Metal Exposure and Risk of Parkinson Disease: A Systematic Review and Meta-Analysis.

Metal exposure has been suggested as a possible environmental risk factor for Parkinson disease (PD). We searched the PubMed, EMBASE, and Cochrane databases to systematically review the literature on the relationship between metal exposure and PD risk and to examine the overall quality of each study and the exposure assessment method. A total of 83 case-control studies and 5 cohort studies published during the period 1963-July 2021 were included, of which 73 were graded as being of low or moderate overall quality. Investigators in 69 studies adopted self-reported exposure and biomonitoring after disease diagnosis for exposure assessment approaches. The meta-analyses showed that concentrations of copper and iron in serum and concentrations of zinc in either serum or plasma were lower, while concentrations of magnesium in CSF and zinc in hair were higher, among PD cases as compared with controls. Cumulative lead levels in bone were found to be associated with increased risk of PD. We did not find associations between other metals and PD. The current level of evidence for associations between metals and PD risk is limited, as biases from methodological limitations cannot be ruled out. High-quality studies assessing metal levels before disease onset are needed to improve our understanding of the role of metals in the etiology of PD.

Prediagnostic Blood Metal Levels and the Risk of Parkinson's Disease: A Large European Prospective Cohort.

BACKGROUND: Metals have been postulated as environmental concerns in the etiology of Parkinson's disease (PD), but metal levels are typically measured after diagnosis, which might be subject to reverse causality. OBJECTIVE: The aim of this study was to investigate the association between prediagnostic blood metal levels and PD risk. METHODS: A case-control study was nested in a prospective European cohort, using erythrocyte samples collected before PD diagnosis. RESULTS: Most assessed metals were not associated with PD risk. Cadmium has a suggestive negative association with PD (odds ratio [95% confidence interval] for the highest quartile, 0.70 [0.42-1.17]), which diminished among never smokers. Among current smokers only, lead was associated with decreased PD risk (0.06 [0.01-0.35]), whereas arsenic showed associations toward an increased PD risk (1.85 [0.45-7.93]). CONCLUSIONS: We observe no strong evidence to support a role of metals in the development of PD. In particular, smoking may confound the association with tobacco-derived metals. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Prognosis communication with older patients with multimorbidity: Assessment after an educational intervention.

This study aimed to assess how internal medicine residents incorporated prognosis to inform clinical decisions and communicated prognosis in primary care visits with older patients with multimorbidity after an educational intervention, and resident and patient perspectives regarding these visits. Assessment used mixed-methods. The authors assessed the frequency and content of prognosis discussions through residents' self-report and qualitative content analysis of audio-recorded clinic visits. The authors assessed the residents' perceived effect of incorporating prognosis on patient care and patient relationship through a resident survey. The authors assessed the patients' perceived quality of communication and trust in physicians through a patient survey. The study included 21 clinic visits that involved 12 first-year residents and 21 patients. Residents reported incorporating patients' prognoses to inform clinical decisions in 13/21 visits and perceived positive effects on patient care (in 11/13 visits) and patient relationship (in 7/13 visits). Prognosis communication occurred in 9/21 visits by self-report, but only in six of these nine visits by content analysis of audio-recordings. Patient ratings were high regardless of whether or not prognosis was communicated. In summary, after training, residents often incorporated patients' prognoses to inform clinical decisions, but sometimes did so without communicating prognosis to the patients. Residents and patients reported positive perceptions regarding the visits.

Incorporating prognosis in the care of older adults with multimorbidity: description and evaluation of a novel curriculum.

BACKGROUND: Prognosis is a critical consideration in caring for older adults with multiple chronic conditions, or "multimorbidity". Clinicians are not adequately trained in this area. We describe an innovative curriculum that teaches internal medicine residents how to incorporate prognosis in the care of older adults with multimorbidity. METHODS: The curriculum includes three small-group sessions and a clinical exercise; it focuses on the assessment, communication, and application of prognosis to inform clinical decisions. The curriculum was implemented with 20 first-year residents at one university-based residency (intervention group). Fifty-two first-year residents from a separate residency affiliated with the same university served as controls. Evaluation included three components. A survey assessed acceptability. A pre/post survey assessed attitude, knowledge, and self-reported skills (Impact survey). Comparison of baseline and follow-up results used paired t-test and McNemar test; comparison of inter-group differences used t-test and Fisher's exact test. A retrospective, blinded pre/post chart review assessed documentation behavior; abstracted outcomes were analyzed using Fisher's exact test. RESULTS: The curriculum was highly rated (4.5 on 5-point scale). Eighteen intervention group residents (90 %) and 29 control group residents (56 %) responded to the Impact survey. At baseline, there were no significant inter-group differences in any of the responses. The intervention group improved significantly in prognosis communication skills (5.2 to 6.6 on 9-point scale, p < 0.001), usage of evidence-based prognostic tools (1/18 to 14/18 responses, p < 0.001), and prognostic accuracy (1/18 to 9/18 responses, p = 0.005). These responses were significantly different from the control group at follow-up. Of 71 charts reviewed in each group, prognosis documentation in the intervention group increased from 1/25 charts (4 %) at baseline to 8/46 charts (17 %) at follow-up (p = 0.15). No prognosis documentation was identified in the control group at either time point. Inter-group difference was significant at follow-up (p = 0.006). CONCLUSION: We developed and implemented a novel prognosis curriculum that had significant short-term impact on the residents' knowledge and communication skills as compared to a control group. This innovative curriculum addresses an important educational gap in incorporating prognosis in the care of older adults with multimorbidity.

