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Navigating the Challenges of Stenotrophomonas maltophilia Infections in Chronic Kidne...
Joydip Chowdhury
Prince Shah-Riar

Joydip Chowdhury

and 4 more

March 18, 2025
A document by Joydip Chowdhury. Click on the document to view its contents.
Traded news and large language models: evidence from China’s stock market
Ziran Zhao

Ziran Zhao

March 18, 2025
with the development of communication equipment like network technology, the articles reported by media can convey information to public readers more timely by all kinds of channels such as news and so on. Therefore, the passages have more impact on the stock price. They may contain valuable information that reflect the change of stock’s fundamentals. In this paper, we utilize the natural language processing (nlp) in deep learning to analyze the stock related news. First, we use large language model (LLM) to map each word of text to an embedding vector. Then we build an attention-based model for stock movement prediction on China’s stock market according to the word embedding vector. A trading strategy can be obtained by the predicted result. Furthermore, we find that when financial knowledge graph is used to measure the relation between stocks, trading profit can be strengthened if we trading the related stock simultaneously. Comparing with previous method, deep learning model shows great potential for feature extraction and stock price prediction.
ICI-Induced Ureteritis and Cystitis in Patients with Lung Cancer and Uterine Malignan...
yu yan
Xiao-Yan Liu

yu yan

and 6 more

March 18, 2025
Immune checkpoint inhibitors (ICIs) have demonstrated significant efficacy in the treatment of various cancers, but their use is also associated with immune-related adverse events (irAEs). While common irAEs, such as dermatitis, pneumonitis, and colitis, are well-documented, rare events like cystitis and ureteritis remain underreported. This report presents three cases of ICI-induced cystitis and ureteritis. The first case involves a 67-year-old female with lung cancer who developed immune-related cystitis and ureteritis twice—once following pembrolizumab treatment and a recurrence after treatment discontinuation. Both episodes were corticosteroid-sensitive. The second case involves a 37-year-old female with cervical cancer who developed these conditions following treatment with cadonilimab. Her symptoms improved with oral corticosteroids and intravesical corticosteroid irrigation. The third case describes a 35-year-old female with endometrial cancer who responded similarly to corticosteroid therapy after receiving pembrolizumab. This report underscores the importance of early recognition and management of rare irAEs, and highlights intravesical methylprednisolone as a potential treatment modality that warrants further investigation.
Transforming Care in the United Kingdom: How Leadership and Culture Drive Healthcare...
Muhammad Arsalan Nazir
Smriti Gautam

Muhammad Arsalan Nazir

and 2 more

March 18, 2025
This study explores how leadership styles and organizational culture influence healthcare professionals’ engagement, performance, and patient care within the NHS, addressing a gap in understanding their combined impact on healthcare outcomes. While leadership and culture are key drivers of healthcare success, they are often studied separately. This research examines their intersection, focusing on transformational leadership and a patient-centric organizational culture. Using a qualitative approach, semi-structured interviews were conducted with healthcare professionals from NHS hospitals in the United Kingdom. Data were analyzed thematically through the lens of transformational and transactional leadership theories and Edgar Schein’s organizational culture framework. The findings reveal three key themes: transformational leadership enhances motivation, performance, and engagement by fostering a supportive work environment; a patient-centric culture strengthens collaboration, teamwork, and high-quality care through shared values; and professional engagement, shaped by leadership and culture, plays a crucial role in job satisfaction and patient outcomes. By integrating leadership and organizational culture, this study offers new insights into their collective impact on healthcare performance. It highlights the need for leadership development programs that promote transformational leadership and patient-centered culture. Future research should further investigate the direct link between leadership, culture, and patient outcomes across different healthcare settings.
The role of ACE2 in SARS-CoV-2 infection, pathogenesis, and antiviral interventions
Michael McVoy
Apparao B. Kummarapurugu

