A. Tsiakiri, Pinelopi Vlotinou, Aikaterini Paschalidou, Christos Konstantinidis, F. Christidi, D. Tsiptsios, Georgia Detsaridou, Alexandra Petridou, Aimilios Gkantzios, Stella Karatzetzou, K. Tsamakis, E. Giannakou, Maria Emmanouilidou, K. Vadikolias, N. Aggelousis
The purpose of the present study was to review all available work published within the last decade focusing on coping strategies in stroke caregivers and their impact on quality of Life (QoL) and psycho-emotional status. A literature search of two databases (MEDLINE, Scopus) was conducted to identify all relevant full-text English studies published between 2013–2023. Sixteen articles were traced and were finally included. Cognitive and behavioral coping strategies were beneficial for stroke caregivers’ and survivors’ QoL. The level of mutuality in the caregiver-survivor relationship was associated with the impact of depressive symptoms on caregivers’ QoL and the protective effect of mutuality on survivors’ QoL over time. The level and quality of social support were positively associated with QoL for stroke caregivers and survivors. Caregivers’ preparedness was a moderator for the impact of depression on both caregivers’ and survivors’ QoL. High levels of spirituality had a significant role in ameliorating the negative impact of depressive symptoms on the psychological and physical QoL of stroke caregivers and survivors. In conclusion, the study of coping strategies can be used as a psychological reserve in the process of stroke rehabilitation and actively contribute to improving the QoL of both caregivers and stroke survivors.
{"title":"A Scoping Review on Coping Strategies and Quality of Life of Stroke Caregivers: Often Underestimated Variables in Stroke Recovery Process?","authors":"A. Tsiakiri, Pinelopi Vlotinou, Aikaterini Paschalidou, Christos Konstantinidis, F. Christidi, D. Tsiptsios, Georgia Detsaridou, Alexandra Petridou, Aimilios Gkantzios, Stella Karatzetzou, K. Tsamakis, E. Giannakou, Maria Emmanouilidou, K. Vadikolias, N. Aggelousis","doi":"10.3390/biomed3030029","DOIUrl":"https://doi.org/10.3390/biomed3030029","url":null,"abstract":"The purpose of the present study was to review all available work published within the last decade focusing on coping strategies in stroke caregivers and their impact on quality of Life (QoL) and psycho-emotional status. A literature search of two databases (MEDLINE, Scopus) was conducted to identify all relevant full-text English studies published between 2013–2023. Sixteen articles were traced and were finally included. Cognitive and behavioral coping strategies were beneficial for stroke caregivers’ and survivors’ QoL. The level of mutuality in the caregiver-survivor relationship was associated with the impact of depressive symptoms on caregivers’ QoL and the protective effect of mutuality on survivors’ QoL over time. The level and quality of social support were positively associated with QoL for stroke caregivers and survivors. Caregivers’ preparedness was a moderator for the impact of depression on both caregivers’ and survivors’ QoL. High levels of spirituality had a significant role in ameliorating the negative impact of depressive symptoms on the psychological and physical QoL of stroke caregivers and survivors. In conclusion, the study of coping strategies can be used as a psychological reserve in the process of stroke rehabilitation and actively contribute to improving the QoL of both caregivers and stroke survivors.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72981330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Polypharmacy, the use of multiple and potentially inappropriate medications, is an increasing problem among older adults. The global polypharmacy prevalence is 34.6% in patients with COVID-19, and polypharmacy in COVID-19 increases with age. The present paper proposes that polypharmacy in older adults with COVID-19 and other comorbid conditions is linked to the medication outcome reporting bias of randomized controlled trials. Outcome reporting bias can occur when treatment efficacy is reported as relative risk reductions, which overestimates medication benefits and exaggerates disease/illness risk reductions compared to unreported absolute risk reductions. The comorbidities common in patients with COVID-19 include high blood pressure, cardiovascular disease, dementia or cerebrovascular disease, and diabetes. Accordingly, the present paper reassesses the relative and absolute risk reductions in clinical trials from a small convenience sample of antihypertension, statin, anticoagulant, and antihyperglycemic medications. Examples demonstrate a wide gap between reported relative risk reductions and unreported absolute risk reductions in medication clinical trials. This paper concludes that medication clinical trial outcome reporting bias is an important upstream factor that contributes to biased medication benefits and poor clinical decision making, leading to polypharmacy in older adults with COVID-19 and other comorbid conditions. Public health campaigns are urgently needed to educate the public about the link between polypharmacy and medication outcome reporting bias.
