The role of vitamin D against COVID-19 infection, progression and severity.

BACKGROUND: The number of coronavirus disease-19 (COVID-19) positive patients and fatalities keeps rising. It is important to recognize risk factors for severe outcomes. Evidence linking vitamin D deficiency and the severity of COVID-19 is tangential but substantial - relating to race, obesity, and institutionalization. OBJECTIVE: This study aims to examine the function of vitamin D and nutritional defense against infections such as COVID-19, which is the goal of this research. METHODS: This study includes observational cohort, cross-sectional, and case-control studies that estimated variances in serum levels of vitamin D among patients with mild or severe forms of COVID-19, and in patients who died or were discharged from hospitals. Studies that assessed the risk of developing severe disorder or death in patients with vitamin D deficiency, defined as levels of vitamin D< 20 ng/mL, were also encompassed. RESULTS: In a retrospective study on 464,383 individuals, results showed that individuals who had the highest risks for severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection, and for COVID-19 severity when infected, had vitamin D levels < 30 nmol/L; Odds Ratio (OR) were 1.246 [95% Confidence Interval (CI): 1.210-1.304] and 1.513 [95%CI: 1.230-1.861], respectively. Additionally, in a retrospective observational study of 191,779 individuals in the USA. The SARS-CoV-2 positivity rate was greater in the 39,190 subjects with vitamin D < 20 ng/mL [12.5%, 95% C.I. 12.2-12.8%] than in the 27,870 subjects with sufficient serum vitamin D levels [8.1%, 95% C.I. 7.8-8.4%] and in the 12,321 subjects with serum vitamin D ⩾ 55 ng/mL [5.9%, 95% C.I. 5.5-6.4%]. CONCLUSION: People hospitalized for COVID-19 should be checked for vitamin D status and supplemented, and high-dose-in testing should be considered in the recovery trial. More importantly, screening for malnutrition and the administration of the best nutritional supplements are essential for the immune system of the human body to function as it should be. Thus, nutritional supplementation is crucial for people with risk factors as well as older adults with compromised immune systems.

Eye Plaque Brachytherapy for Choroidal Malignant Melanoma: A Case Report on the Use of Innovative Technology to Expand Access, Improve Practice, and Enhance Outcomes.

Our institute established an eye plaque interstitial brachytherapy (EPIBT) program in 2007 using the Collaborative Ocular Melanoma Study (COMS) eye plaque. In this case report, we demonstrated an eye plaque treatment planned and executed using Eye Physics Plaque (Los Alamitos, CA) for a 72-year-old male patient with an extra-large tumor with a maximum width of 18.6 mm and height of 13.7 mm. The use of a customized eye plaque, manufactured through three-dimensional (3D) printing, has empowered us to plan and administer treatment for this patient with uveal melanoma. Without this option, enucleation, an option declined by the patient, or proton beam therapy (PBT), which the patient was unwilling to pursue in another state, would have been the alternative course of action. We were able to use more than one activity of the I-125 seeds, which enabled us to shape and reduce the dose to normal surrounding structures at risk within the orbit and in the vicinity of the orbital cavity. Using the dose evaluation tools available with the modern treatment planning system, we reduced the prescription dose from 85 to 70 Gy, with D90 of 140 Gy, thereby providing effective treatment and limiting risk organ doses. In summary, we were able to dose-deescalate without compromising the chances of controlling retinal/scleral tumors. The patient is doing well from a recent follow-up visit 12 months after the eye plaque brachytherapy treatment. The tumor was 4.80 mm high, 1/3 of the original height, and vision is back to 20/60, demonstrating a successful treatment.

The role of angiotensin receptor blockers in treating epilepsy: a review.