Michael McVoy

and 1 more

March 18, 2025
The devastating clinical, psychological, and economic impact of the COVID-9 pandemic, caused by global spread of the second Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), engendered a massive response from the scientific community to rapidly understand the biology of SARS-CoV-2 and to develop interventions to prevent infection or progression to life-threatening disease. Angiotensin converting enzyme-2 (ACE2) and its interaction with the SARS-CoV-2 Spike glycoprotein, which mediates fusion of the virion envelope with the target cell membrane, emerged as a major pharmacological target, as disruption of Spike-ACE2 interaction prevents cells from becoming infected and hence from producing viral progeny. Moreover, the dysregulation of ACE2 that occurs in the context of SARS-CoV-2 infection may have broader implications for COVID-19 pathogenesis. Here we summarize the role of ACE2 as a physiologic regulator of human health, as a facilitator of SARS-CoV-2 infection, as a factor in COVID-19 disease, and as a target for pharmacological interventions.
A 0.1-6 GHz Optimized Flicker Noise Darlington Amplifier with Capacitor Compensation...
Rui Diao
Shiyuan Li

Rui Diao

and 3 more

March 18, 2025
A low flicker-noise Darlington low-noise-amplifier (LNA) based on pHEMT technology is introduced in this article. The proposed amplifier adopts a Darlington cascode structure to increase the gain. A negative feedback network and a shunt peaking inductance are employed to ensure a flat frequency response and broadband stability performance. Moreover, through quantitatively analyzing the flicker noise generation mechanism, a novel gate-channel compensation capacitor scheme is proposed. By introducing this gate-channel capacitor, the flicker-noise caused by active biasing can be shifted to lower frequencies, thereby significantly improving the noise figure (NF) at low frequencies without affecting the amplifier gain. The fabricated LNA attains the NF better than 2.2 dB, the gain larger than 15.7 dB, with input-output (I/O) return losses better than 12 dB over the frequency range of 0.1-6 GHz. The output 1 dB compression point (OP1dB) exceeds 17.2 dBm, and the total chip area is only 0.88 mm2
Accurate Chatacterization of Transceiver Devices Using 3-port Balun De-embedding Tech...
Shirong Lv
Yong Wang

Shirong Lv

and 6 more

March 18, 2025
This article presents a baseband data compensation method that utilizes a 3-port Balun de-embedding technique to accurately measure the RF parameters of transceiver chips, including noise figure and nonlinear characteristics. This study explores the theoretical derivation of the 3-port Balun de-embedding algorithm, the design of calibration components, and the baseband data compensation algorithm. The S-parameters of the Balun are derived using an optimized TRL de-embedding algorithm, and then the baseband data compensation algorithm is applied to correct the amplitude. Experimental results conducted on a PCB demonstrate that this method significantly improves the accuracy of RF parameter measurements, providing technical support for enhancing the performance of programmable RF transceivers. The proposed method not only enhances the accuracy of RF chip testing but also provides new insights and technical approaches for future research in related fields.
Insights into Crouzon syndrome and associated anesthetic implications.
Sunil Bhatta

Sunil Bhatta

March 18, 2025
Title: Insights into Crouzon syndrome and associated anesthetic implications.Author : Bhatta SunilDepartment of Anesthesia and Critical Care, Nisarga Hospital and Research CenterAddress: Dhangadhi-5, Nepal, 10900Email: bhattasunil26@gmail.com (Corresponding author)Phone number: +9779849366618ORCiD: https://orcid.org/0009-0004-7871-3489Data availability statement : Data described to support the findings is openly accessible in the article.
Reproductive Competition in Multiple-queen Fire Ant Colonies: Insights from Analyses...
Sierra Hale Walker
Kip Lacy

