SAGE Open Medicine最新文献

Objective: We aimed to find an optimal cut-off time for percutaneous nephrolithotomy to prevent complications.

Methods: This study enrolled 165 patients aged 18-80 with renal stones ⩾2 cm or ⩾1 cm in lower pole, confirmed via noncontrast computed tomography. Baseline characteristics, stone features, operation time, and anesthesia time were recorded. Logistic regression models were fitted and the ability of the surgery time to predict complications, major complications, and systemic inflammatory response syndrome was evaluated using receiver-operating characteristic curves. Area under the receiver-operating characteristic curve analysis was used as a general indicator of quality.

Results: Out of 165 enrolled patients, 157 were analyzed (8 excluded due to follow-up and surgery data issues). The cohort consisted of 115 males (73.2%) and 42 females (26.7%), with a mean (SD) age of 47.4 (12.65) years. Multivariate analysis indicated that longer operation times and lower body mass index correlated with higher complication rates. A cut-off of 65 min for operation time showed 96.8% specificity for predicting complications. Additionally, 47.8% of patients were systemic inflammatory response syndrome positive postprocedure, and operation times were not shown to be predictive of systemic inflammatory response syndrome.

Conclusion: Operation time seemed to be a potential risk factor for postpercutaneous nephrolithotomy complications and lowering the operation time could prevent postoperative complications.

Background: Sleep is a multifaceted phenomenon influenced by both duration and quality. Various sleep disturbances have been associated with mild cognitive impairment, but the role of specific disturbances in mild cognitive impairment pathophysiology remains unclear. This study investigated the associations between distinct sleep disturbances and mild cognitive impairment in adults aged 50 and older using nationally representative data.

Methods: Longitudinal data from the Health and Retirement Study were analyzed to explore the association between mild cognitive impairment and three types of sleep disturbances: trouble falling asleep, trouble waking up, and waking up too early. Logistic regression models estimated unadjusted (Model 1) and adjusted associations accounting for sex, race/ethnicity, age, social determinants of health (Model 2), general health (Model 3), depression (Model 4), and pain and physical activity (Model 5).

Results: The study cohort included 8877 participants aged ⩾50 years in 2018 (baseline) who were followed up in 2020. Overall, 15.4% reported trouble falling asleep, 23.2% reported trouble waking up, and 12.8% reported waking up too early and being unable to fall back asleep most of the time. Among older adults, approximately 13.1% reported experiencing mild cognitive impairment; The prevalence of mild cognitive impairment was even higher in those who experienced sleep disturbances. The unadjusted odds ratio (uOR) for experiencing trouble falling asleep most of the time was 1.69 (95% CI: 1.42-2.03), for trouble waking up most of the time was 1.31 (95% CI: 1.10-1.57), and for waking up early most of the time was 1.88 (95% CI: 1.51-2.35). However, these positive associations attenuated depending on the covariate adjustment.

Conclusions: Nearly one in seven adults had mild cognitive impairment. The relationship between sleep disturbances and mild cognitive impairment has been challenging to delineate. Our findings demonstrate a positive association between sleep disturbances and mild cognitive impairment, although these associations were sensitive to covariate adjustments. These findings suggest multifaceted pathways for reducing the risk of mild cognitive impairment.

Aim/objective: To evaluate the impact of an m-health training program on nurses' knowledge, attitudes, and practices concerning antimicrobial resistance within hemodialysis units.

Background: Hemodialysis patients face high infection risks, driving antimicrobial use and resistance. Nurses' antimicrobial resistance knowledge gaps underscore the need for effective training.

Design: A parallel group randomized controlled trial.

Methods: A convenience sample of 64 nurses was cluster-randomized into either an m-health group (n = 32) or a control group (n = 32). The m-health group received antimicrobial resistance education through a WhatsApp Chatbot, while the control group received no information on the study topic. However, they were provided the study intervention after the evaluation was completed. The nurses' knowledge, attitudes, and practices regarding antimicrobial resistance were assessed with self-developed instruments at three time points: Baseline (Time 1), immediately after the intervention (Time 2), and 1 month later (Time 3).

Results: Repeated-measures Analysis of Variance (ANOVA) (within-subject) tests indicated significant differences in mean scores for antimicrobial resistance knowledge, attitudes, and practices across the three time points in the m-health group. The repeated-measures ANOVA (mixed model) tests revealed significant interaction effects in antimicrobial resistance knowledge, attitudes, and practice.

