SAGE Open Medicine最新文献

Background: Clostridioides difficile infection (CDI) has been linked to over 200,000 cases of illness in hospitalized patients and over 20,000 deaths annually. Up to 25% of patients with an initial CDI episode will experience recurrent CDI (rCDI), which most commonly occurs in the first 8 weeks following antibiotic therapy. In patients with first or multiple rCDI, infection, the microbiome is similarly disrupted, which highlights the challenges of using antibiotics alone while underscoring the need for microbiome restoration regardless of the number of recurrences. In this systematic review, we describe the role of the gastrointestinal microbiome in CDI, and systematically review fecal microbiota spores, live-brpk (VOWST™; VOS for Vowst Oral Spores) for prevention of recurrence in rCDI.

Methods: The PubMed database was searched using "recurrent Clostridioides difficile infection" AND (SER-109 OR VOS) and limited to clinical trials. The search yielded 7 results: 3 articles describing 3 clinical trials (two Phase 3 trials (ECOSPOR III and ECOSPOR IV) and one Phase 2 trial (ECOSPOR)), 1 describing follow-up of ECOSPOR III, 1 describing a post hoc analysis of comorbidities in ECOSPOR III, and 2 describing health-related quality of life in ECOSPOR III.

Results: Compared with placebo, VOS following standard-of-care antibiotics for CDI significantly reduced risk of recurrence at 8 weeks (relative risk, 0.32 (95% CI: 0.18-0.58); p < 0.001; number needed to treat: 4) with a tolerable safety profile; rCDI rates remained low through 24 weeks. The disrupted microbiome, secondary to/exacerbated by antibiotic treatment, was rapidly (i.e., Week 1) restored with VOS. Compared with placebo, VOS demonstrated greater improvements in health-related quality of life.

Conclusions: Clinical care of patients with rCDI now includes Food and Drug Administration-approved therapeutics to address microbiome restoration. Clinical trial evidence supports use of VOS following antibiotics and importance of microbiome restoration in rCDI.

Background: The relationship between blood pressure variability and hemorrhagic transformation after recombinant tissue plasminogen activator thrombolysis in patients with acute ischemic stroke is uncertain due to inconsistent methodologies across studies. This study aimed to elucidate the association between 24-h systolic blood pressure extremes post-admission and hemorrhagic transformation while considering the possibility of hemorrhagic transformation occurring beyond the initial monitoring period.

Methods: We enrolled patients admitted to The First Affiliated Hospital of Harbin Medical University for ischemic stroke who were treated with intravenous recombinant tissue plasminogen activator within 4.5 h of symptom onset between January 2020 and December 2022. We analyzed the relationships among admission blood pressure, 24-h post-admission recombinant tissue plasminogen activator (mean, maximum, minimum, extreme difference, standard deviation, and coefficient of variation), immediate and 1-h post-thrombolysis blood pressure, and hemorrhagic transformation occurrence within 36 h post-thrombolysis. The potential for delayed hemorrhagic transformation was also considered during the interpretation of the results.

Results: Among the 138 patients, 39.1% experienced post-thrombolytic hemorrhagic transformation. Multivariate analysis revealed that hemorrhagic transformation was significantly associated with coronary artery disease, cerebral leukoaraiosis, large cerebral infarction, elevated random glucose levels, and 24-h systolic blood pressure extremes at admission. Specifically, 24-h systolic blood pressure extremes showed a significant positive correlation with hemorrhagic transformation (OR = 1. 042; 95% CI: 1.000-1.086, p < 0.05).

Conclusion: These findings underscore the importance of establishing robust protocols for continuous blood pressure monitoring and intervention strategies tailored to individual risk profiles. Given that hemorrhagic transformation can occur beyond the initial 36 h, clinicians should maintain vigilance for delayed hemorrhagic transformation, particularly in patients with high recombinant tissue plasminogen activator. Strict control of blood pressure, especially minimizing extremes in systolic blood pressure, is essential to ensure the safety of patients undergoing thrombolysis.

