Tag: pubmed

Arch Med Sci. 2024 Jul 24;20(5):1461-1471. doi: 10.5114/aoms/181134. eCollection 2024.

ABSTRACT

INTRODUCTION: This study will explore the correlation of peroxisome proliferator activated receptor-α (PPAR-α) regulation of metabolic remodelling in the myocardial fibrosis of atrial fibrillation (AF) in rheumatic heart disease.

MATERIAL AND METHODS: The left atrial appendage tissues were evaluated by Masson staining for fibrosis degree, and Western Blot was used to detect the expression of proteins related to glucose metabolism disorder, lipid metabolism abnormality, and mitochondrial dysfunction. The myocardial fibroblasts were established by stimulation with ANG II, and the PPAR-α agonist GW7647 was administered. The changes of phenotype transformation of myocardial fibroblasts were detected by cellular immunofluorescence, the secretion level of supernatant collagen was detected by ELISA. Finally, the correlation between PPAR-α protein expression and myocardial fibrosis was analysed and a conclusion was drawn.

RESULTS: Masson staining showed that the degree of myocardial fibrosis in patients with AF was significantly increased; WB analysis showed that there were statistically significant differences in protein expression related to glucose metabolism disorder, lipid metabolism abnormality, and mitochondrial dysfunction. There was a correlation between PPAR-α protein expression and myocardial fibrosis (r = -0.5322, p < 0.0001). After stimulation with PPAR-α agonist GW7647, the phenotypic differentiation of myocardial fibro-blasts into myofibroblasts was inhibited. The protein expression related to mitochondrial dysfunction was statistically different.

CONCLUSIONS: This study found that there is a negative correlation between the expression of PPAR-α protein and myocardial fibrosis in rheumatic heart disease AF, which plays a protective role. PPAR-α may participate in the pathogenesis of myocardial fibrosis in rheumatic heart disease AF by regulating glucose metabolism, lipid metabolism, and mitochondrial function.

PMID:39649284 | PMC:PMC11623188 | DOI:10.5114/aoms/181134

Arch Med Sci. 2024 May 28;20(5):1538-1546. doi: 10.5114/aoms/183947. eCollection 2024.

ABSTRACT

INTRODUCTION: This study aimed to compare the effectiveness of two methods for non-invasive mechanical ventilation in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – using a helmet interface with a flow meter and positive end-expiratory pressure valve versus a traditional mechanical ventilator.

MATERIAL AND METHODS: We conducted a single-center randomized clinical trial involving 100 adult SARS-CoV-2 patients in a specialized private hospital. Participants were randomly assigned to two groups: one using the helmet interface with a flow meter and positive end-expiratory pressure valve and the other employing conventional mechanical ventilation. Our study included participant selection, blood gas analysis, assessment of respiratory rate, peripheral oxygen saturation, modified Borg scale scores, and a visual analog scale.

RESULTS: The study showed no significant difference in intubation rates between the mechanical ventilation (54.3%) and helmet interface with flow meter and positive end-expiratory pressure valve (46.8%) groups (p = 0.37). Additionally, the helmet group had a shorter average duration of use (3.4 ±1.6 days) compared to the mechanical ventilation group (4.0 ±1.9 days). The helmet group also had a shorter average hospitalization duration (15.9 ±7.9 days) compared to the mechanical ventilation group (17.1 ±9.5 days).

CONCLUSIONS: This single-center randomized clinical trial found no statistically significant differences between the two methods of non-invasive ventilation. Implications for clinical practice: using the helmet interface with the flow meter and positive end-expiratory pressure valve can simplify device installation, potentially reducing the need for intubation, making it a valuable tool for nurses and physiotherapists in daily clinical practice.

PMID:39649277 | PMC:PMC11623150 | DOI:10.5114/aoms/183947

Infect Dis Model. 2024 Nov 16;10(1):325-337. doi: 10.1016/j.idm.2024.11.001. eCollection 2025 Mar.

ABSTRACT

OBJECTIVE: This study aims to assess the feasibility of evaluating the COVID-19 epidemic trend through monitoring the positive percentage of SARS-CoV-19 RNA in wastewater.

