International Journal of Clinical Practice最新文献

Objective. To assess the effectiveness of atrioventricular valve regurgitation (AVVR) detection using color Doppler in the four-chamber view (4CV) for identifying atrioventricular septal defects (AVSDs) during 11–13 + 6 weeks’ gestation. This study compares AVVR detection to conventional 2D ultrasound and investigates associations between AVSD and increased nuchal translucency thickness (NT), as well as additional cardiac, extracardiac, and chromosomal abnormalities in the first trimester. Materials and Methods. This prospective study analyzed data from singleton pregnancies diagnosed with AVSD at 11–13 weeks gestation. It included routine ultrasound examinations focusing on fetal anatomy, NT measurement, and blood flow analysis across AVVR using both color and directional power Doppler. Evaluations targeted the 4CV and the three-vessel and trachea views (3VT). Ratios such as LAVV/RAVV and main pulmonary artery-to-aorta (PA/AO) diameter were also calculated. Results. Over three years, 452 fetuses were diagnosed with congenital heart disease in the first trimester, including 25 cases of AVSD (21 complete, 1 partial, and 3 intermediate). Seventeen cases were isolated AVSDs, 13 associated with heterotaxia syndrome, one with tetralogy of Fallot, and two survived. Among these, 92% showed AVVR, 61.54% had NT above the 95th percentile, and 32.0% lacked a nasal bone. AVVR was a more reliable indicator of AVSD than other ultrasonic markers. Conclusion. AVSD exhibits a diverse range of clinical presentations. A comprehensive review of both intracardiac and extracardiac anomalies is essential. AVVR detected during NT scanning in the first trimester can confirm the presence of AVSD.

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.

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.

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.

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.

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.

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.

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.

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.

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.