SAGE Open Medicine最新文献

Background: Screening for latent tuberculosis infection using Interferon-Gamma Release Assays is a routine procedure prior to the initiation of anti-tumor necrosis factor (TNF) biotherapy or immunosuppressive therapy. However, indeterminate results are relatively frequent and are an obstacle to treatment initiation.

Aim: The aim of this cross-sectional study was to estimate the frequency of indeterminate QuantiFERON-TB Gold Plus^® test results in Tunisian patients, and to analyze the potential clinico-biological risk factors associated with these indeterminate results.

Methods: Whole blood samples from 712 patients being monitored for autoimmune diseases and candidates for anti-TNF biotherapy or switch of immunosuppressive therapy were used to screen for latent tuberculosis infection using the QuantiFERON-TB Gold Plus^® test. Based on literature background, the following variables were tested for the association with indeterminate results: gender, age, diabetes, immunosuppressive drugs, lymphocyte count, Neutrophil-to-lymphocyte ratio, serum albumin, and estimated glomerular filtration rate.

Results: The QuantiFERON-TB Gold Plus^® test was negative in 572 (80.3%) patients, positive in 106 (14.9%), and indeterminate in 34 (4.8%) cases. Positive results were significantly associated with a family history of confirmed and treated tuberculosis, OR (95% CI) = 52 (20.2-134.3). The use of immunosuppressive drugs and duration of treatment were significantly associated with the occurrence of indeterminate results: OR (95% CI) = 24.5 (5.8-103) and OR (95% CI) = 1.004 (1.002-1.007), respectively. Biologically, lymphopenia, hypoalbuminemia, and decreased estimated glomerular filtration rate were significant risk factors for indeterminate results: p = 5 E-6, p = 4.3 E-4, and p = 0.002, respectively. Thus, a multiple logistic regression model based on these three biological parameters enabled us to develop a predictive score for indeterminate results with a sensitivity of 91.2% and a specificity of 99.9%, AUC = 0.9964 (0.9917-1), p = 2.8 E-52.

Conclusion: Immunosuppressive therapy, lymphopenia, hypoalbuminemia, and kidney failure appeared to be risk factors for indeterminate QuantiFERON-TB Gold Plus^® results.

Background: Type 2 diabetes, a lifestyle-related disease demanding daily self-management, is a significant health concern. In this context, the use of telemedicine as a management tool is a relatively new and promising approach. This study aims to contribute to the growing body of knowledge by identifying the effectiveness of telemedicine in managing type 2 diabetes through a systematic review approach.

Methods: Four databases were searched including PubMed, Virtual Health Library, Global Health Library, and Google Scholar on 27 July 2022. Additionally, a manual search was performed to identify any relevant articles that may have been missed. The quality of the included articles was rigorously assessed using the Study Quality Assessment Tools of the National Institute of Health.

Results: We analyzed data from 134 articles. All 134 studies were published between 2002 and 2022, including 103 controlled intervention trials, 13 cohort studies, 7 before-after (pre-post) studies with no control group, 1 initial trial, 1 case study, 1 pilot study, and 8 two-arm studies that did not report the study design. Accordingly, most studies show positive changes in glycemic index in every group using telemedicine. Overall, although the BMI and weight indices in the studies improved at the end of the course, the improvement values were considered insignificant.

Conclusion: Telemedicine may be a valuable solution for blood sugar management in patients with type 2 diabetes. However, the effectiveness of telemedicine in improving BMI and quality of life is unclear.

Background: Perforator flaps have recently been used in the field of plastic surgery. Skin defects can be reconstructed to reach functional and cosmetic goals. With the development of reconstructive approaches, utilizing stem cells is a hopeful approach to enhance wound healing and tissue recovery. In this study, we assessed the effect of bone marrow mesenchymal stem cells on the perforator flap's survival in rats.