METHOD: The study collected data from January to August 2023, including the number of reported cases, the positive ratio of nucleic acid samples in sentinel hospitals, the incidence rate of influenza-like symptoms in students, and the positive ratio of wastewater samples in different counties and districts in Shangrao City. Wastewater samples were obtained through grabbing and laboratory testing was completed within 24 h. The data were then normalized using Z-score normalization and analyzed for lag time and correlation using the xcorr function and Spearman correlation coefficient.

RESULTS: A total of 2797 wastewater samples were collected. The wastewater monitoring study, based on sampling point distribution, was divided into two phases. Wuyuan County consistently showed high levels of positive ratio in wastewater samples in both phases, reaching peak values of 91.67% and 100% respectively. The lag time analysis results indicated that the peak positive ratio in all wastewater samples in Shangrao City appeared around 2 weeks later compared to the other three indicators. The correlation analysis revealed a strong linear correlation across all four types of data, with Spearman correlation coefficients ranging from 0.783 to 0.977, all of which were statistically significant.

CONCLUSION: The positive ratio of all wastewater samples in Shangrao City accurately reflected the COVID-19 epidemic trend from January to August 2023. This study confirmed the lag effect of wastewater percent positive and its strong correlation with the reported incidence rate and the positive ratio of nucleic acid samples in sentinel hospitals, supporting the use of wastewater percent positive monitoring as a supplementary tool for infectious disease surveillance in the regions with limited resources.

PMID:39649243 | PMC:PMC11625299 | DOI:10.1016/j.idm.2024.11.001

Cureus. 2024 Dec 2;16(12):e74979. doi: 10.7759/cureus.74979. eCollection 2024 Dec.

ABSTRACT

INTRODUCTION: Perioperative hypothermia is defined as a patient’s core body temperature of less than 36°C, which can lead to several complications. Even mild hypothermia increases the incidence of post-operative wound infection, post-operative ischaemic cardiac events and intra-operative blood loss and prolongs post-operative recovery. It is, hence, essential to maintain and provide normothermia during the perioperative phases for optimal surgical results and patient satisfaction. One of the most significant contributing factors to intra-operative hypothermia is the induction of general anaesthesia, where a significant amount of heat is shifted from the core to the peripheral circulation with consequent loss to an often-cold environment. The difference between the patient’s skin and ambient temperature during the interval from entering the operating room through anaesthesia induction until draping and active warming may be significant. This study aims to look at the incidence of perioperative hypothermia in trauma and orthopaedics patients who present to a busy district general hospital in the National Health Service (NHS) and correlate this with the ambient theatre temperature and phases of surgery to draw a statistical significance.

METHODS: This retrospective observational study conducted at the North Manchester General Hospital’s trauma and orthopaedics department included 300 patients listed in the trauma surgery list from 1 July 2023 to 31 August 2023. Inclusion criteria were trauma patients aged 16-85 years. Elective orthopaedic and other surgical speciality patients were excluded. The perioperative temperature measurements were collected from the anaesthesia records. Statistical calculations were conducted using the StatsDirect software (StatsDirect Ltd, Wirral, UK) from Manchester University NHS Foundation Trust, Manchester.

RESULTS: Among the 300 patients, the overall incidence of hypothermia was 3% pre-operative, 18% pre-induction, 21% intra-operative, 21% post-operative, 3% in recovery and 0% post-recovery. Intra-operative hypothermia incidence was significant, given that active warming was applied to patients with pre-operative hypothermia. Multivariate regression analysis showed that pre-induction temperature and theatre ambient temperature were statistically significant in predicting intra-operative hypothermia.

