Tag: pubmed

Biomedica. 2026 Mar 2;46(1):121-217. doi: 10.7705/biomedica.7946.

ABSTRACT

INTRODUCTION: A second hematopoietic stem cell transplant is required when the first transplant fails, usually due to relapse or graft failure, and is associated with increased morbidity and mortality. Survival rates range from 74 to 82% in non-neoplastic diseases and from 39 to 58% in neoplastic conditions. Evidence on second hematopoietic stem cell transplant in children is limited, particularly in low- and middle-income countries.

OBJECTIVE: To describe the clinical characteristics, complications, and outcomes of children who underwent a second transplant at a high-complexity center between 2012 and 2024.

MATERIALS AND METHODS: Case series study with descriptive and survival analysis using the Kaplan-Meier method in Stata 14™.

RESULTS: A total of 346 allogeneic transplants were performed, of which 20 patients underwent a second transplant. Of these, 17 received a haploidentical donor for their second transplant, and the primary indication was a neoplastic disease in 13 cases. The second transplant was performed due to graft failure in 11 of the 20 patients, and due to relapse in the remaining 9. The mean age was 10.7 ± 5 years, with a male predominance (14 out of 20). Haploidentical transplants accounted for 16 of the 20 cases, and 11 used the same donor. The most common complications were acute graft-versus-host disease in 7 cases, 2 of grade III, cytomegalovirus infection in 10 cases, and graft failure after the second transplant in 4 cases: 3 primary, 1 secondary. Transplant-related mortality was 31%. The 2-year overall survival was 54%, with a median follow-up of 11 months.

CONCLUSIONS: Second hematopoietic stem cell transplant is a viable therapeutic option when no other alternatives are available, particularly in resource-limited settings.

PMID:41875460 | DOI:10.7705/biomedica.7946

Biomedica. 2026 Mar 2;46(1):97-108. doi: 10.7705/biomedica.7551.

ABSTRACT

Introducción. El análisis del flujo vaginal cumple un papel clave en el diagnóstico clínico y en la toma de decisiones médicas. La estandarización del informe es esencial para garantizar la confiabilidad diagnóstica.

OBJETIVO: Evaluar la calidad del informe del frotis vaginal de cinco laboratorios clínicos de la región del Pacífico colombiano. Materiales y métodos. Se trata de un estudio descriptivo y retrospectivo basado en los registros de cinco laboratorios (tres públicos y dos privados) ubicados en tres municipios del Pacífico colombiano. Se utilizó la guía BACOVA ERIGE para evaluar si los componentes analíticos estaban completos o incompletos. Los datos se procesaron con XLSTAT Premium, versión 2024, mediante cálculos de medias, desviaciones estándar, proporciones y razones. Se aplicó la prueba de c2 para comparar el cumplimiento entre laboratorios, y se hicieron análisis de correspondencia múltiple y análisis discriminadores para determinar los patrones del informe y las diferencias entre municipios.

RESULTADOS: Se analizaron 1260 registros de mujeres entre los 18 y los 60 años: el 56,8 % estaban embarazadas y el 57 % se encontraban afiliadas al régimen subsidiado. El cumplimiento de la guía BACOVA ERIGE fue mayor en Ipiales (54,44 %) que en Cali (24,21 %) y Quibdó (21,35 %) (c², p = 0,047). Mediante los análisis de correspondencia múltiple y discriminante, se identificaron tres diferentes patrones de informes por municipio.

CONCLUSIONES: La variabilidad observada en los informes del frotis vaginal pone en evidencia la necesidad de estandarizar los procedimientos posteriores al análisis. La unificación de los criterios técnicos entre laboratorios mejoraría la calidad diagnóstica del desequilibrio de la flora vaginal y fortalecería la toma de decisiones clínicas.

PMID:41875458 | DOI:10.7705/biomedica.7551

Biomedica. 2026 Mar 2;46(1):83-96. doi: 10.7705/biomedica.7730.