Sierra Hale Walker

and 3 more

March 18, 2025
When animals reproduce in social groups, the potential for conflict and cooperation is shaped by the number of reproductive individuals (breeders), their relatedness to one another, and division of reproduction among them. These features comprise species’ “breeding systems.” Despite their importance, breeding systems are poorly characterized in most social animals, and detailed accounts for single species are rare. Here, we fully characterize the breeding systems in invasive populations of the fire ant Solenopsis invicta, a species in which a large genetic element (supergene) determines whether a colony has a single queen (monogyne social form) or multiple queens (polygyne form). Colonies of the monogyne form are simple families, and the breeding system is correspondingly straightforward. The breeding system of the polygyne form is complex, with many features still uncharacterized. We conducted a large longitudinal experiment tracking parentage, relatedness, and supergene genotype in semi-natural polygyne colonies. Along with reanalyzed data from previous studies, we show that colony queen number is highly variable, queens generally mate once, nestmate breeders (queens and their mates) are unrelated, and reproductive skew is pervasive, especially for sexual daughters. Uncommon instances of polyandry occur when a queen remates after initially mating with a male bearing the Sb supergene haplotype (associated with low sperm counts). Paternity skew is pronounced and stable, with Sb sperm contributing to a minority of offspring (particularly sexuals). Thus, the supergene not only determines colony queen number, it broadly affects the breeding system, with impacts on colony kin structure and opportunities for reproductive competition.
Connectivity more than environment shapes prokaryotic and eukaryotic communities in a...
Aïcha Mehirou Zouggar
Pascal Mirleau

Aïcha Mehirou Zouggar

and 6 more

March 18, 2025
We investigated biodiversity drivers in the vast, understudied RAMSAR wetland Chott Ech Chergui, at the northern edge of the Sahara Desert in Algeria using metabarcoding. Our goal was to describe prokaryotic and eukaryotic biodiversity with the 16S rRNA and COI genes and to assess how connectivity and environmental conditions shape communities in various habitats: hot springs, saline or alkaline-salty lakes and freshwater ecosystems. Over one year, we sampled water and sediment at six sites monthly. Both markers revealed higher diversity in water than in sediment and similarly reflected the effects of site, month, connectivity, and abiotic factors. Physico-chemical parameters (temperature, pH, oxygen concentration and salinity) significantly influenced water communities. However, connectivity (sub-network) emerged as a more important driver of β-diversity, not only for eukaryotes but also, to a lesser extent, for prokaryotes. The most similar communities were found in hydrologically connected sites rather than in similar habitats. These results challenge the paradigm that for microorganisms “everything is everywhere, but the environment selects”. Both spatial and temporal β-diversity were similarly high, with their turnover components also comparable, reflecting the wetland’s abiotic instability. This instability prevents local communities from reaching equilibrium with their environment, making connectivity a more influential driver than environmental conditions, even for prokaryotes despite their faster population dynamics. We detected numerous organisms unknown in genetic databases and strongly suggest extending the known range for some eukaryotic species. Our results suggest that this wetland hosts biotechnologically interesting poly-tolerant prokaryotes and that efficient conservation should encompass its entire area.
Alcohol exposure promotes MMP9-mediated CCN1 cleavage in esophageal adenocarcinoma
Wula Aladan
Baoxin Chi

Wula Aladan

and 6 more

March 18, 2025
Background: Alcohol consumption has been a risk factor for more than 200 diseases, including esophageal cancer. CCN1, a matricellular protein, is highly expressed in esophageal squamous cell carcinoma (ESCC) but is barely detectable in esophageal adenocarcinoma (EAC). Alcohol consumption has been identified as a major contributor to ESCC development, but its role in EAC is uncertain. This study investigates how alcohol exposure affects CCN1 expression and function in esophageal epithelial cells. Methods: CCN1 expression in rat esophagus was assessed after 4 weeks of alcohol consumption. Esophageal cell lines, including normal and tumor, were exposed to alcohol to simulate the in vivo experiments. Results: Alcohol exposure moderately increased CCN1 expression in both normal and tumor cells but significantly increased CCN1 cleavage in EAC cells only, generating an 18 kDa fragment benefiting tumor growth. MMP9, which was active in EAC cells exclusively, was found to mediate this cleavage. Forced activation of MMP9 in either normal or ESCC cells improved cell viability while inhibition of MMP9 in EAC cells attenuated cell survival. Conclusions: Alcohol exposure promotes MMP9-mediated CCN1 cleavage in EAC cells, turning CCN1 from an EAC antagonist to an EAC agonist.
Drone-Based Face Detection and Collision Avoidance Framework
Mostafa Farwiz
Mohamed Sabry

