Evelyn Yang, Ching-Pei Tsai, Pao-Sheng Shen
et al.
Abstract This prospective pilot study was conducted to evaluate the safety and efficacy of an innovative laparoscopic pectopexy (LP) technique employing an inverted T-mesh for the concomitant treatment of advanced uterine and anterior vaginal prolapse. 42 patients (62.7%) underwent the innovative LP procedure, while 25 patients (37.3%) with predominant uterine or vaginal vault prolapse underwent conventional laparoscopic sacral hysteropexy or colpopexy (LS). The primary outcome was the anatomic outcomes and functional results. Secondary outcomes included surgical complications and reoperations. At baseline, the demographics of the LP group was younger, with lower body mass index (BMI), and were more sexually active when compared to the LS group (P < 0.05). At one-year follow-up, the anatomic cure rate (POP-Q stage < 2) was significantly lower in the LP group (78.6% [33/42] vs. 92.0% [23/25]; P = 0.0108). Functional outcomes were assessed using the PFDI-20, POPIQ-7 and PISQ-12 questionnaires, and significant improvements were observed in all domains. Multiple logistic regression revealed that the type of surgical procedure was not a significant predictor of outcome. Levator avulsion was the only variable significantly associated with poorer results (P < 0.05). Both groups demonstrated favorable postoperative outcomes, and had no severe surgical complications. Limitations of this study included non-randomization of the sample groups, small sample size and a follow-up time of one year. Despite these limitations, the findings suggest that the innovative LP procedure is a safe and feasible option for the concomitant management of advanced uterine and anterior vaginal prolapse. However, levator ani avulsion markedly increases the risk of anatomic recurrence. This study was registered on ClinicalTrials.gov (NCT07411898; 13/02/2026).
Mrunalini V. Kalikar, Pradipta A. Dutta, Shubham S. Nimbhorkar
Background:
Good clinical practice (GCP) ensures ethical, as well as scientific quality of clinical trials, thus safeguarding participant safety and data integrity. The drug controller general of India mandates GCP training for healthcare professionals who conduct clinical research. However, limited studies assess the effectiveness of such training programs in India.
Aim:
This study evaluates the impact of educational intervention on the knowledge and awareness of GCP among healthcare professionals.
Settings and Design:
A prospective, interventional study was conducted at our tertiary care teaching hospital.
Materials and Methods:
A total of 180 healthcare professionals participated in a GCP workshop, with 172 completing pre- and post-intervention questionnaires. The workshop covered essential GCP topics, including ethical guidelines, informed consent, regulatory requirements, and serious adverse event reporting.
Statistical Analysis Used:
Pre- and postintervention responses were analyzed using Fischer’s exact test in GraphPad Prism 8.4.2. P < 0.05 was considered statistically significant.
Results:
The study revealed a significant improvement in participants’ knowledge across multiple GCP domains. However, gaps remained in understanding specific regulatory timelines.
Conclusion:
Educational interventions, such as GCP workshops, significantly enhance healthcare professionals’ knowledge and awareness, improving compliance with ethical and regulatory requirements in clinical research. Integrating GCP training into medical education may further strengthen research practices.
This viewpoint article explores the transformative role of artificial intelligence (AI) in predicting perioperative hypoxemia through the integration of deep learning with multimodal clinical data, including lung imaging, pulmonary function tests, and arterial blood gas (ABG) analysis. Perioperative hypoxemia, defined as arterial oxygen partial pressure <60 mmHg or oxygen saturation <90%, poses significant risks of delayed recovery and organ dysfunction. Traditional diagnostic methods such as radiological imaging and ABG analysis often lack integrated predictive accuracy. AI frameworks, particularly convolutional neural networks and hybrid models like TD-CNNLSTM-LungNet, demonstrate exceptional performance in detecting pulmonary inflammation and stratifying hypoxemia risk, achieving up to 96.57% accuracy in pneumonia subtype differentiation and an area under the curve of 0.96 for postoperative hypoxemia prediction. Multimodal AI systems, such as DeepLung-Predict, unify computed tomography scans, pulmonary function tests, and ABG parameters to enhance predictive precision, surpassing conventional methods by 22%. However, challenges persist, including dataset heterogeneity, model interpretability, and clinical workflow integration. Future directions emphasize multicenter validation, explainable AI frameworks, and pragmatic trials to ensure equitable and reliable deployment. This AI-driven approach not only optimizes resource allocation but also mitigates financial burdens on health care systems by enabling early interventions and reducing intensive care unit admission risks.
