Physicians' and Patients' Ratings of the Physician-Patient Working Alliance, Adherence, Satisfaction, and Treatment Outcome.

The physician-patient relationship is important and essential to the delivery of effective healthcare. The current study examined a measure of this relationship, which we call the physician-patient working alliance (PPWA). We examined it from both perspectives of the medical dyad, simultaneously, which to date has not been done. Data were analyzed via the Actor Partner Interdependence Model to account for the possibility of interdependence in the ratings provided by each member of the dyad. The sample consisted of sixty-eight physician-patient dyads. Patients' ratings of the PPWA were significantly associated with their ratings of adherence to, and satisfaction with treatment. Physicians' ratings of the PPWA were significantly associated with their ratings of patient adherence and to their own satisfaction with treatment. Significant "partner" effects were uncovered, in that physicians' ratings of the PPWA were significantly associated with patients' ratings of adherence. Significant zero-order correlations were also observed for physician-rated outcome; particularly, significant correlations with patient-rated and physician-rated adherence. We conclude that the PPWA is a significant factor in patients' and physicians' ratings of adherence and satisfaction. This study also provides initial evidence that the PPWA is a dyadic phenomenon (e.g., the perception of the strength of the PPWA in one member of the medical dyad impacts the other member's perception) and that both parts of the medical dyad should be considered in future research and in clinical practice.

Induced Disassembly of a Virus-like Particle under Physiological Conditions for Venom Peptide Delivery.

Virus-like particles (VLPs) show considerable promise for the in vivo delivery of therapeutic compounds such as bioactive venom peptides. While loading and targeting protocols have been developed for numerous VLP prototypes, induced disassembly under physiological conditions of neutral pH, moderate temperature, and aqueous medium remain a challenge. Here, we implement and evaluate a general mechanism, based on ring-opening metathesis polymerization (ROMP), for controllable VLP disassembly. This mechanism is independent of cell-specific factors or the manipulation of environmental conditions such as pH and temperature that cannot be readily controlled in vivo. The ROMP substrate norbornene is covalently conjugated to surface-exposed lysine residues of a P22 bacteriophage-derived VLP, and ROMP is induced by treatment with the water-soluble ruthenium catalyst AquaMet. Disruption of the P22 shell and release of a GFP reporter is confirmed via native agarose electrophoresis, TEM, and dynamic light scattering (DLS) analyses. Our ROMP disassembly strategy does not depend on the particular structure or morphology of the P22 nanocontainer and is adaptable to other VLP prototypes for the potential delivery of venom peptides for pharmacological applications.

Selective Inhibition of Liver Cancer Cells Using Venom Peptide.

Increasingly cancer is being viewed as a channelopathy because the passage of ions via ion channels and transporters mediate the regulation of tumor cell survival, death, and motility. As a result, a potential targeted therapy for cancer is to use venom peptides that are selective for ion channels and transporters overexpressed in tumor cells. Here we describe the selectivity and mechanism of action of terebrid snail venom peptide, Tv1, for treating the most common type of liver cancer, hepatocellular carcinoma (HCC). Tv1 inhibited the proliferation of murine HCC cells and significantly reduced tumor size in Tv1-treated syngeneic tumor-bearing mice. Tv1's mechanism of action involves binding to overexpressed transient receptor potential (TRP) channels leading to calcium dependent apoptosis resulting from down-regulation of cyclooxygenase-2 (COX-2). Our findings demonstrate the importance of modulating ion channels and the unique potential of venom peptides as tumor specific ligands in the quest for targeted cancer therapies.

The physician-patient working alliance and patient psychological attachment, adherence, outcome expectations, and satisfaction in a sample of rheumatology patients.

