Tag: pubmed

Curr Ther Res Clin Exp. 2024 Aug 24;101:100757. doi: 10.1016/j.curtheres.2024.100757. eCollection 2024.

ABSTRACT

PURPOSE: We describe nirmatrelvir/ritonavir (NMV/r) effectiveness in preventing hospitalization among COVID-19 patients at high risk of severe disease.

METHODS: An ongoing US population-based observational cohort study with retrospective and prospective collection of national electronic healthcare data collected from the US Optum® deidentified COVID-19 Electronic Health Record dataset during December 22, 2021-July 20, 2022. Participants were ≥12 years old; had a positive SARS-CoV-2 test, COVID-19 diagnosis, or NMV/r prescription; and were at high risk of severe COVID-19 based on demographic/clinical characteristics. Potential confounders between groups were balanced using propensity score matching. Immortal time bias was addressed. Hospitalization rates within 30 days from COVID-19 diagnosis were evaluated. Sensitivity analyses included 15-day hospitalization, chart review to investigate incidental hospitalization effects, and exclusion of patients identified as having COVID-19 based on NMV/r prescription alone. Outcomes were also evaluated by race, age, and COVID-19 vaccine status.

FINDINGS: Overall, 12,440 and 234,123 patients were included in the NMV/r and non-NMV/r groups, respectively. After propensity score matching, baseline characteristics were well balanced across groups (NMV/r, n = 12,439; non-NMV/r, n = 36,490). Incidence of hospitalization (95% CI) within 30 days was 0.90% (0.74%-1.08%) for the NMV/r group and 5.91% (5.67%-6.16%) for the non-NMV/r group, with relative risk (95% CI) of 0.15 (0.13-0.18; 85% risk reduction). NMV/r was comparably effective in Black patients (relative risk, 0.19 [0.10-0.34]; 81% risk reduction). Sensitivity analyses supported the main outcomes.

IMPLICATIONS: Real-world NMV/r effectiveness against hospitalization during Omicron predominance among COVID-19 patients at high risk of severe disease supports demonstrated clinical trial efficacy. Black patients underutilized NMV/r despite high effectiveness.

PMID:39649410 | PMC:PMC11625212 | DOI:10.1016/j.curtheres.2024.100757

Curr Res Microb Sci. 2024 Nov 17;7:100316. doi: 10.1016/j.crmicr.2024.100316. eCollection 2024.

ABSTRACT

Candida albicans and Staphylococcus aureus have been co-isolated from several biofilm-associated diseases, including those related to medical devices. This association confers advantages to both microorganisms, resulting in detrimental effects on the host. To elucidate this phenomenon, the present study investigated colony changes derived from non-physical interactions between C. albicans and S. aureus. We performed proximity assays by confronting colonies of the yeast and the bacteria on agar plates at six different distances for 9-10 days. We found that colony variants of S. aureus originated progressively after prolonged exposure to C. albicans proximity, specifically in response to pH neutralization of the media by the fungi. The new phenotypes of S. aureus were more virulent in a Galleria mellonella larvae model compared to colonies grown without C. albicans influence. This event was associated with an upregulation of RNA III and agrA expression, suggesting a role for α-toxin. Our findings indicate that C. albicans enhances S. aureus virulence by inducing the formation of more aggressive colonies. This highlights the importance of understanding the intricate connection between environmental responses, virulence and, fitness in S. aureus pathogenesis.

PMID:39649408 | PMC:PMC11621768 | DOI:10.1016/j.crmicr.2024.100316

Front Pediatr. 2024 Nov 22;12:1450121. doi: 10.3389/fped.2024.1450121. eCollection 2024.

ABSTRACT

BACKGROUND: Acquired spontaneous intestinal perforation or SIP occurs most commonly in the extremely premature infant population. As the incidence is rising, understanding modifiable factors such as common medication exposures becomes important for individualizing care.

METHODS: The primary outcome was SIP in premature infants with exposure to indomethacin, ibuprofen, or acetaminophen. The systematic review and meta-analysis were conducted following the Cochrane methodology and PRISMA guidelines.

RESULTS: The point estimates of three RCTs showed an increase in the risk of SIP with indomethacin exposure compared to no medication, the pooled estimate was not statistically significant. There is no statistically significant association between the risk of SIP for indomethacin with treatment use over prophylactic use and when holding feeds. Ibuprofen conferred less risk than indomethacin, and its route of administration did not alter the risk profile. There was not enough evidence to draw conclusions about the risk of SIP and acetaminophen exposure.

