Frontiers in Medicine最新文献

[This corrects the article DOI: 10.3389/fmed.2023.1342466.].

LAM is a rare multi-cystic lung disease for which treatment with sirolimus is indicated in cases of moderate or severe lung disease or declining lung function. The aim of this study was to describe patients treated with sirolimus for LAM and their outcomes. This retrospective observational study was based on data from the French national health insurance data system (SNDS). All adult women receiving sirolimus were identified in France between 2014 and 2021. In the absence of a specific LAM code in the system, an algorithm was developed to identify patients treated for possible LAM exclusion of other sirolimus indications (transplantation, graft-versus-host disease), or probable LAM (among possible LAM, patients hospitalized for pneumothorax, pleural drainage, pleurisy, ascites, chronic respiratory failure, lung transplantation, or angiomyolipoma). Over the entire study period, 638 patients were considered as treated with sirolimus for possible LAM, including 208 patients treated for "probable" LAM and 33 patients for TSC-LAM. Median [Q1; Q3] age at index date was 45.0 years [34.0; 58.5] for patients with probable LAM and 40.0 years [28.0; 56.0] for patients with TSC-LAM. Overall, the number of incident patients varied from 28 to 96 each year for possible LAM, from 11 to 33 each year for probable LAM and from 1 to 4 patients each year for TSC-LAM patients. In 2021, the incidence rate of patients treated with sirolimus for probable LAM in France was estimated at 0.9 per 1,000,000 French adult women and the prevalence rate at 6.3 per 1,000,000 French adult women. The 5-year survival after sirolimus initiation was 84% (95% CI: 76%; 90%) for probable LAM patients, and 77% (95% CI: 48%; 91%) for TSC-LAM patients. This study provides an updated epidemiological estimate of LAM patients treated with sirolimus in France between 2014 and 2021. Even though some of the results should be interpreted cautiously in the light of limitations related to the use of claims database, evolution of the disease and missing safety data, the information retrieved in this study is very valuable, as few studies provide real-world information on LAM populations.

Hereditary heart disease (HHD) is a series of cardiac disorders associated with monogenic or polygenic abnormalities and is one of the leading causes of sudden death, particularly in young adults. The updated European Cardiology guideline for cardiomyopathies provides the first comprehensive summary of genotyping, imaging, and therapy recommendations for inherited cardiomyopathies, but still lacks a comprehensive discussion of research advances and future trends in genetic diagnosis and therapy of HHD. Our research aims to fill this gap. Bibliometric analysis software (CiteSpace 6.3.R1, VOSviewer 1.6.18, and Scimago Graphica) was used to analyze the general information, trends, and emerging foci of HHD in the past 20 years, including author, country, institution, keyword, and so on. There were 5,757 publications were screened and aggregated in the database, including 1876 reviews and 3,881 articles. Hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), Brugada syndrome (BrS), myocardial amyloidosis, and Fabry disease (FD) were the main types of HHD that were explored in greater depth. Moreover, new diagnostic methods, clinical cohorts, and genetically targeted therapies for HHD patients are key research hotspots. The relationship between the pathogenicity of genes and prognosis will become increasingly important for therapy.

Background: Irrational use of medicines is a problem globally that soon needs to be addressed. According to estimates from the World Health Organization, almost half of all medications were improperly prescribed. This study aimed to assess the drug prescribing patterns based on World Health Organization drug use indicators in the dermatology outpatient department of Injibara General Hospital.

Method: A facility-based retrospective cross-sectional study was conducted from August 15 to August 30, 2024, with 620 patient prescriptions issued at the dermatology outpatient department of Injibara General Hospital. All patient prescriptions dispensed from the dermatology outpatient department from April to July 2024 were included. A structured data collection tool adopted from the World Health Organization core medicine use indicator was used to collect data, and Statistical Package for Social Science version 27.1 was used for data analysis.

Results: An average of 1.74 drugs per encounters was prescribed, with 21.6 and 3.1% of prescriptions being antibiotics and injections, respectively. Generics were used in 95.4% of prescriptions, and nearly 84% of drugs were prescribed from the Ethiopian essential-drug list.

