Journal of the National Medical Association最新文献

{"title":"Identification of Follicular Lymphoma Stem Cell Biomarkers","authors":"Daniel P Ashley MPA, BSc,&nbsp;Theodor Borgovan MD,&nbsp;Hyung Sun Yoo MBA,&nbsp;Xin Zhang MD, PhD,&nbsp;Samantha Ahrens,&nbsp;Qingyang Luo,&nbsp;Li Huan MD,&nbsp;John Cole MD,&nbsp;Li Li MD, PhD","doi":"10.1016/j.jnma.2024.07.051","DOIUrl":"10.1016/j.jnma.2024.07.051","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite recent advances in identifying clinical risk factors for follicular lymphoma (FL), there remains a need for prognostic and predictive biomarkers. In this study, our objective was to identify biomarkers that are reliable indicators of FL relapse and overall survival via high-throughput screening using tissue microarray (TMA).</p></div><div><h3>Methods</h3><p>Records of patients diagnosed with FL between 1982 and 2009 were examined, with results sorted based on survival post-diagnosis. Corresponding patient biopsies were collected to create TMAs for high-throughput immunohistochemistry (IHC) screening of putative FL cancer stem cell (F-SC) markers (ABCG2, Ki67, OCT3/4) and CD20. Positivity was analyzed via digital batch processing method using Image-Pro software and microscopy.</p></div><div><h3>Results</h3><p>Fifty-nine patients were partitioned into short -(&lt;5 years, n=26) and long- (&gt;15 years, n=33) survival groups. IHC results showed there was no statistically significant difference in CD20 expression (p=0.6378). The results showed an increased expression pattern with significance for all 3 FL-SC markers. Compared with the long-survival group, the short-survival group had significantly higher expression levels of Ki67 (p=0.0275), ABCG2 (p=0.0251) and OCT3/4 (p=0.0226), as well as the combination of all three biomarkers (p=0.0229).</p></div><div><h3>Conclusion</h3><p>The prognostic biomarkers for FL identified may be used to distinguish those patients who are at greatest risk of relapse and in need of the most aggressive and novel therapies. Qualified prognostic markers for FL may direct clinical decision paradigms on which patients are favorable candidates for early therapy, and will obtain additional insight in the development of targeted regiments and treatment protocols to ameliorate outcomes.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 433"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin-Induced Necrotizing Autoimmune Myopathy (SINAM): A Case Report","authors":"Eric M Teichner BA,&nbsp;Arjun B Ashok BA","doi":"10.1016/j.jnma.2024.07.053","DOIUrl":"10.1016/j.jnma.2024.07.053","url":null,"abstract":"<div><h3>Purpose</h3><p>Statins are widely recognized for their efficacy in reducing cardiovascular risk through cholesterol reduction. Their use, however, is occasionally associated with adverse muscular effects, ranging from mild myalgias to statin-induced necrotizing autoimmune myopathies (SINAM). SINAM presents a significant clinical challenge due to persistent muscle weakness and elevated creatine kinase (CK) levels, even after statin withdrawal.</p></div><div><h3>Methods</h3><p>We explored the diagnostic journey of a 69-year-old African-American male with a history of extensive statin use, who presented with progressive muscular weakness and exceptionally high CK levels. A multidisciplinary diagnostic approach was employed, involving comprehensive laboratory testing, electromyography, muscle biopsy, and advanced imaging techniques. The diagnosis of SINAM was confirmed by identifying anti-HMGCR antibodies.</p></div><div><h3>Results</h3><p>Despite cessation of statin therapy, the patient's muscular symptoms persisted, with laboratory tests revealing remarkably elevated CK levels. The initiation of immunosuppressive therapy, including corticosteroids and intravenous immunoglobulin, led to a gradual improvement in muscle strength and a decrease in CK levels. However, the recovery journey highlighted the chronic nature of SINAM, necessitating ongoing management and careful consideration of long-term immunosuppressive treatment strategies.</p></div><div><h3>Conclusion</h3><p>This case report emphasizes the critical need for heightened vigilance and a high index of suspicion among healthcare providers when patients present with unexplained muscle weakness and elevated CK levels following statin use. Early and accurate diagnosis of SINAM, followed by the prompt initiation of immunosuppressive therapy, is paramount in preventing irreversible muscle damage and optimizing patient outcomes. Future research should focus on elucidating the precise mechanisms underlying SINAM, identifying at-risk populations, and developing targeted treatment protocols.