Tag: pubmed

CHEST Crit Care. 2024 Dec;2(4):100103. doi: 10.1016/j.chstcc.2024.100103. Epub 2024 Oct 28.

ABSTRACT

BACKGROUND: A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.

RESEARCH QUESTION: How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?

STUDY DESIGN AND METHODS: We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.

RESULTS: Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.2%) met at least one ARDS definition, including 1,218 patients meeting the Berlin definition of ARDS (60.1% of all ARDS diagnoses) and 809 new diagnoses of the global definition of ARDS that were not captured by the Berlin definition alone (39.9% of all ARDS diagnoses and 14.0% of all ICU admissions). After adjustment for hospital-level factors, patients who met only the global definition of ARDS criteria (ie, who would not have been captured by the Berlin definition) showed no statistically significant ICU mortality difference vs patients with ARDS according to the Berlin definition (21.7% [95% CI, 18.9%-24.4%] vs 23.8% [95% CI, 21.5%-26.2%]; OR, 0.88 [95% CI, 0.70-1.10]; P = .25). In prespecified exploratory subgroup analyses, patients without COVID-19 who met only the criteria for the global definition of ARDS showed reduced ICU mortality (14.2% [95% CI, 11.6%-16.9%] vs 22.2% [95% CI, 19.8%-24.6%]; OR, 0.58 [95% CI, 0.45-0.75]; P < .0005) compared with patients without COVID-19 who met the Berlin definition for ARDS.

INTERPRETATION: The new global definition of ARDS captures a significant proportion of patients who would not have been included by the Berlin definition alone. These additional patients with ARDS may have heterogenous patterns of outcomes among diagnostic subgroups, including by COVID-19 status, compared with patients with ARDS according to the Berlin definition.

PMID:39711978 | PMC:PMC11661813 | DOI:10.1016/j.chstcc.2024.100103

Cytotechnology. 2025 Feb;77(1):22. doi: 10.1007/s10616-024-00683-6. Epub 2024 Dec 18.

ABSTRACT

The clinical evidence, complications and the pathogenesis of COVID-19 are not clearly understood. In COVID-19 patients, cellular immune response biomarkers and oxidative stress parameters have been used as gravity markers. Indeed, oxidative stress has been proposed to play an essential role in the genesis of COVID-19. In the present research, we investigated lipid peroxidation, protein oxidation, superoxide dismutase activity and the production of auto-antibodies against superoxide dismutase, in the blood of Tunisian patients with corona virus. To evaluate lipid peroxidation, plasma malondialdehyde and conjugated dienes, have been determined in 69 corona virus patients and 30 controls. To determine protein oxidation the thiol level was measured. Plasma superoxide dismutase activity has been measured in 30 corona virus patients and 30 controls on one hand. Utilizing a standard enzyme-linked immunosorbent assay, the level of immunoglobulin G (IgG), and M (IgM) directed against superoxide dismutase was evaluated. To investigate the implication of auto-antibody production in COVID-19 patients in the generation of oxidative stress, a correlation study between auto-antibodies production and oxidative stress parameters was performed. High levels of both malondialdehyde and conjugated dienes were found in the plasma of patients (p < 0.001, respectively). Protein oxidation was confirmed by the high level of thiol (p < 0.001). Superoxide dismutase activity was not significantly lower in COVID-19 patients (p > 0.05). The level of immunoglobulin G (IgG), and M (IgM) directed against superoxide dismutase is significantly higher in COVID-19 patients than in control group (p < 0.001 respectively). Statistical analyses have demonstrated a positive correlation between superoxide dismutase activity and IgM and IgG isotypes antibodies level against superoxide dismutase (p < 0.001). A strong positive correlation was observed between IgG and malondialdehyde level in all cases (r = 0.368; p ≤ 0.01). In addition, a significant positive correlation was noted between IgM and malondialdehyde (r = 0.290; p = 0.024). Similarly, two significant positive relationship was found between IgG / conjugated dienes (r = 0.356; p = 0.005) and between IgM / conjugated dienes (r = 0.285; p = 0.027).

PMID:39711970 | PMC:PMC11655737 | DOI:10.1007/s10616-024-00683-6

Front Oncol. 2024 Dec 6;14:1450388. doi: 10.3389/fonc.2024.1450388. eCollection 2024.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) derived kinetic parameters with high spatiotemporal resolution in discriminating malignant from normal prostate tissues.

