SAGE Open Medicine最新文献

Aims: Viral hepatitis and tuberculosis are major public health concerns with shared risk factors, especially in marginalized communities. Despite this, routine hepatitis B and C viruses screening in tuberculosis patients is uncommon. This study, conducted in Golestan Province, where tuberculosis and hepatitis B virus have high incidence rates, aimed to assess the rates and prevalence of hepatitis B and anti-hepatitis C viruses testing among active tuberculosis patients.

Materials and methods: Our cross-sectional study was conducted between March 2018 and March 2023 and included patient records of 2283 tuberculosis cases registered in the database of Golestan University of Medical Sciences. Hepatitis B and anti-hepatitis C viruses were tested among patients with confirmed tuberculosis. Clinical and demographic data were collected by taking patient records and performing structured interviews. Exclusions were limited to patients with a confirmed tuberculosis diagnosis. Patients who did not consent to participate and had incomplete information were excluded from the study.

Results: Among 2280 tuberculosis patients, 50.1% were male, with a mean age of 46.22 years. Hepatitis B virus surface antigen was detected in 10.57%, and 2.32% tested positive for anti-hepatitis C virus antibodies. Men were more frequently tested for anti-hepatitis C virus positivity than women (62.15% versus 37.85%, p > 0.3). Most co-infected patients resided in rural areas, with pulmonary tuberculosis being the predominant manifestation. Co-infection rates among chronic hepatitis B virus patients varied by family structure: 6.7% in three-generation families, 15% in two-generation families, and 15% in intrafamilial cases. Additionally, 20% of mother-child pairs and 7.5% of intrafamilial hepatitis B virus patients tested positive for anti-hepatitis C virus. Liver function test abnormalities were more common in hepatitis B virus and tuberculosis patients, especially in hepatitis B/anti-hepatitis C viruses positive tuberculosis cases (p = 0.05). Hepatitis B virus DNA levels were higher in CHB/tuberculosis patients compared to CHB-only patients (p = 0.02).

Conclusions: Tuberculosis patients were more likely to test positive for hepatitis B and anti-hepatitis C viruses than the general population. These results emphasize the need for regular screening and coordinated care for co-infected patients.

Objective: While there are significant ongoing advancements in the management of Hodgkin lymphoma, doxorubicin + bleomycin + vinblastine + dacarbazine remains a preferred option for early stage Hodgkin lymphoma and is a frequently used first-line treatment globally. The aim of this retrospective study is to analyze real-world doxorubicin + bleomycin + vinblastine + dacarbazine outcomes from a safety net hospital setting.

Methods: This retrospective cohort consisted of 69 adult patients with classical Hodgkin lymphoma who received first-line doxorubicin + bleomycin + vinblastine + dacarbazine at Harbor-UCLA Medical Center from 2009 to 2024. Early (I-II) and advanced (III-IV) stage patients were included.

Results: The median patient age was 41 years old (range 18-71). There was balanced distribution of early stage (7.2% stage I, 40.6% stage II) and advanced stage (20.3% stage III, 31.9% stage IV) Hodgkin lymphoma. With a median of six cycles (range 2-7) of doxorubicin + bleomycin + vinblastine + dacarbazine, the complete response rate was 78.3% and overall response rate was 82.6%. Five-year progression-free survival was 70.7% (70.2% for stage I-II, 71.3% for stage III-IV). Overall survival at 5 years was 95.4% (100% for stages I-II, 91.5% for stages III-IV). Bleomycin-associated lung toxicity was observed in 10 (14.5%) patients, including one treatment-related death.

Conclusions: Response rates and overall survival from this real-world cohort are comparable to previously published contemporary studies. The high complete response rate, 5-year progression-free survival, and 5-year overall survival in this study further support the robust curative potential of doxorubicin + bleomycin + vinblastine + dacarbazine and validate its continued use in resource-limited settings.

Background: Chronic kidney disease, or renal failure, is a public health problem with an estimated prevalence of 8%-16% worldwide. This study was conducted to investigate the evolution of hematocrit levels over time in renal patients after transplantation and to determine how the evolution of hematocrit levels depends on the patients' age, sex, and other factors.

Objective: The main objective of this study was to employ a mixed-effects model to examine the unbalanced longitudinal evolution of hematocrit levels in chronic kidney failure patients.