CONCLUSION: In studies of infants exposed to either indomethacin or ibuprofen in the last 40 years, the incidence of SIP is still commonly within 2-8%. Moving forward modifiable factors such as medication exposure will help guide care to minimize risk where possible.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/, PROSPERO (CRD42017058603).

PMID:39649405 | PMC:PMC11620902 | DOI:10.3389/fped.2024.1450121

Front Pediatr. 2024 Nov 22;12:1447956. doi: 10.3389/fped.2024.1447956. eCollection 2024.

ABSTRACT

OBJECTIVE: The increasing use of assisted reproductive technologies (ART) has led to a growing interest in the health outcomes of offspring. However, the impact of ART on the immune system of children remains poorly understood. While only two publications were found, their findings contradict each other and did not consider other risk factors in their analysis except for ART use. Therefore, this study aimed to examine the potential impact of ART on the immune system of offspring.

METHODS: A case-control study was conducted in Kazakhstan to investigate the immune system of ART-conceived children compared to those conceived naturally (NC). The study included participants who met certain criteria, such as having undergone a successful ART program resulting in the birth of either a single or multiple pregnancies. Patients who used donor oocytes/sperm, intrauterine insemination, or surrogacy were excluded. Anamnesis data were collected from children in both groups, and laboratory measurements were performed and analyzed using IBM SPSS Statistic 26.

RESULTS: A total of 120 children conceived by ART and 132 NC children under the age of five were included in our study. We observed that compared with NC group, ART children had lower IgA and IgG levels (p < 0.001), absolute lymphocytosis, high levels of active T-lymphocytes (p = 0.001), and pathological T-helper levels (p = 0.004). Therefore, the clinical presentation of respiratory diseases was lower in ART group. Children born after frozen embryo transfers showed significantly higher levels of T-cytotoxic and active T-lymphocytes compared to children born after fresh embryo transfers (p = 0.007 and p = 0.020, respectively). We utilized ordinal logistic regression to control for confounding variables such as multiple pregnancy, cesarean section, premature birth, and breastfeeding. Despite this, the significant impact of ART on immunogram parameters persisted, indicating the independent and influential nature of ART or other unaccounted factors.

PMID:39649404 | PMC:PMC11620871 | DOI:10.3389/fped.2024.1447956

Toxicol Rep. 2024 Nov 19;13:101822. doi: 10.1016/j.toxrep.2024.101822. eCollection 2024 Dec.

ABSTRACT

The governing laws mandate animal testing guidelines (TG) to assess the developmental and reproductive toxicity (DART) potential of new and current chemical compounds for the categorization, hazard identification, and labeling. In silico modeling has evolved as a promising, economical, and animal-friendly technique for assessing a chemical’s potential for DART testing. The complexity of the endpoint has presented a problem for Quantitative Structure-Activity Relationship (QSAR) model developers as various facets of the chemical have to be appropriately analyzed to predict the DART. For the next-generation risk assessment (NGRA) studies, researchers and governing bodies are exploring various new approach methodologies (NAMs) integrated to address complex endpoints like repeated dose toxicity and DART. We have developed four hybrid computational models for DART studies of rodents and rabbits for their adult and fetal life stages separately. The hybrid models were created by integrating QSAR features with similarities-derived features (obtained from read-across hypotheses). This analysis has identified that this integrated method gives a better statistical quality compared to the traditional QSAR models, and the predictivity and transferability of the model are also enhanced in this new approach.

PMID:39649380 | PMC:PMC11621937 | DOI:10.1016/j.toxrep.2024.101822

Front Rehabil Sci. 2024 Nov 22;5:1495621. doi: 10.3389/fresc.2024.1495621. eCollection 2024.

ABSTRACT

INTRODUCTION: Air pollution poses significant risks to cardiovascular health, yet patients often lack comprehensive knowledge about its impact and mitigation strategies. This study aims to evaluate the effectiveness of an educational intervention within a cardiac rehabilitation (CR) context in enhancing patients’ understanding of air pollution and its cardiovascular effects.