METHODS: Fifty patients with suspicious of malignant diseases in prostate were included in this study. Regions of interest (ROI) were manually delineated by experienced radiologists. Voxel-wise kinetic parameters were produced with the following tracer kinetic models (TKMs): Tofts model, extended Tofts model (ETM), Brix’s conventional two-compartment model (Brix), adiabatic tissue homogeneity model (ATH), and distributed parameter model (DP). The initial area under the signal-time curve (IAUC) with an uptake integral approach was also included. Mann-Whitney U test and receiver operating characteristic (ROC) curves were used to evaluate the capability of distinguishing tumor lesions from normal tissues. A p-value of 0.05 or less is considered statistically significant. ROI based parameters correlation analysis between DP and ETM were performed.

RESULTS: 624 lesions and 269 normal tissue ROIs were obtained. Thirty parameters were derived from the six kinetic models. Except for PS from Brix, statistically significant differences between lesions and normal tissues (P<0.05) were observed in other parameters.Ve from DP, ATH and Brix and PS from ATH have AUC values less than 0.6 in the ROC analysis. MTT, Vp and PS from DP, Ktrans from ETM and Tofts, E and PS from ATH, IAUC parameters and F from Brix have AUC values larger than 0.8. Ve and Vp from DP and ETM are correlated (r> 0.65). The correlation coefficient between Ktrans from ETM and PS from DP is 0.751.

CONCLUSION: MTT, Vp and PS from DP, Ktrans from ETM and Tofts, E and PS from ATH, F from Brix and IAUC parameters can be used to differentiate malignant lesions from normal tissues in the prostate.

PMID:39711955 | PMC:PMC11659129 | DOI:10.3389/fonc.2024.1450388

Front Oncol. 2024 Dec 6;14:1491943. doi: 10.3389/fonc.2024.1491943. eCollection 2024.

ABSTRACT

INTRODUCTION: Central nervous system (CNS) tumors are the second most prevalent malignant neoplasms in childhood, with surgical resection as the primary therapeutic approach. The immediate postoperative period following CNS tumor resection requires intensive care to mitigate complications associated with high morbidity and mortality.

OBJECTIVE: The primary aim of this study is to comprehensively describe the postoperative complications observed in pediatric patients who underwent primary CNS tumor resection and were subsequently admitted to the pediatric intensive care unit (PICU) at Hospital Universitario Fundación Valle del Lili in Colombia.

METHODS: We conducted a cross-sectional observational analysis of pediatric patients who underwent surgery for CNS tumors and were admitted to our PICU from January 2011 to December 2021. Clinical, histopathologic, and postoperative complication data were collected. A descriptive statistical analysis was performed using measures of dispersion and central tendency with a 95% confidence interval.

RESULTS: A total of 114 patients were included, of whom 55.3% were male. The median PICU stay was 4 days (2-7). The most common tumor type was embryonal (25.4%), followed by low-grade glioma (20.1%) and high-grade glioma (14.9%). Mechanical ventilation was required in 24.5% of patients, with a median extubation time of 3 days (2-9). In the immediate postoperative period, 6.14% of patients experienced CNS hemorrhage and 3.5% experienced intracranial hypertension. Common complications included motor deficits, facial paralysis, and sensory deficits. The mortality rate was 3.5%.

CONCLUSION: This study describes the postoperative complications, clinical challenges, and interventions observed in pediatric patients after CNS tumor resection in a resource-limited country. Our findings emphasize the importance of tailored interventions and multidisciplinary collaboration to optimize clinical outcomes. Future data comparison from centers sharing similar characteristics will play a crucial role in identifying best practices and enhancing outcomes globally.

PMID:39711949 | PMC:PMC11659208 | DOI:10.3389/fonc.2024.1491943

Cureus. 2024 Dec 18;16(12):e75939. doi: 10.7759/cureus.75939. eCollection 2024 Dec.

