Objective:To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii(A.baumannii)isolates in this study.Methods:A.baumannii isolates were collected from...Objective:To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii(A.baumannii)isolates in this study.Methods:A.baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study,and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2®systems.All isolates were analyzed for biofilm production,then presence of biofilm-associated genes,and class Ⅰ and Ⅱ integron genes.Results:60 non-replicate A.baumannii isolates were included in this study.The resistance rates reached 100%for aztreonam,cefepime,ceftazidime,ciprofloxacin,piperacillin-tazobactam,piperacillin,ticarcillin,and trimethoprim-sulfamethoxazole.A.baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments.Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3%and 16.7%,respectively.Of the isolates,91.6%formed biofilms,categorized as 10%strong,31.6%moderate,and 50%weak.No correlation was found between antibiotic resistance and biofilm formation.The genes csuE,abaI,and ompA were prevalent,but their distribution was similar across biofilm categories.A relationship between Int1 and biofilm production was noted.Conclusions:The high rates of antibiotic resistance and biofilm formation,alongside the presence of integrons including class Ⅰ and Ⅱ,underscore the necessity for ongoing monitoring of A.baumannii.Notably,classⅠintegron presence was significantly linked to biofilm formation.Further research is needed to explore the connection between antibiotic resistance and biofilm production in A.baumannii.展开更多
The aim of this study was to identify and evaluate evidence of clinical nurses’ research capacity building in practice. A systematic review of studies of nurses’ research capacity building in practice was performed....The aim of this study was to identify and evaluate evidence of clinical nurses’ research capacity building in practice. A systematic review of studies of nurses’ research capacity building in practice was performed. The quality of the articles was evaluated and reflected on in accordance with the Quality Assessment and Validity Tool for Correlation Studies. The literature searches identified a total of 4748 abstracts and titles. Eight quantitative studies were included in the evaluation. Three themes emerged from the analysis: Failure to ensure research quality and standards, Developing a research culture and Collaboration and organization of research utilization. The first theme has one sub-theme: Lack of knowledge about how to increase research utilization. The second theme is based on three sub-themes: Ability to identify clinical problems, changing nurses’ attitudes to research and research supervision. Finally, the third theme has one sub-theme: Funding as a success factor. In conclusion, research capacity building requires the development of research competence to generate knowledge that enhances quality and patient safety. Nurse leaders are essential for establishing evidence-based practice and a research culture, thus enhancing nurses’ scientific attitudes and capacity.展开更多
Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where s...Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.展开更多
Alzheimer’s disease is a debilitating,progressive neurodegenerative disorder characterized by the progressive accumulation of abnormal proteins,including amyloid plaques and intracellular tau tangles,primarily within...Alzheimer’s disease is a debilitating,progressive neurodegenerative disorder characterized by the progressive accumulation of abnormal proteins,including amyloid plaques and intracellular tau tangles,primarily within the brain.Lysosomes,crucial intracellular organelles responsible for protein degradation,play a key role in maintaining cellular homeostasis.Some studies have suggested a link between the dysregulation of the lysosomal system and pathogenesis of neurodegenerative diseases,including Alzheimer’s disease.Restoring the normal physiological function of lysosomes hold the potential to reduce the pathological burden and improve the symptoms of Alzheimer’s disease.Currently,the efficacy of drugs in treating Alzheimer’s disease is limited,with major challenges in drug delivery efficiency and targeting.Recently,nanomaterials have gained widespread use in Alzheimer’s disease drug research owing to their favorable physical and chemical properties.This review aims to provide a comprehensive overview of recent advances in using nanomaterials(polymeric nanomaterials,nanoemulsions,and carbon-based nanomaterials)to enhance lysosomal function in treating Alzheimer’s disease.This review also explores new concepts and potential therapeutic strategies for Alzheimer’s disease through the integration of nanomaterials and modulation of lysosomal function.In conclusion,this review emphasizes the potential of nanomaterials in modulating lysosomal function to improve the pathological features of Alzheimer’s disease.The application of nanotechnology to the development of Alzheimer’s disease drugs brings new ideas and approaches for future treatment of this disease.展开更多
Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients ...Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients with chronic pancreatitis who have large radiolucent stones,and to propose a treatment strategy.Methods:This analysis examined the data of patients with large pancreatic ductal stones(≥5 mm)from March 2011 to June 2018.Patients with radiolucent stones were classified as the radiolucent stones group,while those with pancreatic radiopaque stones presented at the same time were randomly selected as controls in a 1:2 ratio.Data on demographics,disease courses and treatment details were retrieved,and stone clearance and pain relief during the follow-up were compared between the two groups.Results:A total of 52 patients with large radiolucent stones and 104 patients with large radiopaque stones were included in the study.Pancreatic extracorporeal shock wave lithotripsy(ESWL)was the ini-tial treatment for large radiopaque stone.Endoscopic retrograde cholangiopancreatography(ERCP)was the first-step treatment for all patients in the radiolucent stones group,of which one patient received medication after failed ERCP cannulation,and four who failed stone extraction were treated with ESWL following the placement of a nasopancreatic catheter.There was no significant difference in the complete stone clearance rate(75.0%vs.78.8%;P=0.553)between the two groups.Among the 51 patients in the large radiolucent stones group who were followed up for 5.8 years(range 2.1-12.6),complete pain relief was achieved in 42 patients(82.4%),with no significant difference compared with the radiopaque group(82.4%vs.76.4%;P=0.409).Conclusions:ERCP is an effective endotherapy for large radiolucent stone and should be considered the first-step treatment.When stone extraction failed during ERCP,ESWL is recommended following the placement of a nasopancreatic catheter.展开更多
Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in ...Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.展开更多
Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controver...Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.展开更多
Debate regarding the premature aging of knee joints in acquired immune deficiency syndrome(AIDS)patients has remained contentious,with conjectures pointing towards its correlation with distinct antiviral regimes.Prote...Debate regarding the premature aging of knee joints in acquired immune deficiency syndrome(AIDS)patients has remained contentious,with conjectures pointing towards its correlation with distinct antiviral regimes.Protease inhibitors(PIs)stand as a prominent class of antiviral agents frequently utilized in AIDS management and have been significantly linked to premature senescence.This study aimed to investigate whether PI-containing regimens would accelerate osteoarthritis(OA)development and explore the molecular mechanisms underlying this association.A retrospective cohort of 151 HIV-infected individuals,categorized into PI and non-PI groups,was established.Patients in PI group exhibited lower KOOS and a higher prevalence of radiological knee OA than those in non-PI group.Additionally,25 anti-HIV drugs were screened and among all antiviral drugs,lopinavir had the most detrimental impact on cartilage anabolism,accelerating cartilage senescence and promoting mouse OA development.Mechanistically,lopinavir accelerated cellular senescence by inhibiting Zmpste24 and interfering nuclear membrane stability,which leads to decreased binding between nuclear membrane-binding protein Usp7 and Mdm2 and activates Usp7/Mdm2/p53 pathway.Zmpste24 overexpression reduces OA severity in mice.These findings suggest that PI-containing regimens accelerate cartilage senescence and OA development through Zmpste24 inhibition,which provides new insights into the selection of HIV regimens.展开更多
Objective:To explain barriers to childbearing among working women from the perspective of working women and midwives.Methods:In this study,a qualitative study of content analysis method was employed.The study was cond...Objective:To explain barriers to childbearing among working women from the perspective of working women and midwives.Methods:In this study,a qualitative study of content analysis method was employed.The study was conducted from December 2021 to July 2022.The population consisted of working women and midwives.Data collection was conducted using semi-structured interviews and continued until data saturation was achieved.Through purposeful sampling,10 women and 11 midwives were selected as the sample.The data were analyzed by Graneheim and Lundman content analysis approach.For more rigorous,Nvivo 14 software was also used for data management,analysis,coding and organization of data.Results:This study included 21 women(10 women employees and 11 midwives)aged 25-43 years(for women employees)and 27-56 years(for midwives)with 1 to 34 years of job experience.In examination of participant’views about the barriers to childbearing,1124 codes were identified,of which we managed to extract six subthemes and two themes.Two themes emerged:“lack of social support and lack of family support”.Subthemes of“lack of social support”were“inadequate leave,long distance from workplace,and insufficient wages”.Subthemes of“lack of family support”were“lack of spouse support,lack of spouse's family support,and lack of their family support”.Conclusions:Different socioeconomic factors influence childbearing tendency in working women.Social and family supports play an important role in this regard.It is important to take these factors into account at the time of policymaking in the field of midwifery.展开更多
Objective:To investigate the prevalence,mechanisms,and trends of knockdown resistance(kdr)in Anopheles(An.)culicifacies and its impact on the efficacy of organochlorine and other insecticides.Methods:A systematic revi...Objective:To investigate the prevalence,mechanisms,and trends of knockdown resistance(kdr)in Anopheles(An.)culicifacies and its impact on the efficacy of organochlorine and other insecticides.Methods:A systematic review was conducted based on PRISMA guidelines,extracting data from biooan.org,Embase,ProQuest,PubMed,Scopus,and Web of Science without a time limit until the end of 2022.Articles meeting the inclusion criteria were assessed using the STROBE checklist.Data on kdr mutations,insecticide resistance,and effectiveness were analyzed across eight selected studies from various regions.Results:The review revealed widespread kdr-mediated resistance in An.culicifacies,primarily against dichloro-diphenyl-trichloroethane(DDT),persisting even decades after discontinued use.Key kdr mutations,including L1014F and L1014S,were identified.Resistance to deltamethrin was less stable,with increased sensitivity observed after short-term discontinuation.The findings underscore the vector's sustained resistance to organochlorine insecticides and relative sensitivity to pyrethroids.Conclusions:Stable kdr resistance in An.culicifacies to organochlorine insecticides highlights the need for periodic susceptibility assessments and strategic rotation or combination of insecticides to combat malaria effectively and prevent the development of resistance.展开更多
Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by re...Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.展开更多
Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpac...Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpaction and maintenance treatment with medications are the main pillars of successful outcome. The medications are variably effective and have potential side effects. Objectives: The current clinical trial was designed to evaluate clinical efficacy of polyethylene glycol (PEG) 3350 and liquid paraffin in chronic functional constipation. Besides, subjects were followed carefully for the side effects. Material and Methods: This study was involved 110 children suffering from chronic functional constipation. They were placed into two different groups, randomly. Each group was treated with PEG 3350 or liquid paraffin. The clinical efficacy and side effects were monitored. Results: After disimpaction with bisacodyl suppositories or combined with Mineral oil enemas in hard fecal impaction, maintenance therapy with PEG 3350 or liquid paraffin was started. The treatment duration and efficacies were not different between the two groups. Furthermore, serious adverse drug reaction was not observed. The family history of constipation and presence of incontinence were two worse prognostic factors. Conclusion: No difference was observed between PEG 3350 and liquid paraffin in chronic functional constipation in children in terms of their efficacies. They are safe and effective medications in this age group.展开更多
BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning...BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research purposes.AIM To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care patients.METHODS A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical ICU.This was then validated in an independent cohort of 100 patients.We compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded reviewers.Disagreement was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was identified.Sepsis versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as Septic Shock-V1 and-V2 respectively.RESULTS In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for Septic Shock-1,and 80%and 90%for Septic Shock-2.An overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and Septic shock 2 respectively.In validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%each.CONCLUSION Supervised machine learning for identification of sepsis and septic shock is reliable and an efficient alternative to manual chart review.展开更多
OBJECTIVE： This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observationa...OBJECTIVE： This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observational studies. METHODS： A multidisciplinary panel of 15 judges produced an initial version of the instrument through iterative Delphi rounds and pilot-tested the instrument on five clinical trials. Later they assessed, under blind conditions, the individualization quality of 40 randomly-selected research reports. The final version of the instrument included six criteria. These items were scored consistently by all the raters regardless of background. RESULTS： The instrument appeared to have adequate face and content validity, acceptable internal consistency or reliability （Cronbach＇s a 0.606 - 0.725）, significant discriminant validity （F = 398.7; P 〈 0.000 1）, moderate interrater reliability （Fleiss K 0.533）, agreeable test-retest reliability （Cohen＇s K 0.765 - 0.934）, moderate sensitivity （0.4; 95% confidence interval 0.253- 0.566）, and high specificity （1.0; 95% confidence interval 0.891-1.000）. CONCLUSION： The initial data suggest that this instrument may be a promising systematic tool amendable for further development.展开更多
Objective:To determine patterns of antimicrobial resistance,analyze the prevalence of oxacillinase and molecular typing of strains of Acinetobacter baumannii(A.baumannii).Methods:A total of 121 strains of A.baumannii ...Objective:To determine patterns of antimicrobial resistance,analyze the prevalence of oxacillinase and molecular typing of strains of Acinetobacter baumannii(A.baumannii).Methods:A total of 121 strains of A.baumannii were obtained from patients admitted to Imam Hossein and Imam Khomeini Hospitals,Tehran,Iran,from January 2016 to November 2018.Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute recommendations.The presence of oxacillinase genes was assessed by polymerase chain reaction(PCR).To determine clonal relatedness,all isolates were subjected to repetitive sequence-based PCR(REP-PCR).Results:The isolates were obtained from 56(46.3%)males and 65(53.7%)females with the mean age of 39.5 years.Colistin with 100.0%sensitivity rate had the highest effect,while ceftriaxone with 16.5%sensitivity rate had the least effect on A.baumannii isolates.In addition,96(79.3%)and 99(81.8%)isolates were resistant to imipenem and meropenem,respectively.A total of 109 isolates(90.0%)exhibited multiple drug resistance with 10 different resistotypes.In total,75(75.7%)of carbapenem resistant isolates were positive for blaOXA-23-like,and 14(14.1%)for blaOXA-24-like gene.The five main clones A,B,C,D,and E were detected in 25(25.2%),36(36.4%),10(10.1%),8(8.0%),and 6(6.1%)of isolates,respectively.Conclusions:Carbapenem-resistant A.baumannii strains are high in the current study.To control the spread of carbapenem-resistant A.baumannii strains,regular monitoring programs are needed.展开更多
<strong>Background: </strong>Cardiac rehabilitation (CR) is a multifaceted treatment that can increase the survival and quality of life of cardiac patients by increasing their functional capacity (FC). In ...<strong>Background: </strong>Cardiac rehabilitation (CR) is a multifaceted treatment that can increase the survival and quality of life of cardiac patients by increasing their functional capacity (FC). In this study, we aimed to investigate the FC changes of cardiac patients after the CR program in different subgroups in terms of anthropometric, clinical, and psychological indices. <strong>Materials and Methods:</strong> This is a descriptive retrospective study that has been derived from the results of a Cohort study at the Rehabilitation Research Center of the Cardiovascular Research Institute of Isfahan (Iran), from 2006 to 2017. In this study, the dependent variable is functional capacity changes based on Mets obtained in exercise testing at the beginning and end of the CR program. Independent variables included age, sex, dyslipidemia, diabetes, smoking, and Body mass index, type of intervention, depression, and EF. <strong>Results:</strong> The sample size is 1250 cardiovascular patients, of which 917 (73.5%) are male and 331 (26.5%) are female. Functional capacity after the CR program significantly increased in all age, gender, body mass index, hypertension, hyperlipidemia, diabetes, smoking, depression, EF, and type of operation performed (angioplasty or open-heart surgery) subgroups, (p < 0.001). Using multiple linear regression analysis, a significant relationship was found between Mets changes and only the variables of gender, depression, and EF. <strong>Conclusion:</strong> The results of this study show the importance of rehabilitation programs in the secondary prevention of cardiovascular disease in different subgroups and factors such as gender, level of primary depression, and EF less than 35 are the most important factors affecting functional capacity increase after CR program in heart patients.展开更多
Objective: To evaluate different doses of ivermectin in adult patients with mild COVID-19 and to evaluate the effect of ivermectin on mortality and clinical consequences.Methods: A randomized, double-blind, placebo-co...Objective: To evaluate different doses of ivermectin in adult patients with mild COVID-19 and to evaluate the effect of ivermectin on mortality and clinical consequences.Methods: A randomized, double-blind, placebo-controlled, multicenter clinical trial was performed at five hospitals. A total of 180 mild hospitalized patients with COVID-19 confirmed by PCR or chest image tests were enrolled and allocated to six arms including hydroxychloroquine 200 mg twice per day, placebo plus hydroxychloroquine 200 mg twice per day, single dose ivermectin(200 μg/kg), three low interval doses of ivermectin(200, 200, 200 μg/kg), single dose ivermectin(400 μg/kg), and three high interval doses of ivermectin(400, 200, 200 μg/kg). The primary endpoint of this trial was all-cause of mortality or clinical recovery. The radiographic findings, hospitalization and low O_2 saturation duration, and hematological variables of blood samples were analyzed. Results: A total of 16.7%(5/30) and 20.0%(6/30) patients died in arms treated with hydroxychloroquine 200 mg twice per day and placebo plus hydroxychloroquine 200 mg twice per day, respectively, and a reduction in mortality rate in patients receiving ivermectin treatment to 0%, 10%, 0% and 3.3% for arms 1-4 were observed. Risk of mortality was also decreased about 15% in the ivermectin treated arms. Conclusions: Ivermectin as an adjunct reduces the rate of mortality, time of low O_2 saturation, and duration of hospitalization in adult COVID-19 patients. The improvement of other clinical parametersshows that ivermectin, with a wide margin of safety, had a high therapeutic effect on COVID-19.展开更多