Computer applications to medicine. Medical informatics
Serap Süzük Yıldız, Ayşegül Polat, Süleyman Yalçın
et al.
Introduction: Most of Bacillus spp. generally avirulent species in healthy patients, but if there is a fragile in the patient, especially their immune system, Bacillus spp. can be an agent for infections.
Case Report: In this case, we report that Bacillus paranthracis, diagnosed by whole genome sequencing, is responsible for bacteremia in a T-ALL patient. A 26-year-old male patient was diagnosed with T-cell acute lymphoblastic leukemia. Bacillus paranthracis was isolated from two sets of blood cultures obtained from a patient with febrile neutropenia.
Results: The bacteria was identified as Bacillus cereus group in a routine microbiology laboratory by MALDI TOF MS. Then whole genome sequencing (WGS) confirmed its name as Bacillus paranthracis. The pathogenicity of the bacterium, especially in immunocompromised patients, has also been demonstrated by WGS.
Conclusions: In a microbiology laboratory, the use of Whole Genome Sequencing (WGS) is important for diagnosing diseases, especially in immunocompromised patients. It will serve the management of these patients for infection control.
Daniel E. Savage, Daniel E. Savage, Aldo Tecse
et al.
IntroductionMyopia, resulting from an excessive axial elongation of the eye, is increasing worldwide at alarming rates. This investigation is a pilot study to determine if a novel collagen mimetic peptide (CMP) has a reparative function for scleral collagen organization after collagenase digestion, a cause for scleral thinning and increased creep rates, as this may have application in the pharmacologic treatment of myopia.MethodsFresh, ex vivo, scleral tissue samples from 3 albino Sprague–Dawley rats (5 eyes) and from 8 C57/Black mice (8 eyes) underwent sequential collagenase digestion and treatment with a CMP solution. Full-thickness second-harmonic generation (SHG) microscopy was performed over a 200 μm × 200 μm area through depth on each of the untreated samples (either scleral tissue samples or full intact eyes), and again after each sequential treatment. The organization of the collagen fibers at each tissue depth was quantified using a previously validated order coefficient (OC). This measure of collagen organization was then used to compare between the untreated, collagenase-digested, and CMP-treated tissue.ResultsSHG microscopy of the untreated scleral tissue showed a high degree of organization. Collagenase treatment resulted in a subjective straightening of the collagen fibers and a widening of the inter-fiber spacing with a statistically significant reduction of the OC (p < 0.05). CMP treatment of digested sclera resulted in a collagen organization that was more similar (i.e., not significantly different) from untreated tissue at depths up to 60 μm (p < 0.05). The restoration of collagen organization was found both in the treated excised rat scleral samples (OC: 0.30 ± 0.01 normal tissue, 0.37 ± 0.05 collagenase-digested and 0.28 ± 0.03 CMP-treated until 20 μm) and on intact mice eyes (OC: 0.25 ± 0.01 normal tissue, 0.30 ± 0.05 collagenase-digested and 0.24 ± 0.01 CMP-treated).DiscussionCMP treatment induced scleral collagen reorganization after collagenase digestion in murine models. These effects are consistent with inhibition or reversal of collagen enzymatic digestion. These results suggest that specific CMPs may have utility in the treatment of progressive myopia.