ABSTRACT

Introducción. El trasplante de órganos es vital para mejorar la calidad de vida de los pacientes con insuficiencia orgánica, pero la escasez de donantes es un desafío global. En Colombia, la demanda supera la oferta, lo cual aumenta la mortalidad de aquellos pacientes en las listas de espera. Objetivo. Analizar las causas de rechazo de potenciales donantes de órganos, según la evaluación de Fundonar en tres regionales del país durante el año 2022. Materiales y métodos. Se llevó a cabo un estudio transversal descriptivo basado en datos retrospectivos de posibles donantes reportados a la Red de Donación y Trasplantes de Colombia. Se incluyeron 1451 casos evaluados. Las causas para rechazar un donante potencial se agruparon en tres categorías: médicas, médico-legales y logísticas. Se utilizó estadística descriptiva, se evaluó la normalidad de las variables y se compararon los donantes con contraindicaciones en cada regional mediante el análisis de varianza. Se utilizó el software R, versión 4.0.3. Resultados. De los 1451 donantes evaluados, 849 tenían causas para el rechazo. De estos, el 29,8 % presentó falla multiorgánica, el 20,8 % tenía alguna comorbilidad y el 15,3 % no cumplía con los criterios diagnósticos de muerte encefálica. Conclusión. La mayoría de las causas médicas de rechazo podrían reconsiderarse sopesando los riesgos y los beneficios para los receptores. Un enfoque personalizado y multidisciplinario, con criterios basados en la evidencia y decisiones en tiempo real adaptadas a Colombia, podría mejorar las tasas de aprobación de donación de órganos.

PMID:41875457 | DOI:10.7705/biomedica.7730

Biomedica. 2026 Mar 2;46(1):71-82. doi: 10.7705/biomedica.7702.

ABSTRACT

INTRODUCTION: Antibiotic consumption and resistance have increased worldwide. Antibiotic resistance results in longer hospital stays and higher healthcare costs.

OBJECTIVE: To describe the consumption of antibiotics and associated expenses in Colombia.

MATERIALS AND METHODS: A meticulous descriptive cross-sectional study of antibiotic consumption and expenditure in Colombia from 2020 to 2023 was conducted. Between 2020 and 2023, a description of the consumption and expenditure of antibiotics in Colombia was made. Data were obtained from IQVIA™ (IMS Health and Quintiles). The prominent families of antimicrobials used in Colombia were selected. Twelve pharmacological families were classified, including 27 antimicrobials and three β-lactamase inhibitors. The defined daily dose was used to measure antibiotic consumption, identify variations, and evaluate medical prescription practices. The defined daily dose per 1,000 inhabitants per day was estimated to obtain information from the population receiving daily antibiotic treatment. The amount of antibiotics used was estimated in grams and tons per year.

RESULTS: The top 10 most consumed antimicrobials by defined daily dose per 1,000 inhabitants per day in Colombia were amoxicillin, azithromycin, metronidazole, cephalexin, ciprofloxacin, trimethoprim-sulfamethoxazole, ampicillin, sulbactam, clarithromycin, cefazolin, and dicloxacillin. The total consumption of antibiotics was 2,139 tons, which represented an expense of USD$ 708,112,587, for an increase of 17 and 8%, respectively, during the period.

CONCLUSIONS: The progressive increase in consumption and spending on antimicrobials in Colombia requires a set of interventions that include promoting changes in medical prescribing behaviour and a public education campaign that leads to the adoption of a sustainable public health policy.

PMID:41875456 | DOI:10.7705/biomedica.7702

Diving Hyperb Med. 2026 Mar 31;56(1):83-87. doi: 10.28920/dhm56.1.83-87.

