International Journal of Clinical Practice最新文献

Introduction

Recent studies suggest that there might be a relationship between lower respiratory tract infections (LRTIs) and increased susceptibility to colorectal cancer (CRC). This study aims to obtain causal estimates between them and measure the mediating impact of established modifiable risk factors.

Methods

In this study, we employed the two-sample Mendelian randomization (MR) approach to explore the potential link between LRTIs and CRC susceptibility. The main results were assessed through the inverse variance weighted (IVW) method, and heterogeneity and pleiotropy were evaluated using Cochrane’s Q test and MR-Egger analysis. Moreover, to investigate potential mediating mechanisms, we conducted a two-step MR analysis evaluating whether 731 immune phenotypes could serve as mediators in this pathway.

Results

IVW revealed a positive causal impact of LRTIs on CRC (odds ratio [ORs] = 1.098, 95% confidence interval [CI]: 1.002–1.203, and p = 0.045). In the two-step MR analysis, we observed suggestively significant causal relationships between LRTIs and 38 immune phenotypes. Among the 38 immune phenotypes, IVW analysis revealed a suggestive causal effect of CD4+ T-cell side scatter area (SSC-A) on CRC risk. Mediation analysis estimated that SSC-A on CD4+ T cells accounted for 10.335% (95% CI: 9.104%–11.566%) of the total effect of LRTIs on CRC.

Conclusion

As an exploratory study, this MR analysis suggests a potential link between LRTIs and CRC, which may partially mediate through the SSC-A profile of CD4+ T cells.

Background

Telepharmacy, a branch of telemedicine, enables remote pharmaceutical services such as medication counseling and drug monitoring. However, the readiness of pharmacists to adopt telepharmacy remains uncertain, particularly in regions like Palestine where no prior studies have explored this topic.

Aims

This study evaluated Palestinian pharmacists’ perceptions, barriers, and willingness to implement telepharmacy.

Methods

A cross-sectional study was conducted among 375 pharmacists in the West Bank, Palestine, using the convenience sampling method. A validated online questionnaire assessed pharmacists’ knowledge, attitudes, and barriers toward telepharmacy, with Cronbach’s alpha values ranging from 0.75 to 0.81, indicating good reliability. The tool demonstrated strong reliability, with Cronbach’s alpha scores of 0.81 (willingness), 0.77 (attitudes), and 0.75 (barriers). Convenience sampling was employed to recruit participants from northern, central, and southern regions, ensuring geographic representation. The questionnaire comprised four sections: demographics, knowledge, attitudes, and barriers.

Results

Among participants, only 36.5% were aware of telepharmacy and 39.7% had poor knowledge, but 57.8% showed high willingness to implement telepharmacy, particularly for patient counseling (82.5%) and provider communication (83.2%). The most frequently used communication tool was WhatsApp (79%), followed by phone calls (68%). Major barriers included low health literacy (78.9%), poor internet access (74.5%), and high operational costs (74.4%). Key barriers included limited health literacy (78.9%), unreliable internet access (74.5%), and high costs (74.4%). Regression analysis revealed that higher education (OR = 2.1; p < 0.001) and female gender (OR = 1.68; p < 0.001) were associated with greater willingness.

Conclusion

While Palestinian pharmacists are receptive to telepharmacy, significant barriers hinder adoption. Addressing these challenges requires targeted training, infrastructure investment, and policy support. This study fills a critical gap in the literature, as no prior research has examined telepharmacy readiness in Palestine.

Background

Vitamin A supplementation (VAS) is a national strategy to address vitamin A deficiency. Children aged 6–59 months receive vitamin A twice a year. Despite this, coverage of VAS remains a major public health challenge for children in Bangladesh, with multiple studies aiming to identify its primary risk factors. This study examines the relationship between various sociodemographic factors and identifies the significant risk factors for low VAS rates, suggesting recommendations to enhance supplementation coverage among children.

Methods

Data were derived from the Bangladesh Demographic and Health Survey (BDHS) 2022. Analysis included 6472 (male: 3316 and female: 3156) weighted children aged 12–59 months; although children aged 6–59 months are eligible to receive VAS, the analysis focused on those aged 12–59 months. This is because the survey question required caregivers to recall VAS received in the past six months, and all children in the 12–59 month age group would have been eligible for supplementation during that period. The chi-squared test was used to assess associations, followed by multilevel logistic regression models for identifying significant risk factors. The multilevel logistic regression model outperformed logistic regression in clustered data analysis.

Results

A proportion of 73.1% (4731) of children had received a vitamin A capsule in the prior six months, below the World Health Organization’s (WHO) 90% target. Children in the Dhaka division were notably 1.097 times more likely not to receive VAS compared to children in other regions. Conversely, children from the wealthiest wealth quartile (AOR = 0.749, p < 0.001, 95% CI: 0.618–0.908) and those with mothers aged 30–49 years (AOR = 0.649, p < 0.001, 95% CI: 0.518–0.812) were significantly less likely to miss VAS. Furthermore, higher maternal education was associated with a reduced likelihood of a child being excluded from the VAS program.

Conclusion

The findings highlight the need for targeted awareness campaigns in vulnerable communities, particularly to educate parents about the benefits of VAS.

Objective

To assess the efficacy and safety of Chaihu-Guizhi-Ganjiang decoction (CGGJD) combined with Danggui-Shaoyao-San (DS) in oligomenorrhea treatment.

