Knowledge and Perceptions of Reactive Arthritis Diagnosis and Management Among Healthcare Workers During the COVID-19 Pandemic: Online Survey

Background@#Reactive arthritis (ReA) is an often neglected disease that received some attention during the coronavirus disease 2019 (COVID-19) pandemic. There is some evidence that infection with severe acute respiratory syndrome coronavirus 2 can lead to “reactive” arthritis. However, this does not follow the classical definition of ReA that limits the organisms leading to this condition. Also, there is no recommendation by any international society on the management of ReA during the current pandemic. Thus, a survey was conducted to gather information about how modern clinicians across the world approach ReA. @*Methods@#An e-survey was carried out based on convenient sampling via social media platforms. Twenty questions were validated on the pathogenesis, clinical presentation, and management of ReA. These also included information on post-COVID-19 arthritis. Duplicate entries were prevented and standard guidelines were followed for reporting internet-based surveys. @*Results@#There were 193 respondents from 24 countries. Around one-fifth knew the classical definition of ReA. Nearly half considered the triad of conjunctivitis, urethritis and asymmetric oligoarthritis a “must” for diagnosis of ReA. Other common manifestations reported include enthesitis, dermatitis, dactylitis, uveitis, and oral or genital ulcers. Threefourths opined that no test was specific for ReA. Drugs for ReA were non-steroidal antiinflammatory drugs, intra-articular injections, and conventional disease-modifying agents with less than 10% supporting biological use. @*Conclusion@#The survey brought out the gap in existing concepts of ReA. The current definition needs to be updated. There is an unmet need for consensus recommendations for the management of ReA, including the use of biologicals.

Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats

Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.

The Queensland Parkinson’s Project: An Overview of 20 Years of Mortality from Parkinson’s Disease

Objective@#The consensus is that life expectancy for individuals with Parkinson’s disease (PD) is reduced, but estimations vary. We aimed to provide an overview of 20 years of mortality and risk factor data from the Queensland Parkinson’s Project. @*Methods@#The analysis included 1,334 PD and 1,127 control participants. Preliminary analysis of baseline characteristics (sex, age at onset, family history, smoking status, pesticide exposure, depression and neurosurgery) was conducted, and Kaplan–Meier curves were generated for each potential risk factor. Standardized mortality ratios (SMRs) were calculated comparing this cohort to the general Australian population. Cox proportional hazards regression modeling was used to analyze potential predictors of mortality. @*Results@#In total, 625 (46.8%) PD and 237 (21.0%) control participants were deceased. Mean disease duration until death was 15.3 ± 7.84 years. Average ages at death were 78.0 ± 7.4 years and 80.4 ± 8.4 years for the deceased PD and control participants, respectively. Mortality was significantly increased for PD in general {SMR = 2.75 [95% confidence interval (CI): 2.53–2.96]; p = 0.001}. SMRs were slightly higher for women and those with an age of onset before 60 years. Multivariate analysis showed that deep brain stimulation (DBS) treatment was associated with lower mortality [hazard ratio (HR) = 0.76; 95% CI: 0.59–0.98], while occasional pesticide exposure increased mortality risk (HR = 1.48; 95% CI: 1.17–1.88). Family history of PD, smoking and depression were not independent predictors of mortality. @*Conclusion@#Mortality in PD is increased. Sex, age at onset and occasional pesticide exposure were independent determinants of increased mortality, while DBS treatment was associated with reduced mortality.

Formulating Hypotheses for Different Study Designs

Generating a testable working hypothesis is the first step towards conducting original research. Such research may prove or disprove the proposed hypothesis. Case reports, case series, online surveys and other observational studies, clinical trials, and narrative reviews help to generate hypotheses. Observational and interventional studies help to test hypotheses. A good hypothesis is usually based on previous evidence-based reports.Hypotheses without evidence-based justification and a priori ideas are not received favourably by the scientific community. Original research to test a hypothesis should be carefully planned to ensure appropriate methodology and adequate statistical power. While hypotheses can challenge conventional thinking and may be controversial, they should not be destructive. A hypothesis should be tested by ethically sound experiments with meaningful ethical and clinical implications. The coronavirus disease 2019 pandemic has brought into sharp focus numerous hypotheses, some of which were proven (e.g. effectiveness of corticosteroids in those with hypoxia) while others were disproven (e.g. ineffectiveness of hydroxychloroquine and ivermectin).