Epilepsy is a chronic brain disease with a global prevalence of 70 million people. According to the World Health Organization, roughly 5 million new cases are diagnosed every year. Anti-seizure drugs are the treatment of choice. However, in roughly one third of the patients, these drugs fail to produce the desired effect. As a result, finding novel treatments for epilepsy becomes inevitable. Recently, angiotensin receptor blockers have been proposed as a treatment to reduce the over-excitation of neurons in epilepsy. For this purpose, we conducted a review using Medline/PubMed and Google Scholar using the relevant search terms and extracted the relevant data in a table. Our review suggests that this novel approach has a very high potential to treat epilepsy, especially in those patients who fail to respond to conventional treatment options. However, more extensive and human-based trials should be conducted to reach a decisive conclusion. Nevertheless, the use of ARBs in patients with epilepsy should be carefully monitored keeping the adverse effects in mind.

Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts.

Breast conservation therapy (BCT) (usually a lumpectomy plus radiotherapy (RT)) has become a standard alternative to radical mastectomy in early-stage breast cancers with equal, if not higher, survival rates. The established standard of the RT component of the BCT had been about six weeks of Monday through Friday external beam RT to the whole breast (WBRT). Recent clinical trials have shown that partial breast radiation therapy (PBRT) to the region surrounding the lumpectomy cavity with shorter courses can result in equal local control, survival, and slightly improved cosmetic outcomes. Intraoperative RT (IORT) wherein RT is administered at the time of operation for BCT to the lumpectomy cavity as a single-fraction RT is also considered PBRT. The advantage of IORT is that weeks of RT are avoided. However, the role of IORT as part of BCT has been controversial. The extreme views go from "I will not recommend to anyone" to "I can recommend to all early-stage favorable patients." These divergent views are due to difficulty in interpreting the clinical trial results. There are two modalities of delivering IORT, namely, the use of low-energy 50 kV beams or electron beams. There are several retrospective, prospective, and two randomized clinical trials comparing IORT versus WBRT. Yet, the opinions are divided. In this paper, we try to bring clarity and consensus from a highly broad-based multidisciplinary team approach. The multidisciplinary team included breast surgeons, radiation oncologists, medical physicists, biostatisticians, public health experts, nurse practitioners, and medical oncologists. We show that there is a need to more carefully interpret and differentiate the data based on electron versus low-dose X-ray modalities; the randomized study results have to be extremely carefully dissected from biostatistical points of view; the importance of the involvement of patients and families in the decision making in a very transparent and informed manner needs to be emphasized; and the compromise some women may be willing to accept between 2-4% potential increase in local recurrence (as interpreted by some of the investigators in IORT randomized studies) versus mastectomy. We conclude that, ultimately, the choice should be that of women with detailed facts of the pros and cons of all options being presented to them from the angle of patient/family-focused care. Although the guidelines of various professional societies can be helpful, they are only guidelines. The participation of women in IORT clinical trials is still needed, and as genome-based and omics-based fine-tuning of prognostic fingerprints evolve, the current guidelines need to be revisited. Finally, the use of IORT can help rural, socioeconomically, and infrastructure-deprived populations and geographic regions as the convenience of single-fraction RT and the possibility of breast preservation are likely to encourage more women to choose BCT than mastectomy. This option can also likely lead to more women choosing to get screened for breast cancer, thus enabling the diagnosis of breast cancer at an earlier stage and improving the survival outcomes.

Patients and Families' Participation in Multidisciplinary Tumor Conferences Improves Patient and Family-Focused Cancer Care: Lessons Learned From a Debate on the Role of Radiation Therapy in Primary Mediastinal Non-Hodgkin Lymphoma.

Incorporation of patients' preferences often leads to improved outcomes when included in the multidisciplinary tumor conference/board (MTC). However, patients' wishes are not included or considered in the MTC decision-making. We need better strategies and approaches for patient-inclusive, shared decision-making. When finding ourselves at a crossroads regarding the next step in a patient's treatment, we saw a unique opportunity for an MTC with the patient and her husband in attendance. The results of a full literature review regarding the role of consolidative radiation therapy (RT) in a patient with primary (thymic) B-cell lymphoma after completion of chemotherapy and fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) scan with a Deauville score of 4 were presented in a creative, engaging debate-style forum with visual aids. The patient and her husband were able to follow the discussion and, in the end, a consensus recommendation, heavily focused on the patient's preferences, was offered and adopted, which ultimately resulted in the avoidance of excess treatment and likely improved her long-term quality of life outcome. These collaborative and innovative interactions benefit not only our patients but enrich our lives too as healthcare providers and strengthen us as a cancer care team in terms of understanding diversity in decision-making processes.