Abstract Head trauma is a common reason for emergency department (ED) visits. Delayed intracranial hemorrhage (ICH) in patients with minor head trauma is a major concern, but controversies exist regarding the incidence of delayed ICH and discharge planning at the ED. This study aimed to determine the incidence of delayed ICH in adults who developed ICH after a negative initial brain computed tomography (CT) at the ED and investigate the clinical outcomes for delayed ICH. This nationwide population cohort study used data from the National Health Insurance Service of Korea from 2013 to 2019. Adult patients who presented to an ED due to trauma and were discharged after a negative brain CT examination were selected. The main outcomes were the incidence of ICH within 14 days after a negative brain CT at initial ED visit and the clinical outcomes of patients with and without delayed ICH. The study patients were followed up to 1 year after the initial ED discharge. Cox proportional hazard regression analysis was used to estimate the hazard ratio for all-cause 1-year mortality of delayed ICH. During the 7-year study period, we identified 626,695 adult patients aged 20 years or older who underwent brain CT at the ED due to minor head trauma, and 2666 (0.4%) were diagnosed with delayed ICH within 14 days after the first visit. Approximately two-thirds of patients (64.3%) were diagnosed with delayed ICH within 3 days, and 84.5% were diagnosed within 7 days. Among the patients with delayed ICH, 71 (2.7%) underwent neurosurgical intervention. After adjustment for age, sex, Charlson Comorbidity Index, and insurance type, delayed ICH (adjusted hazard ratio, 2.15; 95% confidence interval, 1.86–2.48; p < 0.001) was significantly associated with 1-year mortality. The incidence of delayed ICH was 0.4% in the general population, with the majority diagnosed within 7 days. These findings suggest that patient discharge education for close observation for a week may be a feasible strategy for the general population.
Nadia Khakzad, Ehteramsadat Ilali, AbolfazlHosein Nattaj
et al.
Background and purpose: Active aging involves optimizing opportunities to enhance the quality of life in older age. Environmental differences and lifestyle variations between urban and rural areas can significantly affect active aging. This study aimed to compare the indicators of active aging among elderly individuals in urban and rural areas of Behshahr, while also identifying the factors associated with these indicators in 2023.
Materials and methods: This cross-sectional, descriptive-analytical study employed a proportional quota sampling method to examine 350 elderly individuals from comprehensive health service centers in Behshahr. The tools used included a demographic-social factors form and a 40-item questionnaire on the Iranian Active Aging Index. Collected data were analyzed using SPSS version 20 and linear regression tests.
Results: The mean age of the elderly participants was 70.96±13.8 years. Among the participants, 52% were men, and 61% were married. The average scores on the Active Aging Index were 111.47±30.48 for urban residents and 93.73±21.66 for rural residents, demonstrating that urban elderly individuals had significantly higher scores than their rural counterparts (P<0.001). Married elderly individuals in both groups scored significantly higher on the Active Aging Index compared to single individuals. Participants with higher education levels and income also achieved significantly greater scores. In contrast, an increase in age and the number of children was associated with a notable reduction in the Active Aging Index score (P<0.05).
Conclusion: Attention to geographical, cultural, and social differences is crucial when formulating policies for the elderly. Furthermore, there is an urgent need to develop infrastructure that improves access to health and social services for older adults in rural areas. These findings can guide policymakers in enhancing the quality of life for older adults, highlighting the importance of addressing the unique needs of diverse groups.
1Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 2Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 3School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon; 4School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon; 5Department of Family Medicine, University of California, San Francisco, California; 6Division of Hospital Medicine, Zuckerberg San Francisco General Hospital and the Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; 7University of Colorado, Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, Denver, Colorado; 8Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon.
Although national guidelines recommend lung cancer screening for adults at high risk, only a small proportion of eligible adults in the US have been screened. The goal of this study was to understand barriers to screening among a specific but important population: patients who have been referred for screening, but who have not completed the test. We used semi-structured interviews to explore barriers to screening among patients at two academic, safety-net primary care practices. We included patients who had been referred for screening at least 6 months prior but who had not completed the test. Among interviewees (N = 16) a consistent theme was a lack of knowledge about the purpose and process of screening. Despite being referred for lung cancer screening, participants expressed that they knew little about how screening was performed or what it was intended to achieve. Preferences and values also played a role in why some participants did not return for screening. Our findings suggest that lack of knowledge about screening is an important barrier to use, as patients are unlikely to prioritize a test if they know little about it.
