Journal of Medicine, Surgery, and Public Health最新文献

Point shear wave elastography (pSWE) and transient elastography (TE) are at the forefront of non-invasive evaluation of iron overload in beta thalassemia major (BTM) patients, meeting both clinical recommendations and publication standards. This letter to the editor aims at discussing the use of pSWE and TE as safe and efficacious tools for the assessment of liver iron overload and fibrosis. Numerous studies attest to the efficacy of pSWE and TE in detecting iron-excessive-induced hepatic stiffness in patients with BTM. The efficacy of analyzing stiffness in visceral organs demonstrates the rapid and innovative progress of pSWE in modern diagnostic procedures. Empirical evidence demonstrates the remarkable diagnostic accuracy and reliability of pSWE, establishing it as a viable replacement for TE. It is largely eloquent because it streamlines the clinical process and is efficient, requiring fewer assessment values. Moreover, combining pSWE with cutting-edge imaging modalities such as MRI offers a comprehensive examination of iron overload and its deleterious consequences for organ function. Finally, a distinct analysis of the interpreted pSWE results requires deliberation of significant patient characteristics such as liver stiffness and BMI, as well as the substantial area of the liver and hepatic steatosis. The aforementioned factors need to be taken into account in order to maximize the diagnostic utility of pSWE and guarantee an appropriate assessment of liver stiffness.

Chronic myeloid leukemia (CML) is a rare hematologic malignancy characterized by genetic alterations in pluripotential hematopoietic stem cells that result in the BCR-ABL1 fusion gene. Although CML typically progresses through three phases, with the chronic phase being the most common, spontaneous splenic rupture (SSR) remains an exceedingly rare complication. Prompt recognition and intervention are crucial for optimizing patient outcomes in cases of SSR. We present the case of a 43-year-old male diagnosed with chronic-phase CML who experienced sudden-onset abdominal pain and was treated with analgesics during an OPD visit, leading to sudden and unexpected death. Postmortem examination revealed extensive hemoperitoneum secondary to spontaneous splenic rupture. This case highlights the rarity and clinical significance of SSR in patients with CML. Continued reporting and analysis of SSR cases is essential for advancing our understanding and improving patient outcomes. Educating patients about the potential risks of SSR and the importance of prompt reporting of symptoms can empower them to seek timely medical attention, potentially reducing adverse outcomes. Further research into the pathophysiological mechanisms underlying SSR in CML is warranted to inform clinical management strategies and to improve patient care.

This study examines mortality trends and disparities in arrhythmia-related deaths among older adults in the United States from 1999 to 2020. Utilizing mortality data from the CDC WONDER database, we analyzed over 3 million arrhythmia-related deaths identified by ICD-10 codes I47.0-I49.9. The study computed age-standardized mortality rates (ASMR) to assess trends across demographic groups and geographical locations. Statistical techniques, including Joinpoint regression analysis, were employed to examine demographic and regional trends in mortality rates. The overall ASMR for arrhythmia-related deaths increased from 38.0 per 10,000 in 1999 to 47.0 in 2020. The trend showed a decline from 1999 to 2009 (APC: −0.9), followed by increases from 2009 to 2018 (APC: 1.5) and a significant rise from 2018 to 2020 (APC: 7.4). Men had higher ASMRs than women (45.2 vs. 33.0), with significant increases observed in both sexes in recent years. Racial disparities were evident, with Non-Hispanic (NH) Whites having the highest ASMR (40.5), followed by NH Blacks (31.1), NH American Indians/Alaska Natives (28.3), Hispanics (22.7), and NH Asians/Pacific Islanders (19.7). Geographic disparities were also prominent, with Vermont exhibiting the highest ASMR (55.8) and Nevada the lowest (24.9). The Midwest region had the highest regional ASMR (41.2), while nonmetropolitan areas consistently showed higher rates than metropolitan areas (42.1 vs. 37.2). These findings highlight significant disparities in arrhythmia-related mortality, underscoring the need for targeted interventions to address these public health challenges.