Mostafa Farwiz

and 3 more

March 18, 2025
Abstract Drone technological advancements, driven by advances in computer vision and deep learning, have made a variety of applications in urban planning, security, and surveillance possible. Effective face detection and reliable obstacle avoidance are two crucial facets of drone operations that are covered in this study. This model is appropriate for drone platforms with limited resources since it exhibits good accuracy and real-time performance. The major idea is to implement a dual-purpose framework integrating real-time face detection and autonomous collision avoidance for UAV operations. The YOLOv8 model, fine-tuned on the WIDER FACE dataset, is employed for robust face detection, overcoming challenges such as occlusions and varying head poses, and to ensure safe navigation, a stereo camera-based obstacle avoidance system is introduced as a cost-effective alternative to LiDAR. The system utilizes Semi-Global Block Matching (SGBM) and Block Matching (BM) algorithms to generate dense disparity maps, enabling precise per-pixel depth estimation. Together, the advances improve drone-based surveillance systems by incorporating collision avoidance and real-time face detection.
Biased estimates of pollen limitation due to resource reallocation across modular lev...
Xia Jiang
Kai-Hsiu Chen

Xia Jiang

and 6 more

March 18, 2025
Pollen limitation, a decrease in reproductive success via the female function due to deficient pollen receipt, may influence plant demography and the evolution of sexual systems. Nonetheless, empirical estimation of pollen limitation by pollen supplementation is prone to overestimation due to potential resource reallocation among resource pools within an individual, e.g., among flowers and inflorescences. Yet little empirical research has simultaneously evaluated the effect of resource reallocation across different modular levels within a single species, especially in alpine plants. We estimated pollen limitation at three modular levels (i.e., flower, raceme, and whole-plant) in the perennial alpine herb Veratrum grandiflorum in the eastern Himalayan Hengduan Mountains, using fruit set and seed production as two proxies for female reproductive success. Based on seed production, we found that pollen limitation differed significantly among modular levels, with the highest and lowest values being at the flower and whole-plant levels, respectively; this result points to resource reallocation among modules within individuals. In contrast, fruit set was relatively insensitive to pollen supplementation, so estimates of pollen limitation were low and did not differ among modular levels. These results highlight the importance of multi-modular and multi-metric approaches for accurately assessing pollen limitation, which may often be overestimated at lower modular levels.
A Novel ELANE Variant Causing Severe Congenital Neutropenia Diagnosed in Adulthood.
Renato Cerqueira
Josefina Aparecida Pellegrini Braga

