Narra J最新文献

Dengue is the primary arbovirus transmitted by Aedes aegypti mosquitoes. Effective management of dengue demands a multidisciplinary approach. The aim of this study was to conduct an integrated analysis of dengue transmission, focusing on its vector mosquitoes, to establish a baseline for dengue control and prevention in an endemic region of Colombia. The study was conducted from 2015 to 2018 across four municipalities in the Vichada department near the Venezuelan border. Five complementary approaches were employed: (1) determining the natural infection rate and circulation of various dengue virus serotypes in mosquitoes; (2) evaluating the insecticide susceptibility status and examining mosquito genotypes for three knockdown (kdr) mutations linked to insecticide resistance; (3) performing a phylogenetic analysis to identify the lineage of Ae. aegypti; (4) creating risk maps for dengue transmission based on predictive models in two municipalities in the department; and (5) empowering the community. Molecular analysis using RT-PCR indicated dengue virus infections in all municipalities of the Vichada department. Eleven positive pools for serotypes DENV-1, DENV-2, DENV-3, and DENV-4 were detected. The highest minimum infection rate (MIR) was found in Cumaribo, followed by La Primavera, which showed the greatest diversity of dengue virus serotypes. Mosquitoes from all three populations showed susceptibility to malathion and lambda-cyhalothrin pyrethroid, except for mosquitoes from Puerto Carreño, which presented moderate resistance to lambda-cyhalothrin (resistance ratio of 8). Importantly, all mosquitoes had F1534C mutation, while the V1016I and V419L mutations were found at lower frequencies. Risk classification maps for Puerto Carreño and La Primavera showed neighborhoods with high risk, indicating potential hotspots for intervention and vector control. This study established a necessary baseline for the ongoing monitoring and improvement of the early warning system for all municipalities in the Vichada department. The integrative approach employed in this study highlights the importance of incorporating these methodologies into dengue epidemiological surveillance in endemic regions.

Attachment theory suggests that secure relationships are foundational to meaning in life, but less is known about the role of spiritual attachment, especially among religious minorities. This study examined whether attachment to God mediates the relationship between insecure human attachment and the presence of meaning in life among Thai Protestant Christians. A cross-sectional survey was conducted with Thai Protestant Christians, assessing insecure human attachment (avoidant and anxious), attachment to God, and the presence of meaning in life using validated self-report measures. Mediation analysis was used to test the indirect effect of insecure attachment on meaning via attachment to God. The results showed that attachment to God fully mediated the negative relationship between insecure human attachment and the presence of meaning in life. Participants with higher insecure attachment reported lower meaning in life, but those with a secure attachment to God did not display this deficit. Attachment to God serves as a central psychological resource, a positive figure for humans, and enhances meaning in life, particularly in the minority context of Thai Protestant Christians. These findings highlight the importance of spiritual interventions for individuals experiencing relational or social marginalization.

Acute coronary syndrome (ACS) remains a major global health and economic burden. In Indonesia, North Kalimantan reports the highest prevalence of heart disease (2.2%), exceeding the national average of 1.5%. Nunukan, the province's northernmost and predominantly archipelagic region, is served by a single general hospital, reflecting the healthcare challenges faced by many rural Indonesian areas. This study aimed to provide epidemiological insights into ACS cases in this region to inform improved management strategies in similar resource-limited settings. A retrospective cross-sectional study was conducted among ACS patients admitted to Nunukan Regency General Hospital, Nunukan, Indonesia, between January 1 and August 31, 2023. Data on demographics, risk factors, clinical presentation, vital signs, diagnostic findings, treatments, and outcomes were collected from paper-based medical records. Of the 241 patients admitted, 4.56% were diagnosed with ST-elevation myocardial infarction (STEMI), 35.68% with very high-risk non-ST-elevation ACS (VHR NSTE-ACS), and 59.75% with non-very high-risk NSTE-ACS (NVHR NSTE-ACS). The mean age was 55.4±12.26 years, with a predominance of males (51.5%) and obesity (35.7%). The median number of risk factors was 2 (IQR: 1-2.5), with hypertension being the most prevalent (72.6%). Late presentation was common, and only 36.4% of STEMI patients received fibrinolytic therapy. The overall in-hospital mortality rate was 3.3%, and the median length of stay was 6 days (IQR: 5-7). ACS patients in Nunukan exhibited distinct clinical and demographic profiles, characterized by younger age, obesity, multiple risk factors, and delayed presentation. These findings highlight the urgent need to strengthen cardiovascular care capacity and early intervention strategies in remote and resource-limited regions of Indonesia.