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 434"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"URiM Trainees’ Attitudes Towards Research Participation: A Pilot Survey","authors":"Madison A Masters BS,&nbsp;Alexis Mbakwe MS,&nbsp;Erin Johnson PhD,&nbsp;Sierra Mills MS,&nbsp;M. Keith Rawlings MD","doi":"10.1016/j.jnma.2024.07.030","DOIUrl":"10.1016/j.jnma.2024.07.030","url":null,"abstract":"<div><h3>Purpose</h3><p>In 2021 the NIH acknowledged the role of structural racism in research, including the systematic exclusion of diseaseaffected individuals in favor of cohorts that resemble the “census” population. To address future racial exclusion, understanding the attitudes towards research among current Underrepresented in Medicine (URiM) trainees is essential.</p></div><div><h3>Methods</h3><p>An ad-hoc survey of trainees (pre-medical students, medical students, and residents) was conducted at the 2024 Student National Medical Association (SNMA) Annual Medical Education Conference (AMEC). Demographic data was collected, and participants were surveyed on their experiences as research subjects. The anonymous survey was conducted via Microsoft Forms; deidentified data was stored securely on SNMA servers.</p></div><div><h3>Results</h3><p>Out of approximately 3500 attendees, 158 (4.5%) completed surveys. Most were current medical students (76.6%), and identified as Black (93.7%), and as female/women (65.8%). Most respondents (71.5%) had never been a research subject and 64.6% had never been invited. Non-participation was mainly due to scheduling conflicts (35.4%), ineligibility (21.5%), and being unaware of opportunities (12%). Only 8% of respondents cited historical mistrust or friend/family concerns.</p></div><div><h3>Conclusion</h3><p>This pilot survey of AMEC attendees suggests URiM trainees have infrequently been asked to participate in research as subjects, despite possible interest. Contrary to popular narratives, most respondents indicated that logistical concerns, not concerns of historical mistrust, drive underrepresentation in research studies, even among medical trainees. Future directions include surveying trainees’ experiences joining research teams, and further analyses by geographics, age, and levels of training.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 423"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Barriers of Health Career Pursuit for Urban Youth","authors":"Christina M Randolph DO, MPH,&nbsp;Toluwalope Odukoya MD,&nbsp;Ifeywina Mbanefo MS,&nbsp;Adam Perzynski PhD","doi":"10.1016/j.jnma.2024.07.031","DOIUrl":"10.1016/j.jnma.2024.07.031","url":null,"abstract":"<div><h3>Purpose</h3><p>Healthcare workforce diversity is linked to improvements in health outcomes and healthcare spending. Barriers to increasing diversity in the health professions exist across all stages of educational development, including the K-12 level. This study qualitatively explores educational stakeholders’ perspectives of barriers and opportunities in pursuing health careers among youth in an urban Midwest city.</p></div><div><h3>Methods</h3><p>Snowball methodology among known network contacts was used to recruit educational stakeholders within Greater Cleveland. Key healthcare stakeholders were also invited to participate. Semi-structured interviews were performed to explore key questions including perceived challenges and opportunities in students pursuit of health careers and perspectives of ways that schools and health systems could work together to increase interest in health careers.</p></div><div><h3>Results</h3><p>Fifteen stakeholders participated with roles including teacher, assistant principal, administrator, school social worker, and career tech coordinators. Key healthcare stakeholder roles included DEI and workforce development professionals. Thematic analysis identified enabling and disabling factors at the personal, household, school and community levels. Such themes included parental awareness, early adult stress, school support, and role modeling. Participants highlighted an interest in both hands on experiences for students and relationships with health professionals. A suggested model of increasing student interest included experiential learning after health professionals first cultivate relationships with students.</p></div><div><h3>Conclusions</h3><p>Educational stakeholders are an important voice in the conversation of increasing diversity in the health professions. Based on their perspectives, key priorities are multifaceted and should include role modeling and relationship building with students.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 424"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians’ perception on using a multi-cancer early detection blood test to reduce disparities in cancer screening","authors":"Garfield A. Clunie ,&nbsp;Sharon D. Allison-Ottey ,&nbsp;Joy D. Calloway ,&nbsp;Marie L. Borum","doi":"10.1016/j.jnma.2024.07.011","DOIUrl":"10.1016/j.jnma.2024.07.