Article-Level Metrics

In the era of digitization and Open Access, article-level metrics are increasingly employed to distinguish influential research works and adjust research management strategies. Tagging individual articles with digital object identifiers allows exposing them to numerous channels of scholarly communication and quantifying related activities. The aim of this article was to overview currently available article-level metrics and highlight their advantages and limitations. Article views and downloads, citations, and social media metrics are increasingly employed by publishers to move away from the dominance and inappropriate use of journal metrics. Quantitative article metrics are complementary to one another and often require qualitative expert evaluations. Expert evaluations may help to avoid manipulations with indiscriminate social media activities that artificially boost altmetrics. Values of article metrics should be interpreted in view of confounders such as patterns of citation and social media activities across countries and academic disciplines.

Article-Level Metrics

In the era of digitization and Open Access, article-level metrics are increasingly employed to distinguish influential research works and adjust research management strategies. Tagging individual articles with digital object identifiers allows exposing them to numerous channels of scholarly communication and quantifying related activities. The aim of this article was to overview currently available article-level metrics and highlight their advantages and limitations. Article views and downloads, citations, and social media metrics are increasingly employed by publishers to move away from the dominance and inappropriate use of journal metrics. Quantitative article metrics are complementary to one another and often require qualitative expert evaluations. Expert evaluations may help to avoid manipulations with indiscriminate social media activities that artificially boost altmetrics. Values of article metrics should be interpreted in view of confounders such as patterns of citation and social media activities across countries and academic disciplines.

Angina following anaphylaxis: Kounis syndrome or adrenaline effect?

@#We have read with interest a report published in Malaysian Family Physician1 on a 23-year-old Malay atopic patient with a known allergy (angioedema) to metoclopramide, tramadol, aspirin, and CT contrast media who was stung by an insect and developed throat tightness, vomiting, and a swollen uvula. As he was being treated with intramuscular tetanus toxoid, intravenous hydrocortisone, intravenous chlorpheniramine, and 0.5mg (1:1000) of intramuscular adrenaline for anaphylactic shock, he presented, within minutes, with a sudden escalation of drowsiness, worsening throat tightness and chest pain so excruciating on his left side that he fainted. The patient’s electrocardiograms and cardiac enzymes were normal, however, and he regained consciousness with a high oxygen flow of 15 liters per minute. The following day, the patient was discharged in good condition. This report raises the issue of whether the excruciating chest pain was the result of the intramuscular adrenalin administration or of a Kounis Type I syndrome manifestation.

Scientific Hypotheses: Writing, Promoting, and Predicting Implications

Scientific hypotheses are essential for progress in rapidly developing academic disciplines. Proposing new ideas and hypotheses require thorough analyses of evidence-based data and predictions of the implications. One of the main concerns relates to the ethical implications of the generated hypotheses. The authors may need to outline potential benefits and limitations of their suggestions and target widely visible publication outlets to ignite discussion by experts and start testing the hypotheses. Not many publication outlets are currently welcoming hypotheses and unconventional ideas that may open gates to criticism and conservative remarks. A few scholarly journals guide the authors on how to structure hypotheses. Reflecting on general and specific issues around the subject matter is often recommended for drafting a well-structured hypothesis article. An analysis of influential hypotheses, presented in this article, particularly Strachan's hygiene hypothesis with global implications in the field of immunology and allergy, points to the need for properly interpreting and testing new suggestions. Envisaging the ethical implications of the hypotheses should be considered both by authors and journal editors during the writing and publishing process.