Conclusions: m-Health training program significantly enhanced dialysis nurses' knowledge, attitudes, and practice toward antimicrobial resistance. It is recommended to communicate the findings of this study to managers and policymakers to equip them with the information needed to develop and implement effective strategies, policies, and multidisciplinary interventions aimed at reducing antimicrobial resistance in hemodialysis units.

Objectives: Pneumonia is a common perioperative complication in geriatric patients with hip fractures. This study aimed to analyze demographic characteristics, mortality rates, postoperative outcomes, and perioperative comorbidities, identify risk factors for mortality, and develop a nomogram for predicting the prognosis of these patients.

Methods: Data on patients hospitalized for arthroplasty for hip fractures from 2020 to 2023 at three hospitals were retrospectively analyzed. Patients were divided into the P group (patients with hip fractures complicated with pneumonia) and the C group (patients with hip fractures without pneumonia) and demographic characteristics, mortality, postoperative outcomes, and perioperative comorbidities of the patients were analyzed. Multiple logistic regression was then used to identify independent risk factors for inpatient mortality in the P group and a nomogram was constructed to predict inpatient mortality. The predictive performance of the nomogram was assessed using receiver operating characteristic curves, decision curve analysis, and calibration curves.

Results: A total of 311 patients participated in the study. Patients in the P group had longer hospitalization (p = 0.001), higher inpatient mortality (p < 0.001), higher mortality (30 days) (p < 0.001), and a poorer recovery of hip function (p < 0.001). Multiple logistic regression showed that age, BMI, total hip arthroplasty, diabetes, and chronic obstructive pulmonary disease were independent risk factors for inpatient mortality in the P group; these factors were incorporated in the nomogram. The C-index of the nomogram was 0.868 (95% CI: 0.802-0.933), and the C-index of internal bootstrapping validation was 0.851 (95% CI: 0.793-0.908), indicating the effectiveness of the nomogram in predicting patient prognosis.

Conclusions: Coinfection with pneumonia adversely affected both recovery of hip function and survival in geriatric patients with hip fractures. Age, BMI, total hip arthroplasty, diabetes, and chronic obstructive pulmonary disease were found to be independent risk factors for mortality in this patient population.

Background: Bursitis iliopectinea (BI) is a condition that is characterized by swelling of the iliopsoas bursa, leading to compression of inguinal neurovascular structures, causing swelling, pain, paresthesia, or thrombosis of the leg.

Questions: Due to the rare occurrence of BI, the available literature consists of case reports. Our study aims to systematically review the literature for a comprehensive analysis of the etiology, treatment modalities, and clinical outcomes of patients with BI.

Methods: We systematically analyzed 217 studies with 502 cases of BI and extracted information about the terminology, risk factors, diagnostic and treatment strategies, association with neurovascular compression syndromes, treatment outcomes, and recurrence rates.

Results: The overall quality of the analyzed studies was moderate to good. The terminology uses for BI was heterogeneous and included ganglion, tumor, mass, and bursitis. In addition to conventional X-ray, ultrasound, CT, or MRI were used to diagnose BI. The most prevalent etiology of BI was osteoarthritis of the hip or wear-related soft-tissue reactions after total hip replacement (THA). Nearly one-third of the patients suffered from compression syndromes, most frequently of the femoral vein (16%). Only rheumatoid arthritis showed an association with the occurrence of compression syndromes. The most common operative treatments were the resection of the bursa (30%), total hip arthroplasty (29%), and aspiration (24%). Use of analgesics (17%), injection of corticoids (11%), and physiotherapy (9%) were used for conservative treatments. The recurrence rate was highest after physiotherapy (OR: 4.1) or aspiration (4.5) and lowest after THA (OR: 0.2).

Conclusions: Although BI is a condition commonly associated with hip arthritis or local tissue reactions following total hip prosthesis, its impact extends beyond typical hip-related symptoms. Notably, BI related to rheumatoid arthritis shows a high correlation with neurovascular compression symptoms, with femoral vein compression being the most frequently reported. This underscores the necessity of considering BI in patients presenting with nonspecific inguinal pain or neurovascular symptoms of the lower extremity. Additionally, standardizing the nomenclature of BI nomenclature could improve future research.

