International Journal of Clinical Practice最新文献

Objectives. This study aimed to use laboratory and clinical data of systemic lupus erythematosus (SLE) patients to construct prediction models for fundus complications in SLE. Methods. Routine blood test data and clinical information of 277 SLE patients were collected retrospectively. Based on their fundus examination, they were divided into two groups, with or without fundus lesions, defined as retinopathy and choroidopathy in this study. The data of the two groups were compared, and the prediction model was established using binary logistic regression analysis. Results. There were 85 patients in the fundus lesions’ group and 192 patients in the control group. Between the two groups, age, SLEDAI, serositis, hypertension, diabetes, anticardiolipin antibody (ACA), anti-Sm antibody, C-reactive protein (CRP), hemoglobin (Hb), platelet count (PLT), albumin (Alb), serum creatinine(Scr), urea, uric acid(UA), and immunoglobulin G(IgG) were significantly different (p < 0.05). Besides, age, SLEDAI, serositis, hypertension, diabetes, anti-SSB, CRP, Hb, PLT, FIB, Alb, Scr, urea, UA, GLU, and IgG were significantly correlated with SLE-related fundus lesions. PLT, fibrinogen (FIB), IgG, and urea were independent risk factors of SLE-related fundus lesions. The area under the curve (AUC) was 0.830 (p < 0.001; 95% CI = 0.762–0.898), and the nomogram was established with great evaluation efficiency demonstrated by the calibration curve and the Hosmer–Lemeshow test. The result of k-fold cross-validation also showed high prediction accuracy. Conclusions. We have found the independent risk factors of SLE-related fundus lesions and developed a model to improve the prediction of fundus lesions in SLE.

Introduction. Globally, hospitals are an important place in end-of-life care and most frequent place of death in Germany (47%), but at the same time, the least preferred one—both for patients and their informal caregivers. As hospital care in the dying phase on non-palliative care wards has rarely been studied systematically, we assessed the current state of care in the dying phase in hospitals as a first step. Methods. In an online survey, N = 165 national health experts were invited to answer eight open questions on care aspects, facilitators, barriers, and needs for improvement as well as COVID-19 pandemic specifics regarding hospital care in the dying phase. Sociodemographic data were analysed descriptively, and responses were analysed using qualitative thematic analysis. Results. Of n = 65 experts, 52% work as nursing staff and 30% as physicians. We identified facilitators, barriers, and needs for improvement regarding 11 topics on the following three levels: institutional level (general institutional conditions, hospital culture, and integration of specialist palliative care), team level (attitude towards and dealing with death and dying, competencies, communication, and teamwork) and care level (dying phase, symptom control, patient centredness, and involvement of informal caregivers). Conclusion. Improving care in the dying phase has to overcome barriers on various levels. We assume that rather “small” measures will find their way into clinical routine and contribute to the improvement of hospital care in the dying phase.

Most elderly persons suffer from chronic diseases. To treat chronic diseases, good medication adherence and refilling medication as physicians’ advice are key points of pharmaceutical therapy. However, the literature revealed that only limited studies have focused on the medication adherence of the elderly in rural communities. This study evaluated the adherence to medication and the degree of refilling prescriptions as physician’s advice by the Adherence to Refills and Medications Scale (ARMS) and evaluated the factors associated with poor adherence to medication. This cross-sectional study focused on the medication use of the elderly population in rural areas in western Taiwan and analyzed related personal and social factors which influence the behaviors of pharmaceutical therapy. In conclusion, most of the elderly who lived in rural areas in western Taiwan have poor adherence (ARMS score over 12) to medication and a poor degree of refilling prescriptions as per physicians’ advice. Moreover, age ≥75 years and low urbanization were significantly associated with poor adherence. Future research is warranted to assess the effect of the interventions to improve medication adherence on chronic disease control, disability, and mortality.