In response to the new round of COVID-19 outbreaks since March 2022,universities with high outbreak rates around the country have taken quarantine measures to contain the epidemic.Evidence from previous coronavirus ou...In response to the new round of COVID-19 outbreaks since March 2022,universities with high outbreak rates around the country have taken quarantine measures to contain the epidemic.Evidence from previous coronavirus outbreaks has shown that people under quarantine are at risk for mental health disorders.To better understand the impacts of this round of COVID-19 quarantine on domestic college students and their responses,we conducted a systematic survey to assess the stress and anxiety,and to evaluate effective measurements in this population.We searched relevant documents and literature,and designed a questionnaire from six aspects,including psychological status,epidemic situation,study,daily life,sports,and interpersonal communication,with 51 items in total.We sent the questionnaire on the Wenjuanxing Web platform,from April 2 to 8,2022.We evaluated the mental status according to parts of the Generalized Anxiety Disorder-7(GAD-7)and Depression Anxiety Stress Scales-21(DASS-21),and investigated the influencing risk factors and countermeasures.Statistical analysis was performed by using the Chi-square test and multi-variable logistic regression.In total,508 college respondents were recruited in our survey,and the pooled prevalence of mild anxiety(GAD score≥5,or DASS-21 anxiety score≥8)or stress(DASS-21 pressure score≥14)caused by the new round of COVID-19 pandemic quarantine was 19.69%(100/508).The prevalence of the anxiety or stress in college students with COVID-19 quarantine between different genders,regions,and majors was not significantly different.Independent risk factors for the mild anxiety or stress of undergraduates by COVID-19 quarantine included learning efficiency or duration[OR=1.36,95%CI(1.14—1.62),P=0.001],based on the combined analysis of Chi-square test analysis with multi-variable logistic regression analysis.Interestingly,the mental well-beings before COVID-19 epidemic quarantine[OR=0.22,95%CI(0.130.36),P<0.0001],more low-intensity exercise[OR=0.36,95%CI(0.150.87),P=0.02,high-intensity exercise as reference],and good sleep quality[OR=0.14,95%CI(0.07-0.30),P<0.0001:OR=0.42,95%CI(0.300.59),P<0.0001]are protective factors for alleviating the quarantine-caused anxiety or stress in Chinese college students for this round of COVID-19 epidemic quarantine.During the round of COVID-19 epidemic quarantine in 2022,a small number of college students have mild anxiety,affected by decreased learning efficiency or duration,which could be mitigated with low-intensity exercise and good sleep quality.展开更多
Objective:To conduct changes in sexual activity during pregnancy and its related factors in pregnant women.Methods:The present descriptive cross-sectional study was conducted in 2017 on pregnant women who referred to ...Objective:To conduct changes in sexual activity during pregnancy and its related factors in pregnant women.Methods:The present descriptive cross-sectional study was conducted in 2017 on pregnant women who referred to the women's clinic of Afzalipour Hospital in the southeast of Iran.Participants were included in the study through convenient sampling.The data collection tool was a researcher-made questionnaire consisting of two parts of personal social information of the couple and questions to measure the level of sexual activity and the attitude of the subjects during pregnancy compared to before pregnancy.Results:201 Pregnant women were included.The average age of pregnant women was(27.3±6.1)years and their average gestational age was(24.7±11.8)years.More than 62%of women had decreased sexual activity.There was a significant relationship between the amount of changes in sexual activity and delivery time(P=0.013),abortion history(P=0.001)and premature birth history(P=0.002).Most pregnant women believed that sex during pregnancy caused damage to the fetus(67.7%).A decrease in the intensity of sexual desire was reported in 63%of pregnant women.More than 60%of the subjects did not consult with doctors and midwives with regards to sexual issues(63.5%).The most common reason for not consulting was not feeling the need(32%).Most women experienced back pain during(42.8%)and after(39.8%)intercourse.Conclusions:Changes in sex life during pregnancy are often caused by the lack of sexual knowledge and the increase in misconceptions among couples,which can affect the quality of relationships.The role of education is essential.Therefore,it is suggested that by including sexual counseling along with pregnancy care,wrong beliefs and information among women will be corrected.展开更多
Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used ...Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.展开更多
基金This study was financially supported by the Vice Chancellor for Research Affairs,Ilam University of Medical Sciences,Ilam,Iran(Project No.1326).
文摘Objective:To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii(A.baumannii)isolates in this study.Methods:A.baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study,and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2®systems.All isolates were analyzed for biofilm production,then presence of biofilm-associated genes,and class Ⅰ and Ⅱ integron genes.Results:60 non-replicate A.baumannii isolates were included in this study.The resistance rates reached 100%for aztreonam,cefepime,ceftazidime,ciprofloxacin,piperacillin-tazobactam,piperacillin,ticarcillin,and trimethoprim-sulfamethoxazole.A.baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments.Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3%and 16.7%,respectively.Of the isolates,91.6%formed biofilms,categorized as 10%strong,31.6%moderate,and 50%weak.No correlation was found between antibiotic resistance and biofilm formation.The genes csuE,abaI,and ompA were prevalent,but their distribution was similar across biofilm categories.A relationship between Int1 and biofilm production was noted.Conclusions:The high rates of antibiotic resistance and biofilm formation,alongside the presence of integrons including class Ⅰ and Ⅱ,underscore the necessity for ongoing monitoring of A.baumannii.Notably,classⅠintegron presence was significantly linked to biofilm formation.Further research is needed to explore the connection between antibiotic resistance and biofilm production in A.baumannii.