Neutrophil-to-lymphocyte ratio (NLR), an accessible biomarker derived from routine blood counts, has been associated with stroke severity and outcomes. However, its association with angiographically confirmed stenosis has not been fully established. The aim of this study was to investigate the correlation and association between the NLR and the severity of intracranial arterial stenosis assessed by digital subtraction angiography (DSA). An observational analytic study with a cross-sectional design was conducted. Patients with acute ischemic stroke who underwent DSA were included using a total sampling method. Eligible patients were aged >18 years, had ischemic stroke onset <14 days, and had no prior thrombolysis, endovascular treatment, or surgery for cerebral stenosis. Those with infection, hematological disorders, malignancy, or immunosuppression were excluded. NLR was calculated from complete blood count results at admission, while stenosis severity was quantified using the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) method. A total of 44 ischemic stroke patients who underwent DSA were included. Pearson correlation test revealed a strong positive correlation between NLR and the severity of intracranial arterial stenosis (r=0.671; p<0.001). In subgroup analysis, NLR showed a strong positive correlation with stenosis severity in the cerebral arteries (r=0.707; p<0.001), but not in the carotid arteries (r=0.434; p=0.182). One-way ANOVA revealed significant differences in NLR across stenosis severity groups (p<0.0001), with higher NLR in moderate and severe stenosis compared with mild stenosis (p=0.017 and p=0.0003, respectively). These findings suggest that NLR reflects the inflammatory burden contributing to vascular narrowing and may serve as a simple and widely available biomarker for identifying ischemic stroke patients with a higher burden of intracranial arterial stenosis, particularly in settings where access to advanced imaging is limited.

Prostate cancer is a leading cause of death among men worldwide, with limited therapeutic options for castration-resistant metastatic prostate cancer (mCRPC). The aim of this study was to investigate the potential role of doxazosin, an α1-blocker, as an adjunctive therapy for mCRPC in combination with abiraterone. Using mCRPC PC3 cells, the effects of doxazosin on cell viability and apoptosis were assessed. The experimental design was an in vitro study with post-test-only control design. Experimental groups were divided into four groups: control group, doxazosin group, abiraterone group, and combination group (doxazosin and abiraterone). Cell viability was analyzed using the cell counting kit-8 (CCK-8) assay, while apoptosis was analyzed using Fluorescence-activated cell sorting (FACS). This study found that the IC₅₀ value for doxazosin was 25.42±1.42 µM (mean ± standard error). The results indicated that doxazosin significantly reduced cell viability, with effects varying based on the dose administered, and doxazosin was able to induce apoptosis in mCRPC PC3 cells. The combined treatment of doxazosin and abiraterone in mCRPC PC3 cells demonstrated a significantly higher mean apoptosis percentage compared to the control group (16.27%; 95% confidence interval (CI): 11.89-20.65; p=0.001). Furthermore, the combined treatment showed a significantly higher mean apoptosis percentage compared to abiraterone alone (4.79%; 95%CI: 0.41-9.18; p=0.029), and doxazosin alone (10.99%; 95%CI: 6.61-15.38; p=0.001). These findings suggest that doxazosin, traditionally used as an α1-blocker for lower urinary tract symptoms (LUTS), could offer a novel therapeutic approach for mCRPC patients.

