Journal of Medicine and Life最新文献

High-dose intravenous vitamin C (IVC) achieves plasma concentrations that are not attainable by oral administration and has been investigated as an adjunct in sepsis, oncology, and symptom management. To synthesize the evidence regarding the clinical benefits and risks of high-dose IVC, as well as the potential advantages of on-site infusion, a PRISMA-informed search of PubMed/PMC, Scopus, and Web of Science (2010-2025) was conducted, prioritizing randomized controlled trials, systematic reviews, and high-quality observational studies. Pharmacokinetic and mechanistic studies of IVC support plausible physiologic benefits through antioxidant effects, catecholamine biosynthesis, and immune modulation, with recent evidence showing down regulation of pro-inflammatory STAT1/PD-L1 pathways in experimental sepsis. Oncology phase I and II studies demonstrate safety and quality-of-life improvements; a randomized phase II pancreatic trial reported a promising survival benefit when combined with chemotherapy. Some of the major risks include oxalate nephropathy and hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency, especially with very large or repeated doses, suggesting pre-screening to avoid these risks. Furthermore, the literature on home infusion and IV therapies is limited; however, the expanding home infusion infrastructure offers an avenue for monitored IVC delivery. In conclusion, evidence does not support routine use of high-dose IVC in sepsis, and its role in oncology remains supportive and exploratory, with potential risks requiring caution. Furthermore, interest in home-based infusion services is increasing in several healthcare systems, although clinical outcome data specific to high-dose IVC in these settings remain limited.

This study evaluated cephalometric changes in Class II malocclusion patients treated with expansion versus extraction in a Saudi Arabian sample. Data from 90 orthodontic patients meeting strict eligibility criteria were collected from multiple private practices in Saudi Arabia. The sample was divided according to treatment modality: Group 1 consisted of patients treated with four premolar extractions (n = 45), and Group 2 included patients treated with maxillary expansion using a banded rapid palatal expander (RPE) supported by mini-screws (n = 45). Nasolabial angle (NLA) for extraction cases presented a statistically significant difference in post-treatment radiographs (mean difference: -3.07 ± 8.92, P = 0.030) and significant changes in all dental variables (e.g., upper incisor position to A-Pog [UI-APog] pre-treatment mean difference: 4.49 ± 3.89; P < 0.001). In pre-treatment radiographs, only the position of the upper incisor to A-Pog showed a considerable difference (11.27 ± 4.19 vs. 8.83 ± 3.00, P = 0.017). Cases treated with RPE reported significant changes in the lower lip thickness (mean difference: -1.02 ± 2.20, P = 0.028). Cases treated with extraction had a greater influence on the dental component than on the soft tissue. In contrast, expansion cases showed a slight impact dentally but a greater effect on soft tissue parameters. However, neither treatment modality resulted in significant skeletal changes.

Hypertension is a leading non-communicable disease both globally and in Saudi Arabia. Poor adherence to antihypertensive medications remains a major challenge in managing this condition, contributing to higher morbidity, mortality, and healthcare costs. This study aimed to review and synthesize the literature on factors contributing to medication nonadherence among hypertensive patients in Saudi Arabia. A structured literature review was conducted using the PubMed and Scopus databases. Inclusion criteria include English-language studies conducted in Saudi Arabia from 2010 to 2024 involving hypertensive adult Saudi patients. A total of 84 studies were identified. Eleven studies met the final inclusion criteria. All were cross-sectional studies using different validated adherence assessment tools. Adherence rates varied widely, from 33% to 86.1%, influenced by the choice of measurement tool and regional differences. Higher adherence was associated with older age, female gender, higher education level, being married, and higher income. Psychosocial and behavioral factors, including beliefs about the necessity of medication, perceived social support, and strong physician-patient relationships, positively influenced adherence. One study using the Health Belief Model (HBM) found that perceived severity, susceptibility, benefits, and cues to action significantly affected adherence behaviors. Medication adherence among hypertensive patients in the Saudi population is influenced by a complex relationship of demographic, psychosocial, and healthcare-related factors. Addressing these elements through tailored interventions and appropriate assessment tools may enhance hypertension management outcomes.