ABSTRACT

Closed circuit rebreather (CCR) diving sets use soda lime, a sodium hydroxide-based ‘scrubber’ substance to remove CO₂ from exhaled breathing gas thus prolonging dive time and efficiency. Inadvertent water ingress into the set may result in reaction with the scrubber and a highly alkaline solution known as a ‘caustic cocktail’ may be formed. Ingestion or aspiration of this solution can cause severe chemical burns. Irrigation with freshwater is the mainstay of initial treatment of ‘caustic cocktail’ injuries in CCR divers. Published advice advises divers never to use acidic diluents to irrigate and neutralise a caustic cocktail solution due to concerns over the potentially exothermic nature of the neutralisation reaction. However, there is limited available evidence to support this advice, and it was felt that further research into the best treatment options available for caustic cocktails is required. This study used an in vitro model of an ingested caustic cocktail to investigate pH and temperature changes after adding different diluents (including acidic diluents orange juice or coca cola) to a solution of sodium hydroxide. Acidic diluents reduce pH significantly more than neutral diluents with a respective mean drop in pH of 5.99 compared to 0.78 (P = 0.015). There is no statistically significant difference in temperature change noted between the two types of diluent (P = 0.32) with no exothermia generated. We propose that orange juice or coca cola are more effective irrigation solutions than fresh or seawater, and that advice to divers who use CCRs could change.

PMID:41875445 | DOI:10.28920/dhm56.1.83-87

Diving Hyperb Med. 2026 Mar 31;56(1):48-51. doi: 10.28920/dhm56.1.48-51.

ABSTRACT

INTRODUCTION: This study’s aim was to determine the number of scuba tank fills done in Victoria, Australia from 1 July 2024 to 30 June 2025 to provide an estimate of the number of scuba dives conducted during that period and, from that, estimates of the fatality and decompression illness rates.

METHODS: Suppliers of compressed gas for scuba diving in Victoria were identified through internet searches, industry liaison and the Australasian Diving Safety Foundation records. Those identified were emailed an invitation to participate in the tank fill survey and provided with dedicated spreadsheets. Email reminders were sent to collect monthly data on air, nitrox and ‘other’ fills. Data were compiled and, at the end of the survey period, non-regular participants were approached to provide actual numbers or estimates of the year’s fills.

RESULTS: Overall, 38/40 (95%) identified current suppliers participated in the survey, with 27 submitting regular monthly data and the remainder providing actual or estimated annual fills. There were 46,720 reported fills, including 39,386 air, 6,758 nitrox, and 576 others, with proportions of 84%, 15% and 1%, respectively. During that period, 11 scuba divers were treated for decompression illness (DCI) (eight of whom had dived locally) and there were two fatalities.

CONCLUSIONS: It is estimated that around 50,000 scuba tank fills were provided, equating to approximately 50,000 dives conducted in Victorian waters during from 1 July 2024 to 30 June 2025. During that period, there were eight open circuit divers who had dived in Victoria treated for DCI and two scuba diving fatalities, yielding estimates of 16 DCI cases and four deaths per 100,000 dives.

PMID:41875441 | DOI:10.28920/dhm56.1.48-51

Diving Hyperb Med. 2026 Mar 31;56(1):13-20. doi: 10.28920/dhm56.1.13-20.

ABSTRACT

INTRODUCTION: Acute respiratory symptoms after diving are common among competitive breath-hold divers. These symptoms, including shortness of breath, cough, haemoptysis, and chest discomfort, are often linked to immersion pulmonary oedema (IPO) or pulmonary barotrauma. This study aimed to evaluate the incidence, clinical presentation, and risk factors of IPO using portable ultrasound devices in a depth competition for breath-hold divers in Taiwan.

METHODS: This observational study was conducted during a competition around Liuqiu Island, Taiwan. Twenty-five breath-hold divers participated. Lung ultrasonography was performed pre- and post-diving, along with measurements of basic vital signs. Symptoms and diving history were recorded. The primary outcome measure was B-line score before and after diving.

RESULTS: Following the dive, 7/25 (28%) of divers reported acute respiratory symptoms, 10/25 (40%) showed ultrasound evidence of increased extravascular lung fluid, and 2/25 (8%) met the clinical criteria for IPO, presenting with both symptoms and hypoxaemia (SpO₂ ≤ 95%) alongside positive B-lines. B-line scores significantly increased from a median of 4 (range 1-4) to 7 (range 3-13) (P = 0.048). Male sex, higher body mass index, and elevated pre-dive systolic blood pressure were significantly associated with positive ultrasound findings. Among all factors, only diving depth remained statistically significant associated with increased post-dive B-line scores (regression coefficient = 0.046) (P = 0.007).

