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Are We Aware of Hepatitis C Infection? HCV Results from the Tertiary Reference Center in the Aegean Region from Turkey 我们了解丙型肝炎感染吗?土耳其爱琴海地区三级参考资料中心的丙型肝炎病毒检测结果
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-13 DOI: 10.1155/2024/8857910
Gözde Derviş Hakim, Pınar Şamlıoglu, Murat Aysin, Taner Kara, Şükran Köse

Background. With the advent of direct-acting antiviral agents, the rate of sustained virological response in the treatment of hepatitis C virus (HCV) infection has reached 100%. However, it has been observed that many patients still do not have access to treatment. Aim. The aim of this study was to identify patients who are anti-HCV and HCV-RNA-positive, to reveal undiagnosed cases, and thus to reveal the necessity of increasing HCV follow-up tests and diagnosis. Methods. The microbiology database of Tepecik Research and Training Hospital was examined for patients who were tested for anti-HCV and HCV-RNA from January 2013 to January 2023. Patients were indexed based on their entry date, and duplicate values were manually removed. The data were then grouped according to the clinics that requested the analysis. Results. Between 2013 and 2023, a total of 334,537 anti-HCV tests were conducted without duplications. The annual average number of tests was 33,454 ± 10,027. During the ten-year period under review, the total number of patients with a positive result for the anti-HCV test was 3,943. The positivity rate among all anti-HCV tests was 1.18%. The annual average number of positive test results was 394 ± 54. Between 2013 and 2022, out of the 3,943 patients who tested positive for anti-HCV, HCV-RNA analysis was conducted on 2,500 of them (63.4%). Among the 2,500 patients who underwent HCV-RNA analysis, 682 were found to be HCV-RNA-positive (27.4%), while 1,818 were HCV-RNA-negative (72.6%). In the ten-year period, when the distribution of the 334,537 anti-HCV tests according to internal and surgical branches was evaluated, it was found that 157,680 tests (47.1%) were requested from internal branches, while 176,857 tests (52.9%) were requested from surgical branches. Of the 2,500 patients who tested positive for anti-HCV and underwent HCV-RNA analysis, 2,273 (90.9%) were requested by internal branches, while surgical branches requested 227 tests (9.1%). Among the 1,443 patients who tested positive for anti-HCV but did not have HCV-RNA tests ordered, 788 (54.6%) were evaluated in internal branches, and 655 (45.4%) were evaluated in surgical branches. Conclusion. In this study, it was observed that multiple anti-HCV tests were requested for the same individual, and HCV-RNA tests were not ordered for those testing positive for anti-HCV. Moreover, patients were not referred to the infection or gastroenterology clinics for HCV-RNA testing. Consequently, it was concluded that sufficient and necessary tests for diagnosis were not conducted, leading to the inability to access treatment. To achieve the World Health Organization’s goals for HCV eradication, it is imperative to increase the rates of HCV-RNA testing, enhance the utilization of reflex testing, and ensure proper referral to the necessary clinics.

背景。随着直接作用抗病毒药物的出现,治疗丙型肝炎病毒(HCV)感染的持续病毒学应答率已达到 100%。然而,据观察,许多患者仍无法获得治疗。研究目的本研究旨在确定抗-HCV 和 HCV-RNA 阳性的患者,揭示未确诊病例,从而揭示增加 HCV 跟踪检测和诊断的必要性。研究方法对特佩契克研究与培训医院微生物数据库中 2013 年 1 月至 2023 年 1 月期间接受抗-HCV 和 HCV-RNA 检测的患者进行研究。根据患者的输入日期对其进行索引,并人工去除重复值。然后根据要求进行分析的诊所对数据进行分组。分析结果在 2013 年至 2023 年期间,共进行了 334,537 次抗 HCV 检测,无重复检测。年平均检测次数为 33,454 ± 10,027 次。在这十年间,抗-HCV 检测结果呈阳性的患者总数为 3943 人。在所有抗-HCV 检测中,阳性率为 1.18%。检测结果呈阳性的年平均人数为 394 ± 54。2013 年至 2022 年间,在抗-HCV 检测呈阳性的 3943 名患者中,有 2500 人(63.4%)进行了 HCV-RNA 分析。在接受 HCV-RNA 分析的 2 500 名患者中,发现 682 人(27.4%)HCV-RNA 阳性,1 818 人(72.6%)HCV-RNA 阴性。在这十年中,根据内科和外科分支机构对 334,537 次抗 HCV 检测的分布情况进行评估后发现,157,680 次检测(47.1%)来自内科分支机构,而 176,857 次检测(52.9%)来自外科分支机构。在抗-HCV 检测呈阳性并接受 HCV-RNA 分析的 2,500 例患者中,2,273 例(90.9%)由内科分院申请,而外科分院申请了 227 例(9.1%)。在抗-HCV 检测呈阳性但未进行 HCV-RNA 检测的 1,443 名患者中,有 788 人(54.6%)在内科进行了评估,655 人(45.4%)在外科进行了评估。结论本研究发现,同一患者需要进行多次抗-HCV 检测,而对于抗-HCV 检测呈阳性的患者,并未要求进行 HCV-RNA 检测。此外,患者并未被转诊至感染科或消化科诊所进行 HCV-RNA 检测。因此,得出的结论是,没有进行充分和必要的诊断检测,导致患者无法获得治疗。为了实现世界卫生组织根除 HCV 的目标,当务之急是提高 HCV-RNA 检测率,加强反射检测的利用率,并确保适当转诊到必要的诊所。
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引用次数: 0
Construction and Evaluation of a Predictive Model for Liver Injury Associated with Heatstroke: A Multicenter Retrospective Study 构建和评估与中暑相关的肝损伤预测模型:一项多中心回顾性研究
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-09 DOI: 10.1155/2024/6485323
Hongguang Gao, Guo Tang, Sha Yang, Ying Yang, Jie Sheng, Rong Yao