Renato Cerqueira

and 4 more

March 18, 2025
Letter to the EditorAuthors: Renato Cerqueira¹; Josefina Aparecida Pellegrini Braga¹; Elyse Moritz¹; João Bosco Pesquero¹; José Orlando Bordin¹Institution : 1 - Universidade Federal de São PauloTitle: A Novel ELANE Variant Causing Severe Congenital Neutropenia Diagnosed in Adulthood.Dear Editor,Severe congenital neutropenia (SCN) has been associated with approximately 30 genes, with ELANE accounting for 45-55% of cases. ELANE is an autosomal dominant gene with over 200 described variants.1, 2,3-5 Predominantly affecting childhood, SCN is characterized by a life-threatening bone marrow failure syndrome. Before the introduction of granulocyte colony-stimulating factor (G-CSF), the mortality rate exceeded 80% due to bacterial infections, even with the use of antibiotics. The advent of G-CSF significantly reduced mortality, but the cumulative incidence of death from sepsis remains at 10% after 15 years of treatment.1We report the case of a 29-year-old woman admitted to the hospital with a tonsillar abscess and severe neutropenia. She had a lifelong history of neutropenia, with recurrent oral ulcers, gastroenterocolitis, urinary tract infections, pneumonia, and skin abscesses. Notably, she had no history of using G-CSF either prophylactically or during infections, having only received briefly for six months around the age of 10. Additionally, she lost her lower central incisor teeth at the age of 23 due to severe periodontitis.Physical examinations consistently revealed painful oral ulcers and skin abscesses. Serial blood counts, performed approximately twice a week over a ten-week period, were not compatible with cyclic neutropenia (Figure 1). Bone marrow aspirate revealed granulocytic series hypocellularity with maturation arrest at the promyelocyte stage, and bone marrow trephine confirmed global hypocellularity (~40%). Immunophenotyping showed no clonal cell populations, and a normal karyotype G band was observed in 20 metaphases. Whole exome sequencing identified a novel ELANE variant (ELANE :c.47T>G:p.[Leu16Arg]) confirmed by Sanger sequencing. This specific ELANE variant results in a leucine to arginine substitution at position 16 of the protein. Leucine is a hydrophobic amino acid, while arginine is hydrophilic and positively charged, which can cause significant changes in the structure or stability of the protein, possibly interfering with its function. Mutations in the ELANE gene are typically associated with defects in the processing of neutrophil elastase, leading to the accumulation of misfolded proteins in the endoplasmic reticulum of granulopoiesis precursor cells. This accumulation can trigger cellular stress, programmed cell death (apoptosis) and, consequently, failure in the maturation of neutrophils, which is characteristic of SCN.6Her parents were non-consanguineous, and her father, who died at the age of 68 from a stroke, was reportedly neutropenic but asymptomatic, though no blood count records were available. Her mother had normal blood counts and no history of recurrent infections, nor did she carryELANE variants. The patient’s only sister, aged 34, had a history of chronic neutropenia with recurrent skin abscesses, pneumonia, tooth loss at the age of 24 due to severe periodontitis, and had been using G-CSF since the age of 2. Blood samples revealed that this sibling is also heterozygous for the ELANE (c.47T>G) variant.To our knowledge, there have been no recorded cases of SCN diagnosed as late as 29 years of age, particularly when associated with ELANE mutations. This case reinforces the importance of considering genetic testing for neutropenia in selected adult patients, especially when clinical manifestations suggest SCN. Additionally, this novelELANE variant may be associated with a milder clinical phenotype, potentially explaining the delayed diagnosis in this patient.
“Recurrent Transfusions and Severe Infections: Unmasking Hatipoglu Immunodeficiency S...
Shivani Singh
Apurva Garg

Shivani Singh

and 2 more

February 21, 2025
Title: “ Recurrent Transfusions and Severe Infections: Unmasking Hatipoglu Immunodeficiency Syndrome”
A Novel Approach to Hostility Detection: Employing GPT-2 for Text Classification
Bharti Sharma
Minakshi Tomer

Bharti Sharma

and 4 more

March 18, 2025
Social media platforms provide an easy way to share valuable information and convey personal opinions. Even though these platforms have many benefits, they have made aggressive posts more common. People post hate speech and insulting comments for their own pleasure or to help their political campaigns. The entire platform experience can be rendered hostile by the harassing effect of the hostile posts. Therefore, it is crucial to identify antagonistic posts in order to preserve social media hygiene. Languages with limited resources, such as Hindi, are particularly susceptible to this issue. In this study, we introduce methods for detecting hostile text in the Hindi language. The Constraint@AAAI 2021 Hindi hostility detection dataset is used to evaluate the proposed approaches. For this multi-label classification problem, we assess a variety of deep learning methods that are based on GPt-2. We demonstrate that the performance of models based on GPT-2 is optimal.
DYNAMIC PREDICTIVE ROUTING FOR SATELLITE MEGACONSTELLATIONS
Mike Greenwood
Rob Hunter

Mike Greenwood

and 2 more

March 18, 2025
The size and complexity of emerging low-earth orbit (LEO) satellite communications (Satcom) constellations introduce challenges for network traffic engineering. As low latency Satcom connectivity LEO constellations with inter-satellite link (ISL) technology take off, improvements in cost and performance are key to increasing market share. Delivering the best service to customers in this increasingly competitive marketplace is driving operators to consider new technologies to scale-up capacity whilst improving service performance and controlling expenditure. The vision at the heart of all mega-constellation systems is a Very Wide Area Network (VWAN) with low latency that can compete with land-based fibre systems. One area where ISL-enabled mega-constellation systems show promise is delivering lower latency and higher throughput communications over long distances with fewer satellite network gateways, which in turn drives the total cost of ownership of the system down substantially.
Beyond 5G and non-terrestrial network (NTN) integrated architecture: access challenge...
Byung Woon Kim
Ga Eun Choi