Over the past twenty years, the physician-patient relationship (eg, the physician-patient working alliance) has emerged as an integral component to the treatment of patients for a myriad of health conditions. Psychological, emotional, and behavioral dimensions of patients' working alliance with their physicians, along with patients' attachment styles, were examined in relation to rheumatology patients' adherence to treatment plans, outcome expectations, and satisfaction. Study participants were 101 adult outpatients from a rheumatology clinic. Path analyses demonstrated that the physician-patient working alliance predicted outcome expectations (Standardized Beta [SB] = 0.27), and patient satisfaction (SB = 0.62), and that patient satisfaction in turn predicted patient adherence (SB = 0.48). Physicians' ratings of patient adherence were significantly and positively correlated with patients' ratings of the physician-patient working alliance. No significant paths were evident with respect to patient attachment. The physician-patient working alliance directly predicts patient satisfaction, and outcome expectations, and indirectly predicts adherence through patient satisfaction.

Dermatoglyphic Pattern Assessment in Smokeless Tobacco Users in the North Gujarat Population: A Comparative Case-Control Study.

Introduction: Dermatoglyphic patterns identify genetic conditions as they develop early in pregnancy and remain constant throughout life. Multiple studies suggest that there is a genetic link to smokeless tobacco use. So, this study has been conducted to assess dermatoglyphic patterns among smokeless tobacco users in the North Gujarat population with nonconsumers. Materials and Methods: A total of 500 cases were investigated for "ATD" angle and patterns, of which 250 subjects of smokeless tobacco are assessed for statistical significance via comparing them to 250 subjects of nonconsumers. Student's t-test was employed for evaluating quantitative factors (also known as the "ATD" angle), and the Chi-square test was used to analyze qualitative variables (also known as fingerprint patterns). A P value of 0.05 or less was considered significant. Results: In this study, the angle "ATD" was found to be reduced in both the palms of males (P 0.001) and females (P 0.001) when compared to controls, which was statistically highly significant. In our study, we discovered that the number of whorls and arches is lower in male cases as compared to male controls, which is highly significant (P = 0.020 and P = 0.010). Male cases had a greater number of loops than male controls, which was statistically significantly greater (P 0.001). Conclusion: In this latest study, an association between smokeless tobacco users and palmar dermatoglyphics was identified. Though dermatoglyphics solely is unable to identify individuals who abuse alcohol and/or cigarette packs, the results of this research could serve to further develop diagnostic guidelines.

Measurement of mandibular incisive canal diameter using cone beam computed tomography.

Cone beam computed tomography was used for measuring the diameter of a Mandibular incisive canal. The dental practice can now visualize small bone structures with low dose and high spatial resolution due to the introduction of CBCT (Cone Beam Computed Tomography). Therefore, it is of interest to measure the diameter of the MIC (Mandibular Incisive Canal) using the CBCT. Fifty CBCT scans obtained for implant placement preoperative planning were included in the study material. Observers carefully examined the CBCT data to determine the MIC's presence & position. The inner diameter of the MIC was measured by taking the longest distance between the inner cortical borders of the canal which was further analyzed using software CS3D software. The collected data were further subjected to statistical analysis. The average mean of the population was 1.7130±.5178. The average diameter of MIC in males was 1.735±.5406 and in females was 1.6800±.4934. Complications from implant surgery in the anterior mandible may be prevented by utilizing CBCT scans to analyze the smallest diameter of the MIC.

Addressing the Gap: Racial Disparities and Public Health Strategies in the Epidemiology of Gastrointestinal Stromal Tumors.