CONCLUSION: This study highlights the need for active interventions to recognise and prevent perioperative hypothermia in trauma and orthopaedics patients. Active pre-warming of patients and the operating rooms, regardless of surgery type and duration, is feasible and potentially beneficial. Further studies should include a randomised controlled trial comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

PMID:39649238 | PMC:PMC11624031 | DOI:10.7759/cureus.74979

Cureus. 2024 Dec 6;16(12):e75205. doi: 10.7759/cureus.75205. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Femoral neck fractures in elderly individuals cause significant morbidity, and their management is particularly challenging in rural areas where healthcare access is limited. The recommended treatment for displaced femoral neck fractures in elderly patients with poor mobility, cognitive dysfunction and multiple comorbidities is a hemiarthroplasty, which can be performed with various implants, including monopolar implants like Austin Moore prosthesis (AMP) and bipolar prosthesis (BP). In developing countries like India, rural areas often have constraints with healthcare resources. Furthermore, the per-capita income is low, limiting access to affordable healthcare. As a result, treatment is often tailored to ensure affordability, and AMP continues to be used as it is a relatively inexpensive implant. The objective of our study is to assess and compare the mortality, infection rate and functional outcomes (Harris hip score [HHS]) of AMP and BP in treating femoral neck fractures one year following surgery in a resource-constrained setting in a rural district general hospital in India.

METHODOLOGY: This retrospective observational study analysed all patients who underwent a hemiarthroplasty for acutely displaced femoral neck fractures between 1 January 2017 and 31 December 2017, with a minimum one-year follow-up following surgery. Pathological hip fractures, patients with pre-existing hip pathologies and those with an abbreviated mental test score of six or less were excluded. Medical records were reviewed, and demographic data, mortality, infection rates and HHS one year following surgery were recorded and compared for patients who underwent hemiarthroplasty with an AMP and BP.

RESULTS: A total of 118 patients underwent hemiarthroplasty, with two (1.69%) lost to follow-up. Therefore, 116 patients were included, comprising 81 (69.83%) women and 35 (30.17%) men, with similar demographics between both groups. No statistically significant difference was found in mortality rate (AMP 1, 1.79%, vs. BP 1, 1.67%, P = 0.96), infection rate (AMP 1, 1.82%, vs. BP 1, 1.69%, P = 0.96) and HHS (AMP 85.2 vs. BP 88.5; P = 0.08). No dislocations or periprosthetic fractures were noted at one-year follow-up in both groups.

CONCLUSIONS: While AMP and BP have similar clinical and functional outcomes, AMP is more cost-effective and perhaps more suitable in low socioeconomic demographics and low-resource settings. Further research is suggested to evaluate long-term outcomes in underserved populations with a low per-capita income.

PMID:39649236 | PMC:PMC11622164 | DOI:10.7759/cureus.75205

World J Gastrointest Surg. 2024 Nov 27;16(11):3546-3558. doi: 10.4240/wjgs.v16.i11.3546.

ABSTRACT

BACKGROUND: Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer (CRC) surgery. While probiotics have been proposed as a potential strategy to mitigate the risk of these infections, contemporary meta-analyses have produced conflicting findings.

AIM: To synthesize the available evidence regarding the prophylactic efficacy of probiotics in preventing infections following CRC surgery.

METHODS: A comprehensive search of PubMed and Scopus was conducted to identify relevant meta-analyses published up to February 2024. To assess the efficacy of probiotics on outcomes, relative risks (RR) and their corresponding 95%CI were pooled using a random effects model.

RESULTS: This comprehensive umbrella meta-analysis integrated eleven meta-analyses encompassing 11518 participants who fulfilled the inclusion criteria. Probiotics administration resulted in a statistically significant reduction in the incidence of total infections (RR: 0.40, 95%CI: 0.31-0.51; moderate certainty), surgical site infections (RR: 0.56, 95%CI: 0.49-0.63; high certainty), pneumonia (RR: 0.38, 95%CI: 0.30-0.48; high certainty), urinary tract infections (RR: 0.44, 95%CI: 0.31-0.61; moderate certainty), bacteremia (RR: 0.41, 95%CI: 0.30-0.56; high certainty), and sepsis (RR: 0.35, 95%CI: 0.25-0.44; high certainty). However, probiotics did not significantly affect intra-abdominal, central line, or peritoneal infections.

CONCLUSION: Probiotics have demonstrated potential in mitigating postoperative infectious complications among patients undergoing CRC surgery.

PMID:39649207 | PMC:PMC11622088 | DOI:10.4240/wjgs.v16.i11.3546

World J Gastrointest Surg. 2024 Nov 27;16(11):3437-3444. doi: 10.4240/wjgs.v16.i11.3437.

