SAGE Open Medicine最新文献

Objective: Overweight and obesity are highly prevalent in Saudi Arabia, likely due to a combination of poor dietary choices and sedentary lifestyles. Young Saudi females face increasing societal pressure related to family life and higher education. Previous studies suggest that the transition to higher education at the university level, particularly in health-related disciplines, is a critical period for the development of unhealthy lifestyle. In this study, we aimed to evaluate changes in weight, appetite, and physical activities among medical students over time and compare them with those of nonmedical students.

Methods: In this 5-month prospective cohort study, we evaluated changes in weight, appetite, and physical activity among normal-weight females enrolled in medical (n = 25) and business (n = 26) programs at the University of Jeddah, Saudi Arabia, during a single academic semester.

Results: Business students experienced a small but significant weight loss (approximately 1.7%, p = 0.03), while medical students showed no change in weight (p = 0.83). However, in both groups, waist circumference increased significantly (3%-4%; p = 0.012), suggesting a shift toward central fat accumulation. Total physical activity, particularly low-intensity activity, decreased significantly in both groups (p < 0.03). Sedentary time increased in business students but decreased among medical students (time-by-group interaction, p = 0.003). Diastolic blood pressure followed an opposite pattern; it decreased significantly in business students (-6.3%) and increased significantly in medical students (+3.0%; time-by-group interaction, p = 0.003).

Conclusions: Different academic disciplines were not associated with weight gain among initially normal-weight Saudi females. Both groups experienced an unfavorable shift in body fat redistribution (increased waist circumference), likely driven by reduced physical activity. These changes may exacerbate long-term health risks even in the absence of overt obesity, underscoring the need for lifestyle interventions.

Objectives: Legionellosis, primarily caused by Legionella pneumophila serogroup 1, remains a public health concern in Thailand, particularly in tourism-driven regions. Conventional culture-based surveillance is hindered by limited sensitivity and prolonged turnaround times. This study aimed to develop and validate an optimized multiplex TaqMan real-time PCR assay for simultaneous detection of Legionella spp., Legionella pneumophila, and Legionella pneumophila serogroup 1 in environmental water, while also investigating antimicrobial resistance genes.

Methods: A modified primer-probe set targeting the 23S-5S rRNA, mip, and wzm genes was combined with optimized DNA extraction and PCR conditions. Analytical sensitivity was assessed using colony suspensions and spiked water, and specificity was tested against 24 bacterial strains. The assay was validated on 202 environmental water samples collected from four provinces in southern Thailand. Samples positive by real-time PCR were further screened for antimicrobial resistance genes (lpeAB and tet56) using conventional PCR.

Results: The optimized assay achieved a detection limit of 1 CFU/mL in suspensions and 1 CFU/L in filtered water, with 100% specificity. Among 202 field samples, PCR detected Legionella in 48.51%, significantly higher than culture (24.26%; p < 0.001). Detection was particularly enhanced in cold-water systems from premise plumbing (41.61% versus 9.49%; p < 0.001). Both methods identified Legionella pneumophila serogroup 1 in 14.29% of samples. Spatial mapping identified Patong subdistrict, Phuket, as a contamination hotspot. Antimicrobial resistance surveillance showed lpeAB in 6.1% of samples and tet56 in one Legionella pneumophila isolate, representing the first report of antimicrobial resistance in environmental Legionella from Thailand.

Conclusions: This optimized multiplex real-time PCR assay offers a rapid, sensitive, specific, and cost-effective alternative to culture for Legionella surveillance. The detection of antimicrobial resistance genes highlights potential emerging resistance risks, underscoring the need for integrated molecular and resistance monitoring. Implementation of this approach can strengthen outbreak preparedness and improve water safety management in high-risk settings.

Objective: To identify the association between sex hormones and Sjogren's disease.