Comprehensive Approach to Open Access Publishing: Platforms and Tools

The Open Access Initiative is gaining momentum due to the worldwide availability of advanced digital tools, online publishing platforms, and systems for tracking academic contributions. Several declarations and initiatives, including Plan S, have already laid a foundation for moving away from subscription to full and immediate open-access publishing. The global initiatives imply targeting journals satisfying the upgraded quality and visibility criteria. To meet these criteria, a comprehensive approach to Open Access is recommended. This article overviews the essential components of the comprehensive approach, increasing transparency, adherence to ethical standards, and diversification of evaluation metrics. With the increasing volume of quality open-access journals, their indexing with free databases and search engines is becoming increasingly important. The Directory of Open Access Journals and PubMed Central currently free searches of open-access sources. These services, however, cannot fully satisfy the increasing demands of the users, and attempts are underway to upgrade the indexing and archiving of open-access sources in China, Japan, Korea, Russia, and elsewhere. The wide use of identifiers is essential for transparency of scholarly communications. Peer reviewers are now offered credits from Publons. These credits are transferrable to their Open Researcher and Contributor iDs. Various social media channels are increasingly used by scholars to comment on articles. All these comments are tracked by related metric systems, such as Altmetrics. Combined with traditional citation evaluations, the alternative metrics can help timely identify and promote publications influencing education, research, and practice.

Twenty-one episodes of peritonitis in a continuous ambulatory peritoneal dialysis patient: What is the root cause?

A 51-year-old female, with non-alcoholic liver cirrhosis, portal hypertension, type 2 diabetes mellitus, autosomal dominant polycystic kidney disease with a clipped cerebral aneurysm and chronic kidney disease stage 5 was on continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years elsewhere. She came for opinion on continuation of CAPD as she had 21 episodes of peritonitis in 76 months. Her blood pressure was 80/50 mmHg. She was on haemodialysis with a temporary central access for 2 weeks. She had no abdominal tenderness, and exit site looked normal. Fluid was negative for Mycobacterium tuberculosis. Laparoscopically, we replaced the catheter with a new swan-neck Tenckhoff double-cuff catheter through a different exit site in the same sitting. Catheter-tip biofilm culture isolated Enterococcus casseliflavus. Peritoneal sampling biopsy showed evidence of fibrosis. She has adequate ultrafiltration and is currently on automated peritoneal dialysis for 5 months.

Updated Editorial Guidance for Quality and Reliability of Research Output

Over the past few years, updated editorial policy statements of several associations have provided a platform for improving the quality of scientific research and publishing. The updates have particularly pointed to the need for following research reporting standards, authorship and contributorship regulations, implementing digital tools for the identification and crediting academic contributors, and moving towards optimal ethical open-access models. This article overviews some of the recent editorial policy statements of global editorial associations and reflects on the role of the regional counterparts in advancing scholarly publishing. One of the globally promoted documents is the Recommendations of the International Committee of Medical Journal Editors (ICMJE). Its latest versions contain statements on proper research reporting, reviewing, editing, and publishing. Points on ethical target journals and ‘predatory’ sources are also available. This year, in a move to update its editorial policy, the Committee on Publication Ethics (COPE) released the Core Practices, comprehensively reflecting on the major issues in publication ethics. Updated joint statements of medical writers associations are also available to implement transparent policy on contributorship in sponsor-supported research projects and related reports. Several suggestions are put forward to improve global editorial statements on online profiling, crediting, and referencing. It is also highlighted that knowledge and implementation of updated editorial guidance is essential for editors' good standing.

Alteration in Claudin-4 Contributes to Airway Inflammation and Responsiveness in Asthma

PURPOSE: Claudin-4 has been reported to function as a paracellular sodium barrier and is one of the 3 major claudins expressed in lung alveolar epithelial cells. However, the possible role of claudin-4 in bronchial asthma has not yet been fully studied. In this study, we aimed to elucidate the role of claudin-4 in the pathogenesis of bronchial asthma. METHODS: We determined claudin-4 levels in blood from asthmatic patients. Moreover, using mice sensitized and challenged with OVA, as well as sensitized and challenged with saline, we investigated whether claudin-4 is involved in the pathogenesis of bronchial asthma. Der p1 induced the inflammatory cytokines in NHBE cells. RESULTS: We found that claudin-4 in blood from asthmatic patients was increased compared with that from healthy control subjects. Plasma claudin-4 levels were significantly higher in exacerbated patients than in control patients with bronchial asthma. The plasma claudin-4 level was correlated with eosinophils, total IgE, FEV1% pred, and FEV1/FVC. Moreover, lung tissues from the OVA-OVA mice showed significant increases in transcripts and proteins of claudin-4 as well as in TJ breaks and the densities of claudin-4 staining. When claudin-4 was knocked down by transfecting its siRNA, inflammatory cytokine expressions, which were induced by Der p1 treatment, were significantly increased. CONCLUSIONS: These findings thus raise the possibility that regulation of lung epithelial barrier proteins may constitute a therapeutic approach for asthma.

