Journal of International Medical Research最新文献

Ventilator-associated pneumonia substantially increases mortality and imposes a heavy burden on healthcare resources. Patients undergoing endotracheal intubation and mechanical ventilation in emergency departments face a particularly high risk of ventilator-associated pneumonia. Compared with healthcare providers in intensive care units, those in emergency departments often lack sufficient awareness of timely and systematic ventilator-associated pneumonia prevention strategies, and existing intensive care unit-based care bundles are rarely tailored to emergency department-specific constraints. This gap leads to suboptimal implementation of ventilator-associated pneumonia preventive measures and increases the risk of ventilator-associated pneumonia. In this narrative review, we synthesize the current evidence on ventilator-associated pneumonia prevention and assess the feasibility of care bundles in resource-constrained emergency department settings. We propose the use of position, hand hygiene, airway, sedation, and equipment-a structured, multicomponent ventilator-associated pneumonia prevention strategy-in emergency departments with limited resources, supported by enabling strategies such as electronic checklists, multidisciplinary collaboration, and training to ensure adherence. Moving forward, efforts should focus on establishing consensus on emergency department-specific ventilator-associated pneumonia prevention protocols and optimizing nursing resource allocation to support implementation.

BackgroundSepsis remains a leading cause of mortality in critically ill patients, necessitating the identification of reliable prognostic markers. The triglyceride glucose-body mass index, which combines lipid and glucose metabolism, may serve as a valuable predictor of long-term outcomes in this population.MethodsThis study employed a retrospective observational cohort design and analyzed data from the MIMIC-IV database encompassing 2424 septic patients admitted between 2008 and 2019. Patients were categorized into quartiles based on triglyceride glucose-body mass index values. The primary outcomes assessed were all-cause mortality rates at 30, 90, and 180 days as well as 1-year post-admission, and analysis was performed using multivariable Cox proportional hazards models.ResultsIn total, 2424 septic patients meeting the inclusion criteria were finally included in the analyses. Lower triglyceride glucose-body mass index values have been associated with higher long-term mortality outcomes in critically ill septic patients. However, higher triglyceride glucose-body mass index quartiles were associated with a significant reduction in mortality risk at 180 days and 1 year after admission, even after adjustment for potential confounding variables. Patients in the third (hazard ratio: 0.81, 95% confidence interval: 0.67-0.98, p = 0.028) and fourth (hazard ratio: 0.73, 95% confidence interval: 0.56-0.96, p = 0.026) quartiles exhibited significantly lower hazard ratios for mortality than those in the lowest quartile. Notably, no significant associations were observed with 30-day mortality, suggesting that triglyceride glucose-body mass index values are more strongly associated with long-term outcomes.ConclusionIn this retrospective cohort study, lower triglyceride glucose-body mass index values were associated with higher long-term mortality in critically ill septic patients. Our findings suggest that the triglyceride glucose-body mass index serves as a useful prognostic marker and can help identify patients at increased risk of mortality. These results highlight a potential association that warrants further investigation in prospective studies to clarify the role of triglyceride glucose-body mass index in sepsis management.

ObjectiveThis study aimed to evaluate the potential of hepatocyte-derived fibrinogen-related protein 1 (HFREP1) as a biomarker for community-acquired pneumonia and community-acquired pneumonia secondary to sepsis.MethodThis cross-sectional observational study included 124 patients with community-acquired pneumonia, 52 patients with community-acquired pneumonia-sepsis, and 123 healthy controls. Clinical data were collected, including procalcitonin and C-reactive protein levels. Serum HFREP1 concentrations were measured, and statistical analyses were performed.ResultHFREP1 levels differed significantly among the healthy control, community-acquired pneumonia, and community-acquired pneumonia-sepsis groups (37.2 vs. 211.6 vs. 696.8 ng/mL). Binary logistic regression analysis identified procalcitonin and HFREP1 as independent predictors of community-acquired pneumonia-sepsis, while C-reactive protein was not an independent predictor. The area under the curve for HFREP1 in distinguishing community-acquired pneumonia patients from healthy controls was 0.8810. For differentiating community-acquired pneumonia-sepsis from community-acquired pneumonia, the area under the curves were 0.8814 for HFREP1, 0.8167 for C-reactive protein, and 0.8902 for procalcitonin.ConclusionHFREP1 may serve as a biomarker for community-acquired pneumonia and community-acquired pneumonia-sepsis. In community-acquired pneumonia-sepsis, HFREP1 was strongly correlated with C-reactive protein and procalcitonin, and its diagnostic performance was comparable to that of procalcitonin.