This study aimed to evaluate disparities in preterm birth and low birth weight among newborns of mainland Southeast Asian migrant versus Thai mothers during the COVID-19 pandemic in Thailand, and to assess the immigrant paradox by examining associations between maternal migrant status and adverse birth outcomes using directed acyclic graphs. The study population consisted of mainland Southeast Asian migrant and Thai mothers and their newborns who received antenatal care and gave birth at a public hospital in Samut Sakhon from December 2020 to May 2022. Preterm birth (gestational age < 37 weeks) and low birth weight (< 2500 g) were the study outcomes. Migrant status was defined using personal identification (e.g., passport). Associations between migrant status and birth outcomes, adjusted for pertinent covariates, were modeled using a directed acyclic graph. Poisson regression with robust standard errors was applied to estimate the risk ratio. Preterm birth incidence was 10% and 9% among newborns of migrant and Thai mothers. Low birth weight incidence was significantly higher among newborns of Thai mothers (10.7%) compared to those of migrant mothers (8%). After adjusting for covariates, immigrant status did not increase the risk of preterm birth or low birth weight in newborns compared to those of Thai mothers. Contrary to the assumption that migrant mothers may face hardships leading to newborns' poor birth outcomes, risk of preterm birth and low birth weight were similar among newborns of migrant and local mothers in this study, indicating an immigrant health paradox.

This narrative study proposes an engineering framework to model a value-based, trauma-informed primary care system. It is based on the premise that effective patient outcomes could be achieved by screening for adverse childhood experiences (ACEs). The protocol involves the administration of the ACE survey and an in-person trauma evaluation by mental health professionals embedded within the primary care settings. The ACE evaluation is then followed by the collection of psychophysiological stress response data. Depending on the level of symptomatic somatization, patients are then referred to appropriate treatment modalities. An engineering-based robust design methodology is utilized to demonstrate a model of a trauma-informed primary care system. To be deployed, the proposed value-based systems model of medicine warrants further investigation with clinical and empirical studies.

Romania's healthcare system struggles with the EU's highest rates of treatable and preventable mortality and the lowest per capita health expenditure. Critical issues include unsustainable financing, an entrenched physician-centered model lacking institutional accountability, delayed digitalization, and inadequate clinical research capacity, necessitating structural and paradigmatic shifts. The objective of this study was to synthesize multi-stakeholder consensus recommendations for comprehensive reform of the Romanian healthcare system, focusing on financing, service delivery, and human resources. This manuscript details recommendations from a multi-stakeholder consensus conference organized in April 2025 by the Aspen Institute Romania. Participants addressed topics including financing, patient-centered hospital models, clinical research, health innovation, and the European Health Data Space (EHDS). Consensus recommendations include: stabilizing national health insurance funds (broadened contributions, multi-year budgets); shifting hospitals to patient-centered, institutionally accountable models (transparent allocation, digital integration, eradicating informal payments); equitable hospital reimbursement (unified tariffs); accelerated digital transformation (EHDS alignment, national Electronic Health Record); enhanced clinical trial capacity (personnel, infrastructure, regulatory efficiency); and exploring regulated dual practice, contingent on successful prior reforms. Key challenges include transforming hospital culture, promoting digital adoption, and navigating the complexities of politics and finance. These interconnected recommendations form a roadmap for transformative reform, crucial given the untenable status quo. Success requires sustained political will, stakeholder collaboration, investment, and robust governance to create a financially stable, patient-centered, equitable, and innovative system.