ABSTRACT

Background Cosmetic procedures have become increasingly popular worldwide; however, male participation remains relatively low, especially in conservative societies like Saudi Arabia. This study explores the awareness, attitudes, and experiences of men concerning aesthetic procedures in Saudi Arabia, with a focus on sociodemographic factors and sources of information. This study aimed to assess male awareness, attitudes, and experiences with aesthetic procedures in Saudi Arabia and identify factors influencing their engagement with these interventions. Methodology A cross-sectional study was conducted involving 818 male participants from various regions in Saudi Arabia. Data on sociodemographic profiles, awareness levels, and attitudes toward cosmetic procedures were collected using a structured questionnaire. Descriptive statistics, chi-square tests, and logistic regression models were used for data analysis performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results The study found that 504 (61.6%) participants had never undergone a cosmetic procedure. The most common reasons for not undergoing such procedures included the social image of men (198, 39.2%), cost (145, 28.7%), and no health issues requiring aesthetic intervention (66, 13.1%). Awareness of cosmetic procedures was relatively low, with 223 (27.3%) participants rating their awareness as “low” and 101 (12.3%) as “very low.” Social media (333, 40.7%), physicians (211, 25.8%), and television (144, 17.6%) were the primary sources of information. Significant factors influencing attitudes included age, education level, employment status, and marital status, all of which had a significant p-value below 0.05. Conclusions Awareness and acceptance of cosmetic procedures among Saudi males are increasing, influenced by various cultural, societal, and personal factors. This study highlights the need for targeted campaigns and education to promote understanding and acceptance. Further research is needed to examine how these attitudes evolve and their implications for the cosmetic industry and healthcare providers.

PMID:39711943 | PMC:PMC11659918 | DOI:10.7759/cureus.75939

Cureus. 2024 Dec 21;16(12):e76146. doi: 10.7759/cureus.76146. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Excessive sun exposure is a significant risk factor for various skin conditions, including sunburn, premature aging, and skin cancer. This study aimed to assess the awareness, attitudes, and practices regarding sun exposure and sunscreen use among college students in Saudi Arabia.

METHODOLOGY: A cross-sectional study was conducted with 388 college students from various disciplines. Data were collected using a structured questionnaire covering demographic information, awareness, and practices related to sun exposure and sunscreen use. Descriptive statistics and chi-square tests were employed to analyze the data.

RESULTS: This study comprised 209 (53.9%) females and 179 (46.1%) males, with the majority aged between 18 and 23 years. Formal education on sun exposure dangers was lacking in 43.0% (167) of participants. The most recognized consequences of excessive sun exposure were sunburn (313, 80.6%) and skin cancer (289, 74.4%). Factors influencing sunscreen use included weather conditions and healthcare provider recommendations. Males were significantly less likely to use sunscreen compared to females. First-year students and participants without formal education on sun exposure were less likely to use sunscreen regularly.

CONCLUSION: Despite awareness of the risks associated with excessive sun exposure, sunscreen use among college students in Saudi Arabia is inconsistent and influenced by various factors, including gender and education level.

PMID:39711940 | PMC:PMC11663009 | DOI:10.7759/cureus.76146

Cureus. 2024 Dec 22;16(12):e76179. doi: 10.7759/cureus.76179. eCollection 2024 Dec.

ABSTRACT

Background and objectives A modified aligner appliance with nickel-titanium springs (MAA) is a relatively new appliance that has not received extensive attention in orthodontics. This study evaluated the patient-reported outcomes when orthodontic treatment was provided using a modified aligner appliance to treat mild lower incisor crowding. Materials and methods This prospective cohort study consisted of 42 patients (11 males and 31 females; mean age 21.69 ± 2.56 years) with mild crowding. Twenty-one patients were treated using a modified aligner with nickel-titanium springs, while the remaining patients were treated with a conventional fixed orthodontic appliance (FA). Patient responses regarding pain, discomfort, and difficulty in chewing, swallowing, and speaking were recorded using a visual analog scale (VAS) at six assessment times: 24 hours (T1), two days (T2), three days (T3), two weeks (T4), one month (T5), and two months (T6) after appliance application. Results The mean perceived pain and discomfort levels were generally lower in the traditional fixed appliance (FA) group than the modified aligner appliance with nickel-titanium springs group at most assessment times. However, no statistically significant differences were found between the two groups. Chewing difficulty levels were similar between the two groups with no substantial differences. Swallowing and speech difficulty were significantly higher in the MAA group compared to the FA group during the first two days of treatment (P < 0.008). Conclusions Patients using both types of orthodontic appliances experienced temporary discomfort, including pain and difficulty chewing. While the modified aligners appliance with nickel-titanium springs caused additional challenges with swallowing and speaking, these issues were resolved over time, allowing patients to adjust to the treatment.

PMID:39711937 | PMC:PMC11663397 | DOI:10.7759/cureus.76179

GMS J Med Educ. 2024 Nov 15;41(5):Doc52. doi: 10.3205/zma001707. eCollection 2024.