Background: Fragile X syndrome, with an approximate incidence rate of 1 in 4000 males to 1 in 8000 females, is the most prevalent genetic cause of heritable intellectual disability and the most common monogenic cause of autism spectrum disorder. The full mutation of the Fragile X Messenger Ribonucleoprotein-1 gene, characterized by an expansion of CGG trinucleotide repeats (>200 CGG repeats), leads to fragile X syndrome. Currently, there are no targeted treatments available for fragile X syndrome. In a recent large multi-site trial, FXLEARN, the effects of the mGluR5 negative allosteric modulator, AFQ056 (mavoglurant), were investigated, but did not show a significant impact of AFQ056 on language development in children with fragile X syndrome aged 3-6 years.

Objectives: The current analyses from biospecimens collected in the FXLEARN study aimed to determine whether AFQ056 affects the level of potential biomarkers associated with Akt/mTOR and matrix metalloproteinase 9 signaling in young individuals with fragile X syndrome. Previous research has indicated that these biomarkers play crucial roles in the pathophysiology of fragile X syndrome.

Design: A double-blind placebo-controlled parallel-group flexible-dose forced titration design.

Methods: Blood samples for biomarkers were collected during the FXLEARN at baseline and subsequent visits (1- and 8-month visits). Biomarker analyses included fragile X messenger ribonucleoprotein-1 genotyping by Southern blot and PCR approaches, fragile X messenger ribonucleoprotein-1 mRNA levels determined by PCR, matrix metalloproteinase 9 levels' detection using a magnetic bead panel, and targets of the Akt/mTOR signaling pathway with their phosphorylation levels detected.

Results: This research revealed that administering AFQ056 does not affect the expression levels of the investigated blood biomarkers in young children with fragile X syndrome.

Conclusion: Our findings of the lack of association between clinical improvement and biomarkers' levels in the treatment group are in line with the lack of benefit observed in the FXLEARN study. These findings indicate that AFQ056 does not provide benefits as assessed by primary or secondary endpoints.

Registration: ClincalTrials.gov NCT02920892.

Introduction: Family planning is among the best suggested strategies to decrease the high maternal mortality and morbidity prevailing among pastoral communities. Despite this fact, there is no sufficient information regarding the unmet need for family planning in the study area. Therefore, this study was intended to assess the prevalence of unmet need for family planning and its associated factors among currently married women residing in pastoralist community of West Omo zone, Ethiopia.

Methods: Community-based cross-sectional study was conducted from 01 January to 01 April 2021 in West Omo zone. Five-hundred-sixty currently married women aged 15-49 were interviewed, and the study participants were randomly selected by employing a modified random walk approach. Data were checked manually for completeness and consistency, then entered into Epidata 3.1 and exported to SPSS version 22 for analysis. Multivariate binary logistic regression was used to identify the associated factors, and Adjusted Odds Ratio (AOR) at 95% CI with p-value < 0.05 was considered as significant variables.

Result: A total of 560 currently married women agreed to participate in this study making a response rate of 93.17%. Two hundred three, that is, about 36.3% (95% CI: 32.1, 40.2%) currently married women had an unmet need for family planning, with 119 (58.6%) wishing to delay childbirth and 84 (41.4%) seeking to limit. Have no formal education (AOR = 2.86 (95% CI: 1.61, 5.10)), having poor knowledge of family planning (AOR = 2.83 (95% CI: 1.45, 5.54)), and lack of husband support of family planning (AOR = 2.38 (95% CI: 1.22, 4.67)) are positively associated with unmet need for family planning.

Conclusion: The magnitude of unmet need for family planning in this study is fairly high as compared to previous studies done among non-pastoral community. Hence, it's important to consider the above identified factors while designing effective public health intervention.

Purpose: To evaluate whether hydrogel spacer injection, which increases the distance between the prostate and rectum, prior to local radiation therapy for prostate cancer reduces rectal and bladder toxicity.

Patients and methods: With institutional review board approval (05-004), we retrospectively reviewed rectal and bladder toxicity after local radiation therapy in patients with prostate cancer who were followed up for more than 1 year.

