Journal of International Medical Research最新文献

ObjectiveThe purpose of this study was to assess whether circulating soluble ST2 independently predicts prognosis in patients with chronic heart failure.MethodsThis study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the unique registration number CRD42023489018. Two researchers systematically searched PubMed, Embase, and Web of Science for all studies published up to 1 September 2024. To evaluate the quality of the study, the Newcastle-Ottawa Scale was used; Review Manager software was used for statistical analysis and construction of forest plots.ResultsThe final analysis comprised 17 studies in total. This meta-analysis demonstrated that a high soluble ST2 level was a predictor of poor all-cause mortality (hazard ratio: 1.03, 95% confidence interval: 1.02-1.04, p < 0.00001), poor all-cause mortality/heart failure-related readmission (hazard ratio: 1.46, 95% confidence interval: 1.33-1.61, p < 0.00001), and higher cardiovascular mortality/heart failure-related hospitalization (hazard ratio: 1.50, 95% confidence interval: 1.30-1.74, p < 0.00001) in patients with chronic heart failure. Subgroup analyses were conducted based on ethnicity, sex, left ventricular ejection fraction, and follow-up duration for both all-cause mortality and all-cause mortality/heart failure-related readmission. Soluble ST2 demonstrated good prognostic value in all subgroups.ConclusionThis study, based on current evidence, suggests that soluble ST2 has independent prognostic value in patients with chronic heart failure. The soluble ST2 biomarker performed well in predicting all-cause mortality/heart failure-related readmission and cardiovascular mortality/heart failure-related hospitalization. Further research is needed to validate its role in clinical practice.

ObjectiveOptimal utilization of drugs and judicious prescription, combined with high-quality and accessible supplies, are crucial for enhancing the efficacy of healthcare services. This study evaluated the prescribing practices at Women's Specialized Hospital in Shiraz, Iran, the largest women's specialized hospital in southern Iran.MethodsThis retrospective observational drug utilization study analyzed prescription data from 13,909 hospitalized patients. Drug utilization trends, prescription patterns by ward, routes of administration, and prescription frequencies by drug classes, focusing on antimicrobials and nonsteroidal anti-inflammatory drugs were evaluated.ResultsThe mean duration of hospitalization was 3.12 ± 5.49 days. The newborn ward accounted for 15.7% of total prescriptions and had the highest proportion of antimicrobial prescription of 24.3%. In the neonatal intensive care unit, patients received an average of 41.3 medications. Overall, 4009 (28.8%) were prescribed at least one nonsteroidal anti-inflammatory drug. Injectable formulations accounted for 71.3% of all prescribed medications, which is markedly higher than World Health Organization recommendations. Frequent use of antimicrobials, nutritional agents, cardiovascular drugs, and analgesics was observed, with critical care wards showing particularly high use of injectable and antimicrobial drugs.ConclusionsThe findings indicate frequent use of injectable antimicrobials and nonsteroidal anti-inflammatory drugs, especially in neonatal and critical care units. These data highlight the need for enhanced monitoring of rational prescription, antimicrobial stewardship, and drug utilization audits to optimize patient care.

BackgroundSpinal anesthesia is a commonly used anesthetic technique for a variety of surgical procedures. Despite its popularity and safety, failed spinal anesthesia remains an important clinical challenge, resulting in patient discomfort, need for repeated attempts, and/or conversion to general anesthesia. This systematic review compiles contemporary evidence from 2015 to 2025 on the predictors of failed spinal anesthesia.MethodsA systematic search was performed using PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar. Studies published between January 2015 and May 2025 reporting contributors of failed spinal anesthesia were included. Methodological quality was evaluated using the Joanna Briggs Institute tool.ResultsTwenty-one studies comprising obstetric, orthopedic, urologic, and general surgical populations were included. Failure rates ranged from 0.9% to 25.3%. Contributors of failed spinal included low local anesthetic dose, use of isobaric solutions, provider inexperience, presence of bloody cerebrospinal fluid, absence of free cerebrospinal fluid flow, lumbar puncture at the L4-L5 interspace, high body mass index, prior spinal anesthesia exposure, emergency surgery, and multiple puncture attempts.ConclusionFailed spinal anesthesia is multifactorial and is influenced by technical, patient-related, and contextual factors. Optimization of technique, adequate dosing, enhanced provider training, and improved patient assessment may reduce failure rates.

Central compartment atopic disease is a recently delineated inflammatory endotype of chronic rhinosinusitis. It is characterized by involvement of the central intranasal compartment-the middle turbinate, superior turbinate, and posterior superior nasal septum-and is associated with a predominantly polypoid phenotype. This review synthesizes current evidence on local allergic pathophysiology, diagnostic frameworks, and stratified management of central compartment atopic disease to facilitate accurate diagnosis and individualized treatment.

ObjectiveThis study aimed to evaluate treatment patterns and clinical outcomes among patients with multiple myeloma treated at a major cancer center in Kazakhstan over a 10-year period.MethodsThis retrospective observational study analyzed data from 261 patients with multiple myeloma treated at the National Research Oncology Center, Astana, between 2010 and 2021. Sociodemographic and clinical characteristics, treatment regimens, and survival outcomes were assessed using data from electronic medical records.ResultsMost patients were diagnosed with stage II of multiple myeloma, based on the Durie-Salmon staging system, and the majority received bortezomib plus dexamethasone as first-line treatment. Hematopoietic stem cell transplantation was performed in 117 (45%) patients, with a 5-year overall survival rate of 63.6%, compared with 46.2% in patients who received chemotherapy alone.ConclusionsThe mean age of this cohort was 54 years, suggesting an earlier onset of multiple myeloma in the Kazakh population. Treatment regimens, stem cell yield, and post-transplant complications significantly influenced survival outcomes, underscoring the need to optimize transplant strategies and supportive care in Kazakhstan.

