SAGE Open Medicine最新文献

Quality has been a concern of the World Health Organization since its inception and is defined as fitness for use. Since our ancestors began trading several millennia ago, Falsified Pharmaceutical Products has been a recurring problem and still threatens economic stability and public health. Its definition various from country to country and according to World Health Organization, 2017, it is 'a product that is deliberately and fraudulently mislabelled with respect to identity and/or source'. The implementation of anti-falsified nanomaterial technologies is the prominent preventive measure to track and/or detect Falsified Pharmaceutical Products. Software and hardware companies had made encouraging progress towards implementing Radio Frequency Identification devices for ensuring the authenticity of pharmaceutical products. The purpose of the review was to critically appraise Radio Frequency Identification devices technology for the purpose of track and trace Falsified Pharmaceutical Products circulating in the market. Different search engines such as Google Scholar, Science Direct and PubMed were applied and mesh terms and keywords were searched. Different guides and related books were investigated in addition to the articles. Radio Frequency Identification devices technology is a compact electronic device that contains a small chip and reader with antenna that enables wireless transmission of identity of pharmaceutical products. The authenticated Radio Frequency Identification devices model is used for pharmaceutical products' authentication from origin of pharmaceutical industry to the pharmacy at any point along the chain of the distribution. Popular pharmaceutical products, such as OxyContin and Sildenafil Citrate, which are particular targets of falsification have mandated the use of Radio Frequency Identification devices technology.

Objective: We investigated the effect of the pandemic on neurological hospitalizations and complications associated with severe acute respiratory syndrome coronavirus 2 infection or vaccinations.

Methods: We retrospectively analyzed data of patients hospitalized in our neurology division from 1 April 2019 to 31 March 2022 as the opt-out study. We classified the neurological diseases into nine subgroups, evaluated changes of neurological disease characteristics, and analyzed patients hospitalized with the complications from severe acute respiratory syndrome coronavirus 2 infection or after the coronavirus disease 2019 vaccination over three eras based on the pandemic stages: (1) pre-pandemic, (2) during the pandemic but before vaccines, and (3) during the pandemic with vaccines.

Results: Overall, 1756 patients were included in the analyses. The patient characteristics significantly changed throughout the pandemic (p < 0.01). Although the number of autoimmune cases did not change throughout the pandemic (p = 0.53), that of psychological cases and that of unknown cases were significantly changed (p < 0.05, p < 0.01). There were four infectious cases and 11 cases following vaccination from 1 April 2020 to 31 March 2022. The 11 postvaccination cases involved 10 kinds of neurological diseases.

Conclusions: The neurological characteristics significantly changed throughout the pandemic and there were diverse neurological complications following vaccinations.

Objectives: We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals.

Methods: Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change.

Results: Active and inactive participants differed in their perspectives about how Gerofit impacted their progress toward meeting personal health goals. Active participants noted program features (e.g., schedule, staffing) as facilitators and suggested greater self-efficacy about program participation compared to inactive participants. Both groups perceived the camaraderie with other veterans as a facilitator.

Conclusions: Exercise program features, including camaraderie, are important factors that affect the ability of older veterans to participate in exercise and achieve personal health goals.

In our article, we explore the transformative potential of Artificial Intelligence and Machine Learning in oculo-oncology, focusing on the diagnosis and management of ocular adnexal tumors. Delving into the intricacies of adnexal conditions such as conjunctival melanoma and squamous conjunctival carcinoma, the study emphasizes recent breakthroughs, such as Artificial Intelligence-driven early detection methods. While acknowledging challenges like the scarcity of specialized datasets and issues in standardizing image capture, the research underscores encouraging patient acceptance, as demonstrated in melanoma diagnosis studies. The abstract calls for overcoming obstacles, conducting clinical trials, establishing global regulatory norms and fostering collaboration between ophthalmologists and Artificial Intelligence experts. Overall, the article envisions Artificial Intelligence's imminent transformative impact on ocular and periocular cancer diagnosis.