CONCLUSIONS: The incidence of post-dive acute respiratory symptoms was 28%, and 8% of participants exhibited clinical features of IPO. Positive lung ultrasound findings were observed in 40% of divers, mostly asymptomatic. Maximum diving depth was significantly associated with increased post-dive B-line scores.

PMID:41875438 | DOI:10.28920/dhm56.1.13-20

JMIR Form Res. 2026 Mar 24;10:e88445. doi: 10.2196/88445.

ABSTRACT

BACKGROUND: There is a growing interest in developing novel psychological interventions for eating disorders, with an emphasis on targeting maintaining factors. One hypothesized mechanism underlying illness maintenance is the experience of an “inner eating disorder voice,” which reinforces maladaptive thoughts, emotions, and behaviors. Preliminary studies suggest that the eating disorder voice is common among patients and is linked to greater illness severity.

OBJECTIVE: This single-arm, mixed methods pilot feasibility study aimed to evaluate a novel virtual reality (VR)-based therapy targeting the eating disorder voice. The intervention was adapted from AVATAR therapy for psychosis and was examined as an adjunct to treatment as usual in individuals with eating disorders. In this adaptation, participants engaged with a therapist-controlled avatar representing their inner eating disorder voice in VR. The primary objectives were to assess the feasibility, acceptability, and safety of the intervention and to provide preliminary estimates of its clinical efficacy.

METHODS: Adults with anorexia nervosa (9/10, 90%) or bulimia nervosa (1/10, 10%) took part in a 7-session VR-based therapy course at the Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark, alongside their treatment as usual. Quantitative measures of feasibility (recruitment, retention rates, and satisfaction scores), safety, and eating disorder-related outcomes were collected at baseline and after treatment between June 2023 and January 2024. Qualitative interviews conducted after the intervention (October 2023 to November 2023) explored participants’ experiences. Descriptive statistics, paired t tests, and thematic analysis were conducted, and the analyses were finalized in October 2025.

RESULTS: Recruitment targets were met: 14 individuals were referred, and 11 provided consent well within the prespecified time frame. Treatment completion rate was 80% (8/10; 95% CI 44%-97%), and no serious adverse events occurred. Participants reported high satisfaction (7/10, 70%; mean 9, SD 1.15 on a 10-point Likert scale; median 9, IQR 8.5-10.0; range 7-10), and qualitative data (8/10, 80%) suggested that they valued the immersive virtual representation of their eating disorder voice. Exploratory analyses indicated improvements in eating disorder symptoms (Hedges g=-0.99, 95% CI -1.74 to -0.24; P=.01), power dynamics associated with the eating disorder voice (Hedges g=-1.63, 95% CI -2.59 to -0.67; P=.002), and emotion regulation via cognitive reappraisal (Hedges g=0.87, 95% CI 0.08-1.66; P=.04).

CONCLUSIONS: The VR-based avatar intervention for eating disorders was feasible, acceptable, and safe, with preliminary signals of clinical improvement. These findings support further development and evaluation of the intervention in a randomized clinical trial.

PMID:41875424 | DOI:10.2196/88445

JMIR AI. 2026 Mar 24;5:e80549. doi: 10.2196/80549.

ABSTRACT

BACKGROUND: The workload that stems from writing clinical histories is one of the main sources of stress and overload for primary care professionals, accounting for up to 43% of the working day. The introduction of technology, specifically artificial intelligence (AI), in the field of health could significantly reduce the time spent writing clinical reports without compromising the quality of care.

OBJECTIVE: The objective of this study is to evaluate the impact of implementing an AI solution for the automatic transcription of consultations in several primary care centers in Catalonia.

METHODS: A proof of concept of a multicenter study was carried out with alternating assignment of consultations to the intervention group (use of an AI assistant that automatically generates consultation notes) or control group (usual clinical practice). The impact was evaluated through the recorded documentation time and the initial quality of the transcription measured with the Levenshtein distance expressed as corrected words per minute, complemented by a qualitative categorization of clinician-reported errors and the perceived satisfaction of patients and professionals through questionnaires evaluated through a Likert scale.