Methods: Perforator flaps (2.5 × 11 cm) were transplanted into rats and focused on the thoracodorsal, intercostal, and deep circumflex arteries, which were randomly divided into three groups: control, saline, and bone marrow mesenchymal stem cells (7 × 10⁶ ml). Seven days after the surgery, tissue edema, inflammation, and discharge were observed and photographed. Histological analyses were performed to determine flap survival. Hematoxylin and eosin staining was performed to assess levels of microvascular density determined in skin flaps.

Results: Rats in the bone marrow mesenchymal stem cells group exhibited higher average flap survival area, and higher microvascular density levels at the dynamical regions of the flaps compared with the other two groups. Subdermal injection of bone marrow mesenchymal stem cells significantly increased ischemic perforator flap survival due to stimulated neovascularization in rats.

Conclusion: Our findings suggest the potential usefulness of bone marrow mesenchymal stem cells in preventing skin flap perforator tissue necrosis.

Background: Sleeve gastrectomy has gained prominence in obesity treatment, yet it is not without complications, such as the development of anemia in the medium term. Given the high prevalence of Helicobacter pylori infection in Peru, it is imperative to explore its potential association with this postoperative complication.

Objective: To evaluate the association between the presence of Helicobacter pylori and the development of anemia 12 months after sleeve gastrectomy.

Methods: A retrospective cohort study was carried out based on an analysis of secondary data from a private clinic in Lima, Peru, which included two groups of people over 18 years of age who had undergone sleeve gastrectomy between 2010 and 2020. We considered the subjects who had the previous diagnosis of Helicobacter pylori as well as those who did not have the infection, according to the detection of the bacteria by endoscopy before surgery.

Results: A total 313 individuals were analyzed, and it was found that the prevalence of Helicobacter pylori was 46.0% and the incidence of anemia 12 months after sleeve gastrectomy was 18.2%. The presence of Helicobacter pylori increased the risk of de novo anemia (Relative Risk = 1.56; 95% confidence intervals: 1.02-2.41; p = 0.043). When stratifying by sex, the association was maintained only for the male group (Relative Risk = 2.84; 95% confidence intervals: 1.02-7.02; p = 0.047).

Conclusions: It was identified that the presence of Helicobacter pylori had a significant association with the development of de novo anemia, mainly in male subjects, 1 year after undergoing sleeve gastrectomy.

Objectives: The 2030 Sustainable Development Agenda stresses a feminist approach for healthcare services. Cultural and religious influences impact utilization of healthcare services by Muslim women within the Middle East, posing unique challenges. This paper aimed to investigate the factors influencing Middle Eastern women's utilization of healthcare services within the region.

Methods: In the year 2024, a systematic review was conducted. PubMed, Scopus, ProQuest, and the Cochrane Database of Systematic Reviews were searched for this purpose. The quality of the included articles was assessed using the Accuracy, Coverage, Objectivity, Date, Significance (ACODS) checklist. Subsequently, the Joffe method of thematic analysis was employed to analyze the data obtained from the review.

Results: A final selection comprising 59 studies was made for inclusion in the research. The studies demonstrated a high level of quality, and the risk of bias within them was deemed acceptable. The thematic analysis revealed seven principal themes, which encompassed Demographic Factors, Level of Education and Awareness, Sources of Information, Risk Factors, Personal Factors, Level of Service Access and Quality, and Organizational Factors.

Conclusions: This study highlighted key factors influencing women's utilization of healthcare in the Middle East and potentially the healthcare systems with a large number of Middle Eastern female immigrants around the globe: educational factors such as awareness campaigns and patient education, and personal barriers like fear and cultural norms. Moreover, Telehealth, particularly mHealth, was suggested to enhance women's participation and utilization of healthcare services. Further research is needed to explore this assertion with greater precision.

