Identification of Lynch Syndrome Carriers among Patients with Small Bowel Adenocarcinoma

Background: Small bowel adenocarcinoma (SBA) is a rare disease which can be associated with Lynch syndrome (LS). LS tumors are characterized by the presence of microsatellite instability (MSI) and/or the loss of mismatch repair (MMR) protein expression. In SBA, the frequency of MMR deficient (MMRd) tumors varies from 5% to 35%. This study aims to describe the prevalence of LS carriers among patients with MMRd small bowel adenocarcinomas. Methods: A multicenter retrospective study with identification and MMR testing of all consecutive SBA between 2004 and 2020 in a multicenter Spanish study. Demographical data, tumor characteristics, follow-up and survival information were collected. Germline testing was driven by identification of MMRd tumors. Results: A total of 94 individuals diagnosed with SBA were recruited. We observed 20 (21.3%) MMRd tumors. In 9/15 (60%) patients with MMRd tumors, a pathogenic variant was identified (three MLH1, four MSH2, one MSH6 and one PMS2). Accordingly, the prevalence of LS among all SBA cases was 10.1%. Conclusions: More than one-fifth of SBA display MMRd and in more than a half is due to LS. Our data supports the implementation of universal MMR tumor testing among SBA for the identification of LS families.

Level of Knowledge of Sports Coaches and Physical Education Teachers in Physical Therapy in Jordan

Physiotherapy is a profession that helps to restore movement and function following an injury or illness. This study sought to identify the physical therapy knowledge of physical education teachers and sports coaches in Jordan. This study is a cross-sectional study conducted on several sports coaches and physical education teachers in Jordan. Participants were given the questionnaire through google forms, and they were all advised to fill it up. A predetermined selection criterion was used to select the participants. Out of 250 volunteers chosen for the study, only 152 questionnaires were selected for the final analysis. A self-administer questionnaire consisting was developed, which includes two parts. Part I collects the demographical data, and part II contains the questionnaires, including physiotherapy. The consent form is attached with the questionnaire, and those who gave consent to use the data were included in the analysis. Collected data were analyzed using SPSS 20.0. with the alpha set for significance at <0.05. Overall, it identified that 84% of the sports coaches and physical education teachers know physiotherapy services well. This study concluded that a more significant proportion of the sports coaches and physical education teachers have a good understanding of physical therapy services provided to the sports personnel in Jordan. They have good knowledge of physical therapy techniques and services provided, and they also have a good understanding of their role in on-field and off-field management.

Demographical Analysis and Cultural Characteristic to Attract Japanese Tourists to Indonesia

Japan is one of the biggest international tourist contributors to Indonesia. However, in recent years, there is a negative growth. It is caused by the demographical change of the Japanese population and outbound. Hence, research about the cultural ethnicity and social conditions affecting international travelers' behavior in tourism activities is needed. The research focused on the segmentation and strategies to attract foreign tourist which Indonesia would carry. The applied research method was a qualitative descriptive approach that utilized secondary data, such as demographical data and cultural characteristics. Data were taken from the Central Bureau of Statistics of the Republic of Indonesia, Ministry of Tourism and Creative Economy of the Republic of Indonesia, World Bank, and Statistics Bureau of Japan. Then, those data were analyzed by a descriptive statistics method. The result intends to formulate a strategy to seek more potential tourist growth from a Japanese market. The result shows four strategic efforts that Indonesia can take to maximize the potential for the arrival of foreign tourists from Japan. The government can consider the increased number of “silver age” and adult female workers (Joshitabi), which dominate the travelers’ segment to Indonesia, and pay attention to air connectivity and unique cultural characteristic of Japan.

Exposure to SARS-CoV-2 in Hospital Environment: Working in a COVID-19 Ward Is a Risk Factor for Infection

Aims. Health care workers (HCWs) are at risk of acquiring the Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2). The aim of the study is to determine the SARS-CoV-2 positivity rates during the first epidemiologic peak among HCWs of a south Belgian hospital and to identify risks factors for infection. Methods. All hospital staff who worked during the first epidemiological peak were asked to answer a questionnaire regarding demographical data, function, type of working unit, type of contact with patients, eventual symptomatology, and the positivity of reverse transcription-polymerase chain reaction (RT-PCR) testing or immunoassay. Results. A total of 235 questionnaires were collected; 90 (38%) HCWs tested positive for SARS-CoV-2 from either RT-PCR or immunoassay testing. The positivity rate of HCWs between wards was statistically different (p = 0.004) and was higher in COVID-19 wards than Intensive Care Unit (ICU) and Emergency Department (ED). A total of 114 (49%) HCWs presented SARS-CoV-2-compatible symptomatology; 79 (88%) were positive on either RT-PCR or immunoassay testing; 74 (37%) HCWs were unable to work during the studied period; 5 were hospitalized. No deaths were reported. Multivariate logistic regression modeling showed that having symptoms was highly associated with test positivity (OR 23.3, CI 11.1, 53.1, p-value < 0.001). Working in a COVID-19 ward against working in ICU or ED was also predictive of positivity among HCWs (OR 3.25, CI 1.50, 7.28, p-value = 0.003). Discussion and Conclusions. This study shows a higher positivity rate compared to already reported positivity rates among HCWs. Reported differences in positivity rates depend on many factors, such as local crisis intensity, screening strategy, training in use of self-protective equipment, and study selection bias. HCWs working in COVID-19 wards, in comparison to ED and ICU, seemed at greater risk of being infected in this study. This could be explained by the disparity of HCWs’ experience in handling self-protective equipment and knowledge in infection prevention. Hence, care should be taken in proper training for less-experienced HCWs during hospital epidemics. The latter could increase HCWs’ protection and consequently decrease work absenteeism, ensuring enhanced continuity of patient care during hospital crisis. Rapid quarantine of symptomatic HCWs could reduce contamination rates, as having symptoms was highly associated with test positivity in this study.