Conclusion: The World Health Organization's recommended threshold for the average number of prescriptions prescribed per encounter was met, indicating proper prescribing practices that reduce polypharmacy. The percentage of encounters with antibiotics was within the World Health Organization's value, which reflects that dermatologists are less likely engaging in irrational antibiotic prescriptions. Likewise, the World Health Organization's recommendations for the percentage of encounters with injection was met, indicating an effort to minimize unnecessary use of injections by dermatologists, which can reduce complications associated with injection use. However, the World Health Organization's guidelines for generic drug prescriptions were not met, suggesting that dermatologists are less likely to prescribe generic drugs, which can raise patient healthcare expenditures considerably. Prescriptions from the Ethiopian essential medicine list also fell short of World Health Organization's standards, indicating a failure to follow established guidelines.

Background: Strongyloides stercoralis is an opportunistic pathogenic parasite. Most individuals with normal immune function may not exhibit significant symptoms, and the signs are atypical, which can easily lead to missed diagnoses and delayed treatment. People with underlying diseases and weakened immunity are prone to develop severe conditions after infection with Strongyloides stercoralis.

Case presentation: We report an immunocompromised patient in whom the pathogen was initially not detectable using traditional parasitic detection techniques. However, Strongyloides stercoralis was identified in both the alveolar lavage fluid and blood through metagenomic next-generation sequencing. Subsequently, Strongyloides stercoralis was detected in the alveolar lavage fluid after multiple rounds of testing using traditional microscopic examination techniques. Based on the mNGS results and other examination findings, the patient was diagnosed with Strongyloides stercoralis in combination with concurrent multiple pathogens infections. After the combined drug therapy of Meropenem, Vancomycin, and Albendazole, the patient's condition was gradually brought under control.

Conclusion: This case demonstrates the advantage of integrating traditional detection methods with metagenomics next-generation sequencing technology in the etiological diagnosis of immunocompromised individuals. It is conducive to clarifying the etiological diagnosis of patients and thereby facilitating the timely initiation of corresponding treatments.

Introduction: Adverse events in hospitals significantly compromise patient safety and trust in healthcare systems, with medical errors being a leading cause of death globally. Despite efforts to reduce these errors, reporting remains low, and effective system changes are rare. This systematic review explores the potential of artificial intelligence (AI) in clinical risk management.

Methods: The systematic review was conducted using the PRISMA Statement 2020 guidelines to ensure a comprehensive and transparent approach. We utilized the online tool Rayyan for efficient screening and selection of relevant studies from three different online bibliographic.

Results: AI systems, including machine learning and natural language processing, show promise in detecting adverse events, predicting medication errors, assessing fall risks, and preventing pressure injuries. Studies reveal that AI can improve incident reporting accuracy, identify high-risk incidents, and automate classification processes. However, challenges such as socio-technical issues, implementation barriers, and the need for standardization persist.

Discussion: The review highlights the effectiveness of AI in various applications but underscores the necessity for further research to ensure safe and consistent integration into clinical practices. Future directions involve refining AI tools through continuous feedback and addressing regulatory standards to enhance patient safety and care quality.

The growing global prevalence of diabetes mellitus (DM), along with its associated complications, continues to rise. When clinically detected most DM complications are irreversible. It is therefore crucial to detect and address these complications early and systematically in order to improve patient care and outcomes. The current clinical practice often prioritizes DM complications by addressing one complication while overlooking others that could occur. It is proposed that the commonly targeted cell types including vascular cells, immune cells, glial cells, and fibroblasts that mediate DM complications, might share early responses to diabetes. In addition, the impact of one complication could be influenced by other complications. Recognizing and focusing on the shared early responses among DM complications, and the impacted cellular constituents, will allow to simultaneously address all DM-related complications and limit adverse treatment impacts. This review explores the current understanding of shared pathological signaling mechanisms among DM complications and recognizes new concepts that will benefit from further investigation in both basic and clinical settings. The ultimate goal is to develop more comprehensive treatment strategies, which effectively impact DM complications in multiple organs and improve patient care and outcomes.