Diet plays a critical role in shaping the gut microbiome, which in turn regulates molecular activities in the colonic mucosa. The state and composition of the gut microbiome are key factors in the development of colorectal cancer. An altered gut microbiome, linked to weakened immune responses and the production of carcinogenic substances, is a significant contributor to colorectal cancer pathogenesis. Dietary changes that involve low-fiber and phytomolecule intake, coupled with higher consumption of red meat, can raise the risk of colorectal cancer. Salutary filaments, which reach the colon undigested, are metabolized by the gut microbiome, producing short-chain fatty acids. Short-chain fatty acids possess beneficial anti-inflammatory and antiproliferative properties that promote colon health. A well-balanced microbiome, supported by beneficial fibers and phytochemicals, can regulate the activation of proto-oncogenes and oncogenic pathways, thereby reducing cell proliferation. Recent research suggests that an overabundance of specific microbes, such as Fusobacterium nucleatum, may contribute to adverse changes in the colonic mucosa. Positive lifestyle adjustments have been demonstrated to effectively inhibit the growth of harmful opportunistic organisms. Synbiotics, which combine probiotics and prebiotics, can protect the intestinal mucosa by enhancing immune responses and decreasing the production of harmful metabolites, oxidative stress, and cell proliferation. This narrative review provides a concise understanding of evolving evidence regarding how diet influences the gut microbiome, leading to the restoration of the colonic epithelium. It underscores the importance of a healthy, plant-based diet and associated supplements in preventing colorectal cancer by enhancing gut microbiome health.

Introduction: Contact with pets within healthcare settings is considered worldwide an added value to assistance both in the case of animal-assisted interventions and also when pets are visiting hospitalized owners, due to the special emotional relationship between them and their pets. The goal of this work was to analyze local experiences on access of pets to healthcare facilities using a survey sent to doctors, veterinarians, and students in the region of Sardinia (Italy).

Methods: The online survey consisted of 17 questions, with the objective to evaluate knowledge and interest of study participants on some aspects of human-animal interaction with particular reference to potential access of pets to hospitals facilities and nursing homes and to promote an initial social judgment in the medical and healthcare environment. A total of 2484 subjects were invited to participate to the survey through an email explaining the purpose of the study. Statistical analysis on the survey results was conducted by comparing the characteristics of respondents with their answers to animal-assisted-intervention-related questions.

Results: Results showed that over 70% of the participants owned an animal; almost 80% of responses showed that survey participants were in favor of animal presence in hospitals; furthermore, the responses showed how the concept of One Health seems not only scarcely established, but also barely known. The large majority of respondents (over 80%) positively responded on questions around the role of animals as co-therapists.

Conclusions: On the one hand, this study showed lack of knowledge on the concept of One Health, whose essence is too often unknown and, on the other hand, it confirmed that women may be more inclined to show empathy and sensitivity toward animals. Regarding the profession, students seem more concerned about the introduction of animals into hospitals than healthcare workers.

Objectives: Post-COVID-19 vaccine-associated vasculitis stands as one of the most serious side effects attributed to COVID-19 vaccines. This complication encompasses diverse manifestations which vary in presentation and severity. Moreover, it can impact patients across all age groups, with a notably elevated incidence in the elderly. This systematic review seeks to review and evaluate the spectrum of vasculitis manifestations linked to COVID-19 vaccination.

Methods: A systematic review of the literature was done by searching through PubMed, Google Scholar, and Scopus up to October 2022. Articles including data about sex, age at diagnosis, vasculitis clinical manifestations, type of vaccination, most commonly used investigations, comorbid medical conditions, treatments, and clinical outcomes were included in the final analysis. Furthermore, vasculitis flare-ups post-vaccination were considered part of this review.

Results: A total number of 117 studies describing 158 patients developing vasculitis following COVID-19 vaccination were included in the final analysis. Among the patients who developed vasculitis, the most administered type of vaccination was the mRNA vaccine subtype (n = 103), followed by the viral vector vaccines (n = 42) and inactivated viral vaccines (n = 10). On the other hand, about 38% of vasculitis-related symptoms occurred after the administration of the first dose of the vaccine and 37% occurred after taking the second dose. The skin (60.7%) and the kidneys (27.8%) were the most affected organs and complete remission was achieved in 111 patients (70%), while partial remission occurred in 11% of the patient population.