RESULTS: For the intervention group, the average processing time was 6.63%, while the review time by the professional amounted to 15.2%. Because documentation-time data were not available for the control group, no direct between-group comparison of time savings was possible; time-related findings are therefore exploratory and limited to intervention-group process and review metrics. Levenshtein-based estimates showed that in most cases, the review was <24 words per minute and 26% of drafts required no edits, indicating a high-quality initial transcription. A qualitative analysis of clinician feedback showed that context or meaning errors were the most frequent, while unsupported additions or hallucinations were uncommon. The satisfaction surveys were answered by 289 patients and 213 professionals. Patient satisfaction was high (≥4/5), with no statistically significant differences between the control and intervention groups. The professionals rated the audio quality at 9.06 out of 10 (SD 1.18; medicine) and 7.62 out of 10 (SD 1.58; nursing) and the transcription at 8.14 out of 10 (SD 1.74) and 6.93 out of 10 (SD 1.52), respectively.

CONCLUSIONS: The implementation of an AI tool was feasible in routine primary care, was well accepted by clinicians, and did not negatively affect patient satisfaction, with a generally low transcription review burden. However, this proof-of-concept study does not allow conclusions about comparative time savings, and adequately powered randomized studies are needed to confirm benefits for care quality and efficiency.

PMID:41875421 | DOI:10.2196/80549

JMIR Res Protoc. 2026 Mar 24;15:e86515. doi: 10.2196/86515.

ABSTRACT

BACKGROUND: Young adults face rising wellness challenges, including prediabetes risk, requiring sustained engagement with preventive health interventions. Digital wellness applications offer promise for promoting healthy lifestyle behaviors, yet high dropout rates and inadequate personalization limit their effectiveness. This paper outlines the technical implementation and formative usability evaluation of MiCARE, a theory-driven progressive web application (PWA) designed to support sustained wellness engagement among young adults through user-centered design.

OBJECTIVE: This study aims to systematically implement theory-driven design specifications into a functional web application, the MiCARE platform, and to conduct a formative usability evaluation with a convenience sample of 20 university-affiliated young adults aged 18 to 34 years in Victoria, Australia, in both rural and urban areas using the task-technology fit and unified theory of acceptance and use of technology frameworks as organizing lenses to assess usability, usefulness, and satisfaction.

METHODS: This is an embedded mixed methods study conducted across 2 phases: phase 3 and phase 4. Phase 3 involves the technical implementation of 6 theory-driven features (ie, empathetic chatbot, learning hub, dynamic goal setting, gamification, personalized reminders, and progress dashboard) using HTML5, CSS3, JavaScript, Google Dialogflow ES, and Firebase services, following the Agile methodology over 6 months with biweekly self-managed sprints and clinical verification. Phase 4 is a 3-month formative usability feasibility evaluation with 20 young adults recruited from La Trobe University (Bundoora and Bendigo campuses). Participants will complete screening and initial, midpoint, and final surveys assessing usability, usefulness, and satisfaction, while real-time use analytics captures engagement patterns. Data analysis will use the task-technology fit and unified theory of acceptance and use of technology frameworks as interpretive guides, with quantitative data analyzed using descriptive statistics (R Studio) and qualitative feedback analyzed through thematic analysis (NVivo). Use analytics will provide descriptive contextual information only. The study has received ethics approval from the La Trobe University Human Research Ethics Committee (HEC24507).

RESULTS: The study will take place between 2025 and 2026. Phase 3 (technical implementation) commenced in October 2025 and is currently ongoing, with core features under active development and verification. Phase 4 (formative usability and feasibility evaluation) is scheduled to commence following completion of phase 3. Evaluation results will be disseminated in academic forums and peer-reviewed publications in early 2027. The findings will enable us to evaluate the feasibility, acceptability, and usability of a theory-driven PWA in this university-affiliated sample, informing refinements and future larger-scale studies.

CONCLUSIONS: This study will contribute to the technical implementation and formative usability evaluation of a multitheoretical, user-centered PWA for wellness engagement in preventive health, bridging the gap between conceptual frameworks and deployed interventions.

PMID:41875407 | DOI:10.2196/86515