Background Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal neoplasms of the gastrointestinal tract, arising from the interstitial cells of Cajal. These tumors bridge the nervous system and muscular layers of the gastrointestinal tract, playing a crucial role in the digestive process. The incidence of GISTs demonstrates notable variations across different racial and ethnic groups, underscoring the need for in-depth analysis to understand the interplay of genetic, environmental, and socioeconomic factors behind these disparities. Linear regression analysis is a pivotal statistical tool in such epidemiological studies, offering insights into the temporal dynamics of disease incidence and the impact of public health interventions. Methodology This investigation employed a detailed dataset from 2009 to 2020, documenting GIST incidences across Asian, African American, Hispanic, and White populations. A meticulous preprocessing routine prepared the dataset for analysis, which involved data cleaning, normalization of racial terminologies, and aggregation by year and race. Linear regression models and Pearson correlation coefficients were applied to analyze trends and correlations in GIST incidences across the different racial groups, emphasizing an understanding of temporal patterns and racial disparities in disease incidence. Results The study analyzed GIST cases among four racial groups, revealing a male predominance (53.19%) and an even distribution of cases across racial categories: Whites (27.66%), Hispanics (25.53%), African Americans (24.47%), and Asians (22.34%). Hypertension was the most common comorbidity (32.98%), followed by heart failure (28.72%). The linear regression analysis for Asians showed a decreasing trend in GIST incidences with a slope of -0.576, an R-squared value of 0.717, and a non-significant p-value of 0.153. A significant increasing trend was observed for Whites, with a slope of 0.581, an R-squared value of 0.971, and a p-value of 0.002. African Americans exhibited a moderate positive slope of 0.277 with an R-squared value of 0.470 and a p-value of 0.201, indicating a non-significant increase. Hispanics showed negligible change over time with a slope of -0.095, an R-squared value of 0.009, and a p-value of 0.879, suggesting no significant trend. Conclusions This study examines GIST incidences across racial groups, revealing significant disparities. Whites show an increasing trend (p = 0.002), while Asians display a decreasing trend (p = 0.153), with stable rates in African Americans and Hispanics. Such disparities suggest a complex interplay of genetics, environment, and socioeconomic factors, highlighting the need for targeted research and interventions that address these differences and the systemic inequalities influencing GIST outcomes.

A Double-Edged Sword: Quality and Credibility of Colon Cancer Screening Content on YouTube.

Introduction Colorectal cancer (CRC) remains a significant public health challenge globally, with its pathogenesis involving the transformation of benign adenomas into malignant carcinomas. Despite advancements in screening and early detection significantly improving outcomes, the rise of digital platforms like YouTube for disseminating health information presents new challenges. Concerns over the accuracy and reliability of content underline the necessity for rigorous evaluation of these digital health education tools. Methods Our study was conducted at Nassau University Medical Center, East Meadow, New York. We meticulously analyzed YouTube videos on "colon cancer screening awareness," employing strict selection criteria to ensure both relevance and quality, focusing on English-language content with pertinent audio. Videos were evaluated for their quantitative and qualitative attributes-views, subscriber counts, likes/dislikes, comments, and content type, classifying them as scholarly or personal. We assessed video credibility through scientific accuracy using the DISCERN instrument, Global Quality Score (GQS), and Patient Education Materials Assessment Tool (PEMAT), ensuring consistency in quality and reliability evaluation among seven researchers via the intraclass correlation coefficient. These tools - DISCERN for assessing reliability and quality, GQS for evaluating overall quality, and PEMAT for understandability and actionability - facilitated a comprehensive evaluation framework. Our analysis, leveraging descriptive and inferential statistics, scrutinized differences in content quality between academic and private institutions, employing t-tests to identify statistically significant disparities. The study utilized Microsoft Excel (version 16.73, Microsoft Corporation, Redmond, Washington, United States) and IBM SPSS Statistics for Windows, version 29.0 (released 2022; IBM Corp., Armonk, New York, United States). for robust data processing and analysis, confirming the educational value and trustworthiness of the examined YouTube content. Results Our study of 156 YouTube videos on educational content, split between academic (68 videos) and private sources (88 videos), revealed significant quality differences. Using the DISCERN, PEMAT, and GQS metrics, academic videos consistently outperformed private ones, with significant margins: DISCERN (54.61 vs. 34.76), PEMAT (3.02 vs. 2.11), and GQS (3.90 vs. 2.02), supported by low p-values indicating a statistically significant superiority. These findings suggest that the source of content-academic versus private-plays a crucial role in determining the quality and reliability of educational materials on platforms like YouTube, highlighting the academic sector's commitment to higher educational standards. Conclusion The study emphasizes the critical role of credible sources in enhancing the quality of health education content on YouTube, particularly concerning CRC screening. The superiority of academic institutions in providing high-quality content suggests a need for viewers to critically assess the source of information. It also calls for enhanced regulatory oversight and measures to ensure the accuracy and reliability of health information online.