Methodology: This longitudinal study included 1160 patients who received a renal transplant. These patients were followed for at most 10 years. The hematocrit level was considered the response, while the covariates were time in years, sex, and age of the patients. Different statistical methods, such as explanatory analysis, multivariate regression, two-stage analysis, and linear mixed-effects models, were employed to explore the evolution of hematocrit over time.

Results: The results revealed that hematocrit levels in kidney transplant patients evolve. The sex and age of the patient significantly affect the evolution of hematocrit levels. Males tend to have a greater increase in hematocrit levels over time than females do. Hematocrit levels tend to increase with increasing age. Furthermore, cardiovascular problems before transplant and rejection symptoms did not significantly affect the evolution of hematocrit levels.

Conclusions: Hematocrit levels evolve, and this evolution follows a quartic time effect. The change in hematocrit levels varies according to the sex and age of the patient after a kidney transplant. Patients with low hematocrit levels tend to have a greater increase over time.

Background: Chimeric antigen receptor T-cell therapy has emerged as a highly effective treatment for relapsed and refractory lymphomas; however, its application in individuals with human immunodeficiency virus remains underexplored. People with human immunodeficiency virus face an increased risk of developing malignancies such as lymphoma, where standard chemotherapy often results in suboptimal responses and heightened toxicity.

Objective: To review and synthesize current literature on the use of chimeric antigen receptor T-cell therapy and bispecific antibodies in human immunodeficiency virus-associated lymphoma, examining efficacy, safety, and potential barriers to implementation.

Methods: A systematic review of the literature was conducted using PubMed. Included studies comprised clinical trials, cohort studies, case reports, and preclinical research published between January 2000 and September 2024. Search terms included "HIV," "lymphoma," "CAR T cell therapy," "bispecific antibodies," "immunotherapy," and "HIV-associated lymphoma."

Results: Preliminary data suggest chimeric antigen receptor T-cell therapy is feasible in human immunodeficiency virus-positive patients, with response rates comparable to human immunodeficiency virus-negative populations and manageable adverse events, including cytokine release syndrome and neurotoxicity. Engineering chimeric antigen receptor T cells to target human immunodeficiency virus-infected cells is under investigation as a potential curative strategy. However, challenges such as immunosuppression, low antigen expression, and interactions with antiretroviral therapy complicate treatment. Bispecific antibodies have shown promise in hematologic malignancies, but data in people with human immunodeficiency virus remain limited due to trial exclusions.

Conclusion: Early findings support the feasibility and potential efficacy of chimeric antigen receptor T-cell therapy in human immunodeficiency virus-associated lymphoma. Larger, controlled trials are needed to establish safety, optimize treatment strategies, and expand therapeutic options for people with human immunodeficiency virus.

Objectives: We conducted a cross-sectional survey among young, middle-aged, and older adults to assess knowledge, attitudes, and beliefs about balance in the United States.

Methods: A community-based online cross-sectional survey was administered to a nationally representative sample of United States adults. Respondents were categorized into three age groups (young, middle-aged, older adults). Chi-square tests were used to assess differences in categorical variables, and analysis of variance was applied for continuous variables to examine differences in responses between age groups.

Results: All age groups demonstrated knowledge of balance, had a positive attitude toward improving their balance, and agreed with beliefs about the balance importance with age. While most respondents reported their balance was good, 25%-51% could not stand on one leg for more than 30 s, and one-third were not sure if they could. Regardless of age group, 34%-38% of respondents reported falling in the past year.

Conclusions: Balance is important across all age groups, yet most respondents do not report visiting a medical provider due to concerns about balance. A history of falls in the past year among younger and middle-aged adults may be higher than previously reported. Thus, balance education and balance practice should ideally begin well before the age of 65.

Objectives: Previous studies present conflicting evidence on the relationship between hepatocellular damage biomarkers and dementia risk. While elevated serum transaminases have been associated with mild cognitive impairment, other studies link lower transaminase levels and reduced high-density lipoprotein-cholesterol levels to increased risk of cognitive decline. This study investigated the association between serum transaminase-to-high-density lipoprotein-cholesterol ratios and probable dementia among people living with HIV on antiretroviral therapy.