ABSTRACT

AIMS: Comprehensive provision of general healthcare (i.e. primary care) within the populace is contingent on there being enough general practitioners (GPs) in proximity to patients. It is no longer the case that vacated allocated positions for primary-care physicians are being filled in all regions. Support for specialist training in general medical practice is one of the measures intended to ensure provision of GP services. This analytical project aims to make a data-driven contribution to gauging the impact of such support on primary care in Germany, while also delivering pointers for further research.

METHODS: On the basis of routinely collected data, the history of such support was examined in detail for all practice-based, statutory health insurance (SHI)-accredited GPs during the period 2016-2022. In the analysis, GPs were broken down by whether they took up full-time or part-time roles, self-employed or salaried roles, and roles in a practice or in an ambulatory healthcare centre (MVZ).

RESULTS: During the period under review, the proportion of those who have both recently commenced work as SHI-accredited GPs and had previously used support for their specialist training, increased from 57% to 81%. The total number of new GPs (headcount) rose from 1,590 to 1,955. Results indicate that those who had availed themselves of this support take up self-employed and full-time roles more often than those who had not.

CONCLUSIONS: Both take-up of support for specialist training, and the number of new GPs, increased markedly during the period under review. The data does not indicate any causal links. However, these results could form a jumping-off point for further research (in general) into support for specialist training, and (in particular) into how this may impact these individuals’ subsequent work roles.

PMID:39711872 | PMC:PMC11656181 | DOI:10.3205/zma001707

GMS J Med Educ. 2024 Nov 15;41(5):Doc54. doi: 10.3205/zma001709. eCollection 2024.

ABSTRACT

BACKGROUND: A competency-based education approach calls for frequent workplace-based assessments (WBA) of Entrustable Professional Activities (EPAs). While mobile applications increase the efficiency, it is not known how many assessments are required for reliable ratings and whether the concept can be implemented in all sizes of residency programs.

METHODS: Over 5 months, a mobile app was used to assess 10 different EPAs in daily clinical routine in Swiss anesthesia departments. The data from large residency programs was compared to those from smaller ones. We applied generalizability theory and decision studies to estimate the minimum number of assessments needed for reliable assessments.

RESULTS: From 28 residency programs, we included 3936 assessments by 306 supervisors for 295 residents. The median number of assessments per trainee was 8, with a median of 4 different EPAs assessed by 3 different supervisors. We found no statistically significant differences between large and small programs in the number of assessments per trainee, per supervisor, per EPA, the agreement between supervisors and trainees, and the number of feedback processes stimulated. The average “level of supervision” (LoS, scale from 1 to 5) recorded in larger programs was 3.2 (SD 0.5) compared to 2.7 (SD 0.4) (p<0.05). To achieve a g-coefficient >0.7, at least a random set of 3 different EPAs needed to be assessed, with each EPA rated at least 4 times by 4 different supervisors, resulting in a total of 12 assessments.

CONCLUSION: Frequent WBAs of EPAs were feasible in large and small residency programs. We found no significant differences in the number of assessments performed. The minimum number of assessments required for a g-coefficient >0.7 was attainable in large and small residency programs.

PMID:39711857 | PMC:PMC11656171 | DOI:10.3205/zma001709

SAGE Open Nurs. 2024 Dec 19;10:23779608241305782. doi: 10.1177/23779608241305782. eCollection 2024 Jan-Dec.

ABSTRACT

INTRODUCTION: The intrauterine device (IUD) represents the most cost-effective, long-acting reversible form of contraception, but accounts for only 1% of all contraception methods used in Tanzania.

OBJECTIVE: This study aims to determine the uptake of IUD use and investigate the perceptions, challenges, and recommendations surrounding the use of intrauterine devices among women of reproductive age in Tanzania.

METHOD: A cross-sectional study was conducted including 347 women, as well as qualitative semi-structured interviews with 11 women. Quantitative data were entered into SPSS, and descriptive statistics were employed to summarize the data. Content analysis was used to analyse the qualitative data.

RESULTS: The prevalence of IUD use was 5%. The majority of the women interviewed were aware of myths and misconceptions concerning IUDs but wanted to use it after receiving information from healthcare providers.

CONCLUSION: The study found that the use of intrauterine devices was low in the study area and that there is a need to strengthen community engagement to reduce misconceptions about the use of IUDs.

PMID:39711855 | PMC:PMC11660266 | DOI:10.1177/23779608241305782