Background. Liver injury related to heatstroke plays a pivotal role in secondary multiorgan damage and is a direct cause of mortality in affected patients of heatstroke. This study was designed to identify independent risk factors associated with liver injury in heatstroke and to construct a clinically applicable predictive model. Methods. We conducted a retrospective analysis of 188 patients diagnosed with heatstroke, treated in the emergency departments of eight medical institutions from July 1, 2022, to September 30, 2023. Patients were categorized into a liver injury group (n = 80) and a nonliver injury group (n = 108), based on liver function indices recorded during hospitalization. Lasso regression was employed for variable refinement, while multifactorial logistic regression was utilized to identify independent risk factors for liver injury in heatstroke and to construct a nomogram model. The model’s efficacy was evaluated using the C-index, calibration curves, and decision curve analysis, examining its discriminative ability, calibration, and clinical utility. Results. The nomogram included predictive factors such as the Glasgow score, absolute lymphocyte count, lactate dehydrogenase levels, and creatine kinase isoenzyme. The model showed high accuracy and discriminative capability. The C-index was 0.852 (95% CI 0.80–0.905) with a calibration index of 0.843. Decision curve analysis revealed significant clinical applicability for this nomogram. Conclusion. The study identified four key independent risk factors for liver injury in heatstroke patients. The constructed nomogram, based on the four clinical indicators, demonstrated robust predictive accuracy, discriminative power, and clinical relevance.

背景。与中暑有关的肝损伤在继发性多器官损伤中起着关键作用,是中暑患者死亡的直接原因。本研究旨在确定与中暑肝损伤相关的独立风险因素,并构建一个适用于临床的预测模型。研究方法我们对2022年7月1日至2023年9月30日期间在8家医疗机构急诊科接受治疗的188名确诊为中暑的患者进行了回顾性分析。根据住院期间记录的肝功能指数,将患者分为肝损伤组(80 人)和非肝损伤组(108 人)。采用拉索回归对变量进行细化,同时利用多因素逻辑回归确定中暑肝损伤的独立风险因素,并构建一个提名图模型。利用 C 指数、校准曲线和决策曲线分析对模型的有效性进行了评估,考察了其鉴别能力、校准和临床实用性。结果。提名图包括格拉斯哥评分、绝对淋巴细胞计数、乳酸脱氢酶水平和肌酸激酶同工酶等预测因素。该模型显示出较高的准确性和判别能力。C指数为0.852(95% CI 0.80-0.905),校准指数为0.843。决策曲线分析表明,该提名图具有显著的临床适用性。结论该研究确定了中暑患者肝损伤的四个关键独立风险因素。根据这四个临床指标构建的提名图显示了强大的预测准确性、鉴别力和临床相关性。
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引用次数: 0
Quantitative Anatomical Study of the Supratentorial and Infratentorial “Endoscopic Keyhole” Approach to the Peripineal Region 会阴部上腔和下腔 "内窥镜锁孔 "入路的定量解剖学研究
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-31 DOI: 10.1155/2024/6851468
Hao Wu, Aierpati Maimaiti, Qiang Xie, Yirizhati Aili, Mamutijiang Muertizha, Guohua Zhu, Maimaitili Mijiti, Yandong Li, Yongxin Wang

Background. The pineal region represents significant challenges in terms of neurosurgery. Currently, anatomical research that simulates surgery for the endoscopic keyhole approach to the pineal region is lacking. This study aims to summarize the exposure range and operational characteristics of total endoscopic surgery under the four supratentorial and infratentorial keyhole approaches, through rigorous quantitative anatomical research. We also aim to understand the surgical exposure characteristics and surgical feasibility under each approach. Method. Six wet cadaveric head specimens (a total of 12 sides) were subjected to simulated surgery with a keyhole bone window size of approximately 3 × 4 cm. The median endoscopic supracerebellar infratentorial approach (M-ESCITA), the paramedian endoscopic supracerebellar infratentorial approach (PM-ESCITA), the endoscopic occipital transtentorial approach (EOTA), and the endoscopic interhemispheric high occipital transtentorial approach (EHOTA) were used to measure the surgical path depth, maximum distance between the tentorial margins, maximum operable area, operable angle, and relative degree of freedom of each approach. Results. There was no difference in the exposure range of the surgical area. The surgical path of PM-ESCITA was the longest (p < 0.001), and its horizontal operating angle was the largest (p < 0.001), whereas the anteroposterior operating angle of EHOTA was the largest (p < 0.001). The maximum operational area of M-ESCITA was the largest in the pineal region (p < 0.01), whereas that of EHOTA was the largest in the tetrapod region (p < 0.001). M-ESCITA had the highest relative degree of freedom during surgery at the pineal gland level (p < 0.001), PM-ESCITA at the splenium of the corpus callosum (p < 0.01), and EHOTA at the corpora quadrigemina (p < 0.001). Conclusions. Each of the four endoscopic keyhole approaches has its own advantages. Through anatomical research, doctors can train themselves and master the differences in surgical procedures through different approaches. The choice of approach and surgical challenge are dependent on the microsurgical techniques employed by the surgeon. A balance between minimally invasive and safe endoscopic surgery should be pursued.