ObjectivePrevious studies have suggested a potential association between the platelet-to-lymphocyte ratio and disease activity in myasthenia gravis. However, the immunological mechanisms underlying this association remain insufficiently elucidated.MethodsA retrospective cohort of 229 patients with myasthenia gravis and a single-cell RNA sequencing dataset were analyzed to investigate the relationship between platelet-to-lymphocyte ratio and disease severity. Clinical associations were assessed using the Myasthenia Gravis Foundation of America classification and multivariable logistic regression, while single-cell RNA sequencing data were integrated to characterize immune alterations associated with elevated platelet-to-lymphocyte ratio.ResultsPatients with severe myasthenia gravis had longer disease duration and higher frequencies of bulbar symptoms, thymoma, and repetitive nerve stimulation positivity (all p < 0.001). Although median platelet-to-lymphocyte ratio values did not demonstrate significant groupwise differences (p = 0.108), multivariate analysis confirmed that an elevated platelet-to-lymphocyte ratio was independently associated with greater myasthenia gravis severity (adjusted odds ratio = 1.027, 95% confidence interval: 1.003-1.052, p = 0.034). Single-cell RNA sequencing revealed immune dysregulation in patients with a high platelet-to-lymphocyte ratio, characterized by increased platelets and neutrophils, reduced natural killer cells, and upregulation of platelet activation, cell-cell adhesion, and integrin-mediated signaling pathways, indicating a shift toward innate immune activation and impaired immune coordination.ConclusionElevated platelet-to-lymphocyte ratio independently predicts myasthenia gravis severity and may reflect immune dysregulation that contributes to disease progression and neuromuscular junction dysfunction.

ObjectiveThe objective of this study was to examine the associations of the systemic immune-inflammation index and the systemic inflammation response index with all-cause and cardiovascular mortality in cancer and noncancer populations.MethodsWe analyzed data from 42,503 adults in the National Health and Nutrition Examination Survey using Cox models and restricted cubic spline analyses.ResultsCompared with the lowest tertile, the highest systemic immune-inflammation index tertile was associated with increased risks of all-cause mortality (hazard ratio, 1.24; 95% confidence interval: 1.16-1.32) and cardiovascular mortality (hazard ratio, 1.29; 95% confidence interval: 1.15-1.45). The highest systemic inflammation response index tertile demonstrated similar increases in all-cause mortality (hazard ratio, 1.33; 95% confidence interval: 1.24-1.43) and cardiovascular mortality (hazard ratio, 1.42; 95% confidence interval: 1.25-1.61). Risks increased across tertiles, and dose-response patterns were supported by spline analyses. Estimates were greater among participants with cancer than among those without cancer.ConclusionsElevated levels of systemic immune-inflammation index and systemic inflammation response index were associated with increased risks of all-cause and cardiovascular mortality, particularly among participants with cancer, supporting their potential use as low-cost screening tools for risk stratification. Given the observational design and single baseline measurement, residual confounding and measurement error remain possible; prospective validation is warranted.

ObjectiveIn this study, we aimed to evaluate the safety and efficacy of a combination of 100 mg mebeverine and 25 mg sulpiride (Colona®) in patients with functional gastrointestinal disorders.MethodsThis multicenter, cohort study was conducted in Egypt, comprising 253 patients diagnosed with functional gastrointestinal disorders. The treatment duration was 2 weeks. The primary endpoint was the percentage of relative change in the tailored gastrointestinal symptoms rating scale.ResultsThe baseline tailored gastrointestinal symptoms rating scale mean (±SD) score was 11.42 ± 4.10. However, after 2 weeks (±1 week) of combination therapy, the score significantly decreased to 3.11 ± 2.48 (p < 0.01), demonstrating a mean (±SD) improvement of 71.84% ±20.56%. Among 253 patients, 227 patients (89.72%, 95% confidence interval: 85.96%-93.49%) demonstrated ≥50% improvement in the tailored gastrointestinal symptoms rating scale total score, whereas 26 (10.28%) did not report any improvement. In terms of safety, 2 (0.79%) patients reported diarrhea, 1 (0.4%) had mild dyspepsia, and 1 (0.4%) had galactorrhea.ConclusionOur results suggest that the combination of mebeverine and sulpiride may represent a safe and effective treatment option for patients with functional gastrointestinal disorders.

ObjectiveThis study aimed to explore the association between lactate dehydrogenase-to-albumin ratio and the severity of coronary artery disease in patients with acute myocardial infarction.MethodsPatients with acute myocardial infarction were categorized into three groups based on the lactate dehydrogenase-to-albumin ratio tertiles. Demographic characteristics and Gensini scores were collected. Logistic regression and the receiver operating characteristic analyses were performed to evaluate the predictive ability of the lactate dehydrogenase-to-albumin ratio for a high Gensini score (>60). The area under the curve was calculated.ResultsA total of 489 individuals were retrospectively enrolled in this study. Multivariate logistic regression analysis demonstrated that the highest lactate dehydrogenase-to-albumin ratio was an independent risk factor for a high Gensini score (odds ratio, 3.45; 95% confidence interval: 1.37-8.71; p = 0.009). The receiver operating characteristic analysis showed that the lactate dehydrogenase-to-albumin ratio had good predictive ability for identifying a high Gensini score (area under the curve, 0.743; 95% confidence interval: 0.698-0.788).ConclusionsLactate dehydrogenase-to-albumin ratio may serve as a novel indicator for predicting the severity of coronary artery disease in patients with acute myocardial infarction.