The Effect of Calendarized Drug Package on Patients Compliance with Antibiotics

BACKGROUND: Patients’ compliance with antibiotics has been one of the global challenges in combating antibiotics resistance. Patients will tend to forget their antibiotics, especially when they feel better. Related to this phenomenon, the development of medication reminder media is essential. AIM: This experimental study was aimed to develop and apply calendarized package as a medication reminder media in patients with short-course antibiotics to improve their compliance. METHODS: Calendarized package was prepared from the labeling of the original package of antibiotics with stickers. Patients above 18 years old who were prescribed short-course oral antibiotics (not more than 7 days) during the study period were asked to participate in this study. Patients were grouped into two groups (control and intervention group). Patients’ demographical data, medications prescribed, and the last antibiotics course day was recorded. Patients were then contacted for compliance evaluation on the latest antibiotics course day. RESULTS: A total of 150 patients who met the inclusion criteria were recruited in this study. Seventy-six patients were grouped into the intervention group, while the remaining 74 patients were the control group. The results showed that the number of compliant patients in the intervention group was higher (72.37%) than those in the control group (45.95%), respectively (p < 0.000). CONCLUSION: The application of the calendar on the package indicates the positive impact on the patients’ compliance with antibiotics. However, in this study, the compliance measurement was conducted indirectly because of the coronavirus disease 2019 pandemic. However, several limitations should be considered. Future research using a bigger sample size and stricter compliance measurement method is needed to confirm this finding.

Topological Data Analysis Highlights Novel Geographical Signatures of the Human Gut Microbiome

Background: There is growing interest in the connection between the gut microbiome and human health and disease. Conventional approaches to analyse microbiome data typically entail dimensionality reduction and assume linearity of the observed relationships, however, the microbiome is a highly complex ecosystem marked by non-linear relationships. In this study, we use topological data analysis (TDA) to explore differences and similarities between the gut microbiome across several countries.Methods: We used curated adult microbiome data at the genus level from the GMrepo database. The dataset contains OTU and demographical data of over 4,400 samples from 19 studies, spanning 12 countries. We analysed the data with tmap, an integrative framework for TDA specifically designed for stratification and enrichment analysis of population-based gut microbiome datasets.Results: We find associations between specific microbial genera and groups of countries. Specifically, both the USA and UK were significantly co-enriched with the proinflammatory genera Lachnoclostridium and Ruminiclostridium, while France and New Zealand were co-enriched with other, butyrate-producing, taxa of the order Clostridiales.Conclusion: The TDA approach demonstrates the overlap and distinctions of microbiome composition between and within countries. This yields unique insights into complex associations in the dataset, a finding not possible with conventional approaches. It highlights the potential utility of TDA as a complementary tool in microbiome research, particularly for large population-scale datasets, and suggests further analysis on the effects of diet and other regionally varying factors.

Urbanization Patterns around the North Sea: Long-Term Population Dynamics, 1300–2015

Around the North Sea, how have port cities and cities in the hinterlands of port cities influenced one another in the past? What possible links are there between population trends in various urban areas and time periods? Is it possible to identify the origin of the urbanization patterns around the North Sea? To understand the current era of urbanization, we need to analyze historical trends and urbanization patterns in the long term. By mapping the population figures for eight moments in history and combining this with data on political boundaries and large infrastructures that facilitate flows of goods and people, this article aims to contribute to an improved understanding of contemporary and historical urbanization trends around the North Sea. It also presents the first spatial dataset on urban settlements around the North Sea by means of a series of demographic maps, from 1300 to 2015. It provides a detailed explanation of the method used for mapping and handling demographical data. Each map is accompanied by a brief explanation of the urbanization pattern, with special attention to identifying demographic and economic developments and possible clarifications for centers of gravity and shifts. The maps lay the foundation for further research on social patterns and spatial developments in urban (port) regions around the North Sea and for understanding urban culture through space and time. Port cities must be analyzed from the perspective of the sea, which requires a rethinking of data sets and data borders, to understand the ways in which these port cities have served as porous distribution hubs and as transit nodes for boundary-crossing flows.