ABSTRACT

BACKGROUND: With the widespread use of hemocoagulase in patients with gastrointestinal bleeding, clinicians have become increasingly concerned about coagulation disorders associated with this medication. Risk factors for hypofibrinogenemia associated with hemocoagulase are poorly understood.

AIM: To determine risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

METHODS: We performed a retrospective analysis of the medical documentation of hospitalized patients treated with hemocoagulase for gastrointestinal bleeding. Hypofibrinogenemia was defined as a decrease in plasma fibrinogen concentration to less than 2.0 g/L. The included patients were divided into two groups: acquired hypofibrinogenemia group and non-hypofibrinogenemia group. We used logistic regression analysis to identify potential risk factors and established risk assessment criteria by employing a receiver operating characteristic curve.

RESULTS: There were 36 patients in the acquired hypofibrinogenemia group and 73 patients in the non-hypofibrinogenemia group. The hypofibrinogenemia group showed higher rates of intensive care unit admissions (P = 0.021), more female patients (P = 0.005), higher in-hospital mortality (P = 0.027), larger hemocoagulase doses (P = 0.026), more Packed Red Cells transfusions (P = 0.024), and lower baseline fibrinogen levels (P < 0.000). Binary logistic regression was employed to examine the risk factors associated with acquired hypofibrinogenemia. The analysis revealed that baseline fibrinogen [odds ratio (OR) 0.252, 95%CI: 0.137-0.464, P < 0.000], total hemocoagulase doses (OR 1.074, 95%CI: 1.015-1.137, P = 0.014), and female gender (OR 2.856, 95%CI: 1.015-8.037, P = 0.047) were statistically significant risk factors.

CONCLUSION: Higher doses of total hemocoagulase, female gender, and a lower baseline fibrinogen level were risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

PMID:39649201 | PMC:PMC11622085 | DOI:10.4240/wjgs.v16.i11.3437

SAGE Open Nurs. 2024 Dec 5;10:23779608241299507. doi: 10.1177/23779608241299507. eCollection 2024 Jan-Dec.

ABSTRACT

INTRODUCTION: Pre-hospital care personnel, including paramedics and emergency medical technicians (EMTs), are crucial frontline responders in emergency medical situations. They are critical in delivering timely medical assistance to individuals in emergencies. However, the demanding nature of their work can subject them to significant job stress, which may adversely affect their well-being and job performance.

OBJECTIVES: This study aimed to assess the levels of job stress and explore associated factors among pre-hospital care providers in Addis Ababa.

METHODOLOGY: A cross-sectional study was conducted at a healthcare facility, involving 134 ambulance healthcare providers. Participants were selected through a simple random sampling technique. Data collection employed pretested, self-administered questionnaires utilizing a nursing stress scale. Descriptive statistics were utilized to summarize the findings. Logistic regression analysis was employed to ascertain associations between variables while controlling for potential confounders. The strength of the association between dependent and independent variables was evaluated using odds ratios with a 95% confidence interval.

RESULT: Of the 134 study participants, 47% (95% CI: 38.2, 55.8) of them had job stress. Notably, several factors were significantly associated with job stress among pre-hospital healthcare providers working in ambulances. Conflict with leaders (AOR = 5.07; 95% CI: 2.98, 12.53), fear of mistakes (AOR = 8.22; 95% CI: 1.86, 36.34), lack of resources (AOR = 11.06; 95% CI: 5.19, 22.41), overloaded with ambulance care (AOR = 18.94; 95% CI: 4.33, 38.73) and inadequate information from dispatchers (AOR = 7.35; 95% CI: 3.32, 16.62) were identified as significant associated factors of job stress among these providers. These findings highlight the critical need to address leadership conflicts, fear of errors, and communication deficiencies to mitigate job stress among pre-hospital healthcare providers working in ambulances.

CONCLUSION: This study highlights the prevalence of job stress among pre-hospital healthcare providers working in ambulances, and found it as a significant problem. Notably, conflict with leaders, fear of mistakes, lack of resources, work overload and inadequate information from dispatchers emerged as significant associated factors contributing to job stress among pre-hospital health care providers. Efforts to foster better communication channels between providers and dispatchers, promote supportive leadership practices, and implement error-reduction strategies are essential. By addressing these challenges, healthcare organizations can create a more conducive work environment that supports the mental and emotional health of pre-hospital healthcare providers.

