Medical Principles and Practice最新文献

Objectives: Recurrence of Takotsubo syndrome (TTS) has been reported with a rate up to 4%. The effect of TTS recurrence on clinical outcomes has not been in the focus of studies so far.

Methods: In our study, we enrolled 435 patients with TTS, of whom 14 patients had a recurrence. The inclusion interval for the index event was from 2015 to 2022, and patients were followed to categorize them in the group of TTS with or without the recurrence. TTS recurrences were registered until June 2024. Blood samples, data on clinical presentation, precipitating factors, cardiovascular risk factors, medications, demographics, echocardiographic and electrocardiographic parameters were obtained. The 30-day cardiovascular mortality (CV), the 30-day mortality, and arrhythmia during hospitalization were evaluated.

Results: Comorbidities, ECG changes, premedication, and symptoms were not significantly different between TTS patients with and without recurrence. Only the index left ventricular ejection fraction (LVEF) of TTS patients with recurrence was significantly decreased (p = 0.046). In the case of outcome parameters, TTS patients with recurrence had a significantly, higher 30-day CV mortality compared to those without recurrence (21.4% vs. 3.8%, p = 0.001) with a 5.9-fold higher 30-day CV mortality (B(SE) = 1.94 (0.70), p = 0.001).

Conclusion: In our study, the TTS recurrence was associated with 5.9-fold higher 30-day CV mortality. Therefore, a more precise monitoring is necessary in this high-risk group. Whether only the reduced LVEF is responsible for the increased 30-day CV mortality is an open issue and more factors can be assumed to play a role.

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

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.

Objective: We investigated the relationship between D-dimer levels and long-term major adverse cardiovascular events (MACEs) in masked hypertension patients admitted to the cardiology outpatient clinic.

Methods: A total of 512 masked hypertension patients with a median 6 years of follow-up data who underwent serum D-dimer measurement in the hypertension outpatient clinic between April 2014 and June 2016 were retrospectively enrolled. The patients were stratified according to their D-dimer levels and were then divided into tertiles. Clinical outcomes were assessed for MACEs, which were defined as all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke.

Results: The long-term incidence of MACE in masked hypertension patients was higher in the highest tertile of D-dimer. In multivariable analysis, D-dimer was an independent predictor of long-term MACE in masked hypertensive patients (OR: 1.006 [1.004-1.007]; p < 0.001). Compared to the lowest tertile, MACE was approximately 3 times higher in tertile 2 and approximately 10.5 times higher in the highest tertile. In addition, MACE was approximately 3.5 times more common in tertile 3 than in tertile 2. D-dimer was able to predict MACE in patients with masked hypertension (AUC for MACE 0.778; 95% CI: 0.724-0.832; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan-Meier curve showing follow-up without MACE (MACE free) according to the D-dimer cutoff value, the long-term incidence of MACE was significantly higher in the high D-dimer group (p < 0.001).

Conclusions: D-dimer levels in patients with masked hypertension showed a significant association with increased long-term risk of MACE in this study.

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.

Objective: This study analysed the prevalence of hypertension and its associated risk factors in Czech adults aged 25-64 using data from the 2019 European Health Examination Survey (EHES). Given the limited number of large-scale studies in Central Europe, this study provides crucial evidence to inform public health strategies. Examining gender differences and applying updated control thresholds, it provides valuable insights into hypertension management in Czechia.

Subject and methods: We conducted a cross-sectional analysis using EHES 2019 data. Participants underwent a medical examination assessing cardiovascular health, including blood pressure and blood tests. A total of 1,056 participants were included, aged 25-64 years (mean age of 44.4 ± 0.73) years and with a mean BMI of 27.6 ± 0.35 kg/m2. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure (mean of the second and the third measurements, 1 min apart) ≥140/90 mm Hg and/or current antihypertensive treatment. Awareness was determined by self-reporting prior diagnosis. Control was assessed as blood pressure <130/80 mm Hg (control 1) or <140/90 mm Hg (control 2).

Results: Hypertension prevalence was 36.3%, with higher rates in males (46.0%) than in females (26.3%, p < 0.001). Awareness was 64.8% greater in females (72.0% vs. 60.9%, p = 0.027). Treatment was received by 47.6% of hypertensives, more by women (57.7% vs. 42.0%, p < 0.001). Control rates were 10.4% (control 1) and 49.4% (control 2).

Conclusion: Hypertension is common in Czech adults, with gender differences in prevalence, awareness, and treatment. Despite high awareness, treatment and control remain suboptimal, indicating the need for targeted interventions.