背景。松果体区域是神经外科的重大挑战。目前,还缺乏模拟松果体区域内窥镜锁孔入路手术的解剖学研究。本研究旨在通过严格的定量解剖学研究,总结四种松果体上和松果体下锁孔方法下全内窥镜手术的暴露范围和操作特点。我们还旨在了解每种方法的手术暴露特点和手术可行性。方法。对六具湿尸头部标本(共 12 侧)进行模拟手术,锁孔骨窗大小约为 3 × 4 厘米。采用中位内镜小脑上皮层下入路(M-ESCITA)、副中位内镜小脑上皮层下入路(PM-ESCITA)、内镜枕骨横切入路(EOTA)和内镜半球间高位枕骨横切入路(EHOTA),测量每种入路的手术路径深度、触角边缘之间的最大距离、最大可操作面积、可操作角度和相对自由度。结果手术区域的暴露范围没有差异。PM-ESCITA 的手术路径最长(p <0.001),水平手术角度最大(p <0.001),而 EHOTA 的前后手术角度最大(p <0.001)。在松果体区域,M-ESCITA 的最大工作面积最大(p <0.01),而在四足动物区域,EHOTA 的最大工作面积最大(p <0.001)。在松果体水平,M-ESCITA 在手术中的相对自由度最高(p < 0.001),PM-ESCITA 在胼胝体脾水平(p < 0.01),而 EHOTA 在四肢骨水平(p < 0.001)。结论。四种内窥镜锁孔方法各有优势。通过解剖学研究,医生可以锻炼自己,掌握不同方法在手术过程中的差异。方法的选择和手术挑战取决于外科医生采用的显微外科技术。应在微创和安全的内窥镜手术之间寻求平衡。
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引用次数: 0
Comorbidity Profiles in Inflammatory Rheumatic Diseases: An Analytical Perspective 炎症性风湿病的共病特征:分析视角
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-27 DOI: 10.1155/2024/3244597
Rezan Koçak Ulucaköy, Hakan Babaoğlu, Esra Kayacan Erdoğan, Kevser Orhan, Ebru Atalar, Serdar Can Güven, Hatice Ecem Konak, Bahar Özdemir Ulusoy, Pınar Akyüz Dağlı, Özlem Karakaş, Hakan Apaydın, Mehmet Akif Eksin, Bünyamin Polat, Serdar Esmer, İsmail Dogan, Yüksel Maraş, Ahmet Omma, Orhan Küçükşahin, Şükran Erten, Berkan Armağan

Background. Inflammatory rheumatic diseases (IRDs) are often associated with multiple comorbidities. Managing comorbidities now seen as important as management of primary IRDs. The aim of this study was to analyse the profiles and prevalence of comorbidities in patients with IRDs and also to highlight the critical need for comprehensive and routine screening for comorbidities. Methods. This study was a retrospective single-center study conducted between 2019 and 2023. IRDs were classified according to the following categories: rheumatoid arthritis, spondyloarthritis, connective tissue diseases, autoinflammatory diseases, Behçet’s disease, large vessel vasculitis (LVV), small vessel vasculitis (SVV), and crystal deposition diseases (CDD). The demographic characteristics and comorbidities (including hypertension, diabetes mellitus, hyperlipidemia, obesity, coronary artery disease, arrhythmia, heart failure, chronic kidney disease, asthma, osteoporosis, thyroid diseases, demyelinating diseases, depression, and malignancies) were obtained from the electronic patient files. Results. The study included 10 417 patients with IRDs (mean age 50.9 ± 14.5 years; 66.8% female). The five most prevalent comorbidities were hypertension (34.8%), obesity (29.1%), diabetes mellitus (14.1%), hyperlipidemia (12.1%), and osteoporosis (9.2%). The Poisson regression analysis demonstrated a significant association between the total number of comorbidities and CDD, LVV, and SVV. The most prevalent comorbidities were cardiovascular risk factors. Furthermore, the prevalence of osteoporosis was high in LVV, and the prevalence of chronic kidney disease and asthma was high in SVV. Conclusion. Our study not only presents observational data but also highlights the critical need for comprehensive and routine screening for comorbidities in patients with rheumatic diseases. We found that CDD followed by LVV and SVV were identified as the rheumatic conditions most associated with comorbidities, and these diseases are most commonly accompanied by cardiovascular risk factors. Additionally, our findings suggest that patients with rheumatological conditions may be underscreened, leading to potential underdiagnosis of comorbidities such as hyperlipidemia, osteoporosis, and possibly malignancies.