Introduction: Pharmacy services in hospitals are designed to meet the needs of all patients. This is undoubtedly one of the most complex services provided by hospitals. In government hospitals, including those in Ethiopia, pharmacies mainly serve as drug stores and dispensaries. To the best of our knowledge, this study is the first to assess and ensure better quality assurance for hospital pharmacy services in Ethiopia. Therefore, the objective of this article was to assess the current status of the quality assurance of pharmacy services in hospitals.

Methods: A cross-sectional survey was conducted. The data were collected from hospital pharmacy heads using the Kobo Collect mobile application and then exported to the Statistical Package for Social Science (SPSS) version 25 for analysis. Descriptive statistics for categorical variables are presented as percentages and frequencies.

Results: All (100%) of the studied hospital pharmacies had a qualified pharmacy director and worked in the pharmacy full-time. Only 40% had a drug information center and a functional drug formulary committee. All pharmacies had their own disposal facilities but did not regularly dispose of expired or unfit medications. The results revealed that all hospital pharmacies did not have a responsible body delegated for quality evaluation.

Conclusion: The findings of this study clearly show that quality assurance services in hospital pharmacies are compromised. The findings can be used to identify areas of improvement and develop strategies to enhance the quality of hospital pharmacy services.

Objective: The cause of syncope is generally determined based on clinical manifestations. There has been little discussion about the value of electrocardiograms for diagnosing neurally mediated syncope. The aim of this study was to test the predictive value of the isolated very low QRS voltage in tilt-table testing for suspected neurally mediated syncope in a Chinese population.

Methods: This retrospective study enrolled patients with suspected neurally mediated syncope. Tilt-table testing was a part of the diagnostic examination. Each patient underwent echocardiography and electrocardiogram. isolated very low QRS voltage referred to a voltage of ⩽0.3 mV for the QRS complex in an isolated frontal lead or ⩽0.7 mV for the QRS complex in an isolated precordial lead.

Results: In total, 157 patients were included in the tilt-table testing positive group, and 242 patients were included in the tilt-table testing negative group. Compared with the testing negative group, the testing positive group had more patients with isolated very low QRS voltage in the frontal leads (p < 0.001). Moreover, for patients with isolated very low QRS voltage in the precordial leads, no significant difference was noted between the testing positive group and testing negative group (p = 0.289). Isolated very low QRS voltage in the frontal leads demonstrated 84.08% sensitivity and 74.38% specificity for a positive tilt-table testing response. The area under the curve of isolated very low QRS voltage for a positive tilt-table testing response in frontal leads was 0.806 (p < 0.0001).

Conclusion: In patients with suspected neurally mediated syncope, isolated very low QRS voltage in the frontal leads is a parameter that can predict a positive tilt-table testing response. The presence of isolated very low QRS voltage in frontal leads can serve as a parameter for evaluating syncope patients.

Background: The development of multidrug resistant strains of extended-spectrum β-lactamase-producing Escherichia coli has become a global problem; therefore, the discovery of new antibacterial agents is the only available solution.

Objective: To improve and propose new compounds with antibacterial activity, the three-dimensional quantitative structure-activity relationship and molecular docking studies were carried out on Aztreonam analogs as E. coli inhibitors in DNA gyrase B.

Method: This study's 3D-Quantitative structure-activity relationship model was created using on the Comparative Molecular Field Analysis and the Comparative Molecular Similarity Indices Analysis. Using the Comparative Molecular Field Analysis (Q ² = 0.73; R ² = 0.82), excellent predictability was achieved, and the best Comparative Molecular Similarity Indices Analysis model (Q ² = 0.88; R ² = 0.9). The generated model's ability to predict outcomes was assessed through external validation using a test set compound and an applicability domain technique. In this study, the steric, electrostatic, and hydrogen bond acceptor fields played a key role in antibacterial activity.

Results: The results of the molecular docking revealed that the newly generated compound A6 has the highest binding affinity with DNA gyrase B. It forms 10 hydrogen bonds with amino acid residues of Asn104, Asn274, Asn132, Ser70, Ser237, Thr105, Glu273, and 2 salt bridges with amino acid residues of Ser70 and Glu273 and one pi-pi interacting with Gys271 amino acid residue in the binding site of 5G1, and this result was validated by a new assessment method. We created some novel, highly effective DNA gyrase B inhibitors based on the earlier findings, and the most accurate model predicted their inhibitory actions. The ADMET characteristics and pharmacological similarity of these novel inhibitors were also examined.