Objectives: To explore the impact of obesity on clinical outcomes, health-related quality of life, emotional well-being, and work productivity in people/patients with obesity across six countries by body mass index and the presence of complications.

Methods: Adelphi Real World Obesity Disease Specific Programme™ captured data related to physicians and their consulting people/patients with obesity on a weight management program or anti-obesity medication in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia, and the United Arab Emirates from April to December 2022. Physicians reported data for up to eight qualifying people/patients with obesity. People/patients with obesity voluntarily completed outcome measures: 36-Item Short Form Health Survey, emotional well-being, and Work Productivity and Activity Impairment.

Results: Of 1506 people/patients with obesity, 58% were female (mean ± standard deviation age: 41 ± 12.7 years; body mass index: 32.3 kg/m² ± 7.7 kg/m²). Overall, 82% had ⩾1 complication (median and interquartile range: 2.0 (1.0-3.0)). People/patients with obesity struggled with weight for a mean ± SD of 64.1 ± 86.6 months with a median (interquartile range) of 3.0 (2.0-5.0) weight-loss attempts. Mean ± standard deviation 36-Item Short Form Health Survey scores for people/patients with obesity above the obesity threshold showed impairment in general health (42.3 ± 11.5), social functioning (44.3 ± 9.2), role-emotional (46.0 ± 9.3), and mental health (45.7 ± 9.6). People/patients with obesity with complications showed similar impairment. People/patients with obesity reported bother/embarrassment about their weight, with 72% worried about future weight gain. Work productivity and activity impairment scores among people/patients with obesity above the obesity threshold showed impairment in activity (36%), overall work (34%), and presenteeism (31%). Findings were similar for people/patients with obesity with complications.

Conclusion: Results suggest that obesity alongside the presence of complications negatively impacts health-related quality of life, emotional well-being, and work productivity, reinforcing the need for comprehensive interventions for this complex health issue.

Objective: Bacterial extracts have been used for many years to prevent airway infections. Recent findings suggest that immunity can be trained by inducing an immunological memory in both the innate and acquired immune response. This real-life observational study investigated the potential of sublingual bacterial immunotherapy in the prevention of ear, nose, and throat infections.

Methods: Patients received sublingual bacterial immunotherapy for 12 months and were followed for 24 months. The number of ear, nose, and throat infection episodes from the previous year was recorded during the initial visit based on the patient's clinical history. Patients were then followed up with visits every 2 months, and the occurrence of ear, nose, and throat infection episodes was documented at 6, 12, 18, and 24 months after the start of the study.

Results: The results demonstrated a strong potential for preventing ear, nose, and throat infections, with a reduction in the number of episodes by 75.68%, 82.27%, 82.78%, and 89.88% at 6, 12, 18, and 24 months, respectively. No adverse effects related to sublingual bacterial immunotherapy administration were reported.

Conclusion: The results suggested that long-term sublingual bacterial immunotherapy is safe and effectively prevents ear, nose, and throat infections, even after treatment ends.

Objective: This study utilized a sample of trangender, nonbinary, and gender-diverse (TGD) patients to build on emerging literature that suggests that hypermobile Ehlers-Danlos syndrome may be overrepresented in TGD populations. The objective of this retrospective chart review was to determine the prevalence of hypermobile Ehlers-Danlos syndrome syndrome at a gender-affirming primary care clinic.

Methods: A retrospective chart review of medical records was conducted with records between May 2021 and June 2024. Eligible participants were active patients at the gender-affirming primary care clinic, who were over the age of 16, were TGD, and had a diagnosis of hypermobile Ehlers-Danlos syndrome. Of 2180 patients over the age of 16, 59 patients met the criteria. The primary outcome was the prevalence of hypermobile Ehlers-Danlos syndrome in the sample, summarized by frequency and percentage. Secondary outcomes were the prevalence of associated clinical features within the sample of TGD patients with hypermobile Ehlers-Danlos syndrome.

Results: The prevalence of hypermobile Ehlers-Danlos syndrome syndrome was 2.7%. Within the sample of patients with hypermobile Ehlers-Danlos syndrome, 81.4% were found to have diagnoses of anxiety, depression, or attention deficit hyperactivity disorder, 50.8% had a history of migraines or dysautonomia, 39.0% had a history of gastroesophageal reflux disease, irritable bowel syndrome, nausea, diarrhea, or gastroparesis, 16.9% had history of mast cell activation disorder, 32.2% had postural orthostatic tachycardia syndrome, 30.5% had dysmenorrhea, 83.1% reported chronic pain, and 44.1% reported chronic fatigue.

