Current health sciences journal最新文献

Palmoplantar pustulosis (PPP) is a chronic, recurrent inflammatory dermatosis affecting the palms and soles, classified as a form of acral pustular psoriasis. Nail involvement occurs in over half of PPP patients. This report presents a patient with PPP and idiopathic thrombocytopenic purpura who exhibited purpuric plantar and nail lesions. Dermoscopic examination revealed the hypopyon sign in both plantar and nail lesions, as well as centrally located eccrine duct openings within the plantar pustules. The hypopyon sign has been rarely documented, with previous reports limited to lymphangioma circumscriptum and angiosarcoma. This case supports the role of microvascular abnormalities in psoriasis pathogenesis and warrants further investigation into the underlying mechanisms.

Prostate cancer is the most common malignancy in men, and systematic ultrasound-guided biopsy remains the diagnostic gold standard. The transrectal (TR) route, while widely used, carries an increased risk of infectious and haemorrhagic complications. The transperineal (TP) biopsy approach has been developed to reduce these risks while maintaining comparable diagnostic accuracy. This study aimed to compare cancer detection rates, histopathological patterns, and complication rates between TP and TR prostate biopsies.

Methods: A retrospective analysis was conducted on 310 patients who underwent prostate biopsy between January 2023 and January 2024. Patients were divided into TP (n=178) and TR (n=132) groups. Clinically significant prostate cancer (csPCa) was defined as Gleason score ≥7 or ISUP grade ≥2. Data regarding detection rates, ISUP distribution, complications, and age were compared using the Chi-square test. Age distribution and ISUP grade across age decades were evaluated to exclude age-related bias.

Results: The overall cancer detection rate was significantly higher in the TP group (60.67%) than in the TR group (49.24%) (p=0.045), while csPCa detection did not differ significantly (TP 49.44% vs TR 43.94%, p=0.20). High-grade (ISUP 5) tumours were more frequent in the TR group (41.5% vs 25.0%, p=0.034). Complications were significantly more common after TR biopsy (15.2% vs 6.7%, p=0.027), with infections and rectal bleeding occurring only in TR cases. Patient age distribution was similar between groups (χ²=4.49, p=0.213), and ISUP grade distribution by age decade showed no significant differences (all p>0.05). No non-prostatic pathology was identified in either cohort.

Conclusions: Transperineal prostate biopsy demonstrated a higher overall detection rate and significantly fewer complications compared to the transrectal approach, while maintaining equivalent detection of clinically significant prostate cancer. The absence of age-related or histological bias confirms that the lower complication rate of TP biopsy is attributable to the procedural route rather than patient-related factors.

Antibiotic-resistant infections in children are a growing clinical concern worldwide. Klebsiella pneumoniae (K.pneumoniae) is a leading cause of hospital-acquired infections and often exhibits multidrug resistance, including extended-spectrum β-lactamase (ESBL) production and carbapenem resistance. This study examines the prevalence of K. pneumoniae in pediatric patients upon hospital admission and characterizes its antibiotic resistance profile.

Objectives: This study aimed to determine its prevalence and resistance patterns in children at hospital admission.

Methods: We conducted a retrospective study of 93 pediatric inpatients admitted to a tertiary children's hospital. Clinical and microbiology records were reviewed to identify patients with K. pneumoniae isolated from admission cultures. Antibiotic susceptibility testing was performed on each K. pneumoniae isolate for a panel of antibiotics spanning penicillins, cephalosporins, carbapenems, aminoglycosides, tetracyclines, and fluoroquinolones. The frequencies of resistance and sensitivity were determined for each antibiotic. Fisher's exact tests and factorial ANOVA were used to assess associations between patient diagnosis and resistance.

Results: Out of 93 pediatric patients, 18 (19.35%) had K. pneumoniae isolated, with 72.2% of strains classified as multidrug-resistant. Resistance was highest to ceftriaxone (50%) and ampicillin (44%). Carbapenems and amikacin remained largely effective.

Conclusion: Nearly one-fifth of children admitted had K. pneumoniae detected on initial cultures, with a majority of these isolates exhibiting multidrug resistance, especially to common cephalosporins and penicillins. The high rate of ceftriaxone resistance suggests a prevalence of ESBL-producing strains. Carbapenems and amikacin remained largely effective, underscoring their importance as empiric or targeted therapies in severe pediatric infections.