The Path to Sustainable Healthcare: Implementing Care Transition Teams to Mitigate Hospital Readmissions and Improve Patient Outcomes.

Introduction Hospital readmissions within 30 days suggest care quality issues and increased mortality risks. They result from ineffective initial treatment, poor discharge planning, and inadequate post-acute care. These high readmission rates harm patient outcomes and financially strain healthcare institutions, inviting penalties and discouraging potential patients. Enhancing inpatient care, care transitions, and case management is crucial to lowering readmissions. Our research underscores the role of care transition teams in reducing readmissions and financial stress in hospitals. By consistently applying transition strategies and focusing on high-quality care, we can improve patient outcomes and ensure hospital success in the long run. Methods This two-phase study investigated readmission rates and risk factors in a community hospital from May 2017 to November 2022. Phase 1 determined a baseline readmission rate and identified individual risk factors using logistic regression. In phase 2, a care transition team addressed these factors by providing post-discharge patient support through phone calls and assessing social determinants of health (SDOH). Readmission data from the intervention period was compared to baseline data using statistical tests. Data, including demographics, medical conditions, and comorbidities, were collected via electronic medical records and the International Classification of Diseases (ICD-10 codes). The study focused on patients aged 20-80 with readmissions within 30 days. Exclusions were made to minimize confounding effects from unmeasured comorbidities and ensure an accurate representation of factors affecting readmissions. Results In the study's initial phase, 74,153 patients participated, with an 18% mean readmission rate. Women accounted for 46% of readmissions, and the white population had the highest rate (49%). The 40-59 age group showed a higher readmission rate than other age groups, and certain health factors were identified as risk factors for 30-day readmission. In the subsequent phase, a care transition team intervened with high-risk groups using an SDOH questionnaire. They contacted 432 patients, resulting in a reduced overall readmission rate of 9%. The 60-79 age group and the Hispanic population experienced higher readmission rates, and the previously identified health factors remained significant risk factors. Conclusion This study emphasizes the crucial role of care transition teams in reducing hospital readmission rates and easing the financial strain on healthcare institutions. By identifying and addressing individual risk factors, the care transition team effectively lowered the overall readmission rate from 18% to 9%. Continually implementing transition strategies and prioritizing high-quality care focused on minimizing readmissions are essential for improving patient outcomes and long-term hospital success. Healthcare providers should consider utilizing care transition teams and social determinants of health assessments to better understand and manage risk factors and tailor post-discharge support for patients at higher risk of readmission.

Investigating the Impact of COVID-19 Vaccines on Liver Function: Insights From a Single-Institute Study.