Byung Woon Kim

and 1 more

March 18, 2025
This study analyzes the architecture of the beyond 5G-NTN (Non-Terrestrial Network) integrated network and presents the technical, legal, and regulatory challenges and considerations for expanding the AIoT (Artificial Intelligence of Things) ecosystem. 5G-NTN integrates LEO, MEO, and GEO satellite communications with terrestrial networks (Mobile Network Operator, Mobile Virtual Network Operator) to provide global connectivity. Based on the 3GPP Rel-17/18 standards, it incorporates key technologies such as network slicing, edge computing, and dynamic spectrum allocation. To establish a robust AIoT ecosystem, technological solutions such as shared licensing for NTN and terrestrial network spectrum, optimization of network slicing, and QoS-based service differentiation are required. From a legal and regulatory perspective, cooperation with global regulatory bodies such as the ITU, FCC, and MSIT is necessary to establish NTN access models and wholesale policies. Additionally, policies for satellite data security and privacy protection must be developed. Strengthening interoperability between MNOs and Satellite Network Operators (SNOs) and establishing the Satellite Virtual Network Operator (SVNO) model, which includes MVNOs and the private 5G market, is crucial. This study emphasizes that the 5G-NTN-based AIoT ecosystem will serve as a key infrastructure driving future digital innovation and provides practical insights for policymakers, telecom operators, and research institutions. The global AIoT economy is projected to reach $411.5 billion by 2040, necessitating technical standardization and regulatory support to sustain its growth.
Polygonati Rhizoma reduces inflammation and improves muscle atrophy and fibrosis in s...
Zhongyuan Liu
Zining Huang

Zhongyuan Liu

and 3 more

March 18, 2025
Polygonati Rhizoma, a traditional Chinese medicine, demonstrates therapeutic potential for sarcopenia, though its bioactive components and mechanisms remain unclear. Ultra-high-performance liquid chromatography-tandem mass spectrometry identified 826 compounds in Polygonati Rhizoma extract(PRE), with Genistein, Camptothecin, and Chrysoeriol highlighted as key bioactive constituents. Network pharmacology analysis revealed critical targets including EGFR, TNF, and CTNNB1, along with associated pathways such as MAPK, IL-17, and TNF signaling. Molecular docking confirmed strong binding affinities between these compounds and targets, with binding energies below -5 kcal/mol. In a D-galactose-induced sarcopenia mouse model, PRE administered at 60 and 120 mg/kg for 8 weeks improved exercise capacity, reduced muscle atrophy and fibrosis through histopathological assessments, and suppressed inflammatory markers. Mechanistic studies demonstrated that the extract enhanced EGFR phosphorylation, activated MAPK signaling, and inhibited TNF and CTNNB1-mediated fibrotic pathways. Pathway analysis further linked these effects to MAPK, IL-17, and TNF signaling cascades, underscoring their roles in mitigating inflammation and fibrosis. This study identifies Genistein, Camptothecin, and Chrysoeriol as pivotal components of Polygonati Rhizoma, acting through multi-target and multi-pathway mechanisms to alleviate sarcopenia. The findings provide a scientific foundation for its clinical application in treating muscle atrophy disorders.
Absence of Anti-Compensatory Saccades Despite Normal VOR Gain: A New Indicator of Cen...
Marco Tramontano
Laura Casagrande Conti

Marco Tramontano

and 2 more

March 18, 2025
Introduction The Suppression Head Impulse Paradigm (SHIMP) is a valuable tool for assessing vestibulo-ocular reflex (VOR) function by eliciting anti-compensatory saccades (ACs) in individuals with intact angular VOR (aVOR). While previous studies have extensively examined VOR gain in neurological disorders, the absence of ACs in patients with preserved VOR gain has not been described. This study investigated whether the absence of ACs during SHIMP is a distinguishing feature of central vestibular dysfunction. Methods This cross-sectional study included 119 patients with multiple sclerosis (PwMS), severe traumatic brain injury (PwTBI), stroke (PwS), and Parkinson’s disease (PwPD). The video Head Impulse Test (vHIT) was performed to assess the VOR gain across all semicircular canals using both the HIMP and SHIMP paradigms. The presence, absence, or delay of ACs was systematically recorded. Results Among the 119 patients evaluated (238 semicircular canals), 24 (20%) demonstrated normal aVOR gain but failed to generate ACs during SHIMP. The absence of ACs was observed in seven PwMS, five with PwTBI, six with PwS, and six with PwPD. Conclusion The absence of ACs despite normal VOR gain suggests a potential impairment in the central pathways controlling saccadic responses, independent of peripheral vestibular function. These findings underscore the clinical relevance of integrating the SHIMP into vestibular assessments to improve the identification of central vestibular dysfunction in neurological disorders.
Piriformis Syndrome in Enteric Fever: A Rare Musculoskeletal Complication of Salmonel...
Muhammad  Abu Bakkar
Abdul Moeez