Ischemic colitis (IC) is a multifaceted condition that often manifests with nonspecific symptoms such as abdominal pain and bloody diarrhea, particularly in older adults with vascular risk factors. Diagnosis is supported by elevated levels of white blood cells, lactate, and C-reactive protein (CRP). Computed tomography (CT) imaging typically reveals wall thickening and fat stranding in watershed areas. Colonoscopy may demonstrate mucosal erythema, ulceration, or necrosis. IC can be differentiated from inflammatory bowel disease (IBD), diverticulitis, and colorectal cancer based on symptom patterns and imaging findings. The absence of specific biomarkers can complicate diagnosis, potentially causing delays. Illustrating these challenges is the case of a 53-year-old male patient who arrived at the hospital exhibiting abdominal pain and diarrhea. Enhanced CT scans and colonoscopy identified a mass in the ileocecal region of the colon, and subsequent tissue biopsy revealed ischemic lesions in the submucosa. Initially diagnosed with IC, the patient's symptoms gradually improved with conservative treatment, which included antibiotics, fluid resuscitation, and bowel rest. Follow-up endoscopy showed significant lesion improvement, and no recurrence was detected during subsequent follow-ups. This case illustrates the healing process of IC as manifested by colon mass under endoscopy. Also, it highlights the critical importance of timely diagnosis and personalized treatment strategies in atypical presentations to improve patient outcomes.

Objective: This study aimed to evaluate the health-related quality of life (HRQoL) in ankylosing spondylitis (AS) patients in the Chaoshan region and identify factors influencing the ASAS Health Index (ASAS-HI) to enhance comprehensive AS treatment strategies.

Methods: A survey of ASAS-HI was conducted on 82 AS patients from the rheumatology outpatient department of the First Affiliated Hospital of Shantou University Medical College. The Bath Ankylosing Spondylitis Global Score (BAS-G) assessed overall health status, the Ankylosing Spondylitis Quality of Life Questionnaire (AS-QOL) evaluated quality of life, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured disease activity, and the Bath Ankylosing Spondylitis Functional Index (BASFI) assessed functional difficulties. Inflammatory markers and patient data were collected, and univariate/multivariate logistic regression analyses were used to explore influencing factors of ASAS-HI.

Results: The mean ASAS-HI score was 3.52 ± 3.12. ASAS-HI was positively correlated with BASDAI (r = 0.478, p < 0.001), ASDAS-CRP (r = 0.406, p < 0.001), BASFI (r = 0.338, p < 0.002), and BAS-G (r = 0.335, p < 0.002). Patients with ASDAS-ESR ≥ 2.1, ASDAS-CRP ≥ 2.1, and spinal tenderness had significantly higher ASAS-HI scores than others (p < 0.001). Spinal tenderness and radiographic grading were identified as key influencing factors.

Conclusion: ASAS-HI is significantly impacted by disease activity and functional limitations. Early assessment of ASAS-HI is crucial for optimizing disease management in AS patients.

The ethical governance of pharmaceutical clinical trials in Europe, particularly under Regulation 536/2014, is intended to ensure the safety, rights, and well-being of participants. Despite this regulatory framework, significant gaps in ethical oversight remain. This paper identifies five key deficiencies: (1) European regulations only partially address ethical imperatives set by international guidelines, thereby restricting the ethical mandate of relevant entities; (2) the role of research ethics committees is largely limited to pre-approval activities, reducing continuous oversight during trials; (3) GCP inspectors operate within a narrow scope regarding ethical oversight, which limits their ability to identify a broad range of unethical practices; (4) there is insufficient transparency and collaboration between RECs and regulators, specifically GCP inspectorates, leading to fragmented oversight; and (5) there is minimal integration of ethical findings into the marketing authorization decision process by entities such as clinical assessors and the CHMP. To bridge these gaps, the paper suggests a shift from a prospective ethics review to a comprehensive end-to-end model of ethical governance.