METHODS: A pre-post pilot study was conducted from February 2021 to June 2021 at the Gregorio Marañón University General Hospital, Madrid, Spain. A total of 43 patients with cardiovascular disease attending CR were enrolled. Participants received a 1-h educational intervention delivered either in-person or online, focusing on the effects of air pollution and strategies to reduce exposure. Pre- and post-intervention questionnaires assessed participants’ knowledge and perceptions. Descriptive statistics were used to analyze changes in awareness and understanding.

RESULTS: Initially, participants demonstrated a high level of awareness about the health impacts of air pollution, with 100% acknowledging its effects on health. However, detailed knowledge about specific concepts such as the Air Quality Index (AQI) and particulate matter (PM2.5) was limited. Post-intervention, there was a significant increase in knowledge, with familiarity with AQI rising from 61% to 81% (p = 0.02) and understanding of PM2.5 improving from 28% to 58% (p = 0.01). This indicates that the educational intervention effectively bridged gaps in understanding and reinforced the importance of environmental factors in cardiovascular health management.

DISCUSSION: The pilot study highlights the critical role of targeted education in improving patient awareness and knowledge about air pollution. The significant improvement in understanding key concepts underscores the need for broader educational initiatives that extend beyond CR programs. Future research should explore the impact of such interventions on long-term health outcomes and consider expanding educational efforts to include healthcare providers and family members.

PMID:39649374 | PMC:PMC11621042 | DOI:10.3389/fresc.2024.1495621

Health SA. 2024 Nov 27;29:2645. doi: 10.4102/hsag.v29i0.2645. eCollection 2024.

ABSTRACT

BACKGROUND: South Africa is experiencing increased medico-legal litigations in maternity services arising from poor recordkeeping. To enhance the quality of recordkeeping and reduce the lawsuits, the strategies were developed and validated by maternal healthcare experts.

AIM: The study is aimed to develop and validate strategies for recordkeeping during intrapartum care in Limpopo province.

SETTING: The study was conducted in seven hospitals located in Sekhukhune District, Limpopo province.

METHODS: The hospitals were purposefully selected to participate in this study. A sequential explanatory mixed-method design was applied. For the quantitative phase, the maternity case records were reviewed for completeness. Statistician assisted in translation of the checklist into statistical package for social science (SPSS) program. The data analysis included descriptive and inferential statistics. The qualitative phase, focus group discussions and in-depth interviews were conducted with midwives and doctors to describe and determine their perceptions and experiences of recordkeeping during intrapartum. A co-coder was engaged in qualitative data analysis. The findings of quantitative and qualitative phases were integrated to develop the strategies for recordkeeping. A two-rounds Delphi technique was employed to validate the strategies by engaging maternal healthcare experts.

RESULTS: Ten (10) strategies to enhance recordkeeping were developed and validated by the experts.

CONCLUSION: The proposed strategies were operationalised into interventions with the aim to improve recordkeeping.

CONTRIBUTION: The strategies aim to improve the quality-of-service provision during intrapartum care and reduce or culminate legal claims in Limpopo province.

PMID:39649349 | PMC:PMC11621868 | DOI:10.4102/hsag.v29i0.2645

Health SA. 2024 Oct 28;29:2675. doi: 10.4102/hsag.v29i0.2675. eCollection 2024.

ABSTRACT

BACKGROUND: Online platforms have gained considerable support from students and lecturers post COVID-19, however they are associated with student exhaustion and fatigue.

AIM: To determine Zoom exhaustion and fatigue in nursing students at a selected university in South Africa.

METHODS: A quantitative cross – sectional study was conducted in KwaZulu-Natal to collect data from 146 nursing students registered at the selected university for the 4-year Bachelor of Nursing programme. The Zoom Exhaustion and Fatigue Scale collected data on responses to domains of general fatigue, visual fatigue, social fatigue, motivational fatigue, and emotional fatigue. The data were analysed using the International Business Machines, Statistical Package for Social Sciences, version 26.0. Descriptive statistics were calculated for demographics, a total score was calculated and mean scores and 95% confidence intervals for the different domains were calculated. Mann Whitney U and Kruskal Wallis Independent Tests were calculated to determine associations between demographics and Zoom usage.

RESULTS: The overall Zoom exhaustion and fatigue score was 46.71 (s.d. = 10.50). The motivational fatigue construct had the highest mean score of 3.29 (s.d. = 0.83), followed by general (3.18 s.d. = 0.81), social (3.11, s.d. = 0.88), emotional (3.06, s.d. = 0.99) and visual fatigue (2.92, s.d. = 0.94).