Quality of life in female cancer survivors: is it related to ovarian reserve?

PURPOSE: The purpose of the study is to assess the quality-of-life scores and possible association with measures of ovarian reserve in female cancer survivors compared to healthy controls of similar age. METHODS: In this prospective cohort study, fifty-nine cancer survivors aged 16-39 years and 66 healthy, similarly aged unexposed women were recruited at the University of Pennsylvania. The primary outcome measures are the generic and cancer-specific domain scores on the Quality of Life in Adult Cancer Survivors (QLACS) instrument, early follicular phase serum hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), inhibin B (INH), anti-Mullerian hormone (AMH), and ovarian ultrasound measurements [ovarian volume and antral follicle count (AFC)]. RESULTS: Cancer survivors had significantly higher total and cancer-specific domain scores compared to unexposed participants. Serum AMH, INH, ovarian volume, and AFC were lower while serum FSH was higher in cancer survivors. Although survivors exhibited diminished ovarian reserve, these markers were not independently associated with total QLACS score. Cancer survivors with irregular menstrual function were found to have lower quality-of-life (QOL) scores than those with regular cycles. CONCLUSIONS: We found that QOL appears to be significantly impaired in cancer survivors compared to controls, even when remote from initial cancer diagnosis. In addition, our study suggests that reproductive aging contributes to QOL in the setting of irregular menses and likely profound impairment of ovarian function.

An Overview on the Zoonotic Aspects of COVID-19.

Disruption of pristine natural habitat has a strong positive correlation with this increase in pandemics and thus, the zoonotic aspects are the most important part to uncover scientifically. On the other hand, containment and mitigation are the two basic strategies to stop a pandemic. The route of infection is of utmost importance for any pandemic and often left behind in combating the fatalities in real time. The increase in recent pandemics, from ebola outbreak to ongoing COVID-19 havoc, exerts implicit significance in the search of zoonotic transmissions of the diseases. Thus, a conceptual summary has been made through this article in understanding the basic zoonotic mechanism of the disease COVID-19 based on available published data and schematic presentation has been drawn on the route of transmission, so far discovered.

Phytoextracts as Antibacterials: A Review.

Botanicals have been cultured to flavour food, to treat health disorders and to put a stop to diseases caused by various microorganisms. The awareness of curative features of different medicinal plants has been spread among human communities. The application of herbal products as antimicrobial agents may be a better choice for the extensive and imprudent use of synthetic antibiotics. World Health Organization recommended traditional medicines as the safest remedies for the treatment of diseases of microbial origin. The plant extracts are generally nonhazardous, available in plenty at reasonable prices, biodegradable, eco-friendly and sometimes show broad-spectrum activities against different microorganisms. The current knowledge on plant extracts, phytochemicals and their antibacterial activity, target specific mechanism of action, solvents deployed during extraction, properties of an active ingredient isolated may help in biological control of bacteria. Antimicrobial properties of different plant parts, which act in a low dose, have been organised separately for easy understanding.

Larvicidal activity of phytosteroid compounds from leaf extract of Solanum nigrum against Culex vishnui group and Anopheles subpictus.