{"title":"Polypharmacy and Medication Outcome Reporting Bias in Older Patients with COVID-19","authors":"Ronald B. Brown","doi":"10.3390/biomed3030027","DOIUrl":"https://doi.org/10.3390/biomed3030027","url":null,"abstract":"Polypharmacy, the use of multiple and potentially inappropriate medications, is an increasing problem among older adults. The global polypharmacy prevalence is 34.6% in patients with COVID-19, and polypharmacy in COVID-19 increases with age. The present paper proposes that polypharmacy in older adults with COVID-19 and other comorbid conditions is linked to the medication outcome reporting bias of randomized controlled trials. Outcome reporting bias can occur when treatment efficacy is reported as relative risk reductions, which overestimates medication benefits and exaggerates disease/illness risk reductions compared to unreported absolute risk reductions. The comorbidities common in patients with COVID-19 include high blood pressure, cardiovascular disease, dementia or cerebrovascular disease, and diabetes. Accordingly, the present paper reassesses the relative and absolute risk reductions in clinical trials from a small convenience sample of antihypertension, statin, anticoagulant, and antihyperglycemic medications. Examples demonstrate a wide gap between reported relative risk reductions and unreported absolute risk reductions in medication clinical trials. This paper concludes that medication clinical trial outcome reporting bias is an important upstream factor that contributes to biased medication benefits and poor clinical decision making, leading to polypharmacy in older adults with COVID-19 and other comorbid conditions. Public health campaigns are urgently needed to educate the public about the link between polypharmacy and medication outcome reporting bias.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82694257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dimitrios Spaggoulakis, Antonios Kontaxakis, A. Asimakos, Stavroula Spetsioti, Archontoula Antonoglou, P. Gounopoulos, Martha-Spyridoula Katsarou, Helen Iasonidou, S. Gatzonis, P. Katsaounou
Dysautonomia in the post-COVID-19 condition appears to affect a significant number of patients, with reports raising the incidence up to 61%, having an overlap with myalgic encephalomyelitis/chronic fatigue syndrome. Quality of life and daily function are significantly impacted and conservative management interventions, despite the lack of high-quality evidence to date, are needed to ameliorate disability. A total of 50 adults with a dysautonomia post-COVID-19 diagnosis based on the Ewing battery and a NASA lean test will be enrolled in a randomized single blinded controlled trial with a crossover design. Feasibility and lack of definite dysautonomia diagnosis will be the primary outcomes, while secondary outcomes will be health-related, clinical and cardiopulmonary exercise test indicators. Safety and acceptance will also be checked, primarily excluding participants with post-exertional malaise. The Long-COVID patients Causal Diagnosis and Rehabilitation study in patients with Dysautonomia (LoCoDiRE-Dys) intervention will consist of an educational module, breathing retraining and an individualized exercise intervention of biweekly sessions for two months with regular assessment of both groups. LoCoDiRe-Dys aims to be the first post-COVID-19 randomized study in people with dysautonomia offering a multimodal intervention both in diagnosis and management. The need for evidence in effectively supporting patients is eminent.