基金funded by Buskerud and Vestfold University College,Faculty of Health,Institute for Nursing Science,Centre for Womens’,Family&Child Health and Stord/Haugesund University College.
文摘The aim of this study was to identify and evaluate evidence of clinical nurses’ research capacity building in practice. A systematic review of studies of nurses’ research capacity building in practice was performed. The quality of the articles was evaluated and reflected on in accordance with the Quality Assessment and Validity Tool for Correlation Studies. The literature searches identified a total of 4748 abstracts and titles. Eight quantitative studies were included in the evaluation. Three themes emerged from the analysis: Failure to ensure research quality and standards, Developing a research culture and Collaboration and organization of research utilization. The first theme has one sub-theme: Lack of knowledge about how to increase research utilization. The second theme is based on three sub-themes: Ability to identify clinical problems, changing nurses’ attitudes to research and research supervision. Finally, the third theme has one sub-theme: Funding as a success factor. In conclusion, research capacity building requires the development of research competence to generate knowledge that enhances quality and patient safety. Nurse leaders are essential for establishing evidence-based practice and a research culture, thus enhancing nurses’ scientific attitudes and capacity.
文摘Candida auris since it discovery in 2009 is becoming a severe threat to human health due to its very quickly spread, its worldwide high resistance to systemic antifungal drugs. In resource-constrained settings where several conditions are met for its emergence and spread, this worrisome fungus could cause large hospital and/or community-based outbreaks. This review aimed to summarize the available data on C. auris in Africa focusing on its epidemiology and antifungal resistance profile. Major databases were searched for articles on the epidemiology and antifungal resistance profile of C. auris in Africa. Out of 2,521 articles identified 22 met the inclusion criteria. In Africa, nearly 89% of African countries have no published data on C. auris. The prevalence of C. auris in Africa was 8.74%. The case fatality rate of C. auris infection in Africa was 39.46%. The main C. auris risk factors reported in Africa were cardiovascular disease, renal failure, diabetes, HIV, recent intake of antimicrobial drugs, ICU admissions, surgery, hemodialysis, parenteral nutrition and indwelling devices. Four phylogenetic clades were reported in Africa, namely clades I, II, III and IV. Candida auris showed a pan-African very high resistance rate to fluconazole, moderate resistance to amphotericin B, and high susceptibility to echinocandins. Finally, C. auris clade-specific mutations were observed within the ERG2, ERG3, ERG9, ERG11, FKS1, TAC1b and MRR1 genes in Africa. This systematic review showed the presence of C. auris in the African continent and a worrying unavailability of data on this resilient fungus in most African countries.
基金supported by the Natural Science Foundation of Shanghai,No.22ZR147750Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.23Y11906600Shanghai Changzheng Hospital Innovative Clinical Research Project,No.2020YLCYJ-Y02(all to YY).
文摘Alzheimer’s disease is a debilitating,progressive neurodegenerative disorder characterized by the progressive accumulation of abnormal proteins,including amyloid plaques and intracellular tau tangles,primarily within the brain.Lysosomes,crucial intracellular organelles responsible for protein degradation,play a key role in maintaining cellular homeostasis.Some studies have suggested a link between the dysregulation of the lysosomal system and pathogenesis of neurodegenerative diseases,including Alzheimer’s disease.Restoring the normal physiological function of lysosomes hold the potential to reduce the pathological burden and improve the symptoms of Alzheimer’s disease.Currently,the efficacy of drugs in treating Alzheimer’s disease is limited,with major challenges in drug delivery efficiency and targeting.Recently,nanomaterials have gained widespread use in Alzheimer’s disease drug research owing to their favorable physical and chemical properties.This review aims to provide a comprehensive overview of recent advances in using nanomaterials(polymeric nanomaterials,nanoemulsions,and carbon-based nanomaterials)to enhance lysosomal function in treating Alzheimer’s disease.This review also explores new concepts and potential therapeutic strategies for Alzheimer’s disease through the integration of nanomaterials and modulation of lysosomal function.In conclusion,this review emphasizes the potential of nanomaterials in modulating lysosomal function to improve the pathological features of Alzheimer’s disease.The application of nanotechnology to the development of Alzheimer’s disease drugs brings new ideas and approaches for future treatment of this disease.
基金supported by grants from the National Nat-ural Science Foundation of China(82270679 and 82370657)Shanghai Municipal Hospital Emerging Frontier Technology Joint Project(SHDC12021107)+1 种基金Shanghai Chenguang Program(20CG42)Shanghai New-Star Youth Doctor Program(HWRS2020087).
文摘Background:Previous studies have not clarified the treatment of large pancreatic radiolucent stones(≥5 mm).The primary objective of this study was to assess the clinical features and therapeutic efficacy in patients with chronic pancreatitis who have large radiolucent stones,and to propose a treatment strategy.Methods:This analysis examined the data of patients with large pancreatic ductal stones(≥5 mm)from March 2011 to June 2018.Patients with radiolucent stones were classified as the radiolucent stones group,while those with pancreatic radiopaque stones presented at the same time were randomly selected as controls in a 1:2 ratio.Data on demographics,disease courses and treatment details were retrieved,and stone clearance and pain relief during the follow-up were compared between the two groups.Results:A total of 52 patients with large radiolucent stones and 104 patients with large radiopaque stones were included in the study.Pancreatic extracorporeal shock wave lithotripsy(ESWL)was the ini-tial treatment for large radiopaque stone.Endoscopic retrograde cholangiopancreatography(ERCP)was the first-step treatment for all patients in the radiolucent stones group,of which one patient received medication after failed ERCP cannulation,and four who failed stone extraction were treated with ESWL following the placement of a nasopancreatic catheter.There was no significant difference in the complete stone clearance rate(75.0%vs.78.8%;P=0.553)between the two groups.Among the 51 patients in the large radiolucent stones group who were followed up for 5.8 years(range 2.1-12.6),complete pain relief was achieved in 42 patients(82.4%),with no significant difference compared with the radiopaque group(82.4%vs.76.4%;P=0.409).Conclusions:ERCP is an effective endotherapy for large radiolucent stone and should be considered the first-step treatment.When stone extraction failed during ERCP,ESWL is recommended following the placement of a nasopancreatic catheter.