Methods: We conducted a secondary data analysis using a dataset from a cross-sectional study conducted among 377 people living with HIV on dolutegravir-based antiretroviral therapy in southwestern Uganda. Probable dementia was screened using the brief Community Screening Instrument for Dementia and defined as a Community Screening Instrument for Dementia cognitive score ⩽4. Serum alanine aminotransferase/high-density lipoprotein-cholesterol and aspartate aminotransferase/high-density lipoprotein-cholesterol ratios were calculated from the respective serum transaminases and high-density lipoprotein-cholesterol divided into tertiles. We used logistic regression to assess the association between the independent variables and probable dementia.

Results: The median age of the study participants was 44 years (interquartile range: 30-59), with 56.2% being female. The median total cholesterol/high-density lipoprotein-cholesterol levels were significantly higher in participants with probable dementia compared to those without (3.86 versus 3.22, p = 0.03). Aspartate aminotransferase/high-density lipoprotein-cholesterol and alanine aminotransferase/high-density lipoprotein-cholesterol levels were also higher among participants with probable dementia compared to those without, although the differences did not reach statistical significance. In the fully adjusted model, compared to participants in the first tertile of aspartate aminotransferase/high-density lipoprotein-cholesterol ratio, the odds of probable dementia were higher in the second tertile (adjusted odds ratio: 1.71; 95% confidence interval: 0.62-4.74; p = 0.301) and significantly elevated in the third tertile (adjusted odds ratio: 4.48; 95% confidence interval: 1.15-17.46; p = 0.031).

Conclusions: The findings suggest that an elevated aspartate aminotransferase/high-density lipoprotein-cholesterol ratio is significantly associated with probable dementia among people living with HIV on dolutegravir-based antiretroviral therapy. A high aspartate aminotransferase/high-density lipoprotein-cholesterol ratio is potentially associated with cognitive decline in this population.

Objective: To assess the quality of healthcare in the emergency departments of governmental hospitals in the Gaza Strip, Palestine, from the perspective of nurses.

Methods: This observational, descriptive, and analytical cross-sectional study was conducted in major governmental hospitals in the Gaza Strip between October 2022 and January 2023. The study population comprised nurses working in adult emergency departments who had at least 6 months of clinical experience. Data were collected using a self-administered English questionnaire designed to assess six key domains of healthcare quality: physician effectiveness, nursing effectiveness, medical equipment efficiency, communication methods, safe environments, and timeliness. Descriptive and inferential statistics were applied using Statistical Package for the Social Sciences version 25.

Results: A total of 193 nurses were included. The study found that nurses rated the overall quality of healthcare in Gaza's emergency departments as high (75.0%). Among the six evaluated domains, communication methods received the highest rating (87.0%), followed by safe environments (82.0%) and physician effectiveness (77.1%). Nurses reported strong teamwork and effective communication within the healthcare team. However, two domains received notably lower scores: the quality of medical devices and instruments (56.5%) and nursing effectiveness (68.5%). Key concerns included shortages in medical equipment, delays in replacements, and insufficient nurse-to-patient staffing ratios. Despite these challenges, nurses acknowledged their commitment to accurate documentation and continuous patient follow-up.

Conclusion: The study indicates that while the overall quality of care in Gaza's emergency departments is rated high by nurses, there are ongoing challenges in medical equipment and personnel. Addressing these issues is essential for improving patient care and outcomes. Future research should focus on optimizing resource allocation and improving nurse-patient ratios in conflict-affected areas.

Objectives: Anemia is a prevalent hematological disorder in children infected with human immunodeficiency virus who are receiving antiretroviral therapy. Anemia is increasingly prevalent among children undergoing antiretroviral treatment; however, studies on the incidence and predictors of anemia in this population within Ethiopia remain limited. Therefore, this study aimed to determine the incidence of anemia and its predictors among children who were enrolled in antiretroviral therapy at health facilities in the Wolaita Zone, South Ethiopia, 2022.

Methods: A facility-based retrospective cohort study was conducted among 352 medical records at health facilities in the Wolaita Zone from February 2022 to January 2023. The medical records were selected using the stratified cluster sampling method. The data were entered into EpiData and analyzed using STATA version 14. The Cox proportional hazard regression model was used. Finally, predictors with p < 0.05 were stated as statistically significant factors. The results were presented using text, tables, and figures.