{"title":"Protocol of the Long-COVID Patients Causal Diagnosis and Rehabilitation Randomized Feasibility Controlled Trial in Patients with Dysautonomia: The LoCoDiRe-Dys Study","authors":"Dimitrios Spaggoulakis, Antonios Kontaxakis, A. Asimakos, Stavroula Spetsioti, Archontoula Antonoglou, P. Gounopoulos, Martha-Spyridoula Katsarou, Helen Iasonidou, S. Gatzonis, P. Katsaounou","doi":"10.3390/biomed3030026","DOIUrl":"https://doi.org/10.3390/biomed3030026","url":null,"abstract":"Dysautonomia in the post-COVID-19 condition appears to affect a significant number of patients, with reports raising the incidence up to 61%, having an overlap with myalgic encephalomyelitis/chronic fatigue syndrome. Quality of life and daily function are significantly impacted and conservative management interventions, despite the lack of high-quality evidence to date, are needed to ameliorate disability. A total of 50 adults with a dysautonomia post-COVID-19 diagnosis based on the Ewing battery and a NASA lean test will be enrolled in a randomized single blinded controlled trial with a crossover design. Feasibility and lack of definite dysautonomia diagnosis will be the primary outcomes, while secondary outcomes will be health-related, clinical and cardiopulmonary exercise test indicators. Safety and acceptance will also be checked, primarily excluding participants with post-exertional malaise. The Long-COVID patients Causal Diagnosis and Rehabilitation study in patients with Dysautonomia (LoCoDiRE-Dys) intervention will consist of an educational module, breathing retraining and an individualized exercise intervention of biweekly sessions for two months with regular assessment of both groups. LoCoDiRe-Dys aims to be the first post-COVID-19 randomized study in people with dysautonomia offering a multimodal intervention both in diagnosis and management. The need for evidence in effectively supporting patients is eminent.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"08 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86051438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Moura, L. Lopes, L. C. Matos, J. Machado, M. Criado
The rapid spread of the new coronavirus disease (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Although specific vaccines are available and natural drugs are being researched, supportive care and specific treatments to alleviate symptoms and improve patient quality of life remain critical. Chinese medicine (CM) has been employed in China due to the similarities between the epidemiology, genomics, and pathogenesis of SARS-CoV-2 and SARS-CoV. Moreover, the integration of other traditional oriental medical systems into the broader framework of integrative medicine can offer a powerful approach to managing the disease. Additionally, it has been reported that integrated medicine has better effects and does not increase adverse drug reactions in the context of COVID-19. This article examines preventive measures, potential infection mechanisms, and immune responses in Western medicine (WM), as well as the pathophysiology based on principles of complementary medicine (CM). The convergence between WM and CM approaches, such as the importance of maintaining a strong immune system and promoting preventive care measures, is also addressed. Current treatment options, traditional therapies, and classical prescriptions based on empirical knowledge are also explored, with individual patient circumstances taken into account. An analysis of the potential benefits and challenges associated with the integration of complementary and Western medicine (WM) in the treatment of COVID-19 can provide valuable guidance, enrichment, and empowerment for future research endeavors.
{"title":"Converging Paths: A Comprehensive Review of the Synergistic Approach between Complementary Medicines and Western Medicine in Addressing COVID-19 in 2020","authors":"A. Moura, L. Lopes, L. C. Matos, J. Machado, M. Criado","doi":"10.3390/biomed3020025","DOIUrl":"https://doi.org/10.3390/biomed3020025","url":null,"abstract":"The rapid spread of the new coronavirus disease (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Although specific vaccines are available and natural drugs are being researched, supportive care and specific treatments to alleviate symptoms and improve patient quality of life remain critical. Chinese medicine (CM) has been employed in China due to the similarities between the epidemiology, genomics, and pathogenesis of SARS-CoV-2 and SARS-CoV. Moreover, the integration of other traditional oriental medical systems into the broader framework of integrative medicine can offer a powerful approach to managing the disease. Additionally, it has been reported that integrated medicine has better effects and does not increase adverse drug reactions in the context of COVID-19. This article examines preventive measures, potential infection mechanisms, and immune responses in Western medicine (WM), as well as the pathophysiology based on principles of complementary medicine (CM). The convergence between WM and CM approaches, such as the importance of maintaining a strong immune system and promoting preventive care measures, is also addressed. Current treatment options, traditional therapies, and classical prescriptions based on empirical knowledge are also explored, with individual patient circumstances taken into account. An analysis of the potential benefits and challenges associated with the integration of complementary and Western medicine (WM) in the treatment of COVID-19 can provide valuable guidance, enrichment, and empowerment for future research endeavors.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85292214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID crisis of the past three years has greatly impacted stakeholder relationships between scientists, health providers, policy makers, pharmaceutical industry employees, and the public. Lockdowns and restrictions of civil liberties strained an already fraught relationship between the public and policy makers, with scientists also seen as complicit in providing the justification for the abrogation of civil liberties. This was compounded by the suppression of open debate over contentious topics of public interest and a violation of core bioethical principles embodied in the Nuremberg Code. Overall, the policies chosen during the pandemic have had a corrosive impact on public trust, which is observable in surveys and consumer behaviour. While a loss of trust is difficult to remedy, the antidotes are accountability and transparency. This narrative review presents an overview of key issues that have motivated public distrust during the pandemic and ends with suggested remedies. Scientific norms and accountability must be restored in order to rebuild the vital relationship between scientists and the public they serve.