基金funded by Shanghai Municipal Health and Wellness Commission Health Industry Clinical Research Special Project(202140299).
文摘Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.
基金supported by grants from the National Nat-ural Science Foundation of China(82222012 and 82120108006)Scientific Innovation Program of Shanghai Municipal Education Committee(201901070007E00052)。
文摘Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.
基金supported by Natural Science Foundation of China(82472476)Fundamental Research Funds for the Central Universities(YG2023ZD15)+2 种基金The Youth Talent Program from Shanghai Health System(2022YQ020)AI-Driven Reform of Research Paradigms Empowers Discipline Advancement Initiatives from Shanghai Municipal Education Commission(Grant No.JWAIZD-7)the Natural Science Foundation of Shanghai(23ZR1437300).
文摘Debate regarding the premature aging of knee joints in acquired immune deficiency syndrome(AIDS)patients has remained contentious,with conjectures pointing towards its correlation with distinct antiviral regimes.Protease inhibitors(PIs)stand as a prominent class of antiviral agents frequently utilized in AIDS management and have been significantly linked to premature senescence.This study aimed to investigate whether PI-containing regimens would accelerate osteoarthritis(OA)development and explore the molecular mechanisms underlying this association.A retrospective cohort of 151 HIV-infected individuals,categorized into PI and non-PI groups,was established.Patients in PI group exhibited lower KOOS and a higher prevalence of radiological knee OA than those in non-PI group.Additionally,25 anti-HIV drugs were screened and among all antiviral drugs,lopinavir had the most detrimental impact on cartilage anabolism,accelerating cartilage senescence and promoting mouse OA development.Mechanistically,lopinavir accelerated cellular senescence by inhibiting Zmpste24 and interfering nuclear membrane stability,which leads to decreased binding between nuclear membrane-binding protein Usp7 and Mdm2 and activates Usp7/Mdm2/p53 pathway.Zmpste24 overexpression reduces OA severity in mice.These findings suggest that PI-containing regimens accelerate cartilage senescence and OA development through Zmpste24 inhibition,which provides new insights into the selection of HIV regimens.
基金This study was supported by Kerman University of medical sciences,with grant number:95000387.
文摘Objective:To explain barriers to childbearing among working women from the perspective of working women and midwives.Methods:In this study,a qualitative study of content analysis method was employed.The study was conducted from December 2021 to July 2022.The population consisted of working women and midwives.Data collection was conducted using semi-structured interviews and continued until data saturation was achieved.Through purposeful sampling,10 women and 11 midwives were selected as the sample.The data were analyzed by Graneheim and Lundman content analysis approach.For more rigorous,Nvivo 14 software was also used for data management,analysis,coding and organization of data.Results:This study included 21 women(10 women employees and 11 midwives)aged 25-43 years(for women employees)and 27-56 years(for midwives)with 1 to 34 years of job experience.In examination of participant’views about the barriers to childbearing,1124 codes were identified,of which we managed to extract six subthemes and two themes.Two themes emerged:“lack of social support and lack of family support”.Subthemes of“lack of social support”were“inadequate leave,long distance from workplace,and insufficient wages”.Subthemes of“lack of family support”were“lack of spouse support,lack of spouse's family support,and lack of their family support”.Conclusions:Different socioeconomic factors influence childbearing tendency in working women.Social and family supports play an important role in this regard.It is important to take these factors into account at the time of policymaking in the field of midwifery.
文摘Objective:To investigate the prevalence,mechanisms,and trends of knockdown resistance(kdr)in Anopheles(An.)culicifacies and its impact on the efficacy of organochlorine and other insecticides.Methods:A systematic review was conducted based on PRISMA guidelines,extracting data from biooan.org,Embase,ProQuest,PubMed,Scopus,and Web of Science without a time limit until the end of 2022.Articles meeting the inclusion criteria were assessed using the STROBE checklist.Data on kdr mutations,insecticide resistance,and effectiveness were analyzed across eight selected studies from various regions.Results:The review revealed widespread kdr-mediated resistance in An.culicifacies,primarily against dichloro-diphenyl-trichloroethane(DDT),persisting even decades after discontinued use.Key kdr mutations,including L1014F and L1014S,were identified.Resistance to deltamethrin was less stable,with increased sensitivity observed after short-term discontinuation.The findings underscore the vector's sustained resistance to organochlorine insecticides and relative sensitivity to pyrethroids.Conclusions:Stable kdr resistance in An.culicifacies to organochlorine insecticides highlights the need for periodic susceptibility assessments and strategic rotation or combination of insecticides to combat malaria effectively and prevent the development of resistance.
基金supported by the U.S.Department of Defense(W81XWH-09-2-0194 for the pilot phase)the Canadian Institutes of Health Research(MCT-94834 for the pilot phase and 14238 for the definitive phase).
文摘Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
文摘Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpaction and maintenance treatment with medications are the main pillars of successful outcome. The medications are variably effective and have potential side effects. Objectives: The current clinical trial was designed to evaluate clinical efficacy of polyethylene glycol (PEG) 3350 and liquid paraffin in chronic functional constipation. Besides, subjects were followed carefully for the side effects. Material and Methods: This study was involved 110 children suffering from chronic functional constipation. They were placed into two different groups, randomly. Each group was treated with PEG 3350 or liquid paraffin. The clinical efficacy and side effects were monitored. Results: After disimpaction with bisacodyl suppositories or combined with Mineral oil enemas in hard fecal impaction, maintenance therapy with PEG 3350 or liquid paraffin was started. The treatment duration and efficacies were not different between the two groups. Furthermore, serious adverse drug reaction was not observed. The family history of constipation and presence of incontinence were two worse prognostic factors. Conclusion: No difference was observed between PEG 3350 and liquid paraffin in chronic functional constipation in children in terms of their efficacies. They are safe and effective medications in this age group.