Ebele, E. Nnadozie, Obinna O. Ike, Ngozi U. Chuke
et al.
The study investigated the influence of psychological ownership on the association between satisfaction with work-family balance and intention to stay in the profession in South-Eastern Nigerian public hospitals. An exploratory research design was adopted for a study that was conducted among 389 nurses recruited from public hospitals in South-eastern Nigeria (females: 373 (96 %); males: 16(4 %); mean age: 37.40 years; SD = 6.33). Participants completed self-report measures of satisfaction with work-family balance, psychological ownership, and intention to stay. Regression analyses showed that work-family balance and psychological ownership positively correlated with nurses' intention to stay. Psychological ownership also moderated the relationship between satisfaction with work-family balance and intention to stay. These findings indicated that psychological ownership and satisfaction with work-family balance are necessary preconditions for striking a balance between job demands and employees’ responsibilities to encourage intention to stay and improve commitment and productivity. Thus, the current findings help hospital managements comprehend and appreciate the critical roles of psychological ownership and satisfaction with work-family balance in enhancing nurses’ intention to stay.
This article S.Krasnova. describes a method for the diagnosis of neuropathy of the lower extremities in patients, particularly diabetes. Determined by the temperature, tactile, pain and vibration Chuv-sitivity. Timely diagnosis of neuropathy can prevent gangrene and disability in patients
Veronica Ghini, Gaia Meoni, Lorenzo Pelagatti
et al.
Metabolomics and lipidomics have been used in several studies to define the biochemical alterations induced by COVID-19 in comparison with healthy controls. Those studies highlighted the presence of a strong signature, attributable to both metabolites and lipoproteins/lipids. Here, 1H NMR spectra were acquired on EDTA-plasma from three groups of subjects: i) hospitalized COVID-19 positive patients (≤21 days from the first positive nasopharyngeal swab); ii) hospitalized COVID-19 positive patients (>21 days from the first positive nasopharyngeal swab); iii) subjects after 2-6 months from SARS-CoV-2 eradication. A Random Forest model built using the EDTA-plasma spectra of COVID-19 patients ≤21 days and Post COVID-19 subjects, provided a high discrimination accuracy (93.6%), indicating both the presence of a strong fingerprint of the acute infection and the substantial metabolic healing of Post COVID-19 subjects. The differences originate from significant alterations in the concentrations of 16 metabolites and 74 lipoprotein components. The model was then used to predict the spectra of COVID-19>21 days subjects. In this group, the metabolite levels are closer to those of the Post COVID-19 subjects than to those of the COVID-19≤21 days; the opposite occurs for the lipoproteins. Within the acute phase patients, characteristic trends in metabolite levels are observed as a function of the disease severity. The metabolites found altered in COVID-19≤21 days patients with respect to Post COVID-19 individuals overlap with acute infection biomarkers identified previously in comparison with healthy subjects. Along the trajectory towards healing, the metabolome reverts back to the "healthy" state faster than the lipoproteome.
Aki Sugano, Yutaka Takaoka, Haruyuki Kataguchi
et al.
Previously, we developed a mathematical model via molecular simulation analysis to predict the infectivity of six SARS-CoV-2 variants. In this report, we aimed to predict the relative risk of the recent new variants of SARS-CoV-2 based on our previous research. We subjected Omicron BA.4/5 and BA.2.75 variants of SARS-CoV-2 to the analysis to determine the evolutionary distance of the spike protein gene (S gene) of the variants from the Wuhan variant so as to appreciate the changes in the spike protein. We performed molecular docking simulation analyses of the spike proteins with human angiotensin-converting enzyme 2 (ACE2) to understand the docking affinities of these variants. We then compared the evolutionary distances and the docking affinities of these variants with those of the variants that we had analyzed in our previous research. As a result, BA.2.75 has both the highest docking affinity (ratio per Wuhan variant) and the longest evolutionary distance of the S gene from the Wuhan variant. These results suggest that BA.2.75 infection can spread farther than can infections of preexisting variants.