背景。炎症性风湿病(IRD)通常伴有多种并发症。目前,治疗合并症与治疗原发性 IRD 同等重要。本研究旨在分析 IRD 患者合并症的概况和患病率,同时强调对合并症进行全面常规筛查的迫切需要。研究方法本研究是一项回顾性单中心研究,在 2019 年至 2023 年期间进行。IRD按以下类别分类:类风湿性关节炎、脊柱关节炎、结缔组织病、自身炎症性疾病、白塞氏病、大血管炎(LVV)、小血管炎(SVV)和晶体沉积病(CDD)。人口统计学特征和合并症(包括高血压、糖尿病、高脂血症、肥胖、冠心病、心律失常、心力衰竭、慢性肾病、哮喘、骨质疏松症、甲状腺疾病、脱髓鞘疾病、抑郁症和恶性肿瘤)均来自患者电子档案。研究结果研究共纳入 10 417 名 IRD 患者(平均年龄为 50.9 ± 14.5 岁;66.8% 为女性)。最常见的五种合并症是高血压(34.8%)、肥胖(29.1%)、糖尿病(14.1%)、高脂血症(12.1%)和骨质疏松症(9.2%)。泊松回归分析表明,合并症总数与 CDD、LVV 和 SVV 之间存在显著关联。最常见的合并症是心血管风险因素。此外,骨质疏松症的患病率在 LVV 中较高,慢性肾病和哮喘的患病率在 SVV 中较高。结论我们的研究不仅提供了观察数据,还强调了对风湿性疾病患者进行全面和常规合并症筛查的迫切需要。我们发现,CDD、LVV 和 SVV 是与合并症关系最密切的风湿病,而这些疾病最常伴有心血管风险因素。此外,我们的研究结果表明,风湿病患者可能筛查不足,导致高脂血症、骨质疏松症等合并症以及可能的恶性肿瘤可能被漏诊。
{"title":"Comorbidity Profiles in Inflammatory Rheumatic Diseases: An Analytical Perspective","authors":"Rezan Koçak Ulucaköy,&nbsp;Hakan Babaoğlu,&nbsp;Esra Kayacan Erdoğan,&nbsp;Kevser Orhan,&nbsp;Ebru Atalar,&nbsp;Serdar Can Güven,&nbsp;Hatice Ecem Konak,&nbsp;Bahar Özdemir Ulusoy,&nbsp;Pınar Akyüz Dağlı,&nbsp;Özlem Karakaş,&nbsp;Hakan Apaydın,&nbsp;Mehmet Akif Eksin,&nbsp;Bünyamin Polat,&nbsp;Serdar Esmer,&nbsp;İsmail Dogan,&nbsp;Yüksel Maraş,&nbsp;Ahmet Omma,&nbsp;Orhan Küçükşahin,&nbsp;Şükran Erten,&nbsp;Berkan Armağan","doi":"10.1155/2024/3244597","DOIUrl":"https://doi.org/10.1155/2024/3244597","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Inflammatory rheumatic diseases (IRDs) are often associated with multiple comorbidities. Managing comorbidities now seen as important as management of primary IRDs. The aim of this study was to analyse the profiles and prevalence of comorbidities in patients with IRDs and also to highlight the critical need for comprehensive and routine screening for comorbidities. <i>Methods</i>. This study was a retrospective single-center study conducted between 2019 and 2023. IRDs were classified according to the following categories: rheumatoid arthritis, spondyloarthritis, connective tissue diseases, autoinflammatory diseases, Behçet’s disease, large vessel vasculitis (LVV), small vessel vasculitis (SVV), and crystal deposition diseases (CDD). The demographic characteristics and comorbidities (including hypertension, diabetes mellitus, hyperlipidemia, obesity, coronary artery disease, arrhythmia, heart failure, chronic kidney disease, asthma, osteoporosis, thyroid diseases, demyelinating diseases, depression, and malignancies) were obtained from the electronic patient files. <i>Results</i>. The study included 10 417 patients with IRDs (mean age 50.9 ± 14.5 years; 66.8% female). The five most prevalent comorbidities were hypertension (34.8%), obesity (29.1%), diabetes mellitus (14.1%), hyperlipidemia (12.1%), and osteoporosis (9.2%). The Poisson regression analysis demonstrated a significant association between the total number of comorbidities and CDD, LVV, and SVV. The most prevalent comorbidities were cardiovascular risk factors. Furthermore, the prevalence of osteoporosis was high in LVV, and the prevalence of chronic kidney disease and asthma was high in SVV. <i>Conclusion</i>. Our study not only presents observational data but also highlights the critical need for comprehensive and routine screening for comorbidities in patients with rheumatic diseases. We found that CDD followed by LVV and SVV were identified as the rheumatic conditions most associated with comorbidities, and these diseases are most commonly accompanied by cardiovascular risk factors. Additionally, our findings suggest that patients with rheumatological conditions may be underscreened, leading to potential underdiagnosis of comorbidities such as hyperlipidemia, osteoporosis, and possibly malignancies.</p>\u0000 </div>","PeriodicalId":13782,"journal":{"name":"International Journal of Clinical Practice","volume":"2024 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3244597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141968199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dietary Networks Identified by Gaussian Graphical Model and Odds of Major Depressive Disorder: A Case-Control Study 高斯图形模型识别的膳食网络与重度抑郁障碍的几率:病例对照研究
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-26 DOI: 10.1155/2024/8749041
Hossein Shahinfar, Sakineh Shab-Bidar, Mohammad Effatpanah, Reza Askari, Shima Jazayeri

