and CAD and working in stressful workplaces with heavy workloads, our study suggests that physicians in Taiwan have a lower risk of stroke compared with the general population. These results may indicate the benefits of higher awareness and more knowledge of diseases.

Standing Posture at Work Does Not Increase the Risk of Varicose Veins among Health Care Providers in Taiwan.

OBJECTIVE: This study compared the risk of varicose veins (VV) among physicians, nonphysician health care providers (HCP), and the general population. SUBJECTS AND METHODS: The Taiwan National Health Insurance Research Database was used to identify 28,844 physicians and 26,099 nonphysician HCP and an identical number of age- and sex-matched patients from the general population. Using logistic regression analyses, VV risks between physicians and the general population, nonphysician HCP and the general population, and physicians and nonphysician HCP, and among physician specialists were compared by tracing their medical histories between 2007 and 2011. RESULTS: Physicians and nonphysician HCP had cumulative VV incidences of 0.12% (34/28,844) and 0.13% (33/26,099), respectively, during the 5-year period, compared to that of the general population within the same 5-year period. Physicians and nonphysician HCP did not have a higher VV risk than the general population after adjusting for deep vein thrombosis (DVT) history (adjusted odds ratio [AOR] 0.86; 95% confidence interval [CI] 0.53-1.40, and AOR 1.43; 95% CI 0.82-2.50, respectively). Physicians did not a have higher VV risk than nonphysician HCP (AOR 0.80; 95% CI 0.43-1.51) after adjusting for age, sex, and DVT history. Surgery had the highest incidence (0.22%) while pediatrics and emergency medicine had the lowest incidence (0%) of VV risk among physician specialists; however, the difference was not significant (all p values >0.05). CONCLUSION: In this study, VV risk did not differ among physicians, nonphysician HCP, and the general population.

Urolithiasis risk: a comparison between healthcare providers and the general population.

BACKGROUND: Healthcare providers have many health-related risk factors that might contribute to urolithiasis: a heavy workload, a stressful workplace, and an unhealthy quality of life. However, the urolithiasis risk in healthcare providers is not clear. METHODS: Using Taiwan's National Health Insurance Research Database, we identified 50,226 physicians, 20,677 pharmacists, 122,357 nurses, and 25,059 other healthcare providers as the study cohort and then randomly selected an identical number of patients who are not healthcare providers (general population) as the comparison cohort for this study. Conditional logistical regression analysis was used to compare the urolithiasis risk between healthcare providers and comparisons. Physician specialty subgroups were also analyzed. RESULTS: Physicians had a lower urolithiasis risk than did the general population (adjusted odds ratio [AOR]: 0.682; 95 % confidence interval [CI]: 0.634-0.732) and other healthcare providers (AOR: 0.661; 95 % CI 0.588-0.742) after adjusting for hypertension, diabetes, hyperlipidemia, coronary artery disease, and residence location. For pharmacists, nurses, and other healthcare providers, the urolithiasis risk was not significantly different than that for general population. Subgroup analysis showed that surgeons and family medicine physicians had a lower urolithiasis risk than did physician comparisons (AOR: 0.778; 95 % CI: 0.630-0.962 and AOR: 0.737; 95 % CI: 0.564-0.962, respectively). CONCLUSIONS: Although job stress and heavy workloads affect physicians' health, physicians had a lower urolithiasis risk than did the general population and other healthcare providers. This might be attributable to their greater medical knowledge and access to healthcare. Our findings provide useful information for public health policy makers about the disease risks of healthcare providers.

Higher migraine risk in healthcare professionals than in general population: a nationwide population-based cohort study in Taiwan.