Methods

In this prospective open-label trial, 35 oligomenorrhea patients (30–40 years) received CGGJD-DS for 3 months, followed by a 2-month follow-up. Outcomes included clinical efficacy rate, menstrual pattern and frequency, serum hormones (E2, LH, and FSH), uterine spiral artery indices (RI, PI, and S/D), endometrial blood flow parameters (VI, FI, and VFI), and endometrial thickness assessed pre-/post-treatment and post–follow-up.

Results

Post-treatment menstrual pattern and frequency both significantly increased versus baseline (p < 0.01), with a 68.6% total efficacy rate. E2 levels significantly increased post-treatment and post–follow-up (both p < 0.01), while LH and FSH decreased significantly (both p < 0.01). Significant improvements occurred in spiral artery indices (all p < 0.01), endometrial blood flow parameters (all p < 0.01), endometrial blood distribution (Wald χ² = 20.8, p < 0.01), and endometrial thickness (p < 0.01). No serious adverse events occurred.

Conclusions

CGGJD-DS effectively improves ovarian function and endometrial perfusion in oligomenorrhea, demonstrating potential as an alternative therapy.

Objectives

Temporomandibular disorders (TMDs) in patients with rheumatoid arthritis (RA) can lead to orofacial pain and dysfunction of the temporomandibular joint (TMJ). Self-care is a recognized primary intervention for controlling TMDs, offering a simple reversible treatment, since there is no specific treatment protocol for TMDs in RA patients. This study aims to investigate the effectiveness of self-management in improving TMD symptoms in RA patients under drug control.

Methods

This prospective Phase II clinical trial included 64 drug-controlled RA patients presenting with signs or symptoms of TMDs. All participants underwent baseline assessment using the RDC/TMD questionnaire, Numerical Analog Scale (NAS), and Helkimo Index, followed by a standardized clinical evaluation of jaw function and muscle/joint tenderness. Patients received structured self-care education, including bilateral chewing exercises, mouth-opening limitation within pain threshold, dietary modification, thermal modalities, parafunctional habit control, and therapeutic massage. Reminder messages and follow-up phone calls were provided to reinforce adherence. Clinical examinations were repeated after 2 months to evaluate changes in pain intensity, jaw mobility, joint sounds, and TMD severity.

Results

Ultimately, reductions in TMD severity based on the Helkimo criteria and patient self-report using the NAS, as well as reductions in the number of painful muscles and joints, improvement in maximum mouth opening, lateral and protrusive movements, and decreased jaw sounds were observed in patients.

Conclusions

Adherence to self-management as the main component of treatment can be a highly effective, sustainable, and side-effect-free approach for managing symptomatic TMD in patients with RA.

Clinical Significance

Self-care significantly reduced TMD pain, improved mouth movements, and decreased jaw sounds in RA patients with TMJ involvement.

Trial Registration: Iranian Registry of Clinical Trials: IRCT N120221113056489

Objective

To evaluate the therapeutic efficacy and safety of pyrazinamide compared with pasiniazid in elderly patients with pulmonary tuberculosis (PTB) and to investigate their effects on serum inflammatory markers, including interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α).

Methods

Clinical data of 82 elderly PTB patients admitted between December 2022 and December 2023 were retrospectively analyzed. According to their documented treatment regimens, patients were divided into a control group (n = 41, treated with pasiniazid) and a study group (n = 41, treated with pyrazinamide). Sputum conversion rate, radiological lesion improvement, incidence of adverse drug reactions, and serum IFN-γ and TNF-α levels were compared between the two groups.

Results

After 3 and 6 months of therapy, sputum conversion rates in the pyrazinamide group were 85.37% and 95.12%, respectively, significantly higher than those in the pasiniazid group (63.41% and 80.49%, P  <  0.05). The total improvement efficiency was 90.24% in the study group versus 70.73% in the control group (P  <  0.05). The incidence of adverse reactions was lower in the pyrazinamide group (14.63%) compared with the control group (36.59%, P  <  0.05). After 3 months of treatment, both TNF-α and IFN-γ levels were markedly reduced in both groups (P  <  0.05), with greater decreases observed in the pyrazinamide group (P  <  0.001), suggesting enhanced immunomodulatory effects and better inflammatory resolution.

Conclusion

Pyrazinamide demonstrates superior therapeutic efficacy and lower adverse reaction rates compared with pasiniazid in elderly PTB patients. Its use is associated with significant reductions in systemic inflammatory cytokines (TNF-α and IFN-γ), indicating potential immunomodulatory benefits and clinical value as an adjunctive agent in tuberculosis management.

Objectives

Understanding the morphology of the root canal is important for successful endodontic treatment. Studies have revealed the role of geographical and racial diversity in root canal anatomical variations. Considering the lack of enough study on the prevalence of C-shaped canals in maxillary molars in Iran, the present study aimed to investigate their prevalence in an Iranian population.

Materials and Methods

This cross-sectional study was performed on 313 maxillary cone-beam computed tomography (CBCT) scans of the Radiology Department of Tabriz Faculty of Dentistry. CBCT data were entered in NNT Viewer Version 2.21. The Martins classification system was used to identify and classify the C-shaped canals.

Results

The C-shaped canal was found in 1.5% and 2.7% of maxillary first and second molars, respectively. Also, the prevalence of C-shaped canals was higher on the left side of the maxilla than on the right side without significant sex predilection.

Conclusion

The prevalence of C-shaped canals in the maxillary first and second molars in an Iranian population was 1.5% and 2.7%, respectively.