Medical Principles and Practice最新文献

Objective: Urinary tract infections (UTIs) are common in neonates. Understanding the changes in the prevalence of common uropathogens is essential for early diagnosis and effective treatment of UTIs. This study aimed to identify etiological agents and determine the local antibiotic susceptibility patterns of uropathogens causing UTIs.

Subjects and methods: A retrospective cross-sectional descriptive study from January 2017 to December 2022 was conducted on hospitalized neonates at Maternity Hospital, Kuwait. Urine samples from neonates were analyzed to identify isolates, and antimicrobial susceptibility testing was determined using the VITEK® 2 system.

Results: Out of 3,996 urine samples processed, 282 (7%) samples yielded significant bacteriuria, mostly from male 185 (65.6%). Gram-negative isolates were the most common 141 (50%), followed by yeasts 84 (29.8%) and Gram-positive isolates 57 (20.2%). The common uropathogens were Klebsiella pneumoniae 50 (17.7%), followed by Escherichia coli 47 (16.8%), Candida albicans 39 (13.8%), Enterococcus faecalis 34 (12%), and Staphylococcus epidermidis 17 (6%). High resistance rates were observed among Enterobacterales against ampicillin, cephalothin, cefuroxime, cefotaxime, nitrofurantoin, amoxicillin-clavulanic acid, ceftazidime, and trimethoprim-sulfamethoxazole. A total of 28 (56%) K. pneumoniae and 18 (38.3%) E. coli were extended-spectrum beta-lactamase producers.

Conclusion: Gram-negative isolates are considered the predominant causative agents of UTIs in neonates at Maternity Hospital. Reduced antibiotic susceptibility to commonly used antibiotics poses a notable challenge in the clinical management of neonates with UTIs. This study underscores the importance of proactive surveillance in monitoring causative organisms and antibiotic susceptibility in neonates.

Objective: Breast cancer (BC) cells exhibit mutations over time, conferring resistance to therapeutic approaches. We attempted to ascertain the efficacy of selected hormonal therapy for advanced BC.

Methods: This is a systematic review and meta-analysis of clinical trials. We searched Medline, PubMed, Cochrane Library, Web of Science, and others. Studies that investigated the effectiveness of hormonal therapy for HR positive (HR+) advanced BC were included. The outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). A random-effect meta-analysis model was employed. The study protocol was registered with the International Prospective Register of Systematic Reviews: CRD42023431939.

Results: Twenty-one studies were included in the meta-analysis with an overall sample size of 8,482. ORR and PFS between aromatase inhibitors (AIs) and other hormonal therapies: selective oestrogen receptor degrader, selective oestrogen modulator (SERM) and androgen inhibitors showed no significant difference (OR = 1.122 [0.917-1.374], p = 0.263; OR = 0.010 [0.000-1.292], p = 0.063), respectively. Subgroup analysis showed a statistically significant difference in ORR in favour of patients who received SERM compared to AI (OR = 1.362 [1.033-1.795], p = 0.028). For OS, no significant difference was observed among anastrozole, letrozole, and exemestane recepients (OR = 1.718 [0.021-139.128], p = 0.809).

Conclusion: Given the above findings, clinical decisions could be based on factors such as the line of cancer treatment, adverse events, drug dosing, and individual drug benefits. Although newer combination therapies are being adopted, the agents explored in this review are still widely used in clinical practice for HR+ BC.

Objective: Behçet's syndrome (BS) is a multisystemic disorder with a complex genetic background. Indoleamine 2,3-dioxygenase (IDO) and IDO2, key enzymes in tryptophan metabolism, have immunomodulatory effects. Specific IDO and IDO2 polymorphisms may influence enzymatic activity. This study aimed to explore the association between IDO/IDO2 gene polymorphisms and BS susceptibility, and assess serum levels of IDO and IDO2 in relation to BS.

Subjects and methods: Ninety patients with BS and 52 healthy controls were enrolled in this study. Predetermined single-nucleotide polymorphisms (SNPs) were studied at specific gene loci for IDO and IDO2. Serum IDO and IDO2 levels were determined using ELISA.

Results: No statistically significant differences were observed in the genotype and allele frequencies of IDO (rs7820268 and rs10108662) and IDO2 (rs4503083) between patients with BS and controls. Furthermore, no significant association was found between clinical findings and SNPs, except that the IDO rs7820268 CT genotype was significantly lower in patients with neurological involvement (0% vs. 42%, p = 0.026, OR = 0.147, 95% CI = 0.18-1.231). Serum levels of IDO and IDO2 were significantly lower in BS patients compared to controls (p < 0.0000 and p < 0.0001, respectively).

Conclusion: Our research revealed that the serum IDO/IDO2 levels of BS were substantially lower than those in the control group. This finding has the potential to impact IDO activity and reduce immune tolerance. No correlation was observed between IDO/IDO2 polymorphisms and most clinical findings of BS. However, the IDO rs7820268 CT genotype was significantly reduced in neuro-BS, suggesting a protective effect. Larger prospective trials are needed to further explore these findings.

Objectives: This pilot retrospective case-control study questioned whether systemic statin use causes pulp calcification using cone-beam computed tomography (CBCT) images from the patients prescribed oral statins and comparing those of healthy individuals.

