Balkan Medical Journal最新文献

Background: Cesarean section is frequently performed for breech presentation; however, external cephalic version (ECV) is recommended as an alternative strategy to increase the likelihood of vaginal birth. Tocolytics agents are commonly administrated to improve ECV success, yet the comparative effectiveness of different regimes remains inadequately characterized.

Aims: To systematically evaluate and compare the efficacy and safety of various tocolytic agents in facilitating successful ECV through a Bayesian network meta-analysis.

Study design: Bayesian network meta-analysis.

Methods: Bayesian network meta-analysis was performed using the "gemtc" package in R 4.1.1. Treatment effects were quantified by calculating odds ratios (ORs) with corresponding 95% credible intervals (CrIs). Surface under the cumulative ranking curve values were used to rank tocolytic agents according to ECV success rates, maternal outcomes, and adverse events.

Results: A total of sixteen RCTs encompassing 2,817 participants and six distinct tocolytic agents met the inclusion criteria. Compared with placebo, terbutaline (OR: 2.7, 95% CrI: 1.1-6.4) and ritodrine (OR: 2.2, 95% CrI: 1.4-3.9) were associated with significantly higher ECV success rates. Additionally, terbutaline was linked to an increased likelihood of vaginal delivery (OR: 2.0, 95% CrI: 1.0-2.9). Maternal adverse effects, including tachycardia, palpitations, hypotension, nausea, dizziness, and flushing, were more frequently reported with terbutaline, nifedipine, and nitroglycerin than with placebo. No statistically significant differences in fetal heart rate abnormalities were detected among the elevated interventions.

Conclusion: Terbutaline and ritodrine appear to offer superior efficacy in improving ECV success compared with alternative tocolytic agents, albeit with a higher incidence of maternal side effects. Consequently, clinical decision-making regarding tocolytic use should be informed by a comprehensive assessment of the associated benefits and potential risks.

Background: Depression and hearing loss (HL) commonly occur in the aging population and may arise from shared mechanisms.

Aims: To investigate the observational associations between depression and HL.

Study design: Observational study.

Methods: Adults aged ≥ 55 years from three nationally representative study cohorts were included: the National Health and Nutrition Examination Survey, the Health and Retirement Study, and the English Longitudinal Study of Ageing. Multiple linear regression was applied to examine the association between depressive severity and audiometric thresholds. Cox regression models were applied to evaluate the associations between depressive symptoms and HL.

Results: Cross-sectional analyses revealed that depression was significantly associated with higher pure-tone average thresholds. In pooled longitudinal analyses of 6,956 participants, individuals with baseline depression exhibited a higher incidence of HL when compared to their non-depressed counterparts. Longitudinal trajectory analyses identified three significant patterns: increasing [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.09-2.21] and fluctuating (HR 1.25, 95% CI 1.12-1.39) depressive symptom trajectories as independent predictors of HL, whereas decreasing trajectories indicated no significant association.

Conclusion: Depression and specific longitudinal trajectories are associated with elevated risk of HL. To further understand this association, integrated care models that synergistically address depression and HL in older adults are warranted.

Background: Ischemic heart damage reduces the pumping efficiency of the heart by affecting the left ventricular ejection fraction (LVEF) and causing wall motion abnormality (WMA). In daily clinical practice, these parameters are interpreted by physicians using two dimensional transthoracic echocardiography (2D-TTE). Because 2D-TTE reports rely on visual evaluations, they are subject to experience-based limitations and exhibit low reproducibility.

Aims: To develop an artificial intelligence algorithm composed of two modules that enable automatic LVEF calculation and WMA detection for analyzing 2D-TTE images.

Study design: Diagnostic accuracy study.

Methods: A total of 600 adult patients were retrospectively included. The model combined static frame segmentation with dynamic tracking using a hybrid Simpson's method applied to apical 2- and 4-chamber views. Model performance was assessed against cardiologist measurements using Bland-Altman analysis. The YOLOv8 and ResNet50 models were employed for the wall motion module. Performance metrics, including accuracy, precision, F1 score, and area under the curve, were evaluated.

Results: In the Bland-Altman analysis, the mean bias between the LVEF module and cardiologist measurements was -4, with limits of agreement ranging from -15 to -3. Regression analysis demonstrated a strong correlation between the LVEF module and cardiologist measurements (r = 0.71, p < 0.001). In the wall motion module, the YOLOv8 segmentation model exhibited high accuracy, while ResNet50 achieved superior performance with an accuracy of 95%. The algorithm's color coding contributed to standardized interpretation among operators, enhancing consistency.

Conclusion: This is the first study to integrate automated EF calculation and WMA detection within a single workflow. SafeHeart offers accurate, reproducible, and rapid analysis, with the potential to support routine echocardiography practice. Color-coded region segmentation can facilitate more standardized and reliable results. Sidem Gül1, Reşit Taşdemir2, Beyza Açıkgöz2, Hakan Duman3, Hamza Hodzic4, Sena Köker5, Nazlı Erdemir6, Mehmet Kıvrak7 Corresponding.

Background: Sepsis-associated encephalopathy is a prevalent complication in the sepsis population, especially in patients in the intensive care unit (ICU). The relationship between the hemoglobin glycation index (HGI) and delirium in sepsis patients in the ICU is not yet clearly established.

Aims: To investigate the relationship between HGI and delirium risk in sepsis patients admitted to the ICU.

Study design: Retrospective cohort study.

Methods: The data were extracted from the Medical Information Mart for Intensive Care IV 3.1 for the sepsis population in the ICU. The primary outcome was delirium occurrence in the ICU, whereas the secondary outcome was 30-day all-cause mortality (ACM) after ICU admission. The patients were stratified into tertiles according to HGI levels: T1 (HGI < -0.612), T2 (-0.612 ≤ HGI < 0.008), and T3 (HGI ≥ 0.008). The link of HGI to clinical outcomes in ICU patients was examined through logistic regression (LR), Cox proportional hazard models, and restricted cubic spline (RCS) and threshold effect analyses. The robustness of our findings was rated through subgroup analyses and interaction tests.

Results: In total, 3,744 patients were encompassed in the final analysis. The LR model showed that delirium risk in the T1 group was 67.7% higher than that in the T2 group [odds ratio (OR) = 1.677, 95% confidence interval (CI): 1.414, 1.992], while that in the T3 group was 24.8% higher than that in the T2 group (OR = 1.248, 95% CI: 1.048, 1.487). The Cox proportional hazard model indicated a 36.2% higher risk of 30-day ACM in T1 compared to T2 (hazard ratio = 1.362; 95% CI: 1.041-1.782). The RCS curve demonstrated an approximately U-shaped relation of HGI to delirium risk. The threshold effect analysis revealed an inflection point at HGI = -0.34. When HGI ≤ -0.34, each one-unit increase in HGI lowered the delirium risk by 36.2% (95% CI: 0.527-0.768).

Conclusion: This study suggested an independent association between HGI and both delirium risk and short-term prognosis in particularly in patients admitted to the ICU. HGI may be used as a prognostic risk stratification biomarker.