Introduction SARS-CoV-2 can cause respiratory and extrapulmonary complications, including liver injury. Therefore, understanding the virus's impact on the liver and the coronavirus disease 2019 (COVID-19) vaccine's protective effect is crucial, given the correlation between hepatic involvement and disease severity. Our study aims to evaluate this relationship and the impact of vaccination on liver injury in COVID-19-infected patients. Methods A retrospective cohort study analyzed liver function outcomes in COVID-19-infected patients who received two doses of the Pfizer-BioNTech or Moderna mRNA vaccine from October 2019 to October 2021. The study population was matched based on baseline characteristics, and Fisher's T-test was used for analysis. Secondary outcomes included COVID-19-related death, hospital stay, and SARS-CoV-2 infection after the second dose. SPSS (IBM Corp., Armonk, NY) and RStudio (RStudio, PBC, Boston, USA) software were utilized to ensure robust statistical analysis. Results A group of 78 patients with a propensity score were matched and analyzed, resulting in two groups of 39 patients each: vaccinated and unvaccinated. The vaccinated group had a lower incidence of liver injury, reduced length of stay, and mortality. The study suggests that COVID-19 vaccination can positively impact infected patients. These findings should be considered when making decisions about vaccine distribution and usage, and more research is needed to fully understand the vaccine's impact on ending the pandemic. Conclusion This study emphasizes the COVID-19 vaccine's significance in reducing liver injury and related outcomes, such as length of stay and mortality in infected patients. The results provide further evidence of vaccination benefits, with implications for healthcare professionals and policymakers. Further research is needed to deepen our understanding of COVID-19's complex effects on the liver and the vaccine's impact. Investing in research can inform clinical management, improve patient outcomes, and ultimately help end the pandemic.

Healthcare Disparities and Upper Gastrointestinal Bleeding: Exploring the Linkages.

Introduction Upper gastrointestinal bleeding (UGIB) refers to blood loss from a gastrointestinal (GI) source proximal or above the ligament of Treitz. Health equity means giving everyone an equal chance to achieve optimal health by addressing injustices, overcoming barriers, and eliminating health disparities. Healthcare providers must analyze racial and ethnic disparities in UGIB management to ensure all patients receive equal care. Identifying risk factors in specific populations leads to tailored interventions that improve outcomes. Our study aims to examine trends and identify disparities in upper gastrointestinal bleeding across races and ethnicities to promote health equity. Methods Retrospective data on upper gastrointestinal bleeding from June 2009 to June 2022 were collected and categorized into five groups based on race. The baseline characteristics of each group were matched to ensure equitable comparison. A joinpoint regression model was used to compare incidence trends, identifying potential healthcare disparities for different racial/ethnic groups over time. Patients aged 18-75 who suffered from upper gastrointestinal bleeding at Nassau University Medical Center in New York from 2010 to 2021 were selected, excluding those with incomplete baseline comorbidity information. Results This study examined 5103 cases of upper gastrointestinal bleeding, with 41.9% female. The cohort was diverse, with 29.4% African American, 15.6% Hispanic, 45.3% White, 6.8% Asian, and 2.9% of other races. Data were split into two groups; 49.9% occurred between 2009 and 2015 and 50.1% between 2016 and 2022. Findings showed increased UGIB among Hispanics and decreased bleeding among Asians during 2016-2021 compared to 2009-2015. However, no significant difference was found for African Americans, Whites, and other races. In addition, Hispanics had a rise in the annual percentage change (APC) rate, whereas Asians had a decrease. Conclusion Our study examined trends in upper gastrointestinal bleeding and potential healthcare disparities across races and ethnicities. Our findings highlight an increased incidence of UGIB in Hispanics and a decreased incidence in Asians. Additionally, we identified a significant increase in the annual percentage change rate in Hispanics and a decrease in Asians over time. Our study underscores the importance of identifying and addressing disparities in UGIB management to promote health equity. Future research can build on these findings to develop tailored interventions that improve patient outcomes.

Ocular and orbital manifestations of granulomatosis with polyangiitis: a systematic review of published cases.