PMID:39649178 | PMC:PMC11622293 | DOI:10.1177/23779608241299507

SAGE Open Nurs. 2024 Dec 5;10:23779608241299345. doi: 10.1177/23779608241299345. eCollection 2024 Jan-Dec.

ABSTRACT

BACKGROUND: Despite free maternal healthcare, about 50% of pregnant women in Ghana initiate their antenatal clinic (ANC) late.

AIM: This study aimed to identify the factors that contribute to the late initiation of ANC among pregnant women in the Jasikan District, Ghana.

METHOD: A cross-sectional study was conducted between December 2021 and May 2022 in multiple health facilities. Multistage sampling was employed to select 352 pregnant women attending ANC in selected health facilities. A structured questionnaire was used to collect the data. The data was analyzed using Stata version 14.0. Descriptive statistics was used to describe the study variables and multivariable logistic regression models were performed to determine the predictors of late ANC initiation at p < .05 and 95% confidence interval (CI).

RESULTS: Approximately 45.7% of the participants initiated ANC late. Age less than 20 years, older age groups (40-49 [odds ratio (OR): 18.0, 95%CI: 3.68-88.0, p < .001]; 30-39 [OR: 6.4, 95%CI: 1.76-22.87, p = .005] and 20-29 [OR: 4.6, 95%CI: 1.30-15.98, p = .018]) were associated with late initiation of ANC. Having a higher number of children (4 [OR: 2.8, 95%CI: 1.36-5.79, p = .005] and 3 [OR: 2.5, 95%CI: 1.33-4.58, p = .004]) were predictors of late ANC initiation as compared to having one child. Women who sought for advice from women leaders (OR: 3.5, 95%CI: 1.18-10.12, p = .02) were about three (3) times more likely to initiate ANC late as compared to those who sought for advice from friends. Women who felt poorly received at ANC (OR: 7.7, 95%CI: 2.188-27.078, p = .001) were about eight (8) times more likely to initiate ANC late as compared to those who felt well received. Again, those who spent over six (6) hours during ANC visits (OR: 18.4, 95%CI: 4.246-79.734, p < .001) had an 18 times higher risk of initiating ANC late relative to those who spent less than 3 h.

CONCLUSION: The study findings highlight the need for interventions that addresses the social and cultural factors, negative perceptions of ANC, and long waiting times at health facilities to improve early initiation of ANC. Such interventions can assume health education and promotion to address the sociocultural and unfavorable perceptions toward ANC. The sector ministry and the health facilities may consider expanding ANC service centers to reduce long waiting times.

PMID:39649177 | PMC:PMC11622304 | DOI:10.1177/23779608241299345

Clin Anat. 2024 Dec 8. doi: 10.1002/ca.24255. Online ahead of print.

ABSTRACT

The accessory renal arteries (ARAs) are a well-described variant of the renal vasculature with clinical implications for radiologists, surgeons, and clinicians. The aim of the present systematic review with meta-analysis was to estimate the pooled prevalence of ARAs, including their variant number, origin, and termination, and to highlight symmetrical and asymmetrical morphological patterns. The systematic review used four online databases in accordance with PRISMA 2020 and Evidence-based Anatomy Workgroup guidelines. R programming software was used for the statistical meta-analysis. A total of 111 studies were considered eligible for our initial aim. The typical renal artery (RA) anatomy (a single bilateral vessel) was identified in 78.92%; the overall ARA prevalence was estimated at a pooled prevalence of 21.10%. The estimated pooled prevalence of one, two, three, and four ARAs were 18.67%, 1.80%, 0.01%, and <0.01%. The ARAs have been the subject of extensive research owing to their clinical importance, including in kidney transplantation surgery and resistant hypertension therapy. Knowledge of the typical and variant anatomy of RAs is essential for anatomists, radiologists, surgeons, and clinicians in order to avoid misunderstanding, complications, and iatrogenic injury.

PMID:39648312 | DOI:10.1002/ca.24255