Frequency and Seasonal Variations of Viruses Causing Respiratory Tract Infections in Children Pre- and Post-COVID-19 Pandemic in Riyadh (2017-2022).

Introduction The COVID-19 pandemic has had a major impact on healthcare systems throughout the world. As the clinical and epidemiological features of COVID-19 share many similarities with other respiratory viruses in children, ensuring optimal management of different viral respiratory diseases is critical. The precautions taken to prevent COVID-19 have seemingly had an indirect effect on the seasonal variations of viral diseases and the frequency of relevant viruses. The seasonal irregularity of and uncertainty surrounding these infection peaks may affect the clinical prediction and management resources. Therefore, the aim of this study is to evaluate the impact of the COVID-19 pandemic on the frequency and seasonal variation of common respiratory viruses in children pre- and post-pandemic. Methodology This study utilizes a descriptive cross-sectional retrospective approach. A total of 726 samples collected from children below 14 years of age and admitted to King Abdulla bin Abdulaziz University Hospital between March 2017 and February 2022 were included in the present study to evaluate the impact of the COVID-19 pandemic on the frequency and seasonal variation of common respiratory viruses in children pre- and post-pandemic. The samples taken before March 15, 2020, were considered pre-COVID-19, and those taken from March 15, 2020, onward were considered post-COVID-19. The seasons were divided based on the months of the year as per the Saudi climate website (winter: December-February, spring: March-April, summer: May-August, and autumn: September-November). Results All nasopharyngeal swabs (NPS) for viral Polymerase chain reaction (PCR) multiplex that were done for all admitted children of age up to 14 years were included, and the total samples amounted to 726, There were 686 (94.4%) positive samples for viruses and 40 (5.5%) negative samples. The number of positive samples pre-COVID-19 pandemic was 494 (72%), and the number of positive samples post-COVID-19 pandemic was 192 (28%). The frequency of different viruses has decreased post-COVID-19 and seasonality has changed; Although Adenovirus, and influenza viruses have no big changes, but Human Rhino/enterovirus (HRE) has increased frequency post-COVID-19 (49%), while post-COVID-19 it was (29.1%). The seasonal peak for Respiratory Syncytial Virus (RSV) pre-COVID-19 showed mainly in winter (49%), while post-COVID-19 it showed no peak. Conclusion The frequency of most types of viruses is noted to be lesser in the post-COVID-19 period, most likely due to precautions followed during the pandemic. This is not the case for HRE which showed increasing frequency in post-COVID-19; However, there are clinically and statistically significant differences among seasonal peaks in Respiratory RSV, HRE, and Parainfluenza viruses (PIV) pre- and post-COVID-19 pandemic. RSV showed no peak in different seasons post-COVID-19, although its peak pre-COVID-19 was in winter and autumn; Additionally typical trend of HRE peak changed to be in Autumn and spring post-COVID-19 instead of winter pre-COVID-19.

Workplace inclusion: A scoping review of the qualitative literature.

BACKGROUND: An inclusive workplace culture supports and values the individual and collective work processes of workers from diverse backgrounds. The reality or perception of inclusion or exclusion at work can influence the social functioning, health, and well-being of workers. However, we lack knowledge about the concepts relevant to inclusion at the workplace. Furthermore, research is needed to better understand the drivers and obstacles to workplace inclusion to better promote participation in working life. OBJECTIVE: This scoping review of the qualitative literature identifies the barriers to and facilitators of workplace inclusion. METHODS: Systematic searches of five databases were conducted from 2000 to January 2020. Pairs of reviewers independently screened and reviewed all citations and full-text articles. We used Arksey and O'Malley's scoping review framework which advances through five stages. Barriers and facilitators of workplace inclusion were categorized relative to a multi-layered conceptualization of workplace inclusion and grouped by theme. Studies were described and thematic results totaled and communicated with evidence tables and conceptual maps. RESULTS: Thirty-nine qualitative studies met our inclusion criteria. All five domains of the multi-layered framework were represented by the reported shared experiences of study participants. Organizational level factors, especially attitudinal barriers were the most reported barriers to workplace inclusion. Facilitators of workplace inclusion focused on employer level factors and most often cited the role of inclusive leadership and support. CONCLUSION: Workplace inclusion requires consideration of societal, organizational, employer, and interpersonal level factors in addition to individual worker characteristics.