BACKGROUND: Vector control is facing a menace due to the appearance of resistance to synthetic insecticides. Insecticides of plant origin may provide appropriate substitute biocontrol techniques in the future. The present study was carried out to investigate the bio control potentiality of active ingredient isolated from chloroform: methanol (1:1 v/v) extract of mature leaves of Solanum nigrum L. (Solanaceae) against early 3rd instar larvae of Culex vishnui group (comprising of Cx. vishnui Theobald, Cx. pseudovishnui Colless and Cx. tritaeniorhynchus Giles) and Anopheles subpictus Grassi. S. nigrum is a common plant distributed in many parts of India with medicinal properties. METHODS: Bioactive compound isolated from chloroform: methanol (1:1 v/v) extract of mature leaves of S. nigrum was (25, 45, 60 mg/L) tested against early 3rd instar larvae of Cx. vishnui group and An. subpictus. The lethal concentration was determined by log probit analysis. The chemical nature of the active substance was also evaluated following gas chromatography-mass spectroscopy (GC-MS) and infrared (IR) analysis. The compound was also studied on non target organisms such as Daphnia sp. and Diplonychus annulatum. RESULTS: TLC spot having Rf value of 0.94 (Rf = 14.1/15 = 0.94) showed larvicidal activity. In a 72 h bioassay experiment, mortality rate at 60 mg/L was significantly higher (P < 0.05) than those at 25 and 45 mg/L against early 3rd instar. Result of log-probit analysis (at 95% confidence level) revealed that LC50 and LC90 values gradually decreased with the exposure period showing the lowest value at 72 h of exposure. A clear dose-dependent mortality was observed, as the rate of mortality (Y) was positively correlated with the concentration (X) having regression coefficient value close to one in each case. The compound was found to be eco-friendly as it did not show any adverse effect to the studied non target organisms. Chemical characterization (GC-MS and IR analyses) of the active ingredient revealed the presence of phytosteroid compounds responsible for mosquito larvicidal activity. CONCLUSION: Leaf extract of S. nigrum has great potential as bio control agent against Cx. vishnui group and An. subpictus. In near future the isolated bioactive phytochemical could be used as a source of an effective mosquitocidal agent.

Current Practices and Opportunities in a Resident Clinic Regarding the Care of Older Adults with Multimorbidity.

OBJECTIVES: Multimorbidity (≥2 chronic conditions) affects more than half of all older adults. The American Geriatrics Society developed and published guiding principles for the care of older adults with multimorbidity in 2012. Improved clinician training in caring for older adults with multimorbidity is needed, but it is not clear what opportunities arise within clinical encounters to apply the guiding principles or how clinicians at all stages of training currently practice in this area. This project aimed to characterize current practice and opportunities for improvement in an internal medicine residency clinic regarding the care of older adults with multimorbidity. DESIGN: Qualitative content analysis of audio-recorded clinic visits. SETTING AND PARTICIPANTS: Thirty clinic visits between 21 internal medicine residents and 30 of their primary care patients aged 65 and older with two or more chronic conditions were audio-recorded. Patients' mean age was 73.6, and they had on average 3.7 chronic conditions and took 12.6 medications. MEASUREMENTS: Transcripts of the audio-recorded visit discussions were analyzed using standard techniques of qualitative content analysis to describe the content and frequency of discussions in the clinic visits related to the five guiding principles: patient preferences, interpreting the evidence, prognosis, clinical feasibility, and optimizing therapies. RESULTS AND CONCLUSIONS: All visits except one included discussions that were thematically related to at least one guiding principle, suggesting regular opportunities to apply the guiding principles in primary care encounters with internal medicine residents. Discussions related to some guiding principles occurred much more frequently than others. Patients presented a number of opportunities to incorporate the guiding principles that the residents missed, suggesting target areas for future educational interventions.

Impact of cancer therapies on ovarian reserve.

OBJECTIVE: To determine whether measures of ovarian reserve differ between females exposed to cancer therapies in a dose-dependent manner as compared with healthy controls of similar age and late reproductive age. DESIGN: Cross-sectional analysis of data from a prospective cohort study. SETTING: University medical center. PATIENT(S): Seventy-one cancer survivors aged 15-39 years; 67 healthy, similarly aged unexposed subjects; and 69 regularly menstruating women of late reproductive age (40-52 years). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Early follicular-phase hormones (FSH, E(2), inhibin B, antimüllerian hormone [AMH]) and ovarian ultrasound measurements (ovarian volume and antral follicle counts [AFC]) were compared using multivariable linear regression. RESULT(S): In adjusted models, FSH, AMH, and AFC differed between exposed vs. unexposed subjects (FSH 11.12 mIU/mL vs. 7.25 mIU/mL; AMH 0.81 ng/mL vs. 2.85 ng/mL; AFC 14.55 vs. 27.20). In participants with an FSH <10 mIU/mL, survivors had lower levels of AMH and AFC compared with controls. Alkylating agent dose score was associated with increased levels of FSH and decreased levels of AMH. Exposure to pelvic radiation was associated with impairment in FSH, AMH, AFC, and ovarian volume. Antimüllerian hormone was similar in women previously exposed to high-dose cancer therapy and 40-42-year-old controls. CONCLUSION(S): Measures of ovarian reserve are impaired in a dose-dependent manner among cancer survivors compared with unexposed females of similar age. Reproductive hormone levels in menstruating survivors exposed to high-dose therapy are similar to those in late-reproductive-age women. The predictive value of measures for pregnancy and menopause must be studied. CLINICALTRIALS.GOV IDENTIFIER: NCT01143844.