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt; Introduction&lt;/h3&gt;&lt;p&gt;&lt;span&gt;Cancer causes significant morbidity and mortality in the United States. It is the second most common cause of death in the United States, after heart disease. African Americans are disproportionately affected by malignancy, with overall higher death rates compared to other racial and ethnic groups. Screening tests can identify early stage malignancy allowing for timely intervention. However, African Americans less frequently undergo &lt;/span&gt;cancer screening. Advancement in genomic technology has led to the identification of signals for cancer in the blood. This has resulted in the development of multi-cancer early detection (MCED) tests which evaluate for circulating cell-free DNA (cfDNA). This study evaluated physicians’ perception of the use of a multi-cancer early detection test (MCED).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;An anonymous, 29 question survey was administered to African American / Black physicians and medical students. Survey participants were identified through the National Medical Association and other professional organizations that included primarily African American physicians. Surveys were excluded from analysis if respondent was non-African American / Black or was not a physician or medical student.&lt;/p&gt;&lt;p&gt;The survey collected physician demographics, percentage of African American / Black patients in their practice, patient barriers to screening, potential use of MCED tests and factors influencing decision to recommend testing. Descriptive statistics were generated. Additional analysis was performed using Chi-Square with statistical significance set at p-value &lt;0.05. The survey was pilot tested for reliability and validity.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;1196 (681 female, 515 male) physicians and medical students completed the survey. 95.8 % were physicians who were or had been in clinical practice. Fifty-three percent of physicians reported that &gt;40 % of their patients were African American / Black. Barriers to cancer screening included lack of understanding of the importance (33.8 %), lack of or limited insurance coverage (23.5 %), socioeconomic factors unrelated to insurance coverage (16.2 %), fear of cancer (8.8 %), history of racism and bias in the health care system (7.4 %) with 8.8 % reporting ‘other’ and 1.5 % reporting no perceived barriers. There was a significant difference (p&lt;0.03) in the rate that physicians’ perceived racism and bias in the health care system as barrier for cancer screening in African American / Black patients when compared to other patients.&lt;/p&gt;&lt;p&gt;Most physicians and medical students indicated that a MCED test would benefit all patients (86.8 %), would encourage further cancer screening tests (83.8 %), and would be beneficial for minority and under-represented patients regardless of socioeconomics or health care access (83.8 %). Seventy-five percent of survey respondents indicated that a MCED test would be beneficial in promoting further cancer screeni","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 325-327"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial disparities in quality of life in Cutaneous T-cell lymphoma","authors":"Christina Asare BS,&nbsp;Shamey A Kassim BS,&nbsp;Jessica Brown-Korsah MD,&nbsp;Dan Hippe MS,&nbsp;Ellen Kim MD,&nbsp;Michi M Shinohara MD","doi":"10.1016/j.jnma.2024.07.036","DOIUrl":"10.1016/j.jnma.2024.07.036","url":null,"abstract":"<div><h3>Purpose</h3><p>Health-related quality of life (HRQoL) is a key outcome for patients with Cutaneous T-cell Lymphoma (CTCL). The incidence of CTCL is higher in Black/African-American (Black/AA) compared to white patients. This study aims to identify if racial disparity in HRQoL exists among CTCL patients.</p></div><div><h3>Methods</h3><p>Patients who self identified as Black/AA were purposefully enrolled and patients who self identified as white were used as controls. Participants were ask to complete the FACT-G, SkinDex-29, and Visual Analog Scale (VAS) Itch Scale. The primary outcome evaluated was differences in health-related quality of life as assessed by the FACT-G/SkinDex-29, and VAS itch scale by race (Black/AA versus white/other).</p></div><div><h3>Results</h3><p>Seventy-one participants were enrolled, the median age was 62y. The cohort was predominately male with 39% identifying as Black/AA. The majority (86%) had MF and early-stage disease (IA-IIA). FACT-G scores were lower for Black/AA participants compared to white participants, with median scores of 77 and 92 {P=0.007}, respectively. Skindex-29 scores for Black/AA participants were higher compared to white participants, with median scores of 31 and 20 {P=0.035}, respectively. Black/AA participants also reported higher degrees of itch (2.2/10) than white participants (1.0/10).