Results: We included 156 patients who had received local radiation therapy. Their ages ranged from 63 to 86 years, with an average of 75 years. Most patients were treated only on the prostate and seminal vesicles. All prostate sites were irradiated as follows: whole pelvis with prostate in 10 patients, whole pelvis with prostate and metastatic sites in six, and prostate and metastatic sites in eight. Radiation therapy (70-74 Gy) was performed for the prostate. Irradiation of 45-46.8 Gy was applied to whole pelvic and para-aortic lymph nodes, with 54-60 Gy applied to bone metastatic sites. In one case, stereotactic body radiation therapy (36 Gy) was performed for a sacral bone metastatic site. The hydrogel spacer was injected in 39 patients. Rectal toxicity was reported in 21 patients without (17.9%) and 3 patients with (7.7%) the hydrogel spacer. Bladder toxicity was reported in five patients without and only one patient with the hydrogel spacer.

Conclusion: Hydrogel spacer injection prior to local radiation therapy for prostate cancer reduces rectal radiation exposure, lowers the risk of rectal complications, and may be a promising method for boosting the irradiation dose in the future.

Background: Traditional birth attendant utilization has become a common malpractice and a leading cause of maternal morbidity and mortality in the developing world, such as Ethiopia. Therefore, this study was aimed at determining the geospatial variation and determinant factors of traditional birth attendant utilization among mothers of reproductive age in Ethiopia.

Methods: The data were taken from the 2019 Ethiopian Demographic and Health Survey. Arc GIS, Excel, and STATA-14 software were used for the data analysis. The adjusted odds ratio with a 95% confidence interval was used to declare significant determinants of traditional birth attendance among mothers of reproductive age in Ethiopia.

Results: Among 5,753 mothers of reproductive age, 34.59% of them utilized traditional birth attendants in Ethiopia during the 2019 Ethiopian Demographic and Health Survey. There was a geospatial variation of traditional birth attendants among mothers of reproductive age in Ethiopia; the Global Moran's index value was 0.39 with a p-value <0.001. The significant factors associated with traditional birth attendant utilization were the age of mothers; higher odds were observed among older mothers aged 35-49 years (AOR = 1.31; 95% CI (1.04-1.63)); educational level of mothers (AOR = 3.04; 95% CI (2.13-4.33)); higher odds were observed in uneducated mothers, wealth index (AOR = 2.76; 95% CI (1.83-4.19)); higher odds were observed among the poorer and poorest households, place of residence (AOR = 5.69; 95% CI (3.35-9.67)); and the regions; the highest odds were observed in Somali (AOR = 12.1; 95% CI (4.99-25.68)) and Afar (AOR = 7.13; 95% CI (2.37-21.38)).

Conclusions: The utilization of traditional birth attendants among reproductive-age mothers became a major public health concern, and the distribution showed geo-spatial variations among the regions of the country. We recommend taking appropriate measures to alleviate the current problem by improving access to maternal healthcare services.

Introduction: Tinnitus is a common medical condition that affects an individual's quality of life. It affects 5%-43% of the global population. Only a few research studies have been conducted in Palestine, so knowledge of tinnitus prevalence and risk factors is limited. The purpose of this study was to determine tinnitus prevalence and risk factors among young university students in Palestine.

Methods: A cross-sectional study of Palestinian university students was done utilizing an online self-administered questionnaire. The questionnaire for the study was developed using the European School for Interdisciplinary Tinnitus Research-Screening Questionnaire. A logistic regression analysis of the associations between tinnitus and influencing factors was performed to determine the effects of various clinically relevant variables on the likelihood of experiencing tinnitus.