Exploring the lived experiences of ethnic minority youth with disabilities: a systematic review and meta synthesis of qualitative data.

PURPOSE: Racial and ethnic minority youth with disabilities often encounter more challenges and poorer health, social and vocational outcomes compared to white youth and yet, relatively little is known about their lived experiences. The purpose of this study was to explore the experiences of ethnic minority youth and young adults with disabilities. METHODS: We conducted a systematic review of qualitative data with eight international databases assessed by four reviewers. RESULTS: Twenty-one studies met the inclusion criteria, which involved 373 youth and young adults, across four countries over a 20-year period. We identified the following themes: (1) accessing and navigating services (i.e., environmental barriers; lack of supports, resources and information); (2) perceptions of disability (i.e., cultural adjustment and tensions between cultures; differing priorities for independence); (3) systemic factors (i.e., language and communication; stigma, discrimination and racism); (4) coping (i.e., reframing; and family involvement and support); and (5) intersectionality (i.e., disability, race and ethnicity, gender, and socio-economic status). CONCLUSIONS: Our findings highlight how racial and ethnic minority youth with disabilities encounter many challenges in dealing with their condition and the urgent need for further research to develop a deeper understanding of their needs so that clinicians and service providers can enhance supports.IMPLICATIONS FOR REHABILITATIONRacial and ethnic minority youth with disabilities encounter different challenges than other youth, such as cultural adjustment, racism and culturally inappropriate services.Clinicians and service providers should be cognizant that ethnic minority youth may need different supports and resources as they grapple with tensions between cultures.Clinicians, educators and service providers should consider the complexity of how disability interacts with many other factors, such as race, ethnicity, gender and socio-economic status.

The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet?

Cardiovascular diseases (CVDs) are the leading cause of mortality globally. Wald and Law proposed the idea of a "polypill"; a fixed dose combination therapy (FDC) in the form of a single pill to curb the CVD epidemic. Such a drug would include the combination of a broad spectrum of drugs including cholesterol lowering drugs, antihypertensive drugs, antiplatelet drugs, anticoagulation drugs, and antiarrhythmic drugs, which are frequently integrated to combat specific CVDs. This "polypill" holds the potential to pose several advantages like increased compliance, improved quality of life, risk factor control, psychological relief, and cost effectiveness along with minimal side effects. Several trials (like TIPS, UMPIRE, PolyIran, etc.) have tested different treatment strategies to test the hypothesis of Wald and Law. Unlike the past, physicians are now highly aware of this new strategy. The future of polypill in the management of CVD lies in a strategy where polypills are treated supplementary to the already existing preventive care, which includes lifestyle modifications and efforts to reduce tobacco use.

Increasing Prevalence of Methicillin-resistant Staphylococcus aureus among Hospital and Community acquired Infections in Khartoum State, Sudan.

BACKGROUND: Staphylococcus aureus is an important bacterium that can cause many diseases. Methicillin-resistant S.aureus (MRSA) is often sub-categorized as Hospital or Community acquired infection. MRSA causes serious problems, such as bloodstream and surgical site infections or pneumonia. OBJECTIVES: The present study aimed to identify S. aureus by 16SrRNA using PCR, estimate the antibiotic susceptibility pattern and determine the prevalence of MRSA among Hospital and community acquired infections. METHODS: A cross-sectional laboratory-based study was conducted during the period from November 2020 to January 2021. Conventional methods were used to identify S. aureus and isolate confirmation was performed by PCR targeting 16SrRNA gene. All isolated organisms were tested for their in-vitro antimicrobial susceptibility. RESULT: Among the enrolled patients (n, 300), MRSA was observed in 185 (61.7%). The highest frequency was shown in the age group over 45 years old (46.7%). The result also showed a high frequency of S. aureus among community infections (81.7%), MRSA in hospital acquired infections was 10.7% while 51% was community acquired. The antimicrobial susceptibilities against MRSA isolates showed high sensitivity to Ceftriaxone 90.0%). Most infections caused by MRSA isolates were respiratory tract infection (RTI) (28.3%) and Septicemia (22.5%). CONCLUSION: The present study highlighted a high proportion of MRSA in clinical settings at Khartoum State. Antibiotic susceptibility results showed that Ceftriaxone was the drug of choice against MRSA isolates. Overuse and misuse of antibiotics, along with self-medication, seem to be the cause of antibiotic resistance, thus should be avoided.