Methods: A case-control study investigating the relationship between sex hormones and Sjogren's disease was conducted at Nanjing Drum Tower Hospital from January 2018 to January 2024. Two-sample Mendelian randomization was then performed to identify the causal association by using the public genome-wide association study data from the UK Biobank and the FinnGen consortium.

Results: In the case-control study, a total of 93 cases diagnosed with Sjogren's disease were compared to 90 Sjogren's disease-like non-Sjogren's disease controls from a population of naturally postmenopausal women. An association was observed between E2 (aOR = 0.984; 95% CI: 0.971-0.997; p = 0.018), hypo-estradiol (aOR = 2.195; 95% CI: 1.156-4.165; p = 0.016), and Sjogren's disease. Mendelian randomization analysis indicated that higher odds of Sjogren's disease were associated with decreased E2 in females, as estimated by the inverse-variance weighted (OR = 0.954; 95% CI: 0.917-0.992; p = 0.019).

Conclusion: Our study demonstrates that Sjogren's disease leads to reduced E2. This indicates that low E2 is a consequence of the disease rather than a causative factor.

Purpose: To evaluate the efficacy of pars plana vitrectomy combined with subretinal tissue plasminogen activator injection, pneumatic displacement, and intraoperative intravitreal antivascular endothelial growth factor therapy for treating submacular hemorrhage secondary to polypoidal choroidal vasculopathy or neovascular age-related macular degeneration.

Methods: This retrospective study enrolled 28 patients who were diagnosed with submacular hemorrhage secondary to polypoidal choroidal vasculopathy or neovascular age-related macular degeneration, all of whom received a minimum follow-up period of 6 months. Key preoperative parameters, such as submacular hemorrhage height and diameter, tissue plasminogen activator dosage, and hemorrhage duration, were documented. Postoperative outcomes evaluated included the degree of submacular hemorrhage displacement, visual acuity changes, incidence of complications, and the requirement for additional intravitreal antivascular endothelial growth factor injections during the follow-up period.

Results: The mean patient age was 66.71 ± 10.62 years. The mean visual acuity progressively improved from a preoperative logMAR of 1.57 ± 0.64 to 1.26 ± 0.67, 1.15 ± 0.59, 1.14 ± 0.55, and 1.12 ± 0.56 at postoperative months 1, 3, and 6, respectively. Complete hemorrhage displacement was achieved in 85.71% (24/28) of cases. Preoperative hemorrhage duration was significantly negatively correlated with postoperative best-corrected visual acuity at 1 month (r = 0.46; p = 0.013), 3 months (r = 0.42; p = 0.028), 6 months (r = 0.41; p = 0.032), and final follow-up (r = 0.38; p = 0.047).

Conclusions: Pars plana vitrectomy with tissue plasminogen activator subretinal injection, pneumatic displacement, and intraoperative vitreous antivascular endothelial growth factor injection represents a safe and effective approach for managing submacular hemorrhage secondary to polypoidal choroidal vasculopathy and neovascular age-related macular degeneration. The duration of submacular hemorrhage emerges as the most critical prognostic factor for final visual outcomes. Patients with hemorrhage duration exceeding 14 days demonstrate a significantly reduced likelihood of achieving favorable visual outcomes.

Title: Traumatic brain injury outcomes and mortality predictors in Eastern India: A prospective observational cohort study.

Objective: To evaluate clinical outcomes and identify predictors of mortality in patients with traumatic brain injury treated at a tertiary trauma centre in Eastern India.

Methods: This was a single-centre prospective observational cohort study conducted at AIIMS, Patna, Bihar, Eastern India, over 18 months (July 2023-January 2025). A total of 383 consecutive patients with traumatic brain injury were enrolled based on predefined inclusion and exclusion criteria. Demographic, clinical, radiological, and management variables were recorded. Functional outcomes were assessed at discharge, 3 months, 6 months months using the Glasgow Outcome Scale-Extended. Logistic regression was used to identify independent predictors of mortality and poor functional outcome.