Background. The Gaussian graphical model (GGM) is a new approach that has recently gained attention for identifying dietary patterns. It examines the connections between different food groups and how they are consumed together. The aim of our study was to investigate the link between dietary networks derived from GGM and the odds of major depressive disorder (MDD). Methods. Two hundred drug-free patients with MDD and 200 healthy individuals were enrolled in this age- and sex-matched case-control study. The mean age of the participants was 45.4 years and 67.5% were female. The Beck Depression Inventory-II questionnaire was used for screening depression in the control group. Dietary intake was assessed using a 168-item food frequency questionnaire A GGM was applied to identify dietary networks. The GGM-derived networks were scored, categorized into tertiles, and their association with MDD was determined using a multivariable logistic regression model controlling for energy intake, marital status, job status, income, living status, education, drug use, smoking status, physical activity level, family history of major depressive disorders, comorbidities, and BMI. Results. GGM identified four dietary networks: healthy, prudent, western, and mixed. Nonleafy vegetables in healthy, grains in prudent, and red meat in western dietary networks were identified as hubs, indicating their important position in the identified network. High adherence to a healthy dietary network was associated with decreased odds of MDD (OR: 0.54, 95% CI: 0.31, 0.92; p value = 0.02), whereas, participants at the highest tertile of the western dietary network had greater odds of MDD (OR: 1.80, 95% CI: 1.05, 3.08; p value = 0.03). Neither prudent nor mixed networks were associated with MDD. Conclusions. Healthy and western dietary networks were associated with lower and higher odds of MDD, respectively. Recommendations for reducing the odds of MDD can be focused on increasing nonleafy vegetables and decreasing red meat consumption.

背景。高斯图形模型(GGM)是一种新方法,最近在确定膳食模式方面受到关注。它研究了不同食物组之间的联系以及它们是如何一起消费的。我们的研究旨在调查从高斯图模型中得出的膳食网络与重度抑郁障碍(MDD)发生几率之间的联系。研究方法这项年龄和性别匹配的病例对照研究招募了 200 名未服药的重度抑郁症患者和 200 名健康人。参与者的平均年龄为 45.4 岁,67.5% 为女性。对照组采用贝克抑郁量表-II问卷进行抑郁筛查。采用 168 项食物频率问卷对饮食摄入量进行评估。采用多变量逻辑回归模型对 GGM 衍生的膳食网络进行评分,并将其分为三等分,确定其与 MDD 的关系,该模型控制了能量摄入、婚姻状况、工作状况、收入、生活状况、教育程度、药物使用、吸烟状况、体力活动水平、重度抑郁症家族史、合并症和体重指数。研究结果GGM 确定了四种膳食网络:健康型、谨慎型、西方型和混合型。健康膳食网络中的非叶菜类蔬菜、谨慎膳食网络中的谷物和西方膳食网络中的红肉被确定为枢纽,表明它们在所确定的网络中处于重要位置。对健康膳食网络的高度坚持与 MDD 发生几率的降低有关(OR:0.54,95% CI:0.31,0.92;P 值 = 0.02),而处于西方膳食网络最高层的参与者发生 MDD 的几率更高(OR:1.80,95% CI:1.05,3.08;P 值 = 0.03)。谨慎饮食网络和混合饮食网络均与 MDD 无关。结论健康饮食网络和西方饮食网络分别与较低和较高的 MDD 发生几率有关。降低多发性硬化症几率的建议可侧重于增加非叶菜类蔬菜的摄入量和减少红肉的摄入量。
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引用次数: 0
Review of the Impact and Burden of Urinary Urgency on Adults with Overactive Bladder 尿急对膀胱过度活跃成人的影响和负担回顾
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-25 DOI: 10.1155/2024/5112405
Adrian Wagg, A. Lenore Ackerman, H. Henry Lai, Diane K. Newman

Overactive bladder (OAB) is a prevalent condition that impairs the quality of life in both men and women, and for many, urgency is the most bothersome symptom. Urgency is thought to drive the presentation of the other symptoms (frequency, nocturia, urgency urinary incontinence [UUI]). However, urgency has been understudied in clinical trials, potentially owing to inherent difficulties in its assessment. The definition of urgency related to OAB has been refined over the years, but it may not be easily understood by patients and clinicians, affecting its use in practice. Variability among the tools to measure urgency further complicates the matter. For example, some measure the frequency of urgency episodes and consider reduction of episode frequency as improvement in urgency severity. Others rate the severity of each episode of urgency along a scale, with some including an accompanying incontinence episode as the most severe form. Reduction in UUI episodes is often a primary endpoint in clinical studies, with many studies requiring UUI—sometimes called OAB-wet—as an inclusion criterion, yet approximately two-thirds of those with OAB do not experience UUI. If patients with OAB without UUI (i.e., OAB-dry) are included, they are often not analyzed separately. Thus, it remains unknown if there are differences in treatment outcomes between patients with and without UUI and whether these differences are driven by pathophysiological processes. This narrative review highlights what is known about the pathophysiology of urgency, how urgency affects individuals with OAB, urgency measurement and associated challenges, and assessment of urgency in clinical trials.