Identifying the indicators of active labor is crucial for timely intervention, enhancing care focused on women, and minimizing unnecessary hospital admissions during the early stages of labor. This research aimed to evaluate the relationship between the educational role of healthcare providers and the knowledge of active labor signs among pregnant Saudi women. A descriptive cross-sectional correlational study was conducted at the Obstetrics and Gynecology Outpatient Department of King Abdulaziz Medical City in Jeddah. A convenience sample of 399 pregnant Saudi women completed a structured questionnaire. Over half of the participants (57.4%) were aged 26-35. Almost all respondents (97.7%) accurately identified cervical dilatation, and 95.5% recognized regular severe abdominal or back pain as signs of active labor. Family, friends, and online platforms were the most frequently cited sources of information (22.2% and 22.1%, respectively). The majority of participants (96%) felt comfortable inquiring about labor signs with healthcare providers, and 71.9% rated communication with providers as effective or very effective. Women showed a good understanding of active labor signs and felt comfortable communicating with healthcare providers. However, informal sources are still prevalent, underscoring the need for structured, provider-led education. It is recommended to incorporate targeted health education programs into routine antenatal visits to improve accurate knowledge and reduce reliance on non-professional sources.

Metabolic syndrome (MetS) represents the concurrent manifestation of multiple cardiometabolic risk factors, including visceral obesity, hyperglycemia, hypertension, hypertriglyceridemia, and low HDL-cholesterol, cumulatively predisposing to accelerated atherosclerosis and type 2 diabetes mellitus (T2DM). Hypothyroidism frequently coexists with T2DM and further exacerbates insulin resistance (IR), lipid abnormalities, and systemic inflammation, increasing the prevalence and severity of MetS in this population. Oral semaglutide is a glucagon-like peptide-1 receptor agonist approved for T2DM management; however, its impact on MetS parameters in patients with coexisting hypothyroidism remains insufficiently explored. This study aimed to evaluate the effects of oral semaglutide on key MetS components in this high-risk subgroup. We conducted a single-center retrospective cohort study involving 51 adult patients with confirmed hypothyroidism and T2DM, on oral semaglutide (final dose = 14 mg daily) and monitored for 6 months. Clinical and biochemical parameters were analyzed, including glycated hemoglobin (HbA1c), body mass index (BMI), blood pressure, and lipid profile. At 6 months, mean HbA1c decreased by 6.7% (P < 0.001), BMI was reduced by 4.04% (P < 0.001), triglycerides decreased by 6.7% (P < 0.001), and HDL-C increased by 9% (P = 0.002). In this observational study, treatment with oral semaglutide was associated with improvements in several components of MetS among patients with coexisting hypothyroidism and T2DM. While these findings suggest a potential therapeutic role for semaglutide in complex metabolic profiles, they should be interpreted with caution due to the study's design limitations. Further prospective studies are warranted to confirm these observations and to explore the interaction between semaglutide and levothyroxine.

Minimally invasive surgery (MIS) has revolutionized modern surgical practice, reducing trauma, speeding recovery, and improving surgical accuracy. Robot-assisted surgery has emerged as a minimally invasive surgical technique as an alternative to laparoscopic surgery. However, determining which of the two surgical techniques is more effective across different surgical specialties remains a matter of research. This narrative review aimed to compare robotic-assisted surgery with laparoscopic surgery with respect to patient outcomes, complications, recovery time, and cost. Studies published in PubMed and ScienceDirect were used, with a focus on studies published between 2015 and 2025. Also, studies that compared both techniques through various specialties were included. Robot-assisted surgery showed positive results by improving surgical precision, reducing the need for conversion to open surgery, and resulting in fewer complications and faster functional recovery in some procedures. However, laparoscopic surgery showed superior results in lowering surgical costs and ease of access, with shorter operating times than robotic-assisted surgery. Both robotic-assisted surgery and laparoscopic surgery offer advantages that make comparing them difficult. Robotic-assisted surgery was better for complex surgical procedures that required high precision. However, laparoscopic surgery was superior for routine cases requiring shorter operating times. Further research and prospective, high-quality, and multicenter studies are still needed to better define the optimal application of each surgical approach.