{"title":"Public Health Needs the Public Trust: A Pandemic Retrospective","authors":"Matthew T. J. Halma, Joshua Guetzkow","doi":"10.3390/biomed3020023","DOIUrl":"https://doi.org/10.3390/biomed3020023","url":null,"abstract":"The COVID crisis of the past three years has greatly impacted stakeholder relationships between scientists, health providers, policy makers, pharmaceutical industry employees, and the public. Lockdowns and restrictions of civil liberties strained an already fraught relationship between the public and policy makers, with scientists also seen as complicit in providing the justification for the abrogation of civil liberties. This was compounded by the suppression of open debate over contentious topics of public interest and a violation of core bioethical principles embodied in the Nuremberg Code. Overall, the policies chosen during the pandemic have had a corrosive impact on public trust, which is observable in surveys and consumer behaviour. While a loss of trust is difficult to remedy, the antidotes are accountability and transparency. This narrative review presents an overview of key issues that have motivated public distrust during the pandemic and ends with suggested remedies. Scientific norms and accountability must be restored in order to rebuild the vital relationship between scientists and the public they serve.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88954997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariacristina Poliseno, Edoardo Paolo Drago, M. Poli, M. Altamura, S. Bruno, A. Calamo, A. Giannelli, G. Infante, Michele Mazzola, Damiana Moschetta, S. Lo Caputo, T. Santantonio, S. Carbonara
Despite the availability of vaccines and antivirals and the biological evolution of SARS-CoV-2, the rate of hospitalizations and deaths from COVID-19 remains high in Italy. It is crucial to understand whether and how the clinical characteristics of patients hospitalized for COVID-19 have changed over 2021–2022 and which risk factors are currently associated with adverse outcomes to develop targeted interventions. In this study, we present and compare the characteristics and outcomes of 310 patients with COVID-19 who were hospitalized between 1 August and 9 December 2021, when the Delta SARS-CoV-2 variant was prevalent (Group A), and between 3 January and 30 June 2022, when the Omicron variant was predominant (Group B). Using Survival Analysis, we estimated the cumulative 28-day hazard ratio (H.R.) of Intensive Care Unit (ICU) admission/death of patients in Group B vs. A. We built uni- and multivariate Cox regression models for the overall population and each group to identify risk factors for ICU admission/death among patient features. We found that Group B had a comparable risk of ICU admission/death (HR 1.60, 95% Confidence Interval, C.I. 1.00–2.58, p = 0.05) but a higher prevalence of elderly and co-morbid subjects than Group A. Non-invasive ventilation requirement was associated with adverse outcomes in both Group A (HR 21.03, 95% C.I. 5.34–82.80, p < 0.001) and Group B (HR 4.53, 95% C.I. 2.39–8.59, p < 0.001), as well as in the overall population (HR 3.88, 95% C.I. 2.49–6.06, p < 0.001). During the Omicron wave, elderly and co-morbid subjects had the highest risk of hospitalization and poor outcomes.