Conclusion: COVID-19 vaccine-induced vasculitis is a rare occurrence associated with COVID-19 vaccines. It generally presents a favorable prognosis and outcomes for the vast majority of patients, ultimately leading to full remission within days. This review emphasizes the notion that the advantages of COVID-19 vaccines outweigh the potential risks, particularly for individuals with compromised immune systems.

Objective: Ventricular assist device is one of the treatment options for heart failure patients. Therefore, the purpose of this review is to aid in clinical decision-making of exchanging previous older ventricular assist device models to the newest one, HM3.

Methods: The search was conducted across several databases until February 25, 2023, and was registered with the ID of CRD42023405367. Risk of bias was performed using Cochrane Risk of Bias 2.0 and the Newcastle Ottawa Scale. In order to rank and evaluate the pooled odds ratios and mean differences with 95% confidence intervals, we employed conventional and Bayesian network meta-analysis converted to surface under the cumulative ranking.

Results: A total of 49 studies with 31,105 patients were included in this review. HM3 is the best device exchange choice that causes the lowest risk of mortality (HM3 (99.98) > HM2 (32.43) > HVAD (17.58)), cerebrovascular accidents (HM3 (99.99) > HM2 (42.41) > HVAD (7.60)), other neurologic events beside cerebrovascular accident (HM3 (91.45) > HM2 (54.16) > HVAD (4.39)), pump thrombosis (HM3 (100.00) > HM2 (39.20) > HVAD (10.80)), and bleeding (HM3 (97.12) > HM2 (47.60) > HVAD (5.28)). HM3 is also better than HM2 in hospital admissions (OR: 1.90 (95% CI: 1.15-3.12)). When complications were present, HM2 or Heartware ventricular assist devices exchange to HM3 lowered the mortality rate compared to exchanging it to the same device type.

Conclusion: HM3 is the best device for all six outcomes. Exchange from Heartware ventricular assist devices or HM2 to HM3 rather than the same ventricular assist device type is recommended only if a complication is present.

Objectives: While extensive research has focused on patient outcomes in skilled nursing facilities, a critical gap remains in understanding factors influencing their managerial performance, particularly occupancy rates. This study examines the occupancy rates of skilled nursing facilities and assesses the significance of two important drivers of managerial performance that have not received sufficient attention-the influence of payer mix and total profit margin. Specifically, we focused on the role played by a nursing home's financial performance (as assessed by profit margin) in influencing the relationship between payer mix and occupancy rate among skilled nursing facilities.

Methods: Data were extracted from the 2019 to 2020 Joint Annual Report of Nursing Homes for a sample of 612 skilled nursing facilities in Tennessee, USA. Regression analysis was performed by fitting a generalized estimating equation of occupancy rate.

Results: Compared to skilled nursing facilities in the lowest quartile of profit margin, for example, those in the highest quartile had approximately 18 percentage points higher occupancy rates per unit increase in resident days of care covered by traditional Medicare (β = 0.18, p = 0.0028). Similarly, skilled nursing facilities in the second highest quartile of profit margin had a higher occupancy rate by approximately 23 percentage points per unit increase in Medicare Advantage (β = 0.23, p = 0.0375) when compared to those in the lowest quartile of profit margin.

Conclusions: Skilled nursing facilities with stronger financial performance generally have higher occupancy rates, particularly notable in relation to an upswing in payer sources such as traditional Medicare and Medicare Advantage, when compared to skilled nursing facilities with weaker profitability. Given the increasingly larger role of Medicare in long-term care funding, policymakers and nursing home managers may find it useful to consider our findings when evaluating opportunities to enhance managerial performance of skilled nursing facilities.