Medical Principles and Practice最新文献

Bronchopulmonary dysplasia (BPD) is a chronic lung disease, with its own clinical, radiological, and histopathological characteristics, which mainly affects premature newborns (NBs), resulting from a combination of factors that include immaturity, inflammation, and lung injury, in addition to therapy with mechanical ventilation and exposure to high concentrations of oxygen. However, even with advances in care for critically ill NBs, BPD continues to be a challenge for the care team and family members. This has been identified as one of the most important causes of morbidity and mortality due to prematurity and can have significant impacts on the quality of life of the affected patients. While interactions between the risk factors associated with BPD characterize it as multifactorial, its real pathogenesis still remains uncertain, as some NBs, despite having similar risk factors, do not develop it, suggesting, therefore, that susceptibility to BPD is genetically determined. Genetic variants in the glutathione S-transferase Mu-1/glutathione S-transferase theta-1-null (GSTM1/GSTT1) genes may be associated with a greater risk of developing BPD in premature NBs, as they affect the function of glutathione S-transferases (GSTs) enzymes and, consequently, the body's ability to eliminate toxic or harmful pro-inflammatory substances. GSTM1/GSTT1-null individuals, due to the absence of gene expression, present loss of enzymatic activity of the respective GST enzymes, triggering failures in the detoxification process and the consequent development of numerous diseases resulting from oxidative damage such as infertility, chronic kidney disease, eryptosis, retinopathy of prematurity, necrotizing enterocolitis, periventricular leukomalacia, intraventricular hemorrhage. The objective of this narrative review was to highlight the role of genetic variants in the GSTM1/GSTT1 genes in the onset of BPD.

Introduction: Leg ulcer is the most common cutaneous manifestation of sickle cell disease (SCD). Asymmetric dimethylarginine (ADMA) inhibits nitric oxide synthase, reducing nitric oxide availability, and causing endothelial dysfunction. This study examined the relationship between arginine/ADMA ratio and leg ulcers in SCD.

Methods: This was a cross-sectional analytical study of 90 adult subjects including 30 "HbS only" with leg ulcer, 30 "HbS only" without leg ulcer and 30 HbAA subjects. Plasma arginine and ADMA levels were measured by ELISA method.

Results: Median arginine level, ADMA level, and arginine/ADMA ratio were 21.05 µmol/L, 3.0 µmol/L, and 7.41, respectively, for HbS-only with leg ulcer; 25.9 µmol/L, 2.8 µmol/L, and 9.6, respectively, for HbS-only without leg ulcer; and 47.8 µmol/L, 1.0 µmol/L (CI: 1.0-1.2), and 48.5, respectively, for HbAA subjects. Median plasma l-arginine level was significantly lower in HbS with leg ulcer compared to HbS without leg ulcer (p < 0.001) and HbAA subjects (p < 0.001). Conversely, median plasma ADMA level was significantly higher in HbS-only with leg ulcer compared to HbS without leg ulcer (p = 0.002), and HbAA subjects (p < 0.001). Median arginine/ADMA ratio was significantly lower in HbS-only patients with leg ulcer.

Conclusion: The HbS-only patients with leg ulcers have lower arginine, higher ADMA, and lower arginine/ADMA ratio when compared to those without leg ulcers and HbAA controls. The prospective arginine/ADMA ratio should be studied to screen patients with higher risks of leg ulcers that could be prevented with specifically targeted care.

Objective: The problem of hospital cross-infection due to contamination of disinfectants has been recognized elsewhere. The passage of bacteria through diluted disinfectants may not only bring about phenotypic changes in their antibiograms but also changes in phage susceptibility patterns. Contact with disinfectants in sublethal concentrations allows survival and multiplication of bacteria.

Methods and materials: Serial passage, through disinfectants at subminimal inhibitory concentrations, induced antibiotic resistance in 18% of derived phenotypic variants of fifty strains of Pseudomonas aeruginosa which were isolated from diarrheal stools of infants in children's hospital.

Results: A proportion of these strains became susceptible to an increased number of antibiotics. The present study revealed that all the isolates were resistant to tetracycline and carbenicillin and 40% of these isolates became sensitive to both antibiotics after exposure to disinfectants. The exposure to disinfectants induced neomycin resistance among two isolates. The resistance patterns were three before disinfectants exposure which increased to be nine different patterns after exposure. No antibiotic resistance was transferred between P. aeruginosa and Escherichia coli K12 as a recipient strain.

Conclusions: Almost 50% of the isolates tested became sensitive to tetracycline, carbenicillin and co-trimoxazole after exposure to disinfectants. The resistance patterns among the 50 isolates were three which changed to be nine different patterns after exposure to disinfectants. Unjustifiable use of disinfectants might give a chance for survival and multiplication of pathogenic bacteria to develop new resistance patterns to antibiotics in use with a short time. These new resistance variants of bacteria which multiply in hospital environment could lead to serious epidemic conflicts particularly the epidemiological reporting and management.