尽管可以获得疫苗和抗病毒药物，并且了解了SARS-CoV-2的生物进化，但意大利的COVID-19住院率和死亡率仍然很高。了解2019冠状病毒病住院患者的临床特征在2021-2022年期间是否发生了变化以及如何发生变化，以及目前哪些风险因素与不良后果相关，对于制定有针对性的干预措施至关重要。在这项研究中，我们介绍并比较了在2021年8月1日至12月9日期间住院的310名COVID-19患者的特征和结果，当时德尔塔SARS-CoV-2变体普遍(A组)，以及在2022年1月3日至6月30日期间住院的Omicron变体主要(B组)。我们估计了B组与a组患者重症监护室(ICU)入院/死亡的累积28天风险比(hr)。我们为总体人群和每一组建立了单因素和多因素Cox回归模型，以确定患者特征中ICU入院/死亡的危险因素。我们发现,B组有一个类似的ICU住院/死亡风险(HR 1.60, 95%置信区间,C.I. 1.00 - -2.58, p = 0.05),但老年人和阶段科目患病率高于a组非侵入式通风的要求是与两组不良预后相关(HR 21.03, 95% C.I. 5.34 - -82.80, p < 0.001)和B组(HR 4.53, 95% C.I. 2.39 - -8.59, p < 0.001),以及在整个人口(HR 3.88, 95% C.I. 2.49 - -6.06, p < 0.001)。在欧米克隆波期间，老年人和合并症患者住院和预后不良的风险最高。
{"title":"Clinical Characteristics, Outcomes, and Risk Factors of Patients Hospitalized for COVID-19 across the Latest Pandemic Waves: Has Something Changed?","authors":"Mariacristina Poliseno, Edoardo Paolo Drago, M. Poli, M. Altamura, S. Bruno, A. Calamo, A. Giannelli, G. Infante, Michele Mazzola, Damiana Moschetta, S. Lo Caputo, T. Santantonio, S. Carbonara","doi":"10.3390/biomed3020024","DOIUrl":"https://doi.org/10.3390/biomed3020024","url":null,"abstract":"Despite the availability of vaccines and antivirals and the biological evolution of SARS-CoV-2, the rate of hospitalizations and deaths from COVID-19 remains high in Italy. It is crucial to understand whether and how the clinical characteristics of patients hospitalized for COVID-19 have changed over 2021–2022 and which risk factors are currently associated with adverse outcomes to develop targeted interventions. In this study, we present and compare the characteristics and outcomes of 310 patients with COVID-19 who were hospitalized between 1 August and 9 December 2021, when the Delta SARS-CoV-2 variant was prevalent (Group A), and between 3 January and 30 June 2022, when the Omicron variant was predominant (Group B). Using Survival Analysis, we estimated the cumulative 28-day hazard ratio (H.R.) of Intensive Care Unit (ICU) admission/death of patients in Group B vs. A. We built uni- and multivariate Cox regression models for the overall population and each group to identify risk factors for ICU admission/death among patient features. We found that Group B had a comparable risk of ICU admission/death (HR 1.60, 95% Confidence Interval, C.I. 1.00–2.58, p = 0.05) but a higher prevalence of elderly and co-morbid subjects than Group A. Non-invasive ventilation requirement was associated with adverse outcomes in both Group A (HR 21.03, 95% C.I. 5.34–82.80, p < 0.001) and Group B (HR 4.53, 95% C.I. 2.39–8.59, p < 0.001), as well as in the overall population (HR 3.88, 95% C.I. 2.49–6.06, p < 0.001). During the Omicron wave, elderly and co-morbid subjects had the highest risk of hospitalization and poor outcomes.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72987731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Machine learning is being increasingly applied in various aspects of medicine. The availability of large amounts of digital health records has enabled researchers to apply machine learning algorithms to tackle different medical problems. Urinary tract infections (UTIs) are common bacterial infections that are prone to being misdiagnosed and over-treated with antibiotics. For appropriate tailored antibiotic therapy, new diagnostic methods providing rapid pathogen identification and antibiotic susceptibility testing are urgently needed. In this review, we first discuss emerging technologies that have employed machine learning models to deliver speedy diagnostic results, particularly for urinary tract infections. We then explore how machine learning models are enabling sequence-based diagnostics by predicting antibiotic resistances from genome sequencing data. Finally, we examine different studies that apply machine learning to electronic health records to improve UTI diagnosis, to reduce antibiotic use and guide treatments without urine culture, and to reduce clinical workload and unnecessary hospital visits.