Background. Delayed cord clamping (DCC) for more than one minute is associated with nutritional and developmental benefits for newborns. However, there is limited evidence regarding the relationship between DCC and outcomes in resource-limited settings. This study aims to assess the effect of the time of cord clamping on serum bilirubin level 24 hours after birth in an Ethiopian Tertiary Care hospital. Methods. A three-arm, single-blind, exploratory randomized controlled trial was conducted between October 2019 and January 2020 targeting healthy, full-term neonates. Study participants were randomly assigned into one of the following intervention groups depending on the timing of cord clamping: immediate cord clamping (<30 seconds), intermediate cord clamping (60 seconds), and DCC (180 seconds). The primary outcome is serum bilirubin level in the newborns, which was assessed 24 hours after birth and before they were discharged home. Descriptive analysis was applied to assess differences between groups in terms of demographic, obstetric, and social characteristics of the participants, while a linear regression model was employed to examine the association between cord clamping time and serum bilirubin level. Result. A total of 141 term newborns were included and randomized into the three categories. The demographic, social, and obstetrics characteristics of included participants were not different across groups except for the labor duration (P value <0.05). While the time of cord clamping was not a significant predictor of total serum bilirubin levels at 24 hours postbirth, cord blood total serum bilirubin (coefficient: 0.24; p < 0.05) and bilirubin nomogram high-risk zone (coefficient: 6.25; p < 0.001) were found to be significant predictors. (4) Conclusion. Our findings indicate that the time of umbilical cord clamping does not affect the total serum bilirubin level of neonates at least within 24 hours of birth.

Background. Long noncoding RNAs (lncRNAs) often facilitate cellular communication via exosomes. However, their specific roles in head and neck squamous cell carcinoma (HNSCC) are not well understood. Methods. We extracted data on exosome-related lncRNAs from exoRBase and collected transcriptional profiles and clinical details for HNSCC from the TCGA database. Data preprocessing and analyses incorporated Tumor Mutation Burden and Microsatellite Instability from Researcher’s Home and drug sensitivity information from Genomics of Drug Sensitivity in Cancer database. We developed a prognostic model using Cox regression and LASSO regression analysis, with subsequent multivariate analysis to identify significant prognostic indicators. We also constructed a nomogram to evaluate the model’s clinical relevance, performed Gene Set Enrichment Analysis (GSEA), and analyzed the immune microenvironment and therapy sensitivity using CIBERSORT and TIDE algorithms. Supporting in vitro experiments and statistical analyses were conducted. Results. Our comprehensive investigation revealed 17 exosome-associated lncRNAs critical for patient survival in HNSCC. This enabled the development of a prognostic model that effectively stratifies patients into high-risk and low-risk categories. These lncRNAs correlate with patient demographics and clinical characteristics such as age, gender, and tumor stage. GSEA highlighted significant gene expression differences between the risk groups, particularly in pathways related to muscle formation, cellular transition, and immune response. The analysis of the immune microenvironment showed distinct immune cell infiltration patterns in high-risk patients, indicative of compromised immune defenses. In addition, we explored the expression of critical immune checkpoints and their impact on immunotherapy efficacy, demonstrating that risk scores may predict treatment responses. Notably, LINC01564 was overexpressed in HNSCC, associated with poorer prognosis, enhanced xenobiotic metabolism, and altered immune cell infiltration. Experimental validation confirmed LINC01564’s role in promoting tumor cell proliferation, invasion, and migration, highlighting its therapeutic potential. Conclusions. Our study highlights the importance of exosome-associated lncRNAs in HNSCC, identifying 17 critical lncRNAs as vital prognostic markers. The upregulation of LINC01564, associated with poor outcomes and increased tumor aggressiveness, underscores its potential as a therapeutic target.

Diabetes nephropathy (DN) is increasingly recognized as a critical complication in individuals with diabetes and a significant contributor to end-stage renal disease (ESRD). Bailing capsules, which contain fermented cordyceps mycelium, are commonly utilized in treating various kidney disorders, including DN in clinical practice. This review aims to comprehensively detail the pharmacologically active components of Bailing, its mechanisms of action, and its clinical usage. By employing network pharmacology, we delve into the possible pathways Bailing impacts DN treatment. Current studies suggest that Bailing’s efficacy in DN primarily involves mechanisms related to lipid and atherosclerosis, cancer pathways, and small-cell lung cancer. Key active ingredients in Bailing that contribute to its therapeutic effects include arachidonic acid, linalyl acetate, β-sitosterol, and CLR. Furthermore, for literature selection in this review, we integrated GPT-4 with bias analysis coprocessing. This evaluation provides a foundational understanding and direction for future research into the use of Bailing as a novel treatment for DN.