Shegaw Zeleke,1 Demewoz Kefale2 1Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Pediatric and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Shegaw Zeleke Email shegawzn@gmail.comBackground: Oxygen therapy is a medical treatment and prescribed to prevent or treat hypoxemia. Based on a WHO report every year at least 1.4 million deaths occur due to the lack of supplemental oxygen therapy and inappropriate administration of oxygen.Objective: To assess the knowledge and practice of nurses on supplemental oxygen therapy in Debre Tabor General Hospital, 2019.Methods: Data was collected using structured questionnaires that measure nurses’ knowledge and practice regarding supplemental oxygen therapy. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 23. Bivariate and multivariate analyses were conducted to examine the association between independent and outcome variables.Results: Only one-third of nurses had a good practice on supplemental oxygen administration. Nurses who had good knowledge of supplemental oxygen administration were 12-times (AOR=12.25, 95% CI=6.48– 32.93) more likely to have a good practice of supplemental oxygen administration than those who had poor knowledge of supplemental oxygen administration.Conclusion: There is a clear knowledge and practice gap among nurses working in Debre Tabor General Hospital. The knowledge and practice level of nurses in the study area is low compared with others. The possible factors were identified; such as lack of supplemental oxygen therapy training, absence of supplemental oxygen administration standard guidelines, workload, and inadequate supply of oxygen and delivery devices.Keywords: knowledge, practice, supplemental oxygen therapy, nurse
Medical emergencies. Critical care. Intensive care. First aid
Hanny Al-Samkari, Rachel P. Rosovsky, Rebecca S. Karp Leaf
et al.
Abstract: Platelet autoantibody (PA) testing has previously shown poor sensitivity for immune thrombocytopenia (ITP) diagnosis, but no previous study used both 2011 American Society of Hematology (ASH) guidelines for ITP diagnosis and 2012 International Society on Thrombosis and Haemostasis (ISTH) PA testing recommendations. We therefore performed a comprehensive retrospective study of PA testing in adult patients with ITP strictly applying these criteria. Of 986 PA assays performed, 485 assays in 368 patients met criteria and were included. Sensitivity and specificity of a positive test result for diagnosis of active ITP (n = 228 patients) were 90% and 78%, respectively. Sensitivity and specificity of a negative test result for clinical remission (n = 61 assays) were 87% and 91%. Antibodies against both glycoprotein IIb (GPIIb)/IIIa and GPIb/IX were required for the presence of antibodies against GPIa/IIa in patients with ITP. Logistic regression analysis revealed that more positive autoantibodies predicted more severe disease (relative to nonsevere ITP, relative risk ratio for severe ITP and refractory ITP was 2.27 [P < .001] and 3.09 [P < .001], respectively, per additional autoantibody); however, serologic testing did not meaningfully predict treatment response to glucocorticoids, intravenous immunoglobulin, or thrombopoietin receptor agonists. Sixty-four patients with ITP had multiple PA assays performed longitudinally: all 10 patients achieving remission converted from positive to negative serologic results, and evidence for epitope spreading was observed in 35% of patients with ongoing active disease. In conclusion, glycoprotein-specific direct PA testing performed using ISTH recommendations in patients meeting ASH diagnostic criteria is sensitive and specific for ITP diagnosis and reliably confirms clinical remission. More glycoproteins targeted by autoantibodies predicts for more severe disease.
Many stroke survivors, despite improvements in mortality and morbidity, remain dependent on others for everyday activities. People with stroke need access to effective specialist multidisciplinary rehabilitation services that are organised and integrated within the whole system of health and social care. They also commonly come under the care of generalists in various clinical contexts, including intercurrent illness. This Clinical Medicine Concise Guideline abstracts key recommendations from the National Institute for Health and Care Excellence Clinical Guideline 162 on stroke rehabilitation of particular relevance to clinicians in general medicine, to inform their front-line practice and promote liaison and collaboration with the specialist service.