BACKGROUND: High stress levels and shift work probably trigger migraine in healthcare professionals (HCPs). However, the migraine risk differences between HCPs and the general population is unknown. METHODS: This nationwide population-based cohort study used Taiwan's National Health Insurance Research Database. Physicians (50,226), nurses (122,357), and other HCPs (pharmacists, technicians, dietitians, rehabilitation therapists, social workers, etc.) (45,736) were enrolled for the study cohort, and randomly selected non-HCPs (218,319) were enrolled for the comparison cohort. Conditional logistical regression analysis was used to compare the migraine risks. Comparisons between HCPs and between physician specialties were also done. RESULTS: Physicians, nurses, and other HCPs had higher migraine risks than did the general population (adjusted odds ratio [AOR]: 1.672; 95 % confidence interval [CI]: 1.468-1.905, AOR: 1.621; 95 % CI: 1.532-1.714, and AOR: 1.254; 95 % CI: 1.124-1.399, respectively) after stroke, hypertension, epilepsy, anxiety, depression, and insomnia had been adjusted for. Nurses and physicians had higher migraine risks than did other HCPs (AOR: 1.303; 95 % CI: 1.206-1.408, and AOR: 1.193; 95 % CI: 1.069-1.332, respectively). Obstetricians and gynecologists had a lower migraine risk than did other physician specialists (AOR: 0.550; 95 % CI: 0.323-0.937). CONCLUSION: HCPs in Taiwan had a higher migraine risk than did the general population. Heavy workloads, emotional stress, and rotating night shift sleep disturbances appear to be the most important risk factors. These findings should provide an important reference for promoting occupational health in HCPs in Taiwan.

Changing Incidence and Characteristics of Photokeratoconjunctivitis During the COVID-19 Pandemic.

Introduction: Photokeratoconjunctivitis (PKC) is primarily caused by welding. However, inappropriate use of germicidal lamps, which have been widely used following the COVID-19 outbreak, can also cause PKC. Our goal in this study was to investigate the incidence of and changes in the causes of PKC during the coronavirus 2019 (COVID-19) pandemic. Methods: We conducted a single-center, retrospective observational study. The health records of patients who visited the emergency department in a tertiary care hospital from January 1, 2018-December 31, 2021 and were diagnosed with PKC, were reviewed. We then conducted an analysis to compare the characteristics of PKC before and after COVID-19 began and the features of PKC caused by welding and germicidal lamps. Results: There were 160 PKC cases with a clear etiology before the COVID-19 pandemic and 147 cases during the COVID-19 pandemic. No significant differences in age and gender were detected between the two groups. The incidence of PKC induced by the use of germicidal lamps during the COVID-19 pandemic was significantly higher (10.2%) than the incidence before the pandemic (3.1%). The ratio of females to males in the germicidal lamp subgroup was significantly higher than the ratio in the welding subgroup. Limitations included incomplete information due to the retrospective nature of the study, underestimation of incidence, and possible recall bias. Conclusion: In the era of COVID-19, clinicians should be aware of the hazards of germicidal lamps. Although the COVID-19 pandemic seems to show signs of easing, new infectious diseases that require protective measures could still emerge in the future. Therefore, injuries related to germicidal lamps deserve more public health attention.

Heat-related illness and dementia: a study integrating epidemiological and experimental evidence.

BACKGROUND: Heat-related illness (HRI) is commonly considered an acute condition, and its potential long-term consequences are not well understood. We conducted a population-based cohort study and an animal experiment to evaluate whether HRI is associated with dementia later in life. METHODS: The Taiwan National Health Insurance Research Database was used in the epidemiological study. We identified newly diagnosed HRI patients between 2001 and 2015, but excluded those with any pre-existing dementia, as the study cohort. Through matching by age, sex, and the index date with the study cohort, we selected individuals without HRI and without any pre-existing dementia as a comparison cohort at a 1:4 ratio. We followed each cohort member until the end of 2018 and compared the risk between the two cohorts using Cox proportional hazards regression models. In the animal experiment, we used a rat model to assess cognitive functions and the histopathological changes in the hippocampus after a heat stroke event. RESULTS: In the epidemiological study, the study cohort consisted of 70,721 HRI patients and the comparison cohort consisted of 282,884 individuals without HRI. After adjusting for potential confounders, the HRI patients had a higher risk of dementia (adjusted hazard ratio [AHR] = 1.24; 95% confidence interval [CI]: 1.19-1.29). Patients with heat stroke had a higher risk of dementia compared with individuals without HRI (AHR = 1.26; 95% CI: 1.18-1.34). In the animal experiment, we found cognitive dysfunction evidenced by animal behavioral tests and observed remarkable neuronal damage, degeneration, apoptosis, and amyloid plaque deposition in the hippocampus after a heat stroke event. CONCLUSIONS: Our epidemiological study indicated that HRI elevated the risk of dementia. This finding was substantiated by the histopathological features observed in the hippocampus, along with the cognitive impairments detected, in the experimental heat stroke rat model.

Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care.

BACKGROUND: We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups. METHODS: This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets-the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint. RESULTS: We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits (25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set. CONCLUSIONS: The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises.

Anticancer Therapy and Mortality of Adult Patients with Hematologic Malignancy and COVID-19: A Systematic Review and Meta-Analysis.

Coronavirus disease 2019 (COVID-19) might affect cancer treatment outcomes. This systematic review and meta-analysis identified the prognostic predictors of adult patients with hematologic malignancies and COVID-19, and evaluated the effect of anticancer therapy on mortality. We performed a literature search of electronic databases and identified additional studies from the bibliographies of the articles that were retrieved. Two investigators independently extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. We evaluated study quality using the Newcastle-Ottawa Scale and performed a meta-analyses in order to evaluate the effect of anticancer therapy on mortality among adult patients with hematologic malignancies and COVID-19. Heterogeneity was assessed with the I2 statistic. The meta-analysis included 12 studies. The overall mortality rate was 36.3%. The pooled risk difference (RD) in mortality between patients receiving and not receiving anticancer therapy was 0.14 (95% confidence interval [CI]: 0.02-0.26; I2 = 76%). The pooled RD in mortality associated with chemotherapy was 0.22 (95% CI: 0.05-0.39; I2 = 48%), and with immunosuppression was 0.20 (95% CI: 0.05-0.34; I2 = 67%). In the subgroup analyses, anticancer-therapy-associated mortality was higher in females (RD = 0.57; 95% CI: 0.29-0.85; I2 = 0%) than in males (RD = 0.28; 95% CI: 0.04-0.52; I2 = 0%). Among patients with hematologic malignancies and COVID-19, those receiving anticancer therapy had a higher mortality risk, regardless of sex. The mortality risk was higher in females than in males. These results indicate that caution should be exercised when administering anticancer therapy to patients with hematologic malignancies and COVID-19.

Using Real-Time PCR Fluorescence Reaction Values to Improve SARS-CoV-2 Virus Detection and Benefit Clinical Decision-Making.

This study aimed to compare the SARS-CoV-2 nucleic acid detection results of the BD MAX™ System and other platforms to formulate an optimized laboratory verification process. The re-examination of 400 samples determined as positive by BD MAX™ indicated that the inconsistency rate between BD MAX™ and the other platforms was 65.8%; the inconsistency rate of single-gene-positive results was as high as 99.2%. A receiver operating characteristic curve was drawn for the relative light unit (RLU) values of samples positive for a single gene, and RLU 800 was used as the cutoff. After setting the retest standard as single-gene positive and RLU ≥ 800, the number of the 260 BD MAX™ single-gene positives that needed to be confirmed again was 36 (13.8%) and the number that could be directly reported as negative was 224 (86.2%). This verification process can shorten the reporting period and speed up the epidemic adjustment time and turnover rate of special wards, thereby improving SARS-CoV-2 detection efficiency and clinical decision-making.

Patients with Hepatitis C Undergoing Direct-Acting Antiviral Treatment Have a Lower SARS-CoV-2 Infection Rate.

This study retrospectively analyzed the medical records of 602 patients with first-time positive results for the HCV nucleic acid test between 1 May 2021 and 31 March 2023, exploring the association between DAA treatment and SARS-CoV-2 infection. The results showed that 9.8% of HCV patients were co-infected with SARS-CoV-2. Gender, age, vaccination status, and HCV genotype did not significantly affect SARS-CoV-2 infection. However, patients undergoing DAA treatment showed significantly lower rates of SARS-CoV-2 infection and mortality compared to those not undergoing DAA treatment. The analysis also compared patients undergoing different DAA treatments, with Epclusa and Maviret showing superior protection against SARS-CoV-2. Furthermore, this study explored the severity and mortality of SARS-CoV-2 infection in patients undergoing and having completed DAA treatment. It revealed that patients diagnosed with COVID-19 during DAA treatment experienced only mild symptoms, and none died, suggesting a potential protective effect of DAA treatment against severe outcomes of SARS-CoV-2 infection. The findings contribute to the understanding of the interplay between HCV, DAA treatment, and SARS-CoV-2 infection, highlighting the need for continued monitoring and healthcare measures for individuals with chronic conditions during the ongoing COVID-19 pandemic.

Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire.

BACKGROUND: Previous studies that compared the postoperative health-related quality of life (HRQoL) outcomes after receiving laparoscopic resection (LR) or open resection (OR) in patients with colorectal cancer (CRC) have different conclusions. AIM: To explore the medium-term effect of postoperative HRQoL in such patients. METHODS: This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups. HRQoL was assessed during the preoperative period and 3, 6, and 12 mo postoperative using a modified version of the 36-Item Short Form (SF-36) Health Survey questionnaire, emphasizing eight specific items. RESULTS: This cohort randomly assigned 541 patients to receive LR (n = 296) or OR (n = 245) surgical procedures. More episodes of postoperative urinary tract infection (P < 0.001), wound infection (P < 0.001), and pneumonia (P = 0.048) were encountered in the OR group. The results demonstrated that the LR group subjectively gained mildly better general health (P = 0.045), moderately better physical activity (P = 0.006), and significantly better social function recovery (P = 0.0001) 3 mo postoperatively. Only the aspect of social function recovery was claimed at 6 mo, with a significant advantage in the LR group (P = 0.001). No clinical difference was found in HRQoL during the 12 mo. CONCLUSION: Our results demonstrated that LR resulted in better outcomes, including intra-operative blood loss, surgery-related complications, course of recovery, and especially some health domains of HRQoL at least within 6 mo postoperatively. Patients should undergo LR if there is no contraindication.

Intermediate bioelectrolyte changes after phospho-soda or polyethylene glycol precolonoscopic laxatives in a population undergoing health examinations.

BACKGROUND: Colonoscopy is a common procedure for diagnosing and screening colon cancer and other bowel-related diseases. Many studies have pointed out that using phospho-soda as a bowel preparation can cause obvious electrolyte abnormalities or acute kidney injury. Nonetheless, there are few studies related to its prevalence and risk factors in the population undergoing health examinations. Our aim was to compare the biochemical and electrolyte changes after using two commonly used bowel preparation regimens in this population. METHODS: In this retrospective study, we collected data about participants who, before a screening colonoscopy, used oral phospho-soda laxatives in 2006, and those who used polyethylene glycol-based laxatives in 2005. Several serum biochemical and electrolyte profiles were compared between the two groups. Additional risk factors of hyperphosphatemia, a well-known side effect of phospho-soda, were also derived. RESULTS: We enrolled a total of 2270 participants (1321 in 2005; 1449 in 2006). The basic demographic data of the two groups were not statistically different. Nonetheless, between the two groups, some serum biochemical and electrolytic data differed significantly: in those using oral phospho-soda laxatives, we found a higher prevalence of hyperuricemia, hypocalcemia, hypokalemia, hypernatremia and hyperphosphatemia. Further analyses showed that using oral phospho-soda laxatives was a risk factor for hyperphosphatemia; conversely, being male was a protective factor. CONCLUSION: Oral phospho-soda laxatives indeed influence the biochemical and electrolyte profiles of persons undergoing health examinations. One should be careful when interpreting bioelectrolytic data while using phospho-soda as a bowel preparation.

Effects of Extract from Solid-State Fermented Cordyceps sinensis on Type 2 Diabetes Mellitus.

Diabetes mellitus is the most common chronic disease in the world, and a wide range of drugs, including Chinese herbs, have been evaluated for the treatment of associated metabolic disorders. This study investigated the potential hypoglycemic and renoprotective effects of an extract from the solid-state fermented mycelium of Cordyceps sinensis (CS). We employed the KK/HIJ diabetic mouse model, in which the mice were provided with a high-fat diet for 8 weeks to induce hyperglycemia, followed by the administration of CS or rosiglitazone for 4 consecutive weeks. Several parameters were evaluated, including changes in body weight, plasma lipid profiles, oral glucose tolerance tests, insulin tolerance tests, and plasma insulin concentrations. Our results show that the CS extract significantly elevated HDL/LDL ratios at 4 weeks and decreased body weight gain at 8 weeks. Interestingly, CS treatment did not lead to obvious improvements in hyperglycemia or resistance to insulin, while in vitro MTT assays indicated that CS protects pancreatic beta cells against the toxic effects of STZ. CS also enhanced renal NKA activity and reduced the accumulation of mesangial matrix and collagen deposition. In conclusion, CS extract can potentially preserve ß-cell function and offer renoprotection, which may afford a promising therapy for DM.