Results: The overall incidence rate of anemia among children was 4.29 (95% confidence interval: 3.46-5.34) per 100 person-years. Being female sex (adjusted hazard ratio = 1.79, 95% confidence interval: 1.29-2.47), advanced disease stage (adjusted hazard ratio = 2.26, 95% confidence interval: 1.26-4.06), a zidovudine-based regimen (adjusted hazard ratio = 2.07, 95% confidence interval: 1.16-3.69), and being stunted (adjusted hazard ratio = 3.37, 95% confidence interval: 2.06-5.50) were the predictors of anemia.

Conclusion: The incidence of anemia in the study setting was relatively low. Females, children at advanced World Health Organization clinical stages, those who were stunted, and those who initiated with a zidovudine-based regimen were the predictors of anemia. Healthcare providers should give special attention to children who are at an advanced disease stage, who were stunted, and who are taking a zidovudine-based regimen.

Objectives: Appropriate insulin injection techniques are crucial for ensuring therapeutic efficacy and patient safety; however, most routine injections are administered by nonspecialist nursing staff across various clinical settings. Assessing their current knowledge is essential to identify educational needs and prevent injection-related complications. Therefore, this study aimed to examine the knowledge gaps regarding insulin injection techniques among nondiabetes specialty nurses and identify the factors influencing their knowledge.

Methods: This cross-sectional questionnaire-based study was conducted on a sample of 815 hospital nurses across Japan using stratified sampling between September and December 2022. The questionnaire included a knowledge quiz, and participants whose scores fell within the lower range were classified into the low-scoring group. Multivariable logistic regression analysis was used to determine the factors associated with the group.

Results: The lowest correct response rate in the low-scoring group was for the question regarding the name of subcutaneous nodules at the injection site (16.48%). Multivariable logistic regression analysis showed that limited knowledge was significantly associated with the time since self-study of insulin injection techniques (95% confidence interval: 1.039-1.295; p = 0.008), lower interest in injection techniques (95% confidence interval: 0.476-0.706; p < 0.001), and the absence of additional certifications beyond a registered nursing license (95% confidence interval: 0.236-0.645; p < 0.001).

Conclusions: Nurses' knowledge of insulin injection techniques largely depends on individual initiative. Improving knowledge levels, offering organizational learning opportunities, and requiring continued education are necessary to ensure consistent knowledge improvement across the workforce.

Background: Preeclampsia/eclampsia places grave barriers to the successful reduction of maternal mortality and morbidity. These barriers have significant adverse outcomes for most women especially in sub-Saharan Africa, with Ghana contributing 88.7% of preeclampsia cases in Africa.

Aim: The aim of this study is to evaluate the maternal, physical and social characteristics that influence the occurrence of preeclampsia/eclampsia in Eastern Region of Ghana.

Methods: A prospective cohort study was conducted among pregnant women with gestational age > 28 weeks seeking antenatal care in seven hospitals in the Eastern Region of Ghana from October 2022 to March 2023. Using a simple random sampling technique, 445 patients were recruited at the antenatal care clinics using the antenatal care register as the reference point, and their delivery outcomes were evaluated after 13 weeks of follow-up.

Results: The study shows that pregnant women with poor personal hygiene are 10 times the odds (aOR: 10.169, p < 0.001, 95% CI: 4.896-21.121) of developing preeclampsia/eclampsia compared to those with good personal hygiene and about five times the risk of haemorrhage (RRR: 5.12, p-value = 0.014, 95% CI: 1.393-18.815) compared to those who are normal. Those who opted for Jadelle contraceptives had 3.4 times the odds (aOR: 3.419, p = 0.028, 95% CI: 1.143-10.227) of developing preeclampsia/eclampsia compared to those who used Depo-Provera contraceptives. Women who depended on borehole as their source of drinking water were 6.95 times the odds (aOR: 6.951, p = 0.013, 95% CI: 1.511-31.981) of developing preeclampsia/eclampsia compared to those who used sachet water. Furthermore, there was statistically significant association between comorbidity conditions and haemorrhage.

Conclusion: The study showed that pregnant women with poor personal hygiene were 10 times more likely to develop preeclampsia/eclampsia compared to those with good personal hygiene. The use of some family planning methods may influence the development of preeclampsia/eclampsia. Women need to seek medical advice on contraceptives before and during pregnancy before choosing contraceptives methods. Also, effective community-based health planning and services concept should be implemented to improve access to family planning services in the rural communities.