</p></div><div><h3>Conclusion</h3><p>In our cohort, participants with MF/SS identifying as Black/AA experienced worse HRQoL. The racial disparity in HRQoL was consistent across instruments and study sites. The reasons for this racial disparity are likely complex. Future studies should attempt to further discern underlying determinants contributing to these disparities.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 426"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of an Implementation Research Framework in Community-Engaged Dietary Intervention","authors":"Nicole Farmer MD,&nbsp;Stephanie Wildridge,&nbsp;Ralph Tuason,&nbsp;Rebecca Metellus,&nbsp;Ayanna Wells,&nbsp;Tiffany M. Powell-Wiley,&nbsp;Gwenyth R. Wallen","doi":"10.1016/j.jnma.2024.07.020","DOIUrl":"10.1016/j.jnma.2024.07.020","url":null,"abstract":"<div><h3>Introduction</h3><p>African-Americans have an increased risk for diet-related diseases. Cooking is a dietary behavior that increases self-efficacy and social support, factors shown to be efficacious in optimizing diet. However, the overall inclusion of African-Americans within dietary interventions remains a key gap area for addressing diet-related disparities. The use of implementation frameworks, such as RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for planning interventions may assist in improving inclusion of African-American predominate communities in dietary interventions.</p></div><div><h3>Methods</h3><p>DC COOKS is a community-engaged cooking behavior intervention in Washington, D.C. The study population (n=35) are AfricanAmerican adults living within a low food access area with at least one reported risk factor for cardiovascular disease (CVD). The study was developed with a community advisory board, formative research including focus groups (n=20) and community-wide recruitment strategies were conducted. A review of study planning, formative research and recruitment strategies were evaluated according to REAIM framework to inform potential implementation.</p></div><div><h3>Results</h3><p>Community Reach was demonstrated by representation of individuals from multiple segments of the neighborhood areas in the study. Effectiveness and adoption by measuring quality of life, economic costs, post-intervention acceptability, and organization interest in adopting the intervention. Implementation and Maintenance will be aided by the use of technology for intervention delivery, inclusion of community food organizations and nutrition education to participants.</p></div><div><h3>Conclusion</h3><p>Use of the RE-AIM framework for planning a dietary intervention may aid in the inclusion of African-Americans living within a low food access area in dietary interventions and community-level implementation of the intervention.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 418-419"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Intractable Nausea and Vomiting in Cerebellar and Medullary Stroke","authors":"Taimur Khalid BS,&nbsp;Ryan Parto MD,&nbsp;John Varras MD, FACP","doi":"10.1016/j.jnma.2024.07.070","DOIUrl":"10.1016/j.jnma.2024.07.070","url":null,"abstract":"<div><h3>Purpose</h3><p>Cerebellar and medullary strokes are relatively rare, comprising only 1-4% of all cerebral infarctions [1–3]. Common symptoms include dizziness or vertigo, nausea, vomiting, and gait disturbance, with nausea and vomiting occurring &gt; 50% of the time [4]. Despite the frequency of these symptoms, there is scarce literature on successful treatment regimens.</p></div><div><h3>Methods</h3><p>We report the case of a 48 year old male with history of diabetes mellitus II who presented with 10-days of nausea, vomiting, and rightsided weakness / paresthesias. MRI brain revealed infarcts in the inferomedial right cerebellum and posterior right medulla brainstem. Initial management of nausea and vomiting with ondansetron 4mg q6h and metoclopramide 10mg q8h proved ineffective.</p><p>Metoclopramide was discontinued and ondansetron increased to 8mg q8h. However, symptoms persisted followed by the development of hiccups. A more aggressive treatment plan was opted for, including chlorpromazine 25mg q4h for hiccups and prochlorperazine 10mg q6h for nausea. The patient saw marked improvement and was discharged on ondansetron 8mg q8h, prochlorperazine 10mg q6h, amitriptyline 25mg nightly, and a scopolamine patch every 3 days.</p></div><div><h3>Results</h3><p>On the patient's one week follow up in the resident clinic, the patient reported almost full resolution of nausea and vomiting.