Background. An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic occurred throughout China from December 2022 to January 2023, and the vast majority of those infected individuals were mild. The symptom characteristics of mildly infected individuals in this epidemic wave of the Omicron variant have not been well described. Methods. We conducted a nationwide survey of symptomatic characteristics of nonhospitalized individuals with mild Omicron infection through a WeChat app. Results. Respondents (68.6% female) were aged 18–87 years (42.6 ± 13.1 years), of whom 79.8% were diagnosed by SARS-CoV-2 PCR or antigen test. Of the 19 symptoms predefined in the questionnaire, an average of 7.8 symptoms was reported. The most common symptoms included cough (81.2%), fever (79.9%), fatigue (73.8%), muscle soreness (62.2%), headache (59.2%), and phlegm (55.1%). Painful swallowing was present in 38.3% of the participants and was one of the most severe symptoms perceived by the participants. Also, we found that young people were more likely to have symptoms such as fever, painful swallowing, and headache compared to the elderly population. 36.9% of respondents graded their symptoms as severe, and the severity of symptoms was higher in young people than in older adults, with fever, cough, painful swallowing, fatigue, and headache being the most severe. In addition, women experienced a significantly higher prevalence of symptoms than men, but there was no significant difference in the severity of most symptoms. The presence of comorbidities did not increase the incidence or severity of symptoms in those with mildly infected individuals. Conclusions. The symptom profile of mild COVID-19 cases in the nationwide Omicron wave in China was markedly different from previous reports, featuring a high incidence of symptoms, multiple symptoms, and heavy symptoms. The symptoms of mild Omicron infection cases are not mild and are more pronounced in young people.

Background. Globally, imprudent consumption practices contribute to the widespread threat of antimicrobial resistance (AMR). Standardized monitoring of antibiotic use is essential to combat AMR, yet few studies in sub-Saharan Africa, including Ethiopia, have utilized the World Health Organization (WHO) point-prevalence survey (PPS) methodology to examine antimicrobial use. Our setting lacks sufficient national data on this issue. This study aimed to examine the prevalence of antimicrobial use, common antimicrobial drug types, and indications for antimicrobial use in a major public hospital. Methodology. A cross-sectional PPS study design conducted in a hospital setting was utilized to explore the usage of antimicrobials in the adult wards of Felege Hiwot Comprehensive Specialized Hospital (FHCSH), employing the WHO-PPS methodology. The research was carried out between December 24th and 26th, 2022. All patients present in a hospital ward at 8 : 00 am on the designated survey day were included. Data were gathered through a combination of reviewing patients′ medical records and conducting interviews with the attending physicians. Results. A total of 410 hospitalized patients were surveyed, out of which 258 (62.9%) patients were treated with at least one antimicrobial on the date of PPS. All antimicrobials were prescribed empirically. The most common indication for the therapeutic use of antimicrobials was community-acquired infections (166, 64.3%). The top three wards with a large number of antimicrobial prescriptions were the surgical (158, 42.5%), medical (144, 38.7%), and gynecology (55, 14.8%) wards. Ceftriaxone was the most frequently used antibiotic (35%) in all the wards. The mean number of antimicrobials prescribed to the patient was 1.44. Of the prescribed 372 antimicrobials, 60.1% belonged to the WHO watch group. Conclusion. Our findings indicate that a significant number of patients received at least one antimicrobial during the point-prevalence survey (PPS). Empirical prescriptions for community-acquired infections were prevalent. These results underscore the need for robust antimicrobial stewardship programs in Ethiopian hospitals.

Oleuropein is the main compound in olives, producing a relatively bitter taste for unprocessed and raw olives. It has been dramatically applied in herbal and traditional medicine and contains several biological functions, anti-inflammatory effects, antimicrobial characteristics, and anticancer and antioxidant activities. The present study dealt with the cytotoxic effect, reactive oxygen species (ROS) suppressor, and wound-healing activity of oleuropein on normal skin cells. Oleuropein’s cytotoxic and apoptotic effects were evaluated using MTT, flow cytometry, and DAPI staining. Moreover, oleuropein’s possible free radical scavenging properties were studied through several methods, including the 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and ABTS tests. The scratch assay was performed for wound-healing features, and qRT-PCR evaluated the expression of apoptosis-associated genes. Oleuropein was found to have a cytotoxic effect on skin cells at higher exposure doses. Apoptosis was induced in the flow cytometry histogram of the cells treated with oleuropein. The results also revealed the strong anti-inflammation and antioxidant effect of oleuropein. They suggested that more studies are necessary to assess the possible pharmacological use of oleuropein to prevent or decrease skin-related diseases.