The choice between first-generation drug-eluting stents (DES) and second-generation DES in managing calcified coronary lesions remains a topic of debate. The aim of this study was to compare outcomes between first-generation DES and second-generation DES in patients with calcified coronary lesions. This meta-analysis study was conducted from October to November 2024. The databases used were Embase, Scopus, and PubMed. Relevant articles were collated, and data regarding outcomes in patients with calcified coronary lesions treated with first-generation and second-generation DES were included to calculate the pooled effect size. The statistical analysis was performed using the Mantel-Haenszel method. Six articles were included in the study. The results indicated that calcified coronary lesions treated with first-generation DES were associated with increased risks of all-cause mortality (Odd ratios (OR): 1.23; 95% confidence interval (95%CI): 1.05-1.45; p-Egger= 0.9346; p-Heterogeneity: 0.9720; p=0.0120), myocardial infarction (OR: 1.48; 95%CI: 1.22-1.80; p-Egger: 0.6472; p-Heterogeneity: 0.5890; p<0.0001); and target lesion revascularization (TLR) (OR: 1.47; 95%CI: 1.24-1.74; p- Egger: 0.9982; p-Heterogeneity: 0.5950; p<0.0001), in comparison with second-generation DES. In contrast, when comparing first- and second-generation DES in terms of cardiac death and major adverse cardiovascular events, a similar risk was depicted. This study compared the outcomes of first-generation and second-generation DES in the management of patients with calcified coronary lesions, which may serve as a reference for selecting DES in the patient population.

The role of coenzyme Q10 (CoQ10) as an antioxidant in the context of cryptorchidism is increasingly recognized due to its potential protective effects against oxidative stress, a key contributor to testicular dysfunction in this condition. The aim of this study was to evaluate the antioxidant activity of CoQ10 and its impact on sperm parameters as an adjuvant therapy in a cryptorchidism mouse model. A total of 36 male Sprague Dawley mice were divided into six groups: control (negative control), cryptorchidism (positive control), orchidopexy only, and orchidopexy treated with CoQ10 at 5, 10 and 20 mg/kg body weight (BW). After seven days of induction into the cryptorchidism model, the mice underwent orchidopexy, and CoQ10 was administered orally from day 1 to day 7 post-orchidopexy. At the end of the treatment period, all mice were euthanized, and the left testes were collected for immunohistochemical analysis of malondialdehyde (MDA) and superoxide dismutase (SOD), as well as histological examination and sperm parameter assessment. Testicular tissue damage was assessed using the Cosentino grade, while spermatogenesis was evaluated using the Johnsen scoring system. Additionally, sperm parameters were analyzed from the left testis. MDA expression in the cryptorchidism group was significantly lower than in all CoQ10-treated groups (p<0.001). In contrast, SOD expression was significantly higher in the cryptorchidism group compared to the 10 mg/kg BW and 20 mg/kg BW CoQ10 groups (both had p<0.001). Cosentino grade and Johnsen score showed no significant differences between the control group and the group treated with 20 mg/kg BW CoQ10 (p=0.891 and p=0.123, respectively). Furthermore, the 20 mg/kg BW CoQ10 group had significantly greater sperm concentration and motility compared to the cryptorchidism group (p<0.001 for both). These findings demonstrated that CoQ10 had significant antioxidant activity as an adjuvant therapy in a cryptorchidism mouse model. CoQ10 supplementation could reduce oxidative stress markers, enhance antioxidant enzyme expression, and improve sperm parameters, supporting its potential to mitigate testicular damage associated with cryptorchidism.

Catheter ablation has been the go-to treatment for ventricular arrhythmia, with traditional fluoroscopy-guided and non-zero fluoroscopy (NZF) catheter ablation posing high radiation risk for operators and patients. Zero-fluoroscopy technique offers elimination of radiation risk; however, its efficacy and safety in ventricular arrhythmia patients are not well explored. The aim of this study was to systematically evaluate the effectiveness, safety, and feasibility of zero-fluoroscopy ablation on ventricular arrhythmia patients. This study only included relevant studies comparing zero-fluoroscopy and NZF in ventricular arrhythmia ablation that were identified from Scopus, PubMed, and ScienceDirect (up to June 20, 2024). The quality of the study was assessed using the ROBINS-I tool, and the meta-analysis was conducted using a random-effect model. Out of 383 studies found, nine cohort studies were included with 1.408 patients. There was no significant difference in the acute procedural success rate of the zero-fluoroscopy and NZF (relative risk: 1.01; 95%CI: 0.95-1.07; p=0.69), with a similar recurrence rate (p=0.88; for four studies; n=374), and comparable procedural time (mean difference: -19.22 minutes; 95%CI: - 41.16-2.72; p=0.09). Adverse events such as pericardial effusion, pseudoaneurysm, and hematoma were similar between zero-fluoroscopy and NZF. Overall, zero-fluoroscopy catheter ablation has demonstrated non-inferiority as a treatment option for ventricular arrhythmia ablation. As zero-fluoroscopy eliminates radiation risk without compromising procedural efficacy, zero-fluoroscopy has the potential to become a widely adopted approach for catheter ablation in ventricular arrhythmia.