</p></div><div><h3>Conclusion</h3><p>Cerebellar and medullary infarcts may frequently present with nonspecific symptoms including intractable nausea and vomiting. Management is complex and may be confounded by underlying conditions with similar presentations. Implementation of successful treatment regimens may greatly expedite recovery and mitigate extraneous workup and expenses. This report details a successful option for treatment.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 441-442"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between Intrauterine Exposure to Malaria and Childhood Neurodevelopment","authors":"Daniel P Ashley MPA, BSc (Hons),&nbsp;Samudragupta Bora PhD","doi":"10.1016/j.jnma.2024.07.068","DOIUrl":"10.1016/j.jnma.2024.07.068","url":null,"abstract":"<div><h3>Introduction</h3><p>The financial cost of mental illness in low- and middle-income countries in 2010 was estimated to be $870 billion USD, with this number expected to double by 2030. There is mounting evidence supporting a link between malaria in pregnancy (MIP) and adverse birth outcomes. However, substantial evidence verifying the impact of MIP on neurocognitive function in offspring is lacking. This viewpoint will discuss the burden of MIP globally and explore current literature linking MIP and neurodevelopmental outcomes.</p></div><div><h3>Methods</h3><p>Through an extensive database search, this narrative review summarized 66 references from the existing literature, which demonstrates a significant association between intrauterine exposure to malaria and adverse childhood neurodevelopment.</p></div><div><h3>Results</h3><p>Malaria incidence is on the rise in many countries and preventative measures not only improve the health outcomes for mother and infant but also potentially reduce the long-term economic burden on countries globally. Much attention has been focused on the effects of malaria on maternal health and birth outcomes, but foetal neurodevelopment is now emerging as an important risk factor. This review highlights the potential risk for neurodevelopmental delay in those children exposed to malaria infection in utero and consequently millions of children may not be meeting their developmental potential.</p></div><div><h3>Conclusion</h3><p>Treating MIP as a preventable risk factor for childhood neurocognitive and adult neuropsychiatric disorders could have overwhelming health and financial implications. Ideally, a shift from global health priorities focused on lifelong treatment and rehabilitation to disease prevention is necessary to combat the adverse outcomes from malaria infection.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 441"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malaria and typhoid fever co-infection: disease severity and immune response","authors":"Ange Maxime TCHOUTANG BS,&nbsp;MacDonald BIN Eric,&nbsp;Severin Donald Kamdem,&nbsp;Marie Chrisitne NKUNO,&nbsp;NGUM Lesly NGUM,&nbsp;Arnauld Tepa,&nbsp;Palmer MASUMBE NETONGO","doi":"10.1016/j.jnma.2024.07.086","DOIUrl":"10.1016/j.jnma.2024.07.086","url":null,"abstract":"<div><h3>Introduction</h3><p>Malaria and Typhoid fever are significant diseases in many parts of the world, especially in the tropics and fever is a common sign. Prominent markers for early diagnosis and better comprehension of this pathological association and immunity are vital to reduce mortality, drug resistance and for clinical purposes. We sought to explore the profile of severity, oxidative stress, and inflammatory markers during malaria and typhoid fever co-infection.</p></div><div><h3>Methods</h3><p>From a cross-sectional study, 81 malaria and/or typhoid fever-positive patients from 288 fever patients were selected. Malaria was diagnosed using a Rapid diagnostic test and microscopy while typhoid fever was diagnosed using a Rapid typhoid test and Widal. Severity, stress level and inflammatory responses were evaluated by hematological analysis using full blood count, erythropoietin, cortisol, IL-10, IL-4 and IFN-γ through ELISA, superoxide dismutase and Catalase activities by spectrophotometer. Data were analysed using SPPS 26 and PRISM 9 software.</p></div><div><h3>Results</h3><p>Co-infected patients present significant alterations of red blood cell lines such as thrombocytopenia and anaemia. We founded also a significant increase of stress marker cortisol, IFN-γ and IFN-γ/IL-10 ratio compared to other groups, a decrease in anti-oxidant activities and an alteration of erythropoietin production. The levels of IL-10 and IL-4 were higher during mono-infections.</p></div><div><h3>Conclusion</h3><p>Co-infected subjects show changes in hematological parameters. The presence of malaria and typhoid fever results in a significant increase in stress, alterations in erythropoietin production, anti-oxidants and TH1- cytokine dominance. These findings allow for better management by the clinicians of these infections in the tropics.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 449"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}