文摘BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research purposes.AIM To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care patients.METHODS A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical ICU.This was then validated in an independent cohort of 100 patients.We compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded reviewers.Disagreement was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was identified.Sepsis versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as Septic Shock-V1 and-V2 respectively.RESULTS In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for Septic Shock-1,and 80%and 90%for Septic Shock-2.An overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and Septic shock 2 respectively.In validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%each.CONCLUSION Supervised machine learning for identification of sepsis and septic shock is reliable and an efficient alternative to manual chart review.
文摘OBJECTIVE： This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observational studies. METHODS： A multidisciplinary panel of 15 judges produced an initial version of the instrument through iterative Delphi rounds and pilot-tested the instrument on five clinical trials. Later they assessed, under blind conditions, the individualization quality of 40 randomly-selected research reports. The final version of the instrument included six criteria. These items were scored consistently by all the raters regardless of background. RESULTS： The instrument appeared to have adequate face and content validity, acceptable internal consistency or reliability （Cronbach＇s a 0.606 - 0.725）, significant discriminant validity （F = 398.7; P 〈 0.000 1）, moderate interrater reliability （Fleiss K 0.533）, agreeable test-retest reliability （Cohen＇s K 0.765 - 0.934）, moderate sensitivity （0.4; 95% confidence interval 0.253- 0.566）, and high specificity （1.0; 95% confidence interval 0.891-1.000）. CONCLUSION： The initial data suggest that this instrument may be a promising systematic tool amendable for further development.
文摘Objective:To determine patterns of antimicrobial resistance,analyze the prevalence of oxacillinase and molecular typing of strains of Acinetobacter baumannii(A.baumannii).Methods:A total of 121 strains of A.baumannii were obtained from patients admitted to Imam Hossein and Imam Khomeini Hospitals,Tehran,Iran,from January 2016 to November 2018.Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute recommendations.The presence of oxacillinase genes was assessed by polymerase chain reaction(PCR).To determine clonal relatedness,all isolates were subjected to repetitive sequence-based PCR(REP-PCR).Results:The isolates were obtained from 56(46.3%)males and 65(53.7%)females with the mean age of 39.5 years.Colistin with 100.0%sensitivity rate had the highest effect,while ceftriaxone with 16.5%sensitivity rate had the least effect on A.baumannii isolates.In addition,96(79.3%)and 99(81.8%)isolates were resistant to imipenem and meropenem,respectively.A total of 109 isolates(90.0%)exhibited multiple drug resistance with 10 different resistotypes.In total,75(75.7%)of carbapenem resistant isolates were positive for blaOXA-23-like,and 14(14.1%)for blaOXA-24-like gene.The five main clones A,B,C,D,and E were detected in 25(25.2%),36(36.4%),10(10.1%),8(8.0%),and 6(6.1%)of isolates,respectively.Conclusions:Carbapenem-resistant A.baumannii strains are high in the current study.To control the spread of carbapenem-resistant A.baumannii strains,regular monitoring programs are needed.
文摘<strong>Background: </strong>Cardiac rehabilitation (CR) is a multifaceted treatment that can increase the survival and quality of life of cardiac patients by increasing their functional capacity (FC). In this study, we aimed to investigate the FC changes of cardiac patients after the CR program in different subgroups in terms of anthropometric, clinical, and psychological indices. <strong>Materials and Methods:</strong> This is a descriptive retrospective study that has been derived from the results of a Cohort study at the Rehabilitation Research Center of the Cardiovascular Research Institute of Isfahan (Iran), from 2006 to 2017. In this study, the dependent variable is functional capacity changes based on Mets obtained in exercise testing at the beginning and end of the CR program. Independent variables included age, sex, dyslipidemia, diabetes, smoking, and Body mass index, type of intervention, depression, and EF. <strong>Results:</strong> The sample size is 1250 cardiovascular patients, of which 917 (73.5%) are male and 331 (26.5%) are female. Functional capacity after the CR program significantly increased in all age, gender, body mass index, hypertension, hyperlipidemia, diabetes, smoking, depression, EF, and type of operation performed (angioplasty or open-heart surgery) subgroups, (p < 0.001). Using multiple linear regression analysis, a significant relationship was found between Mets changes and only the variables of gender, depression, and EF. <strong>Conclusion:</strong> The results of this study show the importance of rehabilitation programs in the secondary prevention of cardiovascular disease in different subgroups and factors such as gender, level of primary depression, and EF less than 35 are the most important factors affecting functional capacity increase after CR program in heart patients.
文摘Objective: To evaluate different doses of ivermectin in adult patients with mild COVID-19 and to evaluate the effect of ivermectin on mortality and clinical consequences.Methods: A randomized, double-blind, placebo-controlled, multicenter clinical trial was performed at five hospitals. A total of 180 mild hospitalized patients with COVID-19 confirmed by PCR or chest image tests were enrolled and allocated to six arms including hydroxychloroquine 200 mg twice per day, placebo plus hydroxychloroquine 200 mg twice per day, single dose ivermectin(200 μg/kg), three low interval doses of ivermectin(200, 200, 200 μg/kg), single dose ivermectin(400 μg/kg), and three high interval doses of ivermectin(400, 200, 200 μg/kg). The primary endpoint of this trial was all-cause of mortality or clinical recovery. The radiographic findings, hospitalization and low O_2 saturation duration, and hematological variables of blood samples were analyzed. Results: A total of 16.7%(5/30) and 20.0%(6/30) patients died in arms treated with hydroxychloroquine 200 mg twice per day and placebo plus hydroxychloroquine 200 mg twice per day, respectively, and a reduction in mortality rate in patients receiving ivermectin treatment to 0%, 10%, 0% and 3.3% for arms 1-4 were observed. Risk of mortality was also decreased about 15% in the ivermectin treated arms. Conclusions: Ivermectin as an adjunct reduces the rate of mortality, time of low O_2 saturation, and duration of hospitalization in adult COVID-19 patients. The improvement of other clinical parametersshows that ivermectin, with a wide margin of safety, had a high therapeutic effect on COVID-19.