Elucidating Post-COVID-19 manifestations in India

Background: In India, a large number of patients with coronavirus disease-2019 (COVID-19), presented with common symptoms including fever, dyspnea, cough, musculoskeletal symptoms (fatigue, myalgia, joint pain) and gastrointestinal symptoms. However, information is lacking on symptoms that persist after recovery from COVID-19. In this study we assessed symptoms that persisted in patients even after their recovery and discharged from the hospital after one month from COVID-19. Methods: This study is an observational cohort study. Participants in this study were enrolled between 30 to 40 days after recovery from COVID-19 of the age 18 years or higher, who were hospitalized with laboratory-confirmed RT-PCR COVID-19 disease. Outcomes from post COVID-19 participants were elicited through questionnaire that consisted of three main parts beginning from subjects demographical data, depicting about the status of COVID-19 and other co-morbidities of the subject, and about post-COVID-19 symptoms and manifestations. Results: All subjects have reported some manifestation after recovery from COVID-19 whereas numerous symptoms and diseases were experienced by a great percentage of participants. Fatigue (56.25%), dyspnea (74.3%) and disturbed sleep (64.3%) were among the most common symptoms. However, more critical manifestations like renal failure and pulmonary fibrosis were reported by only a few percent of the subjects. Rating of worse physical and mental health after post-COVID recovery was also reported by subjects. There was a strong relationship found in between the presence of other co-morbidities before infection like diabetes, hypertension and in disease severity after infection. A total of 280 patients were enrolled and 160 completed the survey. Conclusions: Post COVID-19 sufferers often experience symptoms that cause a disturbance in their physical health, mental health and their respiratory status for several weeks even after recovery from COVID-19. Therefore, all subjects after recovering from COVID-19 should undergo long-term monitoring programme for their symptoms and condition improvement.

Cumulative Antimicrobial Susceptibility Data of Pseudomonas Aeruginosa Isolates from Cystic Fibrosis Patients: 4-Year Experience

Objective Pseudomonas aeruginosa is the most important cause of lung infection among cystic fibrosis (CF) patients, and to reduce the severity of the infection, facility-specific cumulative antibiograms could help clinicians in empirical treatment. Methods Respiratory samples of CF patients between January 2015 and December 2018 were scanned through Laboratory Operating System retrospectively. Demographical data of patients, culture results, and antibiotic susceptibilities are recorded using Microsoft Excel 2010. Cumulative antibiogram data were obtained according to the CLSI M39A4 document. Results The number of registered patients has increased in 4 years from 154 to 253. The mean age of patients varied from 9 to 11.7 (range, 2–42). The ratio of patients with a positive culture for P. aeruginosa increased from 32 to 40%, and the mean patients' age decreased from 16.6 to 11.1 (p <0.05). A total number of 4,146 respiratory samples were analyzed. Sputum samples consisted of 42.5% (n: 1,767) of the samples with a 58.4% isolation rate of P. aeruginosa (n: 1,034). A notable increase of resistance was seen almost all antimicrobials tested by years. The ratio of multidrug-resistant (MDR) P. aeruginosa was 4.1, 10.2, 4.5, and 8.6% in 2015, 2016, 2017, and 2018. Conclusion Antimicrobial resistance is a challenging problem in CF patients, and surveillance should be done regularly.

Infectious diseases screening approach among refugees: results from a single-center study

Introduction: Our aim was to evaluate a screening program, with active case-finding and treatment for active tuberculosis (TB), latent tuberculosis infection (LTBI), blood-borne viruses (BBV), and sexually transmitted diseases (STDs) among refugees living in facility centers. Methodology: We collected data on refugees arriving to our attention in migrant centers in Sardinia, Italy. Socio-demographical data, anamnesis, and clinical features were collected. TST Mantoux was conducted, and X-ray chest (XRC) was performed if TST was positive. Blood-borne virus screening was proposed to all patients. Screening for STDs was offered according to guidelines, anamnesis, and physical examination. Results: Eighty-one patients were included. Seventy (86.4%) were male, and the mean age was 24.8±5.7 years. Thirty-three (40.7%) had scabies. Overall, 40/81 (49.4%) had a positive TST Mantoux. One (2.5%) was hospitalized and died for multi-drug-resistant TB. One (2.5%) patient had intestinal-TB. 52/81 (64.2%) refused HIV screening, whereas no positivity was found among tested migrants. Sixty-two (76.5%) accepted HCV screening, and one (1.6%) had a positive test. Fifty-eight (71.6%%) accepted HBV testing, and 29 (50%) of them had positive serology. Ten (12.3%) patients had anal or genital lesions due to syphilis, Molluscum contagiosum, and HPV in 7 (70%), 2 (20%), and one (10%) case, respectively. Conclusions: Infectious diseases control and prevention are a key strategy among refugees. The stay in a migrant center is an extraordinary occasion for healthcare provision. This condition could allow a broad screening program in which quick BBV screening tests could be a good method to implement uptake. More information and educational programs would allow a higher understanding and acceptance of HIV screening.