膀胱过度活动症(OAB)是一种影响男性和女性生活质量的常见疾病,对许多人来说,尿急是最令人烦恼的症状。尿急被认为是其他症状(尿频、夜尿、尿急尿失禁 [UUI])的诱因。然而,在临床试验中,尿急症状一直未得到充分研究,这可能是由于对其进行评估本身就存在困难。多年来,与 OAB 相关的尿急定义不断完善,但患者和临床医生可能不易理解,从而影响了其在实践中的应用。测量尿急程度的工具各不相同,使问题更加复杂。例如,有些工具测量尿急发作的频率,并将减少发作频率视为改善尿急严重程度。其他一些方法则根据量表对每次尿急发作的严重程度进行评分,其中一些方法将伴随的尿失禁发作作为最严重的形式。尿急发作次数的减少通常是临床研究的主要终点,许多研究都要求将尿急(有时称为 OAB-湿性)作为纳入标准,但约有三分之二的 OAB 患者不会出现尿急。如果纳入了没有 UUI 的 OAB 患者(即干性 OAB),通常也不会对他们进行单独分析。因此,有 UUI 和没有 UUI 的患者在治疗效果上是否存在差异,以及这些差异是否由病理生理过程驱动,目前仍是未知数。本叙述性综述重点介绍了有关急迫感病理生理学、急迫感如何影响 OAB 患者、急迫感测量和相关挑战以及临床试验中急迫感评估的已知知识。
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引用次数: 0
The Impact of Educational Interventions on Nurses’ Perceptions of Parental Support and Attitudes toward Parental Involvement in Neonatal Intensive Care Units 教育干预对新生儿重症监护病房护士对家长支持的看法和对家长参与的态度的影响
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-24 DOI: 10.1155/2024/4816161
Sawsan Abuhammad, Haneen Barakat, Amat-Alkhaleq Mehrass

Aim. To determine the efficacy of interventional programs on nurses’ perceptions of parents’ support and attitudes toward parents’ participation in neonatal care in the neonatal intensive care unit (NICU). Methods. An experimental design was used to determine the efficacy of the interventional program on NICU nurses’ perceptions of parents’ support and attitudes toward parents’ participation in their neonatal care in three hospitals. Nearly 160 nurses from hospitals in North and Middle Jordan participated in the study and were divided into 80 intervention and 80 control groups. Results. The study displayed that nurses had a lower score in the perception of parents’ support and attitude towards their participation in neonatal care in pretest scores than in posttest scores. The mean perception score of parents supported in the control group was 59.17 (SD = 10.1) and in the intervention group was 64.16 (SD = 7.47) (P ≤ 0.01). The mean attitude score of parents’ participation in neonatal care in the control group was 37.08 (SD = 5.76) and that in the intervention group was 38.93 (SD = 5.92) (P = 0.04). Conclusion. The results of the study showed a positive impact of the intervention on nurses’ perceptions of parental support and attitudes toward their participation in neonatal care. Moreover, the study found that the only predictor of NPST and PPAS enhancement among nurses was the implementation of an education program.

目的确定在新生儿重症监护室(NICU)中,干预计划对护士对家长支持的看法以及对家长参与新生儿护理的态度的影响。方法。在三家医院采用实验设计来确定干预项目对新生儿重症监护室护士对父母支持的看法以及对父母参与新生儿护理的态度的影响。来自约旦北部和中部医院的近 160 名护士参与了研究,并被分为 80 个干预组和 80 个对照组。结果显示研究显示,护士对家长参与新生儿护理的支持和态度的感知在前测得分中低于后测得分。对照组家长支持感的平均得分为 59.17(SD = 10.1),干预组为 64.16(SD = 7.47)(P ≤ 0.01)。对照组家长参与新生儿护理的态度平均得分为 37.08(SD = 5.76),干预组为 38.93(SD = 5.92)(P = 0.04)。结论研究结果表明,干预对护士对父母支持的看法以及对父母参与新生儿护理的态度产生了积极影响。此外,研究还发现,在护士中提高 NPST 和 PPAS 的唯一预测因素是教育计划的实施。
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引用次数: 0
Comparative Analysis of Pelvic Floor Muscle Damage Postpartum: Vaginal Delivery vs. Cesarean Section 产后盆底肌肉损伤的比较分析:阴道分娩与剖腹产
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-21 DOI: 10.1155/2024/1169924
Shaohui Chen, Ling Wang, Huitao Guo, Min Jiang, Xiaojun Wang