Improving nutrition in women prior to conception represents an alternative approach to enhancing the quality of pregnancy. Increased knowledge and self-efficacy among preconception women positively impact changes in health behavior. The rapid development of technology provides an opportunity to implement innovative interventions, including digital health. The aim of this study was to systematically review the efficacy of digital health interventions in modifying the behavior of preconception women. The data were obtained by searching relevant articles published from 2015 to 2023 in electronic databases, including Google Scholar, Science Direct, Web of Science (WoS), Biomed Central, and PubMed. The following keywords were used: "digital health" OR "mobile health" OR "e-health" AND "preconception women" OR "pre-marriage women." Of the 266 studies identified in the search phase, only those that met the inclusion criteria were included in the review. These criteria included 10 articles that assessed the effectiveness of digital health interventions on the behavior change of preconception women. The articles included in this study originated from diverse countries and addressed various digital health interventions. The findings of the review indicated that ten articles reported an increase in pregnant women's knowledge, nine articles demonstrated an enhancement in self-efficacy, and nine articles documented behavioral changes. The behavioral changes observed included the initiation of folic acid consumption before pregnancy, an increase in vegetable and fruit consumption, and a reduction in unhealthy dietary behaviors, such as maintaining a normal weight, smoking cessation, and reduced alcohol consumption. In conclusion, digital health literacy interventions, delivered via web-based platforms or mobile applications, demonstrate effectiveness in promoting positive preconception health behaviors among women, ultimately contributing to improved pregnancy outcomes.

Although leptospirosis is a well-recognized zoonotic disease, the occurrence of ST-segment-elevation myocardial infarction (STEMI)-mimicking leptospiral myocarditis, accompanied by subsequent bleeding and thrombocytopenia is an exceptionally rare finding. The dual risks of bleeding and thrombosis further complicate the management of anticoagulation and thrombolytic therapy amidst competing risks. The aim of this study was to present leptospirosis complicated by myocarditis, which mimicked STEMI, followed by bleeding and thrombocytopenia. A 61-year-old male patient was referred from a community health center to the hospital with primary complaints of chest discomfort and diaphoresis, which had started 11 hours prior to admission. These symptoms were associated with a 12-day history of intermittent fever, nausea, and vomiting. Upon physical examination, the patient appeared lethargic, with a blood pressure of 86/63 mmHg, heart rate of 107 bpm, respiratory rate of 22 breaths per minute, and temperature of 39.8°C. Electrocardiography revealed widespread ST-segment elevation. Echocardiography showed global hypokinesia with a reduced ejection fraction of 48%. Laboratory tests confirmed the presence of IgM and IgG anti-Leptospira antibodies, along with elevated high-sensitivity cardiac troponin levels. The patient was diagnosed with Weil's disease (Faine's score 32), with leptospiral myocarditis and STEMI considered as differential diagnoses. Initial management involved a loading dose of dual antiplatelet therapy (aspirin 320 mg and clopidogrel 300 mg) due to the suspected diagnosis of STEMI. However, it was later discontinued on the second day of admission due to the development of severe thrombocytopenia and minor bleeding manifestations. Following the administration of ceftriaxone 2 g every 12 hours and doxycycline 100 mg every 12 hours, the patient's condition improved. This case highlights the importance of recognizing leptospirosis as a potential cause of myocarditis and thrombocytopenia, especially when clinical signs resemble those of STEMI. Early diagnosis and careful management, including the suspension of dual antiplatelet therapy and initiation of targeted antibiotic therapy, were pivotal in preventing further complications and improving the patient's outcomes.