Objective: Granulomatosis with polyangiitis (GPA) is an autoimmune disorder characterized by necrotizing granulomatous inflammation of small and medium-sized vessels. This systematic review aimed to highlight the most common ophthalmic manifestations and to uncover their associations with antineutrophil cytoplasmic antibody (ANCA) positivity and the presence of granulomas. Methods: A literature search of PubMed, Web of Science, and Scopus electronic databases was performed from journal inception to March 21, 2021, for case reports and a series of ophthalmic GPAs. Cytoplasmic-ANCA (c-ANCA), perinuclear-ANCA (p-ANCA), and granulomas were analyzed against many ophthalmic signs and symptoms. 306 patients with GPA were retrospectively studied. Results: Granulomas were present in 47.7% of our sample, c-ANCA in 59.2%, and p-ANCA in 10.8%. Scleritis was significantly associated with higher odds for c-ANCA positivity. Eye discharge, episcleritis, proptosis, and central nervous system (CNS) involvement were each significantly associated with lower odds for c-ANCA positivity. Orbital mass was significantly associated with lower odds for p-ANCA positivity. CNS involvement was significantly associated with higher odds for p-ANCA positivity (OR:3.08, 95% CI:1.02, 9.36, p=0.047) and orbital mass was significantly associated with lower odds for p-ANCA positivity. Conclusions: We recommend that clinicians should consider ocular or orbital GPA in patients presenting with non-specific eye complaints, such as vision impairment, orbital mass, or proptosis, and obtain further assessments to determine the possible presence of granuloma, c-ANCA, or p-ANCA. Abbreviations: GPA = Granulomatosis with Polyangiitis, ANCA = antineutrophil cytoplasmic antibody, c-ANCA = cytoplasmic-ANCA, p-ANCA = perinuclear-ANCA, CNS = central nervous system, AAVs = ANCA-associated vasculitides, SD = standard deviation, GU = genitourinary, ENT = ear nose and throat, OR = odds ratio, CI = confidence interval.

Novel hydrophilic-phase extraction, HILIC and high-resolution MS quantification of an RNA oligonucleotide in plasma.

Aim: In the theme of quantitative LC-MS bioanalysis of oligonucleotides free of ion-pairing, a 22-mer RNA oligonucleotide took center stage. The focus was on a unique polar-based retention scheme to produce a high-recovery extraction presenting a high-performance alternative extraction means, also there was the opportunity to involve hydrophilic-interaction liquid chromatography and contemporary high-resolution MS as the end point. Results: Original LC-MS methodology was developed for the oligonucleotide and the performance was robust for both nominal and accurate mass detection, the latter affording 10× improvement in sensitivity and 4000-fold linear dynamic range, 500 pM to 2000 nM. Conclusion: A novel means of solid-phase extraction is exhibited within a robust pair-free methodology, reaching pM sensitivity with the demonstrably beneficial accurate mass platform.

The Origin-Adjusted Approach for Reliable Quantification of Endogenous Analytes in Mass Spectrometric Bioanalysis.

The reliably accurate and precise quantification of biomarkers is a priceless objective in the drug development and diagnostic arenas. To employ a technique that brings such reliability and furthermore involves a simpler, faster, and inexpensive regime would only underline the potential importance of the concept and technique. To the existing established approaches for biomarker quantification in bioanalytical LC-MS, surrogate matrix (SUR-M) and surrogate analyte (SUR-A), in this Letter we present an approach that fulfills the aforementioned advantages. The concept builds on the historic method of standard addition (SA), in which one source of biological matrix is spiked with analyte to form a calibration curve. With the SA curve back-calculated, the heart of this procedure is the subsequent adjustment of the intercept to zero, the origin, and using only the slope of the curve for interpolation giving calculated sample concentrations. In SA, the concentration axis intercept indicates the endogenous analyte concentration, and our zeroing of this is equivalent to removing the endogenous level. This key shift of the calculated line to the origin unveils our novel origin-adjusted (OA) approach. It enables use akin to a regular xenobiotic method, with no need to ultimately account for the endogenous analyte level in the control matrix used for calibrants. We present a comparison of OA against the control approach of SUR-M in a representative application for kynurenine and tryptophan in human plasma by LC-MS. A numerical performance analysis performed is demonstrative of equivalence between the two approaches for both analytes.

Hemi-central retinal vein occlusion as a rare manifestation of the hypercoagulable state in COVID-19.