BackgroundCoronavirus disease 2019 (COVID-19) is a serious global health threat, and some patients with COVID-19 develop post-COVID-19 symptoms, which are characterized by symptoms following acute infection. In December 2022, China relaxed its strict COVID-19 policies, which was followed by outbreaks. Therefore, it is important to investigate post-COVID-19 symptoms in China to understand their prevalence and risk factors. This multicenter study examined post-COVID-19 symptoms among Chinese healthcare workers to better understand their epidemiology.MethodsHealthcare workers from seven hospitals who met specific COVID-19 and work criteria participated in an anonymous online survey conducted from 17 July to 19 August 2023. The collected data were analyzed using various statistical methods to identify factors associated with self-reported post-COVID-19 symptoms.ResultsOf the 5213 healthcare workers who were included in the study, 17.0% reported post-COVID-19 symptoms. Binary logistic regression confirmed male sex (odds ratio = 1.418, 95% confidence interval: 1.151-1.747), doctor/nurse position (doctor: odds ratio = 1.406, 95% confidence interval: 1.074-1.840; nurse: odds ratio = 1.516, 95% confidence interval: 1.176-1.954), chronic respiratory disease (odds ratio = 1.576, 95% confidence interval: 1.035-2.399), moderate/severe COVID-19 (odds ratio = 1.583, 95% confidence interval: 1.323-1.894), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection (odds ratio = 1.420, 95% confidence interval: 1.219-1.655), and high self-reported COVID-19 severity (odds ratio = 1.707, 95% confidence interval: 1.456-2.001) as post-COVID-19-associated factors.ConclusionOur real-world multicenter study showed that 17% of healthcare workers developed post-COVID-19 symptoms following SARS-CoV-2 infection. Therefore, targeted interventions are required for healthcare workers. This study provides important insights into the prevention and management of COVID-19 in healthcare workers and the general population.

ObjectiveThis study aimed to evaluate the safety profile of progesterone by analyzing adverse event data from the Food and Drug Administration Adverse Event Reporting System (FAERS) between 2004 and 2024.Materials and methodsThis retrospective, observational pharmacovigilance study was based on data from the FAERS database. A total of 1827 adverse event reports associated with progesterone were retrieved. Disproportionality analysis methods, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker, were used to evaluate the frequency, signal strength, and time-to-onset of adverse events.ResultsAmong 24,589,239 adverse event reports in the reporting system, 1827 were associated with progesterone, covering 22 system organ classes and 152 preferred terms. The most frequently reported preferred terms were maternal exposure during pregnancy (151 cases), spontaneous abortion (144 cases), and abnormal product odor (114 cases). The top three preferred terms showing the strongest signals were decidual cast (reporting odds ratio: 2825.23), chondrodermatitis nodularis chronica helicis (reporting odds ratio: 3897.61), and autoimmune dermatitis (reporting odds ratio: 1519.29). Most adverse events occurred within 30 to 180 days after exposure. Newly identified preferred terms associated with progesterone included acute eosinophilic pneumonia, meningioma, and autoimmune dermatitis.ConclusionsThis study identified notable safety concerns associated with progesterone use and detected several rare adverse events. These findings underscore the need for continued monitoring, updated prescribing guidelines, and further investigation into progesterone formulations and adverse event mechanisms.

This case report describes an exceptionally rare occurrence of severe acute respiratory distress syndrome following laparoscopic appendectomy in a previously healthy 57-year-old male. The patient presented with acute appendicitis and underwent an uncomplicated surgical procedure. Approximately 4 h postoperatively, he developed rapid respiratory deterioration with severe hypoxemia, fulfilling the Berlin criteria for severe acute respiratory distress syndrome (partial pressure of arterial oxygen/fraction of inspired oxygen ratio, 99.2). Other causes, including aspiration, pulmonary embolism, and cardiac failure, were excluded. The patient was managed in the intensive care unit with lung-protective ventilation in accordance with the Acute Respiratory Distress Syndrome Network (ARDSNet) protocol along with antibiotics and corticosteroids. He demonstrated rapid clinical improvement, was extubated on postoperative day 7, and discharged on postoperative day 8. This case highlights that severe acute respiratory distress syndrome, although rare, can complicate routine surgical procedures and underscores the importance of early recognition and multidisciplinary management in achieving favorable outcomes.