Conclusion: These findings would be very beneficial in guiding the optimization process for the identification of novel drugs that can address the issue of multiple drug resistance.

Background: Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.

Methods: A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.

Results: The results showed that a total of 333 patients from 415 enrolled were analyzed. Klebsiella pneumoniae (35.4%), Acinetobacter baumannii (29.3%), and Pseudomonas aeruginosa (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by p < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients (p < 0.05).

Conclusions: Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.

Background: We developed a technique to preserve the entire nasolacrimal duct and inferior turbinate, by swinging the nasolacrimal duct upward and the inferior turbinate backward; that is, a nasolacrimal duct and inferior turbinate swing technique for sinonasal inverted papilloma of the maxillary sinus. In this study, we evaluated the long-term results of this technique.

Methods: A retrospective analysis was performed on the data for 53 consecutive pathologically confirmed inverted papilloma patients who were treated using nasolacrimal duct and inferior turbinate swing technique. The frequency of recurrence, the degree of nasolacrimal duct and inferior turbinate preservation, and the frequency of adverse events were assessed.

Results: The median follow-up period was 51 months (mean 62.5 months; range 10-187 months). No cases of recurrence within the maxillary sinus were observed among the cases treated using this technique, whereas three (5.7%) of the 53 cases experienced recurrence in areas other than the maxillary sinus. We could preserve the nasolacrimal duct in all cases. On the other hand, the inferior turbinate was resected during surgery in one case. No epiphora, dacryocystiits, numbness of the cheek, or collapse of the ala of the nose was observed.

Conclusion: This nasolacrimal duct and inferior turbinate swing technique method is a safe and effective method for the excision of primary or recurrent inverted papilloma and demonstrates low rates of recurrence and complications.

Background: Biological agents have revolutionized care in specialties such as oncology, immunology, infectious diseases, and genetic disorders, offering targeted actions on specific molecules or select immune cells. Monoclonal antibodies, known for their high specificity and precision, represent one of the most significant and rapidly expanding categories of these agents. Understanding the drug utilization patterns of monoclonal antibodies is crucial to ensure their optimal use, especially given their high cost and potential adverse effects.

Methods: This analytical cross-sectional study was conducted in a secondary hospital in the United Arab Emirates. Patients of either gender receiving monoclonal antibodies at the study site were included. Treatment patterns, utilization, and factors associated with the discontinuation of monoclonal antibodies were assessed.

Results: Hyperlipidemia (136, 39.1%) was the most common indication for monoclonal antibodies, followed by prophylaxis of respiratory syncytial virus infection in congenital heart disease (104, 29.9%) and osteoporosis (42, 12.1%). Evolocumab was the most commonly prescribed monoclonal antibody (135, 38.8%), followed by palivizumab (104, 29.9%), and dupilumab (38, 10.9%). The majority of monoclonal antibodies demonstrated a prescribed daily dose to defined daily dose ratio of 1.0, reflecting their appropriate utilization. One hundred twenty-nine patients (37.0%) discontinued their treatment during the study. Patient's level of education (OR: 0.416, 95% CI: 0.183-0.943, p = 0.036), BMI (OR: 2.358, 95% CI: 1.164-4.777, p = 0.017), number of concomitant medications (OR: 2.457, 95% CI: 1.202-5.025, p = 0.014), and treatment duration (OR: 9.180, 95% CI: 4.909-17.165, p < 0.001) were identified as predictors of discontinuation of monoclonal antibodies.

Conclusion: This study represents the first comprehensive investigation in the United Arab Emirates focused on treatment patterns, utilization, and discontinuation of monoclonal antibodies among the local population. Monoclonal antibodies were prescribed for the management of a wide range of clinical conditions. The study reports appropriate utilization of most monoclonal antibodies and identifies factors such as patient education level, BMI, concomitant medications, and treatment duration as independent predictors of monoclonal antibody treatment discontinuation.