Patients with severe traumatic brain injury (TBI) develop systemic clinical repercussions, mainly respiratory, with tracheostomy being one of the necessary interventions. This procedure offers benefits such as greater comfort and mobility, as well as, according to some studies, early weaning from mechanical ventilation.

Objective: To evaluate the benefits and the ideal timing for performing tracheostomy in patients with severe TBI, determining its importance in clinical evolution, and to quantify associated complications, as well as the context of brain injury and its systemic repercussions.

Methods: Retrospective observational study that evaluated, through patient medical records, the outcomes of patients with severe TBI at the Hospital de Clínicas de Passo Fundo between January 2016 and December 2018.

Results: Patients who underwent early tracheostomy used antibiotics for an average of 18.5 days compared to 30.3 days for late tracheostomy. Regarding length of stay in the Intensive Care Unit, the early tracheostomy group remained an average of 14.4 days versus 16.7 days for the late tracheostomy group. For total hospital stay, the early tracheostomy group stayed an average of 25.9 days compared to 40.5 days for late tracheostomy. No significant difference in mortality was observed between the two groups.

Conclusion: Early tracheostomy should be instituted in patients with severe TBI with the aim of improving their clinical outcomes.

Introduction: We present a modification of the Blumgart and Kakita techniques, which we call GaMBK (Gamboa-Modified Blumgart and Kakita) anastomosis. Our primary objective was to evaluate the association between clinically relevant postoperative pancreatic fistula (POPF, grades B/C) and the type of pancreaticojejunal anastomosis performed during pancreaticoduodenectomy (GaMBK vs Blumgart).

Methods: From June 2021 to June 2022, the Blumgart anastomosis was performed, and from July 2022 to March 2024, the GaMBK technique was implemented. A total of 38 patients (15 men and 23 women) who underwent pancreaticoduodenectomy for malignant disease were included in this historical cohort study.

Results: The median pancreatic duct diameter was 3mm in both the GaMBK and Blumgart groups (p=0.79). Median drain amylase levels were 38 U/L (range 30-1200) in the GaMBK group and 34U/L (range 30-3263) in the Blumgart group (p=0.40). Clinically relevant POPF occurred in 8.7% of the GaMBK group and 6.7% of the Blumgart group (p=1). All cases were grade B, and no grade C fistulas were identified. Median hospital stay was 7 days for the GaMBK group and 6 days for the Blumgart group. No association was found between the GaMBK technique and an increased risk of POPF (RR 1.304; 95% CI: 0.129-13.149; p=0.66).

Conclusion: The GaMBK anastomosis is a technically simpler modification of the Blumgart and Kakita techniques that does not increase the risk of clinically relevant POPF.

The development of biodegradable biomaterials used in the medical industry represents a crucial aspect in the evolution of therapeutic medical techniques and methods. This research focuses on the microstructural characterization of alloys within the Mg-Ca-Sr system, which includes five distinct formulations composed primarily of magnesium with a fixed 0.5% calcium content and strontium varying from 0.5% to 3%. The alloys were cast in ceramic crucibles utilizing an induction furnace under an inert argon atmosphere to minimize oxidation and eliminate the flammability hazards inherent to magnesium-based materials. Microstructural evaluation was performed using both optical microscopy and scanning electron microscopy, demonstrating homogeneous microstructures free of porosity. The use of these types of biomaterials can foster new directions in implantation, both in orthopedics and maxillofacial medicine.

Various epidemiological indices have been developed to quantify oral hygiene and plaque accumulation, aiding clinical assessment and public health initiatives. The aim of this study was to highlight the main epidemiological indices used for standardized evaluation of oral hygiene and dental plaque, crucial for monitoring and control at both individual and population levels for preventive reason.

Material and method: Through a narrative review, the article analyzes the main indices used to assess oral hygiene.

Results: Some of the most clinically relevant indices are represented by the Oral Hygiene Index (OHI), Simplified Oral Hygiene Index (OHI-S), and Patient Hygiene Performance (PHP), which evaluate soft debris and calculus presence. Our research also covers several bacterial plaque indices including the Silness & Löe Plaque Index, Quigley-Hein Plaque Index, O'Leary Plaque Index, and Approximal Plaque Index (API), which measure plaque thickness and distribution.

Conclusions: The epidemiological indices presented serve as essential tools for dental practitioners and public health professionals to objectively assess oral hygiene status, guide personalized treatments, monitor progress and evaluate preventive programs.