Results: The mean age was 34.4 ± 15.2 years, and most patients were male (68.9%). Road traffic accidents were the leading cause of injury (68.9%). Based on admission Glasgow Coma Scale, 53.3% had mild, 20.1% moderate, and 26.6% severe traumatic brain injury. Mortality was 23.5% at discharge and 24.5% at 6 months, with 95.7% of deaths occurring within the first month. Favourable outcomes (Glasgow Outcome Scale-Extended 6-8) were observed in 66.1% at 3 months and 70.8% at 6 months. Severe traumatic brain injury was significantly associated with 6-month mortality (p < 0.001) and poor outcomes (p < 0.001). Radiological features associated with mortality included intraventricular haemorrhage (p = 0.011), midline shift (p = 0.019), third ventricle obliteration (p = 0.023), sulcal effacement (p = 0.028), and cisternal collapse (p = 0.017). Multivariate analysis confirmed older age, lower Glasgow Coma Scale, abnormal pupillary reflex, intraventricular haemorrhage, and sulcal effacement as independent predictors of 6-month mortality. Among management strategies, burr-hole surgery yielded the best functional recovery (93.3%), while craniectomy was associated with the highest mortality (45.0%).

Conclusions: Traumatic brain injury in Eastern India predominantly affects young males in road traffic accidents. While functional recovery appeared to improve between discharge and 6 months, severe injuries and specific radiological features may be associated with increased mortality. Burr-hole surgery and craniotomy may be linked to more favourable outcomes compared with craniectomy. Strengthening trauma systems and timely surgical interventions may help improve outcomes in resource-limited settings.

Background: Postoperative nausea and vomiting is a prevalent complication during the postoperative phase. Numerous factors affect postoperative nausea and vomiting, which can be categorized into patient-related, anesthesia-related, and surgery-related factors. The management of postoperative nausea and vomiting is multifaceted and consists of both prophylactic and therapeutic approaches.

Objectives: This study aimed to investigate the attitudes and behaviors of anesthesiologists regarding the prophylaxis and treatment of postoperative nausea and vomiting, while also raising awareness of current practices and gaps in adherence to guideline-based management.

Methods: This prospective observational study involved the online administration of a web-based questionnaire comprising 17 questions to physicians actively working in anesthesiology and reanimation clinics. The first five questions pertained to demographic data, while the remaining 12 questions assessed anesthesiologists' attitudes and behaviors regarding the prophylaxis and treatment of postoperative nausea and vomiting.

Results: The rate of missing to conduct postoperative nausea and vomiting risk assessments and not providing prophylaxis (n = 67) was 33.5%, whereas the rate of administering prophylaxis with a single agent to each patient without risk assessment (n = 85) was 42.5%. Among the anesthesiologists who participated in the study, the awareness rate regarding the prophylaxis and treatment of postoperative nausea and vomiting was found to be 90.0%.

Conclusions: This study demonstrates that, in current clinical practice, postoperative nausea and vomiting risk assessment and prophylaxis remain an overlooked complication. A clear gap exists between awareness and evidence-based practice in postoperative nausea and vomiting management. Therefore, the most appropriate prophylaxis and treatment strategies should be identified on a patient-specific basis. These findings highlight the need for structured risk assessment and guideline-based prophylaxis strategies to optimize patient outcomes.

Background: Social anxiety disorder is the most common anxiety disorder in children with burns, which require psychological treatments including storytelling. Therefore, this study was conducted with the aim of determining the effect of storytelling on the social anxiety of hospitalized children with burns.

Methods: In this clinical trial study, 52 people in two test and control groups were selected by random sampling. Storytelling education was conducted in 13 sessions for the intervention group. Data analysis was done using statistical tests by SPSS 22 software.

Results: A significant difference was observed between social anxiety before and after the intervention (p = 0.001). Accordingly, social anxiety and fear of negative evaluation have decreased after the intervention.

Conclusion: Based on this study's results, storytelling effectively reduces the social anxiety disorder of children with burns and reduces social anxiety at different childhood ages.