To date, COVID-19 has no definite effective targeted therapy, and management is primarily supportive. Central retinal vein occlusion (CRVO) is frequently caused by systemic risk factors posing hypercoagulable states. In April 2020, a female patient with a history of hypertension, diabetes mellitus and chronic kidney disease presented with 2 days of loose, watery stools, nasal congestion and severe lethargy. The patient denied dyspnoea or fever. A week after the initial symptoms, the patient reported decreased vision from the left eye. Dilated funduscopy and fluorescein angiography suggested hemi-CRVO. The patient refused intravitreal antivascular endothelial growth factor agents because of non-severe visual loss. Testing was positive for COVID-19 IgG antibodies; reverse transcription PCR was not available. Vision improved within 3 weeks of presentation. We recommend that clinicians keep a high suspicion for acute onset of thrombotic events in patients with COVID-19 and thrombotic predisposing risk factors.

Fulminant Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis After 10 Years of Hydralazine Use.

Vasculitis, by definition, causes changes in the walls of blood vessels, including thickening, weakening, narrowing, and scarring, leading to inflammation and necrosis of the blood vessel walls. Small-vessel vasculitis is commonly associated with anti-neutrophil cytoplasmic antibodies (ANCA), which activate cytokine-primed neutrophils and monocytes that express ANCA antigens proteinase 3 (PR3) and myeloperoxidase (MPO) on their surface. The continuous injury and inflammation of these small vessels characterized by circulating immune complexes and antinuclear antibodies result in clinical features standard in all types of vasculitis. When a 59-year-old male with a history of heart failure, hypertension (on hydralazine 100 mg every eight hours for more than ten years), diabetes mellitus, and dyslipidemia presented to the hospital, he was complaining of hematuria, intermittent periumbilical abdominal pain, and 40-lb weight loss over four months. Initial evaluation showed symptomatic anemia and large blood cells with proteinuria on urine analysis. During his clinical course, the patient developed a new diffuse purpuric rash. Imaging showed systemic involvement with ground-glass opacities, diffuse alveolar hemorrhage, and peripancreatic inflammatory changes, consistent with small-vessel vasculitis. Immunological tests confirmed ANCA-associated vasculitis, and kidney biopsy showed ANCA-mediated pauci-immune glomerulonephritis supported by the salvage technique used by pronase immunofluorescence, which provides evidence against the glomerular disease of the complex immune type in the setting of MPO-ANCA seropositivity. Despite the withdrawal of hydralazine and prompt initiation of immunosuppressive therapy and alternating sessions of plasmapheresis, the patient succumbed to acute massive pulmonary hemorrhage and subsequent demise. We recommend that patients on the common antihypertensive, hydralazine, should be monitored with non-specific inflammatory markers and, if warranted, with qualitative and quantitative assessment tools to measure inflammatory disease activity for possible complications of hydralazine drug-induced vasculitis or hydralazine ANCA-associated vasculitis (HAAV). Furthermore, cumulative dosages may be a predisposing factor for HAAV to present as a pulmonary-renal syndrome, which can be fulminant and fatal, despite aggressive efforts. Therefore, screening, revisiting therapy, early diagnosis, and prompt discontinuation of the drug are imperative.

T-Cell Large Granular Lymphocyte Leukemia in a Patient With Rheumatoid Arthritis.

Large granular lymphocyte leukemia (LGL) is a clonal, lymphoproliferative disorder with an indolent disease course. T-cell LGL (T-LGL) is the most common type of LGL driven from T-cell lineage (85%). The coexistence of T-LGL with several types of autoimmune disorders, mostly rheumatoid arthritis (RA), has been reported. Felty's syndrome (FS) is defined by splenomegaly, low neutrophil count, and destructive arthritis and is usually seen in <1% of patients with RA. About 30% to 40% of patients with FS have been reported to have an expansion of large granulated lymphocytes in the circulation. FS and T-LGL are similar in terms of clinical manifestations, response to immunosuppressive therapy, their smoldering course, and immunogenetic findings, proposing FS and T-LGL with RA might be different aspects of a single disease spectrum. In this article, we present a case with long-standing RA who had never been on DMARD (Disease Modifying Anti-Rheumatic Drugs) treatment found to have constitutional symptoms, neutropenia, and splenomegaly, and the patient was diagnosed with T-LGL.