Unravelling the Complexities of Workplace Disclosure Among Persons with Non-Visible Disabilities and Illnesses: A Qualitative Meta-Ethnography.

BACKGROUND: Deciding whether and how to disclose a disability at work for persons with non-visible disabilities and illnesses involve complex processes. Research has focused on antecedents and outcomes of disclosure. More research is needed to understand the lived experiences related to disclosure decision-making and actual navigation of disclosure and concealment at work. PURPOSE: To understand the experiences of persons with non-visible disabilities and illnesses regarding workplace disclosure decision-making, navigating disclosure and/or concealment, and experiential differences across disability and illness types, ages, geographic locations, and genders. METHODS: We conducted a qualitative meta-synthesis using Noblit and Hare's seven steps of meta-ethnography. Searches were conducted via six databases. Studies were analyzed to develop conceptual categories, third-order constructs (themes), and a line-of-argument with comparisons drawn from the disclosure decision making model, disclosure process model, and consideration of disability and illness types, genders, ages, and geographic locations. RESULTS: Twenty-four studies were included involving 489 participants, aged 16 to 81, from nine countries, focusing on one non-visible disability or illness, or multiple. We developed four themes for the disclosure decision-making process (self- and other-focused, experiential, and environmental/workplace factors) and two themes for the disclosure/concealment event (disclosure/concealment logistics and timing) and noted emerging trends across ages, genders, disability and illness types, and geographic locations. CONCLUSIONS: Knowledge obtained could be used among professionals who support persons with non-visible disabilities and illnesses to help them navigate disclosure at work, and to consider the role of age, genders, disability and illness types, and geographic locations on disclosure.

Exploring Direct and Indirect Associations of Exercise and Sport Participation with Employment among Individuals with Disabilities: A Scoping Review.

Purpose Exercise and sports have many positive benefits for persons with or without a disability. Despite this, the contribution of exercise and sport participation to employment is less documented. The purpose of this scoping review was to provide insight into the direct and indirect associations of exercise and sport participation with employment among persons with disabilities. Methods Six databases were searched (MEDLINE, Embase, Scopus, PsychINFO, CINAHL, and HealthStar) from their inception date to March 20, 2020. Peer-reviewed English and French articles were included if at least one outcome measure on employment or work-related outcomes as a result of participation in, or benefits of exercise and sport participation was the focus of the study. Results The research identified 2796 hits. Of which, 23 published between 1992 and 2019 met eligibility criteria. Seven studies identified a direct association between exercise and sport participation with employment and full-time positions. Sixteen studies reported on improved health/work-related outcomes such as occupational performance (i.e., self-care, functional independence), physical fitness (i.e., upper extremity strength, endurance) and psychological well-being (i.e., self-efficacy). Conclusions This scoping review highlights that exercise and sport participation have associations with employment and work-related outcomes. Benefits of exercise and sports may be considered to a greater extent, than in the past, in programs that facilitate employment for persons with disabilities. Additional research using longitudinal design should be conducted to further understand the strength of these associations and evaluate whether exercise and sport participation should be incorporated more intensely in vocational programs.

Exploring the relationships between race, ethnicity, and school and work outcomes among youth and young adults with disabilities: a scoping review.