Background: Pediatric patients with critical illnesses often exhibit serum electrolyte disturbances, which significantly influence their clinical outcomes.

Methods: This prospective observational study included 534 pediatric patients (age range 1 month to 18 years) admitted to the pediatric intensive care unit of R.D. Gardi Medical College, Ujjain, from January 1, 2023 to April 30, 2024. The objective of the study was to study associations of disturbances in the levels of serum sodium, potassium, calcium, magnesium, and phosphorus with organ system involvement and child mortality, using multiple logistic regression models.

Results: Among the 534 patients, 325 (61%) were boys and 209 (39%) were girls, with a mean ± SD age of 5.17 ± 4.79 years. Most patients presented with fever (71%), fatigue (34%), and malaise (21%). A total of 1057 electrolyte abnormalities were recorded, with hypocalcemia (263 episodes, 25%) being the most common, followed by hypokalemia (192 episodes, 18%) and hyponatremia (172 episodes, 16%). A total of 173 episodes of severe hypocalcemia (S. calcium <6.5 mg/d), 21 episodes of severe hypernatremia (S. sodium >150 mEq/L) and 12 episodes of hypokalemia (S. potassium <2.5 mEq/L). All children with hypocalcemia had neurological symptoms. Hypokalemia was significantly associated with neurological (adjusted odds ratio 2.07), endocrine (adjusted odds ratio 2.26) and cardiovascular system (adjusted odds ratio 10.20) symptoms. Hyponatremia was significantly associated with symptoms of respiratory system (adjusted odds ratio 2.82) and gastrointestinal system (adjusted odds ratio 1.95). Hyperkalemia was significantly associated with symptoms of neurological (adjusted odds ratio 3.84), endocrine (adjusted odds ratio 2.24) and cardiovascular system (adjusted odds ratio 3.53). A total of 34 (6%) deaths were recorded and found to be associated mainly with hypokalemia (56%), hypocalcemia (44%), and hyponatremia (32%). Among these, hypokalemia (odds ratio: 2.43) and hypernatremia (odds ratio: 2.26) were significantly associated with mortality.

Conclusion: Electrolyte abnormalities were highly prevalent among children in the pediatric intensive care unit, with imbalances in the calcium, potassium, and sodium levels being the most common. Hypokalemia and hypernatremia were significantly and positively associated with mortality.

Background: Labor companions often lack clarity about their support roles during childbirth. Therefore, this study aims to analyze factors influencing companions' adherence to support roles during labor and childbirth.

Methods: A convergent parallel mixed-methods design was used to examine factors influencing companions' adherence to support roles from May to June 2024. Systematic random sampling selected 320 participants from the maternity ward. Data were collected via face-to-face exit interviews. Purposive sampling chose 24 labor companions for in-depth interviews. Adherence to support roles was measured using a four-point Likert scale, ranging from "not at all" to "all of the time." Ethical approval was obtained from the IRB at Jimma University, and support letters were secured for each study facility. Written consent was obtained from all participants.

Results: Companions' adherence to support roles during childbirth had an overall mean score of 1.39 (95% CI: 1.29-1.49) on the four-point Likert scale. Specifically, 27.5% of companions reported not at all, and 35.63% reported only a little support, while 17.19% reported providing support all of the time. Awareness among companions was associated with increased adherence to support roles (B = 0.238, p = 0.029). Nevertheless, companions with less prior experience (first time: B = -0.377, p = 0.001; second time: B = -0.280, p = 0.031) showed significantly lower adherence to support roles. The qualitative data also explored that, unclear role definition, unwelcoming approach of healthcare providers, and social-cultural factors were associated with minimal adherence to support roles.

Conclusion: A structured orientation session for companions is a vital recommendation to address hindering factors to their support roles. Such a session might equip them with techniques how to provide.

[This corrects the article DOI: 10.1177/20503121251358313.].