CONCLUSION: The study concluded that while the overall mean score indicated moderate levels of Zoom exhaustion and fatigue among respondents, majority of the respondents scored high levels (> 48) of Zoom fatigue. Students reported higher levels of motivational fatigue compared to the other 4 constructs.

PMID:39649346 | PMC:PMC11621910 | DOI:10.4102/hsag.v29i0.2675

Indian J Nephrol. 2024 Nov-Dec;34(6):630-635. doi: 10.25259/ijn_3_24. Epub 2024 Jun 24.

ABSTRACT

BACKGROUND: Doppler ultrasound examination of blood vessels has a significant role in planning and identifying parameters that affect the functioning and maturation of arteriovenous fistula (AVF). Our goal was to determine the predictive parameters of Doppler ultrasound, measured at different time distances, which affect the maturation of AVF for hemodialysis.

MATERIALS AND METHODS: The research was a retrospective cohort study. The criteria for selecting patients in our study was the existence of information on ultrasound examinations of the lumen of blood vessels before the creation of AVF, as well as lumens of fistula conduits and blood flow measurements, at time intervals of 6-8 weeks and 2-4 months, after the creation of AVF, which we recorded in 105 patients. The respondents were divided into two groups: a group of patients with immature, and mature fistulas. Basic demographic data, clinical characteristics of the responders and laboratory parameters were analyzed.

RESULTS: By comparing clinical and laboratory parameters between the group of subjects with and without AVF maturation, a statistically significant difference was determined between the lumen of the proximal radial vein (p = 0.008) and the lumen of the distal radial vein (p = 0.001). The diameter of the fistulous veins (p = 0.037), and the blood flow through the AVF 6-8 weeks (p = 0.001) and 2-4 months (p = 0.001) after its creation were statistically significantly higher in subjects with mature fistulas. By univariate regression analysis, brachial vein (p = 0.04), proximal (p = 0.011) and distal radial artery (p = 0.001), fistula vein, after 6-8 weeks (p = 0.002), blood flow through AVF 6-8 weeks (p = 0.001) and 2-4 months (p = 0.001) after AVF creation, are statistically significant parameters. Predictive parameters of AVF maturation are AVF blood flow after 6-8 weeks (p = 0.010) and AVF blood flow after 2-4 months (p = 0.001).

CONCLUSION: Our research confirmed that greater the blood flow through AVF, at time intervals of 6-8 weeks and 2-4 months after creation, the better the maturation.

PMID:39649327 | PMC:PMC11619096 | DOI:10.25259/ijn_3_24

Digit Health. 2024 Dec 5;10:20552076241302251. doi: 10.1177/20552076241302251. eCollection 2024 Jan-Dec.

ABSTRACT

OBJECTIVE: Healthcare delivery and research are moving increasingly towards digital engagement, which could inequitably exclude some populations due to differential technology access and uptake. We sought to evaluate study-related digital access, preferences, and use among parents of patients with Medicaid insurance enrolled in research in a pediatric emergency department (ED).

METHODS: We conducted a secondary analysis within a randomized trial at an academic pediatric ED. Children with public insurance and a language of English or Spanish who were treated for asthma symptoms were enrolled; parents completed surveys regarding digital access, preferences and demographics. Associations were tested using Fisher’s exact test.

RESULTS: We enrolled 80 families, of whom 18% had a language for care of Spanish; 31% of children identified as Hispanic, and 25% as Black. All baseline survey respondents (n = 79) endorsed having an internet-connected computer (73%) or smartphone (99%); 85% of smartphone holders reported unlimited data. When given the choice, 73% of participants requested a physical gift card instead of an electronic gift card. Only 31% had patient portal access 6 months after study end. Parents who spoke Spanish or with a child identified as Hispanic or Black more often requested physical gift cards and less often had patient portal access, but these differences were not statistically significant.

CONCLUSION: Despite ubiquitous access to internet-connected digital devices among this Medicaid-insured population, patient portal use was low and many families preferred non-digital reimbursement. Efforts to enhance research inclusion should consider digital preferences in addition to digital access when planning study procedures.

PMID:39649294 | PMC:PMC11622308 | DOI:10.1177/20552076241302251