Recently, Menezes and Zahalka commented on the shortage of anesthesia providers across the United States. With broad strokes, they explore various perspectives of the issue, from the limitations in training positions to the continued growth in demand for surgery. Although rural health care systems face unprecedented challenges, rural residents deserve perioperative care managed by anesthesiologists at the systems level. Physicians, hospital administrators, and health care regulators need to lead the way by exploring different staffing models, lobbying for new legislation that ensures the safety of the most complex patients. And perhaps, by understanding how we can build a different system in the rural setting, we can better health care for American citizens.

Lemierre's syndrome (LS) is a life-threatening, rare condition that starts with an oropharyngeal infection leading to internal jugular vein septic thrombophlebitis and potentially severe systemic complications, highlighting the need for prompt recognition and treatment by healthcare professionals. We present a case of LS in a 37-year-old male who initially presented with a sore throat, cough, and high-grade fever. A diagnostic workup revealed a positive blood culture with Fusobacterium necrophorum, and an ultrasound examination demonstrated internal jugular vein thrombophlebitis, confirming the diagnosis of LS. Treatment commenced with oral antibiotics planned for 6 weeks, alongside oral anticoagulation scheduled for 12 weeks. Our case underscores the need for vigilance and multidisciplinary collaboration in managing LS, highlighting the importance of prompt recognition, targeted therapies, and ongoing research to optimize outcomes and enhance diagnosis and management.

Periodontitis has a high global prevalence, and sleep may impact both the occurrence and the severity of the condition. With an emphasis on sex disparities, this study examined the association between sleep and severe periodontitis in a population sample that was representative of the United States. This study used a sample of 5495 people from the National Health and Nutrition Examination Survey (NHANES) and conducted univariate and multivariate logistic regression analyses before and after adjusting for age, sex, ethnicity, poverty-income ratio (PIR), body mass index (BMI), smoking status, and diabetes mellitus (DM) status. Furthermore, this study included a stratified sex-based analysis to investigate potential sex differences between severe periodontitis and sleep. The results are presented with odds ratios (ORs) and 95% confidence intervals (95% CIs). The results of multivariate logistic regression revealed a significant association between the recommended sleep duration each night (seven to nine hours) and the prevalence of severe periodontitis in women (OR_ad = 0.68, p = 0.003). Furthermore, in women, urinating twice or three times per night was significantly associated with severe periodontitis (OR_ad = 1.44, p = 0.011), whereas the association was more significant in women who urinated at least four times per night (OR_ad = 1.68, p = 0.035). In men, these associations were not observed. There was no significant association between poor sleep quality and severe periodontitis, but the association differed by sex. Severe periodontitis in women was found to be significantly associated with poor sleep quality, but not in men.

The primary objective of this commentary was to identify the strengths and weaknesses of AI technologies, uncover opportunities for improvement, and recognize potential threats that could impede their successful implementation in nursing care. This commentary involved constructing a SWOT matrix to analyze AI adoption, identifying internal strengths and weaknesses, and external opportunities and threats. The analysis revealed several strengths of AI adoption in nursing care, including enhanced data analysis capabilities, improved patient monitoring, and increased efficiency in routine tasks. However, weaknesses such as the high initial costs of implementation and concerns about data security were identified. Opportunities included the potential for AI to reduce healthcare costs and improve patient outcomes. Nonetheless, threats such as resistance to technological change and ethical dilemmas related to AI decision-making processes were recognized as potential barriers to successful adoption. This article sheds light on the intricate landscape of AI adoption in nursing care. While AI brings forth substantial strengths, it simultaneously poses challenges that healthcare systems should confront. To fully harness AI's potential, healthcare organizations should thoughtfully deliberate on the identified weaknesses and threats, actively seeking avenues for seamless integration. In this concerted effort, the healthcare industry is poised to unlock the transformative capabilities of AI, elevating nursing care standards, and ultimately, advancing patient outcomes.