Objective: The problem of hospital cross-infection due to contamination of disinfectants has been recognized elsewhere. The passage of bacteria through diluted disinfectants may not only bring about phenotypic changes in their antibiograms but also changes in phage susceptibility patterns. Contact with disinfectants in sublethal concentrations allows survival and multiplication of bacteria.

Methods and materials: Serial passage, through disinfectants at subminimal inhibitory concentrations, induced antibiotic resistance in 18% of derived phenotypic variants of fifty strains of Pseudomonas aeruginosa which were isolated from diarrheal stools of infants in children's hospital.

Results: A proportion of these strains became susceptible to an increased number of antibiotics. The present study revealed that all the isolates were resistant to tetracycline and carbenicillin and 40% of these isolate

Objective: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients.

Methods: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements.

Results: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects.

Conclusion: Study shows that inhaled aviptadil is well tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia.

Objective: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery, and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients.

Methods: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements.

Results: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years, and 27 of them (33.8%) were female. The average time to discharge was 7.8 ± 4.0 days in aviptadil group and 10 ± 5.0 days in placebo (p = 0.049). Modified Borg scales were not statistically different on day 3 (p = 0.090), but significantly lower in the aviptadil group on day 7 (p = 0.033). The CT lung damage score was not different on day 1 for both groups (p = 0.962); improvement on day 28 was significantly

Although coronavirus disease 2019 (COVID-19) vaccines exhibit diverse side effects, taste and saliva secretory disorders have remained poorly understood despite their negative impact on the overall quality of life. The present study aimed to characterize oral adverse effects following COVID-19 vaccination and assess their similarities with oral symptoms in COVID-19 patients. A literature search was conducted in databases, including PubMed, LitCovid, and Google Scholar, to retrieve relevant studies. The narrative review indicated that a certain number of vaccinated people develop ageusia, dysgeusia, hypogeusia, xerostomia, and dry mouth, while they are rare compared with COVID-19 oral symptoms. The prevalence of oral adverse effects varies by country/region and such geographical differences may be related to the type of vaccine used. Similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 vaccination adversely affects taste perception and salivary secretion in females and older subjects more frequently than in males and younger subjects. Their impairments mostly appear within 3 days of vaccination, and bitter taste is specifically impaired in some cases. Considering that oral adverse effects following COVID-19 vaccination share some characteristics with oral symptoms in COVID-19 patients, it is speculated that the spike protein derived from COVID-19 vaccination and SARS-CoV-2 infection may be pathophysiologically responsible for taste and saliva secretory disorders. This is because such spike protein has the potential to interact with ACE2 expressed on the relevant cells, produce proinflammatory cytokines, and form antiphospholipid antibodies. Our results do not deny the advantages of COVID-19 vaccination, but attention should be paid to post-vaccination oral effects in addition to COVID-19 oral symptoms. Although coronavirus disease 2019 (COVID-19) vaccines exhibit diverse side effects, taste and saliva secretory disorders have remained poorly understood despite their negative impact on the overall quality of life. The present study aimed to characterize oral adverse effects following COVID-19 vaccination and assess their similarities with oral symptoms in COVID-19 patients. A literature search was conducted in databases, including PubMed, LitCovid, and Google Scholar, to retrieve relevant studies. The narrative review indicated that a certain number of vaccinated people develop ageusia, dysgeusia, hypogeusia, xerostomia, and dry mouth, while they are rare compared with COVID-19 oral symptoms. The prevalence of oral adverse effects varies by country/region and such geographical differences may be related to the type of vaccine used. Similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 vaccination adversely affects taste perception and salivary secretion in females and older subjects more frequently than in males and younger subjects. Their impairments mostly appear w

Objectives: Inflammatory bowel diseases which are characterized by endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR) signaling pathway are commonly treated with 5-amino salicylic acid (5-ASA). The objective of this study was to investigate the role of 5-amino salicylic acid in the UPR-signaling pathway in experimental colitis.

Materials and methods: Colitis was induced in male Sprague-Dawley rats by intrarectal instillation of trinitrobenzene sulfonic acid. Animals received 5-amino salicylic acid (100 mg/kg body weight) 2 h before the induction of colitis and repeated daily until day 7. The animals were sacrificed on day 7 and tissues were collected for analysis.

Results: The expression of protein kinase R (PKR)-like ER kinase (PERK), a mediator of UPR signaling increased significantly (p < 0.05), while inositol-requiring enzyme type-1 (IRE1) and the CCAAT/enhancer-binding homologous protein (CHOP) remained unaltered in the inflamed colon. The expression of glucose-regulated protein-78, activator of transcription factor-4, and phosphorylated-eukaryotic initiation factor-2α (eIF2αP) increased (p < 0.05) in the inflamed colon. However, the levels of eIF2α protein and mRNA expression remained unchanged. Myeloperoxidase activity, colon weight, and infiltration of inflammatory cells increased significantly (p < 0.05) in the submucosa whereas the body weight decreased. These changes were significantly inhibited by 5-amino salicylate treatment.