Researcher and Author Impact Metrics: Variety, Value, and Context

Numerous quantitative indicators are currently available for evaluating research productivity. No single metric is suitable for comprehensive evaluation of the author-level impact. The choice of particular metrics depends on the purpose and context of the evaluation. The aim of this article is to overview some of the widely employed author impact metrics and highlight perspectives of their optimal use. The h-index is one of the most popular metrics for research evaluation, which is easy to calculate and understandable for non-experts. It is automatically displayed on researcher and author profiles on citation databases such as Scopus and Web of Science. Its main advantage relates to the combined approach to the quantification of publication and citation counts. This index is increasingly cited globally. Being an appropriate indicator of publication and citation activity of highly productive and successfully promoted authors, the h-index has been criticized primarily for disadvantaging early career researchers and authors with a few indexed publications. Numerous variants of the index have been proposed to overcome its limitations. Alternative metrics have also emerged to highlight ‘societal impact.’ However, each of these traditional and alternative metrics has its own drawbacks, necessitating careful analyses of the context of social attention and value of publication and citation sets. Perspectives of the optimal use of researcher and author metrics is dependent on evaluation purposes and compounded by information sourced from various global, national, and specialist bibliographic databases.

Predatory Publishing Is a Threat to Non-Mainstream Science

This article highlights the issue of wasteful publishing practices that primarily affect non-mainstream science countries and rapidly growing academic disciplines. Numerous start-up open access publishers with soft or nonexistent quality checks and huge commercial interests have created a global crisis in the publishing market. Their publishing practices have been thoroughly examined, leading to the blacklisting of many journals by Jeffrey Beall. However, it appears that some subscription journals are also falling short of adhering to the international recommendations of global editorial associations. Unethical editing agencies that promote their services in non-mainstream science countries create more problems for inexperienced authors. It is suggested to regularly monitor the quality of already indexed journals and upgrade criteria of covering new sources by the Emerging Sources Citation Index (Web of Science), Scopus, and specialist bibliographic databases. Regional awareness campaigns to inform stakeholders of science communication about the importance of ethical writing, transparency of editing services, and permanent archiving can be also helpful for eradicating unethical publishing practices.

The Journal Impact Factor: Moving Toward an Alternative and Combined Scientometric Approach

The Journal Impact Factor (JIF) is a single citation metric, which is widely employed for ranking journals and choosing target journals, but is also misused as the proxy of the quality of individual articles and academic achievements of authors. This article analyzes Scopus-based publication activity on the JIF and overviews some of the numerous misuses of the JIF, global initiatives to overcome the ‘obsession’ with impact factors, and emerging strategies to revise the concept of the scholarly impact. The growing number of articles on the JIF, most of which are in English, reflects interest of experts in journal editing and scientometrics toward its uses, misuses, and options to overcome related problems. Solely displaying values of the JIFs on the journal websites is criticized by experts as these average metrics do not reflect skewness of citation distribution of individual articles. Emerging strategies suggest to complement the JIFs with citation plots and alternative metrics, reflecting uses of individual articles in terms of downloads and distribution of related information through social media and networking platforms. It is also proposed to revise the original formula of the JIF calculation and embrace the concept of the impact and importance of individual articles. The latter is largely dependent on ethical soundness of the journal instructions, proper editing and structuring of articles, efforts to promote related information through social media, and endorsements of professional societies.

Synovial Sarcoma Complicating Total Knee Arthroplasty

Synovial sarcoma is a relatively common periarticular soft tissue malignancy, occurring mostly in the extremities of younger patients. Occasionally, diversity in its clinical features may lead to misdiagnosis and inappropriate management. The authors report herein a unique case of a patient who underwent a primary total knee arthroplasty to treat osteoarthritis. During the operation, a mass was discovered but was attributed to synovitis. Biopsy revealed a rare intra-articular synovial sarcoma. The patient underwent reoperation with wide excision and endoprosthesis placement and is disease-free at the 8-year follow-up.