Simultaneous alcohol and marijuana (SAM) use has become increasingly prevalent among young adult populations. Moreover, lesbian, gay, and bisexual populations are at increased risk for substance use initiation. To date, little research has examined trends in SAM use by sexual identity. This study aimed to investigate trends in SAM use among recent drinkers using nationally representative data. Pooled data from the 2015–2019 and 2020 National Survey on Drug Use and Health (NSDUH) were examined among 120,061 individuals (5.75% LGB) 18 years or older who reported using alcohol in the past month. Given the methodological changes in the study design, we analyzed these waves separately. Covariates included age, race, biological sex, sexual identity, rurality, and past month use of tobacco. Weighted logistic regression models and trend analyses were conducted. An estimated 11,952 of the sample reported using marijuana during their last episode of drinking. A significant linear trend (b = 0.12) of increasing SAM use among recent drinkers from 2015 to 2019. When compared to heterosexual individuals, lesbian or gay (aPR: 1.44, 95% CI 1.26, 1.63) and bisexual (aPR: 1.92, 95% CI 1.77, 2.09) individuals were more likely to report SAM use. Among the entire sample, females had a lower risk of SAM use than males (aPR: 0.68, 95% CI 0.65, 0.72). For 2020, a total of 25,679 adults 18 years or older participated in the survey, with 2622 identifying as LGB and 54.1% reporting past month alcohol use. An estimated 1503 individuals reported SAM use. Consistent with our findings, of those reporting past month alcohol use, LGB populations were at higher risk for SAM use, with gay individuals (aPR: 1.59, 95% CI 1.11, 2.30) at increased risk and bisexual individuals having higher risk (aPR: 2.12, 95% CI 1.73, 2.60). SAM use among individuals presents several critical health concerns, especially for at-risk populations. Findings from the present study can inform tailored interventions to reduce minority stress and stigmatized identities are needed.

Background

Widowhood is a disastrous incident occurring at any stage of life for surviving oneself particularly the older women having critical reflexes on their physical, emotional and as well as socio-economic well-bring. Living alone and being cornered to home may also have serious repercussions on psychological health conditions of geriatric population, a public health concern in recent times.The main essence of this present study was to investigate the impact of widowhood, loneliness and social non-participation on older women depression in Indian context.

Methods

Data for the present study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI), conducted during 2017–2018. A total of 15,559 older adult women were availed for this present study. Descriptive analyses, association studies and finally multinominal logistic regression analyses were performed to fulfill the study objectives.

Result

Currently, 5 % of total study participant’s suffered from depression for most of the times. Findings suggested that widowhood is a catastrophic event giving rise to depression for most of the old women in their later life. With this, living alone in old age period also had a great impact on the prevalence of depression. Preponderance of older women depression is also found among those, not getting involved any social events.

Conclusion

This study suggested that to reduce the prevalence of older women depression, targeted interventions in the form of psychological counseling, screening services and community involvement are very much needed.

Background

Bangladesh is not excluded from the global issue of children being underweight or overweight. This study examined the relationship between underweight, overweight, and sociodemographic variables in children.

Methods

Data from the Multiple Indicator Cluster Survey (MICS) 2019 were used for this study. We employed chi-square and one-way analysis of variance (ANOVA) tests to identify significant variables. Subsequently, we fitted a multilevel mixed-effects logistic regression model and reported odds ratios (OR), confidence intervals (CI), and p-values. STATA version 17 was used for analysis.

Results

The sample size for our study consisted of 10,875 Bangladeshi children under five years of age. From a total of 10,875 children, 20.57% were underweight and 6.80% were overweight. Data were available for 8858 rural and 2017 urban under-five children. The prevalence of underweight was greatly influenced by age, and in rural regions, it consistently increased from 12 months to 59 months. Male children were more likely to be overweight and underweight than female children. Children in the Sylhet division were likelier to be underweight and overweight. Educated mothers reduce the risk of underweight children in urban and rural areas. The richest family children were more likely to be overweight in urban areas. In rural areas, children born with a smaller size were more likely to become underweight and less likely to become overweight.

Conclusions

Our research revealed that the poorest sociodemographic category, the Sylhet division, small newborns, and illiterate mothers were the most vulnerable to child weight problems.