Conclusion: These findings suggest that the anti-inflammatory properties of 5-amino salicylic acid are mediated through the inhibition of the PERK signaling pathway.

Objectives: Inflammatory bowel diseases which are characterized by endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR) signaling pathway are commonly treated with 5-amino salicylic acid (5-ASA). The objective of this study was to investigate the role of 5-amino salicylic acid in the UPR-signaling pathway in experimental colitis.

Materials and methods: Colitis was induced in male Sprague-Dawley rats by intrarectal instillation of trinitrobenzene sulfonic acid. Animals received 5-amino salicylic acid (100 mg/kg body weight) 2 h before the induction of colitis and repeated daily until day 7. The animals were sacrificed on day 7 and tissues were collected for analysis.

Results: The expression of protein kinase R (PKR)-like ER kinase (PERK), a mediator of UPR signaling increased significantly (p < 0.05), while inositol-requiring enzyme type-1 (IRE1) and the CCAAT/enhancer-binding homologous protein (CHOP) remained unaltered in the inflamed colon. The expression of glucose-regulated protein-78, activator of transcription factor-4, and phosphorylated-eukaryotic initiation factor-2α (eIF2αP) increased (p < 0.05) in the inflamed co

Objective: Cardiac catheterization using the distal radial artery (DRA) access, at the level of the anatomical snuff box post-radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemostasis. In this meta-analysis, we compare DRA versus proximal radial artery (PRA) access in cardiac catheterization or angiography.

Methods: A detailed literature search was performed on PubMed, Cochrane, Embase, and Clinicaltrials.gov from inception till June 2024. Risk ratios (RRs) and mean differences (MDs) were pooled for categorical and continuous outcomes, respectively. Random effects meta-analysis was undertaken on RevMan.

Results: Our meta-analyses include 21 randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778). DRA significantly reduced 24-h radial artery occlusion rates (RR 0.30, 95% CI: 0.23 to 0.40, p ≤ 0.00001) and time to hemostasis (minutes) (MD -44.46, 95% CI: -50.64 to -38.92, p < 0.00001), whereas PRA was significantly superior in terms of the puncture success rate (RR 0.96, 95% CI: 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI: 2.02 to 4.15, p < 0.00001), and puncture attempts (MD 0.69, 95% CI: 0.37 to 1.00, p = 0.00001).

Conclusion: DRA was associated with a lower risk of occlusion and lower time to hemostasis, but required a greater number of puncture attempts and had lower success rate. Further research is required to elucidate the most optimal approach.

Oral health is vital to overall well-being but faces significant global challenges, necessitating reform in dental education. Global oral health education empowers professionals to address these issues, promoting global competencies,s and preventive approaches. The objective was to map scientific articles that approach global oral health education, its practical reality, and curricular inclusion in undergraduate dental programs. This study is a scoping review following the Joanna Briggs Institute's approach, with searches in databases such as PubMed and SciELO using the keywords "global health" and "education, dental," along with the Boolean operator AND. After excluding studies outside of the scope of the research and duplicate articles, 26 articles were selected for analysis. Among the analyzed articles, the need to further discuss the following topics was observed: trends and challenges in global dental education, oral health inequalities and the need for global approaches, and the integrating global health into the dental curriculum. The reviewed studies highlight the importance of adapting curricula to global needs, emphasizing the integration of oral health into global health policies and the promotion of interprofessional competencies. The review underscores the need to internationalize dental education and prepare future dentists to address oral health inequalities, with global partnerships and interprofessional collaboration being essential for the success of these initiatives. The conclusion shows that global oral health education should include preventive and interdisciplinary approaches, preparing professionals for global challenges. This requires integrating global health competencies into curricula and promoting international collaborations in dental education.

Xenotransplantation represents a transformative solution to the global organ shortage, leveraging advances in genetic engineering, immunosuppression, and biosecurity. This review explores groundbreaking innovations such as CRISPR-Cas9 and multigene editing, which have redefined immunogenicity reduction and significantly enhanced the graft survival. Key breakthroughs, including the incorporation of human complement-regulatory proteins and α-Gal knockout strategies, have propelled xenotransplantation closer to clinical application. Ethical considerations, such as zoonotic risks and patient selection criteria, are discussed alongside international regulatory efforts to standardize safety protocols. This manuscript uniquely highlights recent preclinical and clinical achievements, such as successful pig-to-human kidney and heart transplants, which underscore the field's potential for clinical translation. By addressing current challenges, such as long-term graft viability and societal acceptance, xenotransplantation is poised to bridge critical gaps in transplantation medicine. Future directions emphasize the integration of innovative technologies and collaborative frameworks to advance clinical applications responsibly.