A Training Program in Working Alliance Communication Skills.

The current paper presents the results from two studies. The first study examined the effectiveness of a training program designed to enhance medical residents' working alliance communication skills. The second study surveyed patients to examine if the resident training program resulted in significantly improved adherence and satisfaction for their patients. The first study used an experimental design, and 104 residents were randomly assigned to one of two groups: one group received working alliance training and the other served as a control and received no training. In the second study, after the training was completed, we surveyed one patient treated by each of the residents who participated in the first study to assess differences by resident group on patient self-reported adherence and satisfaction. In all, 68 patients participated and these patients were blind to whether the resident had participated in the training. For the first study, post-test data for the two groups showed that residents in the training group reported higher working alliance skills than residents in the control group. For the second study, patients cared for by residents who participated in the training reported better adherence and higher satisfaction with treatment than patients of residents in the control group. Thus, the training program appears to enhance residents' working alliance communication skills and is related to self-reported improvement in patient adherence and satisfaction. Further research is warranted to better understand these findings.

Antidiabetic activity of 50% ethanolic extract of Ricinus communis and its purified fractions.

We investigated the antidiabetic activity of 50% ethanolic extract of roots of Ricinus communis (RCRE) along with its bioassay-guided purification. Five-hundred milligram per kilogram body weight appeared to be the effective dose as it caused the maximum lowering of the fasting blood glucose, both in normal as well as type 1 diabetic animals. The maximum hypoglycemic effect was always observed at the 8th h up to which the study has been conducted. Administration of the effective dose of RCRE to the diabetic rats for 20 days showed favorable effects not only on fasting blood glucose, but also on total lipid profile and liver and kidney functions on 10th and 20th day. RCRE was purified using silica gel column chromatography. Out of several different fractions tested, only one fraction (R-18) showed significant antihyperglycemic activity. RCRE seemed to have a high margin of safety as no mortality and no statistically significant difference in alkaline phosphatase, serum bilirubin, creatinine, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase and total protein was observed even after the administration of the extract at a dose of 10 g/kg b.wt. Thus R. communis seems to have a promising value for the development of a potent phytomedicine for diabetes.

Using Drosophila behavioral assays to characterize terebrid venom-peptide bioactivity.

The number of newly discovered peptides from the transcriptomes and proteomes of animal venom arsenals is rapidly increasing, resulting in an abundance of uncharacterized peptides. There is a pressing need for a systematic, cost effective, and scalable approach to identify physiological effects of venom peptides. To address this discovery-to-function gap, we developed a sequence driven:activity-based hybrid approach for screening venom peptides that is amenable to large-venom peptide libraries with minimal amounts of peptide. Using this approach, we characterized the physiological and behavioral phenotypes of two peptides from the venom of predatory terebrid marine snails, teretoxins Tv1 from Terebra variegata and Tsu1.1 from Terebra subulata. Our results indicate that Tv1 and Tsu1.1 have distinct bioactivity. Tv1 (100 µM) had an antinociceptive effect in adult Drosophila using a thermal nociception assay to measure heat avoidance. Alternatively, Tsu1.1 (100 µM) increased food intake. These findings describe the first functional bioactivity of terebrid venom peptides in relation to pain and diet and indicate that Tv1 and Tsu1.1 may, respectively, act as antinociceptive and orexigenic agents. Tv1 and Tsu1.1 are distinct from previously identified venom peptides, expanding the toolkit of peptides that can potentially be used to investigate the physiological mechanisms of pain and diet.