Subjects and methods: CBCT scans of 54 patients, including 27 age- and sex-matched patients for the study and control groups, were analysed using Mimics Innovation Suite software. The study included patients using statins regularly for at least 1 year. Only intact teeth with opposing teeth were selected for the study group and matched with the control group. Dental crown and pulp chamber volumes were calculated and proportioned. The data were analysed with chi-square and Shapiro-Wilk tests to assess normal distribution, followed by Mann-Whitney U test if necessary.

Results: Statistical analysis showed no difference between the study and control groups (p = 0.505). Statin use duration did not cause statistically significant difference in terms of the reduction of pulp chamber volume (p = 0.141).

Conclusion: Within the limitations of the study, systemic statin use did not cause dental pulp calcification. The results suggest, oral administration of the statin drugs is not an unfavourable condition for dental practice. Further studies with larger numbers of patients are needed to support this conclusion.

Objective: This review aimed to summarize the current evidence of reported myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS) overlap syndrome regarding clinical and laboratory features, diagnostic implications, management, outcomes, and comorbid conditions to raise awareness among healthcare providers and aid in proper care provision.

Methods: Recently, a few cases of an unusual association between both diseases have been reported. PubMed, Scopus, and Web of Science were searched from inception until May 2024 to identify eligible studies. After the screening and data extraction, 20 studies with 42 cases suffering from ALS and MG were included.

Results: Forty-two cases were categorized into four groups as follows: the first group had 26 cases with MG onset (age range 26-82 years) preceding ALS (age range 46-83 years). The second group had 9 cases with ALS onset (age range 34-89 years) preceding MG (age range 40-89 years). The third group comprised 5 cases of ALS with positive acetylcholine receptor antibodies but without clinical manifestations of MG. The fourth group involved 2 cases of ALS with initial ocular symptoms that were unresponsive to MG treatments.

Conclusion: The onset of new ptosis or diplopia in ALS patients should prompt clinicians to consider the possibility of a coexisting condition or alternative diagnosis. Additionally, positive acetylcholine receptor antibodies alone are insufficient to diagnose MG if ALS coexists. In patients with ALS, repetitive nerve stimulation tests may be less sensitive for detecting MG. Thus, diagnosing MG in ALS patients should rely on clinical presentation and response to empirical treatment.

Background: Medications exhibiting serotonergic properties, such as selective serotonin reuptake inhibitors (SSRIs) antidepressants, opioids, and other antidepressants can induce serotonin syndrome, a rare but potentially life-threatening adverse event.

Aim: This study aims to investigate the risks of serotonin syndrome among different SSRIs and assess the influence of drug-drug interactions with other medications.

Methods: We analyzed the suspected adverse events in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database.

Results: We identified 13,312 reports of serotonin syndrome, 52% of which involved SSRIs (n = 6,921), with reporting odds ratios (RORs) of 24.19. Among the safety reports involving SSRIs, 4,851 cases reported at least one severe outcome. All active substances of the SSRI group were associated with serotonin syndrome, sertraline, and fluoxetine had the most reports, while fluvoxamine had the highest ROR and risk compared to all other SSRIs (ROR: 2.66, 95% confidence interval: 2.33-3.05). The combinations of SSRIs with other drugs with the most reported cases were SSRIs-antidepressants (n = 2,395) and SSRIs-opioids (n = 2,252). The combinations of SSRIs with serotonin-norepinephrine reuptake inhibitors (ROR 25.42) and "other antidepressants" (ROR 22.74) were associated with a signal for serotonin syndrome. The combination SSRIs-opioids was associated with a safety signal, particularly those with higher risk for serotonin syndrome, like tramadol and fentanyl (ROR 41.95).

Conclusion: Close monitoring for symptoms of serotonin syndrome should be considered in patients with depression with a combination of antidepressants, and in those on SSRIs who also require linezolid, monoamine oxidase inhibitors or high-risk opioids, like tramadol, or fentanyl.

Objective: Cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are distinct disorders with different pathophysiologic pathways, but they share similar clinical presentations that could lead to misdiagnosis and inappropriate therapeutic decisions.

Methods: We searched PubMed and Google Scholar databases and other relevant literature to retrieve comparative studies including CS and ARVC that were published before 2024. The National Heart, Lung and Blood Institute checklist was used for quality assessment and the review was conducted according to the PRISMA guidelines. Three reviewers determined study eligibility and made quality assessments.

Results: A total of seven studies were included in the review. Patients with CS were older (five of seven studies) and had more comorbidities (two of two studies). PR interval (four of five studies) and QRS duration (four of four studies) were longer in CS. Most studies reported lower left ventricular ejection fraction in CS (five of six studies), and septal involvement on cardiac MRI was more common in CS (two of three studies). 18-Fluorodeoxyglucose uptake on positron emission tomography (PET) scan was seen in up to 90% of CS patients. 62.5%-100% of patients with CS fulfilled 1994 or 2010 International Task Force criteria for ARVC.

Conclusions: Available evidence suggests that atrioventricular and intraventricular conduction defects in an older (>40 years) patient with low left ventricular ejection fraction should raise suspicion for CS, especially when other supportive findings, such as 18-fluorodeoxyglucose avidity on PET, were present. Neither 1994 nor 2010 ARVC Task Force criteria should be used to discriminate CS from ARVC.