PURPOSE: Youth with disabilities often encounter barriers in finding meaningful employment and completing post-secondary education. Such challenges are often even more profound for youth who identify as an ethnic minority. The purpose of this study was to understand the relationships between race, ethnicity and school and work outcomes for youth with disabilities. METHODS: We conducted a scoping review while searching eight international databases that identified 49 studies meeting our inclusion criteria. RESULTS: Of the 49 studies that were included in the review, they involved youth and young adults with disabilities (aged 6-29) over a 21-year period. The majority of the studies focusing on school showed that ethnic minority youth with disabilities had poorer school outcomes compared to white youth with disabilities. Meanwhile, most studies focusing on work reported that ethnic minority youth with a disability had worse employment outcomes compared to white disabled youth. Factors influencing school and work included cultural differences in expectations, inequitable access to services and resources, and discrimination. CONCLUSIONS: Our findings highlight the disparities that exist for young people with disabilities from ethnic minority backgrounds. There is an urgent need for further research to understand their lived experiences to help address gaps in school and work outcomes.Implications for rehabilitationClinicians and educators should help to provide ethnic minority youth with equitable resources and opportunities to help them achieve their school and career goals.Clinicians and educators should consider participating in culturally sensitive care training to better understand the different needs and experiences of ethnic minority youth with disabilities.Clinicians and educators should try to work collectively with parents and ethnic minority youth with disabilities to optimize their transition outcomes.

MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States.

Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls. The normal tissue toxicity is comparable or better than historical controls as well. This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting.  The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings. In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.

Facilitators for coping with the COVID-19 pandemic: Online qualitative interviews comparing youth with and without disabilities.

BACKGROUND: The Coronavirus Disease (COVID-19) pandemic has greatly impacted people's mental health. Youth with disabilities are at particular risk for the psychological implications of the pandemic. Although much attention has been given to pandemic-related mental health challenges that youth have encountered, little is known about the facilitators for coping with the stresses of the pandemic and how this varies for youth with and without disabilities. OBJECTIVE: The purpose of this study was to understand facilitators for helping youth and young adults with and without disabilities to cope and maintain mental health during the COVID-19 pandemic. METHODS: This qualitative study involved in-depth interviews with 34 youth and young adults (17 with a disability; 17 without), aged 16-29 (mean age 23.2). A narrative, thematic analysis of the transcripts was performed. RESULTS: Our findings revealed several similarities and some differences between youth and young adults with and without disabilities regarding facilitators for maintaining mental health during the pandemic. Enablers of coping included: (1) social support; (2) financial support, (3) keeping busy (i.e., having a daily routine, working to keep the mind occupied, volunteering to boost mental health, focusing on school work), and (4) work-life balance (i.e., reduced commute, more time for exercising, going outdoors, cooking, sleeping better, and reflection on life's purpose). CONCLUSIONS: Our findings highlight how having coping strategies could help to youth and young adults deal with pandemic-related stress. Youth with disabilities may need some additional support in accessing resources, exercising and going outdoors to help enhance their coping strategies.

Correlation of serum collectrin level and preeclampsia onset: A case control study.

BACKGROUND: Pre-eclampsia is a major contributor to pregnancy-associated morbidity and mortality and the management of this complex syndrome needs to be improved. Recently serum collectrin has emerged as a new member of the renin-angiotensin system that regulates the blood pressure through nitric oxide -endothelial nitric oxide synthase pathway. OBJECTIVE: To evaluate the correlation of serum collectrin level and preeclampsia onset. STUDY DESIGN: A prospective case control study. PATIENTS AND METHODS: Ninety pregnant women attended the outpatient clinic Al-Yarmook Teaching Hospital in Baghdad / Iraq along the period from April 2018 until December 2018 had been divided into three groups. Group A included 30 pregnant women presented with early onset pre-eclampsia (before 34 weeks of gestation), group B included 30 pregnant women presented with late onset pre-eclampsia (at or after 34 weeks of gestation) and group C included 30 apparently healthy term pregnant women. Serum collectrin levels were measured for each pregnant woman by using enzyme-linked immunosorbent assay analyzer. RESULTS: The mean serum collectrin was the lowest in pregnant women with early onset pre-eclampsia (61.65 ± 3.62 pg/ml) while it was (82.61 ± 6.41 pg/ml) for pregnant women with late onset pre-eclampsia and (101.11 ± 8.27 pg/ml) for healthy term pregnant women. These differences were found to be significant (p value = 0.001). This significant decrement was inversely correlated with the systolic blood pressure (r = -0.565, p-value = 0.001) and diastolic blood pressure and (r = -0.748, p-value = 0.001). CONCLUSION: Serum collectrin levels had a significant role in controlling the blood pressure in pregnant women with a significant inverse correlation between serum collectrin concentrations and blood pressure.