Early differentiation between bacterial sepsis and viral infection in pediatric patients is critical for timely and appropriate therapy. We compared the inflammatory markers C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR), and D-dimer in children with bacterial sepsis and those with SARS-CoV-2 infection to discern characteristic profiles.

Methods: We retrospectively analyzed 97 pediatric sepsis cases (culture-confirmed bacterial infections) and 100 pediatric COVID-19 cases (RT-PCR-confirmed SARS-CoV-2). The initial inflammatory marker levels were extracted from the medical records. Statistical comparisons of means and medians were performed, with significance set at p<0.05.

Results: CRP levels were markedly higher in bacterial sepsis (mean 8.1mg/dL, median 7.4mg/dL) than in COVID-19 (mean 4.1mg/dL, median 3.35mg/dL; p<0.001). ESR was also elevated in sepsis (mean 46mm/h) versus COVID-19 (mean 26mm/h; p<0.001). Fibrinogen showed the opposite pattern, being significantly lower in sepsis (mean 304.7mg/dL, median 267mg/dL) than in COVID-19 (mean 421mg/dL, median 448mg/dL; p<0.001). D-dimer was high in both groups; the COVID-19 cohort had a higher mean D-dimer (3.2μg/mL) with considerable variability, whereas the sepsis cohort's D-dimer was slightly lower and more homogeneous (difference not statistically significant).

Conclusions: Pediatric bacterial infection and COVID-19 exhibit distinct inflammatory marker profiles. Sepsis induces a more intense CRP and ESR response, whereas COVID-19 is characterized by markedly elevated fibrinogen and variable D-dimer levels.

Background: The review evaluates the impact of lifestyle interventions, including diet and exercise, on weight reduction to mitigate obesity's health risks and achieve sustainable weight loss in adults.

Methodology: A comprehensive literature search was conducted across three major databases: PubMed, Google Scholar, and institute Library e-Resources, resulting in the identification of 3018 relevant studies. After applying inclusion criteria, 42 trials were selected, with 15 meeting the criteria for meta-analysis. Utilizing rigorous statistical methods mean differences between intervention and control groups were calculated with a 95% confidence interval. Heterogeneity was assessed using the I2 statistic, and potential publication bias was evaluated through forest plots and funnel plots.

Results: The review encompassed a total of 2062 individuals, with an average age of 42.8±9.4 years. Our analysis revealed an overall effect size of -1.78 kg (-2.2%, -1.277%), indicative of significant weight reduction attributed to lifestyle interventions. Furthermore, our investigation unveiled variations in the effectiveness of interventions based on study duration and mode of delivery. Symmetric funnel plots suggested a low risk of publication bias, enhancing the credibility of our findings. This review underscores the importance of lifestyle treatments in weight management and highlights their accessibility and availability in recent years.

Conclusions: Our findings highlight the substantial impact of lifestyle interventions on weight reduction, demonstrating significant efficacy across diverse populations. The variations in effectiveness based on study duration and mode of delivery emphasize the need for tailored approaches in obesity management programs.

Epirubicin, olaparib and ribociclib are three important anti-cancer agents representing distinct classes: an anthracycline (epirubicin), a PARP inhibitor (olaparib) and a CDK4/6 inhibitor (ribociclib). Analytical quantification of these drugs in biological fluids or in dosage forms often uses high-performance or ultra-performance liquid chromatography (HPLC or RP-HPLC), often coupled with ultraviolet (UV) or photo-diode-array detection (PDA), occasionally with mass spectrometric detection (MS). Within this paper, a rapid HPLC method with PDA detection for simultaneous quantitation of these analytes in pharmaceutical dosage forms is presented. The separation was carried out on a Vanquish Core (Thermo Scientific, USA) liquid chromatograph coupled with a PDA detector. Solid Phase Extraction (SPE) using Oasis PRiME HLB® cartridges was employed as sample preparation procedure. Chromatography was performed by using an unconventional porous graphitic carbon column (HypercarbTM); a gradient elution was carried out using a mixture of acetonitrile/tetrahydrofuran. The flow rate of the mobile phase and the injected volume were 1mL/min and 20μL, respectively. The column compartment temperature was set to 60°C. Each chromatographic peak was integrated at its maximum absorption wavelength. Quantification was performed with external standard method. All validation data were assessed according to European Medicines Agency (EMA) Guidelines, regarding stability, limit of detection/quantitation, precision, accuracy and linearity. The presented method was applied in pharmaceutical dosage forms analysis.