An overview of gastrointestinal diseases in patients with COVID-19: A narrative review.

Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has emerged as a global health concern. This study aimed to review the epidemiology and pathophysiology of COVID-19 and provide evidence for the implementation of control measures. We utilized several online databases, including MEDLINE (National Library of Medicine, Bethesda, Maryland, USA), PubMed, EMBASE, Web of Science, and Google Scholar, to collect relevant published papers using a combination of the following keywords: "COVID-19," "SARS-CoV-2," "novel coronavirus," "epidemiology," and "pathophysiology." The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this study. Globally, approximately 3-46% of patients with SARS-CoV-2 infection experience gastrointestinal symptoms. The clinical spectrum of COVID-19 is wide, ranging from mild to severe, and even fatal. COVID-19 was initially reported as a respiratory tract disease; however, gastrointestinal symptoms have only recently been reported. COVID-19 Patients with gastrointestinal symptoms may have more severe clinical manifestations and poor prognosis. This study highlights the need to better understand the mechanisms involved in the development of gastrointestinal symptoms in patients with COVID-19 to prevent the further spread of this pathogen.

Leprosy: A Review of Epidemiology, Clinical Diagnosis, and Management.

Leprosy is a neglected infectious disease caused by acid-fast bacillus Mycobacterium leprae. It primarily affects the skin and then progresses to a secondary stage, causing peripheral neuropathy with potential long-term disability along with stigma. Leprosy patients account for a significant proportion of the global disease burden. Previous efforts to improve diagnostic and therapeutic techniques have focused on leprosy in adults, whereas childhood leprosy has been relatively neglected. This review aims to update the diagnostic and therapeutic recommendations for adult and childhood leprosy. This review summarizes the clinical, bacteriological, and immunological approaches used in the diagnosis of leprosy. As strategies for the diagnosis and management of leprosy continue to develop better and more advanced knowledge, control and prevention of leprosy are crucial.

An app to classify a 5-year survival in patients with breast cancer using the convolutional neural networks (CNN) in Microsoft Excel: Development and usability study.

BACKGROUND: Breast cancer (BC) is the most common malignant cancer in women. A predictive model is required to predict the 5-year survival in patients with BC (5YSPBC) and improve the treatment quality by increasing their survival rate. However, no reports in literature about apps developed and designed in medical practice to classify the 5YSPBC. This study aimed to build a model to develop an app for an automatically accurate classification of the 5YSPBC. METHODS: A total of 1810 patients with BC were recruited in a hospital in Taiwan from the secondary data with codes on 53 characteristic variables that were endorsed by professional staff clerks as of December 31, 2019. Five models (i.e., revolution neural network [CNN], artificial neural network, Naïve Bayes, K-nearest Neighbors Algorithm, and Logistic regression) and 3 tasks (i.e., extraction of feature variables, model comparison in accuracy [ACC] and stability, and app development) were performed to achieve the goal of developing an app to predict the 5YSPBC. The sensitivity, specificity, and receiver operating characteristic curve (area under ROC curve) on models across 2 scenarios of training (70%) and testing (30%) sets were compared. An app predicting the 5YSPBC was developed involving the model estimated parameters for a website assessment. RESULTS: We observed that the 15-variable CNN model yields higher ACC rates (0.87 and 0.86) with area under ROC curves of 0.80 and 0.78 (95% confidence interval 0.78-82 and 0.74-81) based on 1357 training and 540 testing cases an available app for patients predicting the 5YSPBC was successfully developed and demonstrated in this study. CONCLUSION: The 15-variable CNN model with 38 parameters estimated using CNN for improving the ACC of the 5YSPBC has been particularly demonstrated in Microsoft Excel. An app developed for helping clinicians assess the 5YSPBC in clinical settings is required for application in the future.