A 25-year Experience at an Academic Medical Center in the United States: Are There Racial Disparities in the Prognosis of Patients Diagnosed With Hypopharyngeal Carcinoma?

Introduction This study attempted to identify disparities in outcomes between African American (AA) and Caucasian American (CA) patients treated for hypopharyngeal carcinoma at a tertiary care institution over the past 25 years. Methods An institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective analysis was performed on patients with squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes, including median survival and overall survival, were calculated using the Kaplan-Meier method. All analyses were performed using the Social Packages for the Social Sciences (SPSS) v. 24 (IBM Corp., Armonk, NY). Results We identified 144 hypopharyngeal carcinoma patients who were treated during this period. Our patient cohort consisted of 61.8% AA and 35.4% CA (P=0.538). Overall, 96% of them presented at an advanced stage (Stages III & IV) of the disease, and only 4% presented in the early stages (Stages I & II). There was no significant difference between AA and CA patients who presented with advanced disease (96.6% vs. 94.1%). In our patient cohort, 15.3% of patients did not receive any therapy; however, 51.4%, 22.9%, and 10.4% of them underwent definitive chemoradiotherapy, definitive surgery, or palliative chemotherapy, respectively. There were no significant differences in patient racial proportions within each treatment group. The median follow-up of the entire cohort was 13 months. There was no significant difference between the median survival of AA and that of CA patients (16 months vs. 15 months; p=0.917). Moreover, there was no significant difference in the overall survival between AA and CA patients at three years (27.2% vs. 36.3%; p=0.917) and five years (20.4 % vs. 16.7 %; p=0.917). Conclusions A retrospective review of patients with hypopharyngeal cancer treated at our institution over the previous 25 years did not identify significant racial disparities regarding the stage at presentation or prognosis. This study suggests that when patients have equal access to care, they appear to have a similar prognosis despite racial differences. Further studies are needed to validate this hypothesis.

Unilateral right closed-lip schizencephaly.

Schizencephaly is a rare central nervous system (CNS) malformation secondary to neuronal migration defects. The pathogenesis is complex and is secondary to environmental and genetic factors. Clinically, the majority of patients present with varying degrees of motor and psychological disturbances. Imaging plays a cornerstone in the diagnosis by identifying the characteristic lesional features and recognising other associated abnormalities such as an absent septum pellucidum and corpus callosum dysgenesis. Here, we present a male paediatric case who presented with an interestingly asymptomatic unilateral right closed-lip schizencephaly and review the aetiology, clinical presentation and imaging characteristics of the disease and associated literature.

The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-Part 4: Appalachian patients.

PURPOSE: Compared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined. METHODS AND MATERIALS: The National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical). RESULTS: Although the literature investigating RT access disparities in Appalachia is relatively sparse, studies examining lung, colorectal, cervical, prostate, head and neck, breast, and esophageal cancer, as well as lymphoma, indicate an unfortunate commonality in barriers to optimal RT access for Appalachian patients with cancer. These barriers are predominantly socioeconomic in nature (low income and lack of private insurance) but are exacerbated by paucities in both the number and quality of radiation centers that are accessible to this patient population. CONCLUSIONS: Regardless of organ system, there are significant barriers for Appalachian patients with cancer to receive RT. Such diminished access is alarming and warrants resources devoted to addressing these disparities, which often go overlooked because of the assumption that the overall wealth of the United States is tangibly applicable to all of its citizens. Without intelligently targeted investments of time and finances in this arena, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.