{"title":"Machine Learning and Artificial Intelligence for Pathogen Identification and Antibiotic Resistance Detection: Advancing Diagnostics for Urinary Tract Infections","authors":"Mohammed Harris","doi":"10.3390/biomed3020022","DOIUrl":"https://doi.org/10.3390/biomed3020022","url":null,"abstract":"Machine learning is being increasingly applied in various aspects of medicine. The availability of large amounts of digital health records has enabled researchers to apply machine learning algorithms to tackle different medical problems. Urinary tract infections (UTIs) are common bacterial infections that are prone to being misdiagnosed and over-treated with antibiotics. For appropriate tailored antibiotic therapy, new diagnostic methods providing rapid pathogen identification and antibiotic susceptibility testing are urgently needed. In this review, we first discuss emerging technologies that have employed machine learning models to deliver speedy diagnostic results, particularly for urinary tract infections. We then explore how machine learning models are enabling sequence-based diagnostics by predicting antibiotic resistances from genome sequencing data. Finally, we examine different studies that apply machine learning to electronic health records to improve UTI diagnosis, to reduce antibiotic use and guide treatments without urine culture, and to reduce clinical workload and unnecessary hospital visits.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135692545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariacristina Poliseno, D. Lacedonia, Mariangela Niglio, Federica De Gregorio, G. Minafra, Terence Campanino, G. Giganti, G. Scioscia, T. Santantonio, M. F. Foschino Barbaro, S. Lo Caputo
Baricitinib, a reversible Janus-associated kinase-inhibitor, is approved for treating COVID-19, combined with Dexamethasone and, eventually, with Remdesivir (RDV). This retrospective cohort study assesses the real-life advantages and limits of Baricitinib in the current pandemic scenario. Data of all patients consecutively hospitalized with moderate/severe COVID-19 between 1 October 2021 and 31 March 2022 were retrospectively collected and described according to the treatment received (Baricitinib, Baricitinib + RDV, none). We performed survival analyses to estimate the 21-day probability of Intensive Care Unit (ICU) admission, death, and composite. We built multivariate Cox regression models to identify ICU admission/death predictors among patients’ features. Of 111 subjects, 28 received Baricitinib, 21 received Baricitinib + RDV, and 62 could not be treated due to pre-existing conditions. Treated patients had a comparable risk of death (HR 0.50, 95% C.I. 0.20–1.26, p = 0.14) but remarkably lower risk of 21-day ICU admission (H.R., 0.10, 95% C.I., 0.01–0.86, p = 0.03), regardless of the type of treatment received. At multivariable analysis, older age was the only predictor of ICU admission/death (HR 1.14, 95% C.I. 1.03–1.26, p ≤ 0.01).Although effective, the high prevalence of elderly, co-morbid patients limits Baricitinib use in the current pandemic setting.
Baricitinib是一种可逆的janus相关激酶抑制剂，被批准用于治疗COVID-19，与地塞米松联合使用，最终与Remdesivir (RDV)联合使用。这项回顾性队列研究评估了Baricitinib在当前大流行情况下的现实优势和局限性。回顾性收集2021年10月1日至2022年3月31日期间连续住院的所有中/重度COVID-19患者的数据，并根据所接受的治疗(Baricitinib, Baricitinib + RDV，无)进行描述。我们进行了生存分析，以估计21天重症监护病房(ICU)入院、死亡和复合的概率。我们建立了多变量Cox回归模型，以确定患者特征中ICU入院/死亡的预测因素。在111名受试者中，28人接受Baricitinib, 21人接受Baricitinib + RDV, 62人因既往疾病无法治疗。不论接受何种治疗，接受治疗的患者死亡风险相当(HR 0.50, 95% ci 0.20-1.26, p = 0.14)，但入住ICU 21天的风险显著降低(HR 0.10, 95% ci, 0.01-0.86, p = 0.03)。在多变量分析中，年龄是ICU入院/死亡的唯一预测因子(HR 1.14, 95% ci 1.03-1.26, p≤0.01)。虽然有效，但老年和合并症患者的高患病率限制了巴西替尼在当前大流行背景下的使用。
{"title":"Real-Life Advantages and Limits of Baricitinib for the Late Treatment of Adults Hospitalized with COVID-19","authors":"Mariacristina Poliseno, D. Lacedonia, Mariangela Niglio, Federica De Gregorio, G. Minafra, Terence Campanino, G. Giganti, G. Scioscia, T. Santantonio, M. F. Foschino Barbaro, S. Lo Caputo","doi":"10.3390/biomed3020021","DOIUrl":"https://doi.org/10.3390/biomed3020021","url":null,"abstract":"Baricitinib, a reversible Janus-associated kinase-inhibitor, is approved for treating COVID-19, combined with Dexamethasone and, eventually, with Remdesivir (RDV). This retrospective cohort study assesses the real-life advantages and limits of Baricitinib in the current pandemic scenario. Data of all patients consecutively