Researcher and Author Profiles: Opportunities, Advantages, and Limitations

Currently available online profiling platforms offer various services for researchers and authors. Opening an individual account and filling it with scholarly contents increase visibility of research output and boost its impact. This article overviews some of the widely used and emerging profiling platforms, highlighting their tools for sharing scholarly items, crediting individuals, and facilitating networking. Global bibliographic databases and search platforms, such as Scopus, Web of Science, PubMed, and Google Scholar, are widely used for profiling authors with indexed publications. Scholarly networking websites, such as ResearchGate and Academia.edu, provide indispensable services for researchers poorly visible elsewhere on the Internet. Several specialized platforms are designed to offer profiling along with their main functionalities, such as reference management and archiving. The Open Researcher and Contributor Identification (ORCID) project has offered a solution to the author name disambiguation. It has been integrated with numerous bibliographic databases, platforms, and manuscript submission systems to help research managers and journal editors select and credit the best reviewers, and other scholarly contributors. Individuals with verifiable reviewer and editorial accomplishments are also covered by Publons, which is an increasingly recognized service for publicizing and awarding reviewer comments. Currently available profiling formats have numerous advantages and some limitations. The advantages are related to their openness and chances of boosting the researcher impact. Some of the profiling websites are complementary to each other. The underutilization of various profiling websites and their inappropriate uses for promotion of ‘predatory’ journals are among reported limitations. A combined approach to the profiling systems is advocated in this article.

Plagiarism in the Context of Education and Evolving Detection Strategies

Plagiarism may take place in any scientific journals despite currently employed anti-plagiarism tools. The absence of widely acceptable definitions of research misconduct and reliance solely on similarity checks do not allow journal editors to prevent most complex cases of recycling of scientific information and wasteful, or ‘predatory,’ publishing. This article analyses Scopus-based publication activity and evidence on poor writing, lack of related training, emerging anti-plagiarism strategies, and new forms of massive wasting of resources by publishing largely recycled items, which evade the ‘red flags’ of similarity checks. In some non-Anglophone countries ‘copy-and-paste’ writing still plagues pre- and postgraduate education. Poor research management, absence of courses on publication ethics, and limited access to quality sources confound plagiarism as a cross-cultural and multidisciplinary phenomenon. Over the past decade, the advent of anti-plagiarism software checks has helped uncover elementary forms of textual recycling across journals. But such a tool alone proves inefficient for preventing complex forms of plagiarism. Recent mass retractions of plagiarized articles by reputable open-access journals point to critical deficiencies of current anti-plagiarism software that do not recognize manipulative paraphrasing and editing. Manipulative editing also finds its way to predatory journals, ignoring the adherence to publication ethics and accommodating nonsense plagiarized items. The evolving preventive strategies are increasingly relying on intelligent (semantic) digital technologies, comprehensively evaluating texts, keywords, graphics, and reference lists. It is the right time to enforce adherence to global editorial guidance and implement a comprehensive anti-plagiarism strategy by helping all stakeholders of scholarly communication.

Clustering of risk factors for cardiometabolic diseases in low-income, female adolescents

ABSTRACT Objective To assess the prevalence and clustering patterns of cardiometabolic risk factors among low-income, female adolescents. Materials and methods Cross-sectional study involving 196 students of public schools (11-19 years old). The following risk factors were considered in the analysis: excess weight, central obesity, dyslipidemia, high blood pressure, and high fasting glucose. The ratio between observed and expected prevalence and its confidence interval were used to identify clustering of risk factors that exceeded expected prevalence in the population. Results The most prevalent risk factors were dyslipidemia (70.9%), and central obesity (39.8%), followed by excess weight (29.6%), and high blood pressure (12.8%). A total of 42.9% of adolescents had two or more risk factors, and 24% had three or more. Excess weight, central obesity, and dyslipidemia were common risk factors in the clustering patterns that showed higher-than-expected prevalence. Conclusions Clustering of risk factors (≥ two factors) among the adolescents showed considerable prevalence, and there was a non-casual coexistence of excess weight, central obesity, and dyslipidemia (mainly low HDL-cholesterol).