Conclusions: We found that 2.7% of the 2180 patients had a diagnosis of hypermobile Ehlers-Danlos syndrome syndrome. The sample had notably high rates of medical comorbidities as well as anxiety, depression, or attention deficit hyperactivity disorder, consistent with emerging research. The results support the intersecting psychological and healthcare vulnerabilities of TGD patients with hypermobile Ehlers-Danlos syndrome. Further research in this intersection could support mitigation of health care disparities that affect TGD patients with hypermobile Ehlers-Danlos syndrome syndrome.

Background: To investigate the trends in Burkitt lymphoma incidence, mortality, and disability-adjusted life-years, considering sex and age, from 1990 to 2021, with a 20-year forecast.

Method: Data regarding Burkitt lymphoma were extracted from the Global Burden of Disease study for the year 2021.

Results: Globally, there were 19,072 incident cases of Burkitt lymphoma in 2021. Cases of Burkitt lymphoma experienced a 207% increase from 1990 to 2021. Over three decades, Burkitt lymphoma-associated deaths rose from 3843 to 6525. The global incidence rate of Burkitt lymphoma increased from 0.127 in 1990 to 0.236 in 2021 per 100,000 population. High body-mass indexes contribution to Burkitt lymphoma is evident in the disability-adjusted life-years, with the United States and the United Kingdom recording 0.06 and 0.05, respectively. Conversely, China and India demonstrated substantially lower contributions, at 0.02 and 0.005, respectively. The groups aged 0-14 and 50-74 years surpassed other age groups in both Burkitt lymphoma-associated incidence and death numbers. Moreover, males consistently had higher Burkitt lymphoma-associated mortality rates and numbers than females in all age groups. Furthermore, the estimated annual percentage changes of incidence with Burkitt lymphoma were positively correlated with sociodemographic index (Pearson r = 0.606; p = 0.003). The Bayesian age-period-cohort model predicts a significant increase in the age-standardized incidence rates of Burkitt lymphoma over the next 20 years. Interestingly, the age-standardized rates of death did not change dramatically from 1990 to 2021; and the trend is expected to remain relatively stable in the future 20 years.

Conclusion: The burden of Burkitt lymphoma varies according to different regions and genders, and children of 0-14 years, adults of 50-74 years with Burkitt lymphoma disease as well as male patients need special attention. High body-mass index contributes significantly to Burkitt lymphoma burden in the United States and United Kingdom, but less so in China and India. Hopefully, this study will help optimize the prevention, diagnosis, treatment, and management of Burkitt lymphoma to reduce the disease burden.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide, and although it is primarily a respiratory illness, gastrointestinal symptoms have been reported in a significant proportion of patients.

Aim: Prevalence of gastrointestinal symptoms after recovery from COVID-19.

Methodology: A community-based cross-sectional study was conducted in the Aseer region of Saudi Arabia. The study population included individuals aged 18 years or older with COVID-19 and living in the Aseer region. The data were collected through a pretested, structured online questionnaire preceded by consent and were used to maintain the confidentiality of the data. The questionnaire covered participants' data, COVID-19 infection status, and gastrointestinal tract symptoms during and after recovery from the infection.

Results: A total of 409 participants in the Aseer region completed the study survey. The participants' ages ranged from 18 to more than 50 years, with a mean age of 34.5 ± 11.9 years. A total of 205 (50.1%) participants were females. A total of 263 (64.3%) of the study participants experienced gastrointestinal tract symptoms during COVID-19 infection. Additionally, 203 (49.6%) of the study participants had gastrointestinal tract symptoms after recovering from COVID-19 infection. The most commonly reported symptoms were diarrhea (13.2%), nausea (13.2%), anorexia (12.7%), abdominal pain (11%), and constipation. Male sex who suffered form severe COVID-19 infection, and gastrointestinal tract symptoms during acute infection were significantly associated with post-COVID-19 gastrointestinal tract symptoms (p < 0.05).

Conclusions: In conclusion, the current study showed that nearly two-thirds of active COVID-19 patients experienced gastrointestinal tract symptoms. Additionally, approximately half of the COVID-19 patients who recovered had gastrointestinal tract-related symptoms, but few of those patients had gastrointestinal tract-related symptoms within 1 week.