Results: A total of 728 participants responded to the questionnaire aged 20.0 ± 2.0. The overall prevalence of tinnitus was 31%. Having a relative with tinnitus, gastroesophageal reflux, depression and anxiety, hearing difficulties, vertigo, tympanic membrane perforation, chronic otitis, acoustic trauma, head and neck radiotherapy, dental surgery, ear surgery, ear pain, headache, neck pain, temporomandibular joint pain, balance disorders, and nasal septal deviation were significantly associated with tinnitus. The logistic regression analysis showed that suffering from frequent vertigo (at least once per year), from slight hearing difficulty, temporomandibular joint pain, performing ear surgery, and having depression and anxiety is associated with an increased risk of having tinnitus.

Conclusions: The current study concluded that tinnitus is common among Palestinian university students. Furthermore, the study identified several major risk factors for tinnitus. It is critical to explore the possibly modifiable risk factors for tinnitus in order to have a better understanding of the condition and eventually minimize its prevalence.

Background: Rheumatoid arthritis is a severe inflammatory arthritis that causes irreversible damage to joints and bones, resulting in deformities and disabilities. Population-based studies on the co-occurrence in patients with rheumatoid arthritis are lacking despite shared mechanisms with other autoimmune diseases.

Objectives: This study aimed to determine the prevalence and association of autoimmune diseases among patients with rheumatoid arthritis and explore the associations between autoimmune diseases and treatment options for rheumatoid arthritis.

Method: This retrospective study was conducted from 2019 to 2023 at King Fahad Armed Forces Hospitals, Jeddah, Saudi Arabia. Data were cleaned in Excel and analyzed using IBM SPSS version 29. The activity of the disease was assessed through clinical manifestations, laboratory findings, and its associations with other autoimmune diseases.

Results: Our study included 365 patients with rheumatoid arthritis, predominantly female (89%), and observed diverse demographics and comorbidities. Prevalent conditions included diabetes mellitus (28.2%), hypertension (27.3%), and dyslipidemia (14.7%). Other autoimmune diseases were present in 24.9% of patients, with notable associations with age at rheumatoid arthritis diagnosis and endocrine, rheumatology/dermatology, and pulmonary disorders (p < 0.001). Treatment approaches varied, with prednisolone (24.4%) and methotrexate (55.1%) being predominant. No significant associations were observed between autoimmune disorders and specific treatment modalities (p > 0.05).

Conclusion: Our study provides a thorough overview of rheumatoid arthritis in a large cohort, revealing demographic trends, comorbidities, autoimmune disease prevalence, treatment preferences, and associations. Relationships with age at rheumatoid arthritis diagnosis and other autoimmune diseases were noted. Treatment approaches varied, with no significant associations between autoimmune disorders and specific modalities.

Objectives: To assess the influence of age and gender on ocular biometric values and corneal astigmatism features in individuals undergoing phacoemulsification surgery and intraocular lens implantation.

Methodology: This retrospective study measured ocular biometrics and corneal keratometric astigmatism using the IOLMaster 700 instrument prior to phacoemulsification surgery and intraocular lens implantation.

Results: Analysis included ocular biometric and keratometric values from 3385 eyes of 3385 patients. Lens thickness (p < 0.001, r = 0.387), mean keratometry (p < 0.001, r = 0.156), and corneal astigmatism (p < 0.001, r = 0.082) were positively correlated with age. Conversely, axial length (p < 0.001, r = -0.133), anterior chamber depth (p < 0.001, r = -0.244), and horizontal white-to-white corneal diameter (p < 0.001, r = -0.226) exhibited negative correlations with age. Increasing age led to a significant shift towards against-the-rule astigmatism (p < 0.001, r = 0.248). Mean keratometry was significantly lower in males than females (p < 0.001). Axial length, anterior chamber depth, lens thickness, and white-to-white corneal diameter were higher in males compared to females (all ps ⩽ 0.001). Corneal astigmatism types differed significantly between genders (p < 0.001), with against-the-rule being more prevalent among males (52.9%) and with-the-rule astigmatism having the highest prevalence among females (40.3%).

Conclusions: Mean keratometry and lens thickness increased, while axial length and anterior chamber depth decreased with age. Males exhibited higher values for axial length, anterior chamber depth, and lens thickness, whereas females had steeper corneas.