hospitalized with moderate/severe COVID-19 between 1 October 2021 and 31 March 2022 were retrospectively collected and described according to the treatment received (Baricitinib, Baricitinib + RDV, none). We performed survival analyses to estimate the 21-day probability of Intensive Care Unit (ICU) admission, death, and composite. We built multivariate Cox regression models to identify ICU admission/death predictors among patients’ features. Of 111 subjects, 28 received Baricitinib, 21 received Baricitinib + RDV, and 62 could not be treated due to pre-existing conditions. Treated patients had a comparable risk of death (HR 0.50, 95% C.I. 0.20–1.26, p = 0.14) but remarkably lower risk of 21-day ICU admission (H.R., 0.10, 95% C.I., 0.01–0.86, p = 0.03), regardless of the type of treatment received. At multivariable analysis, older age was the only predictor of ICU admission/death (HR 1.14, 95% C.I. 1.03–1.26, p ≤ 0.01).Although effective, the high prevalence of elderly, co-morbid patients limits Baricitinib use in the current pandemic setting.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79180352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariangela Canaan, Kelsey N. Williams, Md Ashfaq Ahmed, Zhenwei Zhang, Venkataraghavan Ramamoorthy, P. McGranaghan, M. Rubens, A. Saxena
Background: A number of corticosteroids are commonly used to treat COVID-19 infection. The aim of this retrospective study was to compare various hospital outcomes among mechanically ventilated COVID-19 patients in an ICU, who were administered either dexamethasone or methylprednisolone. Methods: A total of 121 mechanically ventilated COVID-19 patients from the ICU were included in the analysis, of which 43.8% (n = 53) received methylprednisolone, while 56.2% (n = 68) received dexamethasone. Results: In-hospital mortality (p = 0.381) and hospital length of stay (p = 0.307) were lower among the methylprednisolone group, compared to the dexamethasone group, though not significantly. Survival analysis showed that there were no significant differences between the methylprednisolone and dexamethasone groups (p = 0.978). A Cox proportional regression analysis showed that in-hospital mortality was lower among COVID-19 patients receiving methylprednisolone, compared to the dexamethasone group, though not significantly (hazard ratio (HR), 0.64; 95% CI: 0.35–3.17). Conclusion: Our study showed that in-hospital mortality was lower and hospital length of stay was higher among COVID-19 patients receiving methylprednisolone, compared to dexamethasone. These findings could have been due to the small sample size and limited scope of the study. Therefore, future large-scale studies should evaluate and confirm the findings in this study.
{"title":"Retrospective Comparison of Hospital Outcomes among Mechanically Ventilated COVID-19 Patients in ICU Who Received Methylprednisolone or Dexamethasone","authors":"Mariangela Canaan, Kelsey N. Williams, Md Ashfaq Ahmed, Zhenwei Zhang, Venkataraghavan Ramamoorthy, P. McGranaghan, M. Rubens, A. Saxena","doi":"10.3390/biomed3020020","DOIUrl":"https://doi.org/10.3390/biomed3020020","url":null,"abstract":"Background: A number of corticosteroids are commonly used to treat COVID-19 infection. The aim of this retrospective study was to compare various hospital outcomes among mechanically ventilated COVID-19 patients in an ICU, who were administered either dexamethasone or methylprednisolone. Methods: A total of 121 mechanically ventilated COVID-19 patients from the ICU were included in the analysis, of which 43.8% (n = 53) received methylprednisolone, while 56.2% (n = 68) received dexamethasone. Results: In-hospital mortality (p = 0.381) and hospital length of stay (p = 0.307) were lower among the methylprednisolone group, compared to the dexamethasone group, though not significantly. Survival analysis showed that there were no significant differences between the methylprednisolone and dexamethasone groups (p = 0.978). A Cox proportional regression analysis showed that in-hospital mortality was lower among COVID-19 patients receiving methylprednisolone, compared to the dexamethasone group, though not significantly (hazard ratio (HR), 0.64; 95% CI: 0.35–3.17). Conclusion: Our study showed that in-hospital mortality was lower and hospital length of stay was higher among COVID-19 patients receiving methylprednisolone, compared to dexamethasone. These findings could have been due to the small sample size and limited scope of the study. Therefore, future large-scale studies should evaluate and confirm the findings in this study.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"117 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79369695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Josipa Domjanović, Tea Domjanović Škopinić, Tea Gamberažić Kirevski, Andrija Matetić