Background. Evaluation of pelvic floor muscle (PFM) strength damage across different delivery modes, providing insights into potential preventive measures for pelvic floor dysfunctions (PFDs) in the early postpartum period. Aim. Compare the differences in PFM strength and endurance between full-term cesarean section (CS) and vaginal delivery (VD) in the early postpartum period of primiparous women. Methods. The assessment included stress urinary incontinence (SUI), pelvic organ prolapse (POP), and pelvic floor electromyography (PFE). Muscle fiber strength was categorized into four modes at a threshold level of 3: I < 3 II < 3, I < 3 II > 3; I > 3 II < 3, I > 3 II > 3. Multinomial logistic regression was employed for CS and VD, and a sensitivity analysis was conducted using level 2 as the threshold. Outcomes. When muscle fiber strength was categorized into four modes at a threshold level of 3, Type I, and Type II fiber muscle endurance (FME) are differences between the CS and VD groups. Results. The CS and VD groups differed significantly in SUI and anterior and posterior vaginal wall conditions. MDVP was below the normal range in both groups, and MDVP, PFM strength, and PFM endurance did not differ significantly (P > 0.05). Logistic regression results indicated that higher MDVP, Type I, and Type II FME were protective factors when I < 3 in the VD group. However, I < 3-II > 3, higher MDVP, and Type I FME were protective factors (OR: 0.339, 95% CI: 0.223, 0.516) in the CS group. Clinical Implications. The study introduces a nuanced understanding of the impact of different delivery modes on PFM, contributing valuable insights for clinical prevention and treatment strategies in the early postpartum period. Strengths and Limitations. Muscle fiber strength was categorized into four modes and further sensitivity analysis was conducted. This study only conducted a correlation analysis of outcome variables without considering intervenable variables. Conclusions. The VD group had a higher incidence of pelvic floor dysfunction in the early postpartum period than the CS group. Both groups experienced a decline in PFM function without significant differences. CS was primarily associated with Type I muscle fiber damage, while VD was related to both Type I and II muscle fiber damage. Improving PFM endurance is beneficial for muscle strength recovery.

背景。评估不同分娩方式对盆底肌肉(PFM)力量的损伤,为产后早期盆底功能障碍(PFDs)的潜在预防措施提供洞察力。目的比较足月剖宫产(CS)和阴道分娩(VD)在初产妇产后早期盆底肌力量和耐力方面的差异。方法。评估包括压力性尿失禁(SUI)、盆腔器官脱垂(POP)和盆底肌电图(PFE)。肌肉纤维强度在阈值为 3 时分为四种模式:I < 3 II < 3, I < 3 II > 3; I > 3 II < 3, I > 3 II > 3。对 CS 和 VD 采用了多项式逻辑回归,并以 2 级为临界值进行了敏感性分析。结果。在阈值为 3 时,将肌纤维强度分为四种模式,I 型和 II 型纤维肌耐力(FME)在 CS 组和 VD 组之间存在差异。结果。CS 组和 VD 组在 SUI 和阴道前后壁条件方面差异显著。两组的 MDVP 均低于正常范围,MDVP、PFM 强度和 PFM 耐力无显著差异(P >0.05)。逻辑回归结果表明,当 VD 组的 I < 3 时,较高的 MDVP、I 型和 II 型 FME 是保护因素。然而,在 CS 组中,I < 3-II > 3、较高的 MDVP 和 I 型 FME 是保护因素(OR:0.339,95% CI:0.223,0.516)。临床意义。该研究让人们对不同分娩方式对 PFM 的影响有了细致入微的了解,为产后早期的临床预防和治疗策略提供了有价值的见解。优势和局限。肌肉纤维强度分为四种模式,并进行了进一步的敏感性分析。本研究仅对结果变量进行了相关性分析,未考虑可干预变量。结论VD组产后早期盆底功能障碍的发生率高于CS组。两组的盆底肌功能都有所下降,但无显著差异。CS 主要与 I 型肌纤维损伤有关,而 VD 则与 I 型和 II 型肌纤维损伤有关。提高 PFM 的耐力有利于肌肉力量的恢复。
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引用次数: 0
Efficacy of Experimental Propolis-Based Toothpastes on Dentin Hypersensitivity: A Randomized Clinical Trial 实验性蜂胶牙膏对牙本质过敏症的疗效:随机临床试验
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-17 DOI: 10.1155/2024/8563084
Elma Vieira Takeuchi, Alexandra Melo Pingarilho Carneiro, Brennda Lucy Freitas de Paula, Roberta Pimentel de Oliveira, Antônia Patricia Oliveira Barros, Cecy Martins Silva

Background. Propolis is a natural bee product that has garnered attention due to its harmlessness and numerous beneficial biological properties. This randomized, double-blinded, placebo-controlled clinical trial aimed to assess the effect of toothpastes containing different concentrations of propolis (10% and 15%) on the control of dentin hypersensitivity (DH). Methods. From adults aged 18–40 years with DH, 66 teeth were randomly divided into 3 treatment groups as follows (n = 22): control (toothpaste without active ingredient), 10% propolis toothpaste, and 15% propolis toothpaste. DH was assessed thrice (baseline and 15 and 30 days after treatment) by tactile and evaporative stimuli using the visual analog scale. Data were analyzed using Friedman and Kruskal–Wallis tests. A significance level of 5% was used in all analyses. Results. All the groups showed a reduction in DH during the study (p < 0.05). The experimental groups (10% and 15% propolis) showed significantly greater reduction in DH than the control group (p < 0.05) after 30 days of treatment; however, the experimental groups displayed similar results (p > 0.05). Conclusion. Toothpastes containing propolis at concentrations of 10% and 15% were equally effective in controlling DH, regardless of their concentration. Trial Registration. This trial is registered with NCT05083052. Date of registration: 19/10/2021.