文摘In response to the new round of COVID-19 outbreaks since March 2022,universities with high outbreak rates around the country have taken quarantine measures to contain the epidemic.Evidence from previous coronavirus outbreaks has shown that people under quarantine are at risk for mental health disorders.To better understand the impacts of this round of COVID-19 quarantine on domestic college students and their responses,we conducted a systematic survey to assess the stress and anxiety,and to evaluate effective measurements in this population.We searched relevant documents and literature,and designed a questionnaire from six aspects,including psychological status,epidemic situation,study,daily life,sports,and interpersonal communication,with 51 items in total.We sent the questionnaire on the Wenjuanxing Web platform,from April 2 to 8,2022.We evaluated the mental status according to parts of the Generalized Anxiety Disorder-7(GAD-7)and Depression Anxiety Stress Scales-21(DASS-21),and investigated the influencing risk factors and countermeasures.Statistical analysis was performed by using the Chi-square test and multi-variable logistic regression.In total,508 college respondents were recruited in our survey,and the pooled prevalence of mild anxiety(GAD score≥5,or DASS-21 anxiety score≥8)or stress(DASS-21 pressure score≥14)caused by the new round of COVID-19 pandemic quarantine was 19.69%(100/508).The prevalence of the anxiety or stress in college students with COVID-19 quarantine between different genders,regions,and majors was not significantly different.Independent risk factors for the mild anxiety or stress of undergraduates by COVID-19 quarantine included learning efficiency or duration[OR=1.36,95%CI(1.14—1.62),P=0.001],based on the combined analysis of Chi-square test analysis with multi-variable logistic regression analysis.Interestingly,the mental well-beings before COVID-19 epidemic quarantine[OR=0.22,95%CI(0.130.36),P<0.0001],more low-intensity exercise[OR=0.36,95%CI(0.150.87),P=0.02,high-intensity exercise as reference],and good sleep quality[OR=0.14,95%CI(0.07-0.30),P<0.0001:OR=0.42,95%CI(0.300.59),P<0.0001]are protective factors for alleviating the quarantine-caused anxiety or stress in Chinese college students for this round of COVID-19 epidemic quarantine.During the round of COVID-19 epidemic quarantine in 2022,a small number of college students have mild anxiety,affected by decreased learning efficiency or duration,which could be mitigated with low-intensity exercise and good sleep quality.
文摘Objective:To conduct changes in sexual activity during pregnancy and its related factors in pregnant women.Methods:The present descriptive cross-sectional study was conducted in 2017 on pregnant women who referred to the women's clinic of Afzalipour Hospital in the southeast of Iran.Participants were included in the study through convenient sampling.The data collection tool was a researcher-made questionnaire consisting of two parts of personal social information of the couple and questions to measure the level of sexual activity and the attitude of the subjects during pregnancy compared to before pregnancy.Results:201 Pregnant women were included.The average age of pregnant women was(27.3±6.1)years and their average gestational age was(24.7±11.8)years.More than 62%of women had decreased sexual activity.There was a significant relationship between the amount of changes in sexual activity and delivery time(P=0.013),abortion history(P=0.001)and premature birth history(P=0.002).Most pregnant women believed that sex during pregnancy caused damage to the fetus(67.7%).A decrease in the intensity of sexual desire was reported in 63%of pregnant women.More than 60%of the subjects did not consult with doctors and midwives with regards to sexual issues(63.5%).The most common reason for not consulting was not feeling the need(32%).Most women experienced back pain during(42.8%)and after(39.8%)intercourse.Conclusions:Changes in sex life during pregnancy are often caused by the lack of sexual knowledge and the increase in misconceptions among couples,which can affect the quality of relationships.The role of education is essential.Therefore,it is suggested that by including sexual counseling along with pregnancy care,wrong beliefs and information among women will be corrected.
文摘Background: Noninvasive ventilation (NIV) is an important therapeutic modality for the treatment of acute respiratory failure (ARF). In this review, we critically analyze randomized controlled trials on the most used NIV interfaces in the treatments of ARF. Methods: The searches were conducted in the Medline, Lilacs, PubMed, Cochrane, and Pedro databases from June to November 2021. The inclusion criteria were Randomized clinical trials (RCTs) published from 2016 to 2021 in Portuguese, Spanish, or English and involving adults (aged ≥ 18 years). The eligibility criteria for article selection were based on the PICO strategy: Population—Adults with ARF;Intervention—NIV Therapy;Comparison—Conventional oxygen therapy, high-flow nasal cannula (HFNC) oxygen therapy, or NIV;Outcome—improvement in ARF. The search for articles and the implementation of the inclusion criteria were independently conducted by two researchers. Results: Seven scientific articles involving 574 adults with ARF due to various causes, such as chest trauma, decompensated heart failure, coronavirus disease 2019 (COVID-19), and postoperative period, among others, were included. The interfaces cited in the studies included an oronasal mask, nasal mask, full-face mask, and helmet. In addition, some favorable outcomes related to NIV were reported in the studies, such as a reduction in the rate of orotracheal intubation and shorter length of stay in the ICU. Conclusions: The most cited interfaces in the treatment of ARF were the oronasal mask and the helmet.