Muhammad Abu Bakkar

and 6 more

March 18, 2025
A document by Muhammad Abu Bakkar . Click on the document to view its contents.
Variability in the causes of maternal deaths and the Three-Delays Framework: An obser...
Francis G Muriithi
Charles Ameh

Francis G. Muriithi

and 6 more

March 18, 2025
Introduction Maternal mortality in sub-Saharan Africa remains high, with the rate of decline stagnated. Many countries conduct maternal reviews, which can help identify outliers. Outlier analysis could better inform the design and implementation of strategies to tackle the causes of preventable maternal deaths. Aim To examine the variability in causes of maternal deaths in African countries using the WHO International Classification of Diseases Maternal Mortality (ICD-MM) framework and the contributing factors using the three-delays framework. Methods An observational ecological study of national maternal death review reports from 23 African countries between 2009 and 2022. Results Twenty-three maternal death review reports, covering 19,319 deaths, were included. Direct causes were the most common (43-92%), with variability across ICD-MM groups and three-delay factors observed. Obstetric haemorrhage (ICD-MM Group 3) was the leading cause in 17 reports, non-obstetric complications (Group 7) in five, pregnancy with abortive outcomes (Group 1) in one, and hypertensive disorders (Group 2) in one, with varying magnitudes across countries. Most reports (94%) identified the third delay (delay in receiving adequate care) as the primary contributor, while one report cited the first delay (delay in decision to seek care). The magnitude of each delay varied by country: The first delay contributed 0-34% of the audited maternal deaths; the second delay, 5-44%; and the third delay, 32-100%. Conclusion Efforts to further reduce the burden of preventable maternal deaths in sub-Saharan Africa should prioritise addressing the third delay, i.e. the delay in receiving adequate care within health facilities.
Penicillin allergy de-labeling in the critical care unit. Simulations to design an in...
Cleodie Swire
Sean Keane

Cleodie Swire

and 7 more

March 18, 2025
The majority of penicillin allergy labels are incorrect and a label of penicillin allergy is associated with worse outcomes and increased use of healthcare services. Penicillin allergy assessment and de-labeling may be considered in critically ill patients. An oral penicillin challenge is a common component of most penicillin allergy protocols. In critical illness, the enteral route may not be an option and is less reliable due to altered absorption kinetics. In this study, simulations were undertaken to determine an intravenous infusion dosing schedule for critically ill patients that matches the concentration-time profile of an oral penicillin drug provocation test in the general population. These simulations may help clinicians develop guidelines for intravenous infusion penicillin drug provocation tests for critically ill patients.
Pediatric Bladder Inflammatory Myofibroblastic Tumor: A Rare Case Report and Treatmen...
Kubra Ozturk Yuzdemir

Kubra Ozturk Yuzdemir

and 6 more

March 18, 2025
Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm with intermediate malignancy potential, commonly affecting the lungs and intra-abdominal organs but rarely the bladder. We report a 10-year-old girl with bladder IMT presenting as painless hematuria leading to syncope and requiring transfusion. Initial biopsy suggested rhabdomyosarcoma, but histopathology confirmed IMT. Partial bladder resection was performed, followed by crizotinib treatment due to positive margins and recurrent symptoms. One-year follow-up showed no recurrence. This case highlights the importance of early diagnosis, surgical management, and targeted therapy. Further studies are needed to optimize treatment strategies for pediatric bladder IMT.
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