背景。蜂胶是一种天然蜂产品,因其无毒无害和多种有益的生物特性而备受关注。这项随机、双盲、安慰剂对照临床试验旨在评估含有不同浓度蜂胶(10%和15%)的牙膏对控制牙本质过敏症(DH)的效果。试验方法从18-40岁患有牙本质过敏症的成年人中随机抽取66颗牙齿,分为以下3个治疗组(n = 22):对照组(不含活性成分的牙膏)、10%蜂胶牙膏和15%蜂胶牙膏。使用视觉模拟量表,通过触觉和蒸发刺激,对DH进行三次评估(基线、治疗后15天和30天)。数据采用弗里德曼检验和 Kruskal-Wallis 检验进行分析。所有分析的显著性水平均为 5%。结果在研究期间,所有组的 DH 都有所下降(p < 0.05)。治疗30天后,实验组(10%和15%蜂胶)的DH下降幅度明显高于对照组(p <0.05);然而,实验组显示出相似的结果(p >0.05)。结论含有10%和15%浓度蜂胶的牙膏对控制DH同样有效。试验注册。该试验已在 NCT05083052 上注册。注册日期:19/10/2021.
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引用次数: 0
Epidemiology of Polytrauma at a Teaching Hospital in Northern Ghana: A Cross-Sectional Study 加纳北部一家教学医院的多发性创伤流行病学:横断面研究
IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-16 DOI: 10.1155/2024/4131822
Anwar Sadat Seidu, Abdul Rauf Alhassan, Alexis Dun Bo-ib Buunaaim

Background. Polytrauma refers to multiple life-threatening injuries to more than 2 bodily regions with some significant physiologic derangement. It is a major cause of morbidity and mortality globally. This study aimed to evaluate the epidemiological profile of polytrauma and outline the distribution of extremity fractures among cases in Northern Ghana. Methods. A retrospective cross-sectional study was conducted at the Accident and Emergency Department of Tamale Teaching Hospital. Data were extracted using a data collection tool onto MS Excel, cleaned, and exported onto SPSS version 26 for analysis. Descriptive statistics was used to present data in tables and charts. Analysis of variance (ANOVA) was used to assess whether there was a significant difference in the mean ISS and mean length of stay of the direct causes of death. Results. About 186 out of 5413 attendants to the emergency department were polytrauma, period prevalence of 3.4%. The male-to-female ratio was 1.9 : 1. Young adults (21–40 years) contributed 64% of the participants. The mean age of participants was 32.9 ± 15.4 years, and the mean ISS was 40.6 ± 13.1. Road traffic accidents (68.8%) were the most common cause of polytrauma. The mortality was 33.0%. Traumatic brain injury (TBI) was the most common direct cause of mortality (54.1%). There was a significant mean difference (MD) in the length of stay between multiple organ failure (MOF) and TBI (MD = 3.169, 95% C.I. = 0.48–5.86) and between MOF and hemorrhage (MD = 6.212, 95% C.I. = 2.62–9.80). Most fractures were closed (75.3%) and affected the lower limbs (61.5%). Open reduction and internal fixation were the most common surgery for extremity fractures. Conclusion. We recommend a concerted multidisciplinary policy framework geared towards promoting road safety and reducing accidents in Ghana. We also recommend a tailored robust treatment algorithm for managing traumatic brain injury in our settings to reduce mortality thereof.

背景。多发性创伤是指身体两个以上部位受到多处危及生命的损伤,并伴有一些明显的生理失调。它是全球发病率和死亡率的主要原因。本研究旨在评估多发性创伤的流行病学概况,并概述加纳北部病例中四肢骨折的分布情况。研究方法在塔马利教学医院急诊科进行了一项回顾性横断面研究。使用数据收集工具将数据提取到 MS Excel 中,经过清理后导出到 SPSS 26 版本中进行分析。使用描述性统计以表格和图表的形式呈现数据。方差分析(ANOVA)用于评估直接死亡原因的平均 ISS 和平均住院时间是否存在显著差异。结果在急诊科 5413 名就诊者中,约有 186 人患有多发性创伤,发病率为 3.4%。男女比例为 1.9 :1.其中青壮年(21-40 岁)占 64%。参与者的平均年龄为(32.9 ± 15.4)岁,平均体征(40.6 ± 13.1)。道路交通事故(68.8%)是造成多发性创伤的最常见原因。死亡率为 33.0%。创伤性脑损伤(TBI)是最常见的直接致死原因(54.1%)。多器官功能衰竭(MOF)与创伤性脑损伤(TBI)之间的住院时间平均值(MD)有明显差异(MD = 3.169,95% C.I. = 0.48-5.86),多器官功能衰竭与出血之间的住院时间平均值(MD = 6.212,95% C.I. = 2.62-9.80)也有明显差异。大多数骨折为闭合性骨折(75.3%),受累部位为下肢(61.5%)。四肢骨折最常见的手术是切开复位和内固定。结论我们建议制定协调一致的多学科政策框架,以促进加纳的道路安全并减少交通事故。我们还建议在我们的环境中采用量身定制的稳健治疗算法来处理创伤性脑损伤,以降低死亡率。
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引用次数: 0
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International Journal of Clinical Practice
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