ObjectiveThis study aimed to investigate whether coenzyme Q10 is effective in preventing exercise-induced oxidative stress and muscle damage.MethodsFourteen randomized controlled studies examining the effects of supplementation with coenzyme Q10 analogs on postexercise oxidative stress and muscle damage were identified through searches in literature databases, including PubMed, the Cochrane Library, Embase, and Web of Science, and then the quality of the included studies was assessed. Quantitative and qualitative analyses were performed.ResultsThe study screened 14 randomized controlled trials that included a total of 433 subjects. The results demonstrated that oral coenzyme Q10 elevated blood coenzyme Q10 concentration (standardized mean difference: 2.710, 95% confidence interval: 1.57-3.85, p < 0.00001) and reduced blood malondialdehyde concentration (standardized mean difference: -0.289, 95% confidence interval: -0.541 to -0.038, p = 0.024). Additionally, oral coenzyme Q10 was found to reduce blood creatine kinase values (standardized mean difference: -1.532, 95% confidence interval: -2.856 to -0.209, p = 0.023), suggesting a potential protective effect on skeletal muscle. The metabolism-related blood lactate and maximal oxygen uptake levels were not affected by coenzyme Q10 (standardized mean difference: -0.68, 95% confidence interval: -1.89 to 0.53, p = 0.271; standardized mean difference: -0.156, 95% confidence interval: -0.79 to 0.478, p = 0.630).ConclusionsCoenzyme Q10 may reduce exercise-induced oxidative stress on blood malondialdehyde and exert a protective effect on muscle; however, no effect was observed from the anaerobic and aerobic metabolism of the organism.

Montgomery T-tube tracheal stent placement is a well-established treatment for severe subglottic stenosis. This procedure is typically performed using a rigid bronchoscope under general anesthesia. However, a major limitation of this approach is the requirement for neck hyperextension, which is not feasible in patients with cervical spine injuries. This report details a complex case of subglottic stenosis in a patient with a cervical spinal cord injury and incomplete paraplegia, in whom conventional Montgomery T-tube tracheal stent placement was difficult to achieve. We performed Montgomery T-tube tracheal stent implantation under conscious sedation with oxygen support provided by high-flow nasal cannula, minimizing the risks of general anesthesia and cervical manipulation. The successful outcome suggests that the combination of conscious sedation and high-flow nasal cannula may represent a safe and practical strategy for treating carefully selected complex airway cases. Although this case highlights a promising pathway, further studies are required to confirm the efficacy of this strategy and define its clinical indications in larger patient populations.

ObjectiveThis study examined the association between the systemic immune-inflammation index and urinary incontinence subtypes using data from National Health and Nutrition Examination Survey 2007-2016.MethodsThis cross-sectional study included 21,569 adults. Systemic immune-inflammation index was calculated and log-transformed. Survey-weighted logistic regression analyses, smoothed curve fitting, exploratory threshold analyses, and subgroup analyses stratified by demographic and clinical characteristics were conducted to evaluate its associations with stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence.ResultsHigher log₁₀ systemic immune-inflammation index levels were significantly associated with an increased prevalence of stress urinary incontinence. Associations with urgency urinary incontinence and mixed urinary incontinence were weaker, and quartile trends were not statistically significant. Smoothed curve fitting demonstrated monotonic increases for stress urinary incontinence and mixed urinary incontinence, whereas a nonlinear pattern was observed for urgency urinary incontinence, suggesting a potential threshold at a log₁₀ systemic immune-inflammation index of approximately 2.5.ConclusionElevated systemic immune-inflammation index levels were significantly associated with stress urinary incontinence, whereas associations with urgency urinary incontinence and mixed urinary incontinence were weaker and exhibited nonlinear patterns. Longitudinal studies are required to clarify the temporal relationships underlying these associations.