Background: Timely recognition of high-risk individuals with novel Coronavirus disease (COVID-19) is important. Yet, validated risk scores for kidney transplant recipients with COVID-19 are lacking. The present study aimed to externally validate the novel ImAgeS risk score in this population. Methods: A retrospective analysis of 65 kidney transplant recipients with COVID-19 was conducted. A robust external validation of the novel ImAgeS risk score with respect to 30-day all-cause mortality was performed using regression analysis, discrimination and calibration methods. Results: An overall mortality rate during the study follow-up was 18.5% (N = 12). The ImAgeS risk score showed a statistically significant association with 30-day all-cause mortality (HR 1.04 95% CI 1.00–1.08, p = 0.040). This risk score demonstrated a modest, statistically significant discrimination of all-cause mortality (AUC of 0.679 (95% CI 0.519–0.840, p = 0.027). The calibration of the model was acceptable with a Hosmer-Lemeshow value of 3.74, Harrell’s C concordance index of 0.699 and Somers’ D of 0.397. Conclusions: The ImAgeS risk score demonstrated a significant association with 30-day all-cause mortality in kidney transplant recipients with COVID-19. The model showed modest discrimination and satisfactory calibration, confirming the findings from the computational study. Further studies are needed to determine the utility of the ImAgeS score in this high-risk population.
背景:及时识别新型冠状病毒病(COVID-19)高危人群具有重要意义。然而，目前还缺乏针对肾移植受者感染COVID-19的有效风险评分。本研究旨在从外部验证这一人群的新图像风险评分。方法:对65例新冠肺炎肾移植受者进行回顾性分析。采用回归分析、判别和校准方法对新型图像风险评分进行了30天全因死亡率的可靠外部验证。结果:研究随访期间的总死亡率为18.5% (N = 12)。ImAgeS风险评分与30天全因死亡率有统计学意义(HR 1.04 95% CI 1.00-1.08, p = 0.040)。该风险评分显示全因死亡率存在适度的、统计学上显著的差异(AUC为0.679 (95% CI 0.519-0.840, p = 0.027)。模型的校正是可以接受的，Hosmer-Lemeshow值为3.74,Harrell’s C一致性指数为0.699,Somers’D为0.397。结论:图像风险评分显示与COVID-19肾移植受者30天全因死亡率显著相关。该模型表现出适度的判别和令人满意的校准，证实了计算研究的结果。需要进一步的研究来确定图像评分在这一高危人群中的效用。
{"title":"External Validation of the ImAgeS Risk Score for Mortality in Hospitalized Kidney Transplant Recipients with COVID-19: A Retrospective Observational Study","authors":"Josipa Domjanović, Tea Domjanović Škopinić, Tea Gamberažić Kirevski, Andrija Matetić","doi":"10.3390/biomed3020018","DOIUrl":"https://doi.org/10.3390/biomed3020018","url":null,"abstract":"Background: Timely recognition of high-risk individuals with novel Coronavirus disease (COVID-19) is important. Yet, validated risk scores for kidney transplant recipients with COVID-19 are lacking. The present study aimed to externally validate the novel ImAgeS risk score in this population. Methods: A retrospective analysis of 65 kidney transplant recipients with COVID-19 was conducted. A robust external validation of the novel ImAgeS risk score with respect to 30-day all-cause mortality was performed using regression analysis, discrimination and calibration methods. Results: An overall mortality rate during the study follow-up was 18.5% (N = 12). The ImAgeS risk score showed a statistically significant association with 30-day all-cause mortality (HR 1.04 95% CI 1.00–1.08, p = 0.040). This risk score demonstrated a modest, statistically significant discrimination of all-cause mortality (AUC of 0.679 (95% CI 0.519–0.840, p = 0.027). The calibration of the model was acceptable with a Hosmer-Lemeshow value of 3.74, Harrell’s C concordance index of 0.699 and Somers’ D of 0.397. Conclusions: The ImAgeS risk score demonstrated a significant association with 30-day all-cause mortality in kidney transplant recipients with COVID-19. The model showed modest discrimination and satisfactory calibration, confirming the findings from the computational study. Further studies are needed to determine the utility of the ImAgeS score in this high-risk population.","PeriodicalId":93816,"journal":{"name":"SPG biomed","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89763523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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