Medical Principles And Practice[JOURNAL]
Sun
200 papers
Are Newer Drugs Better? An Analysis of Neonatal Pharmacological Treatments across Generations.
Lai NM, Veettil SK, Chaiyakunapruk N … +1 more , Glasziou P
Med Princ Pract · 2024 · PMID 38857578 · Full text
INTRODUCTION: We evaluated the relative effects of newer versus older medications for neonatal conditions and trends in margin of superiority across generations. MATERIALS AND METHODS: We assessed network meta-analyses (...
INTRODUCTION: We evaluated the relative effects of newer versus older medications for neonatal conditions and trends in margin of superiority across generations. MATERIALS AND METHODS: We assessed network meta-analyses (NMAs) on neonatal pharmacological interventions identified from MEDLINE, Cochrane, and PROSPERO. Interventions were chronologically arranged based on the earliest study and compared for their effects against placebo or no treatment and their immediate predecessor. We assessed the time trend in effect sizes using the Mann-Kendall test. RESULTS: From 8,048 retrieved records, 10 neonatal NMAs covering 352 trials and 102,653 participants were included. Compared to placebo, 56/61 (91.8%) interventions showed superiority with 23 (37.7%) statistically significant. Compared to previous generation, 47/72 (65.3%) showed superiority with 3 (4.2%) statistically significant. No significant trends in effect sizes were observed across generations for most conditions (p = 0.09-1). CONCLUSIONS: We found no evidence that newer generation medications in neonatal care are consistently more effective than older generation medications.
Serum Macrophage Colony-Stimulating Factor Relates to the Severity and the Pregnancy Outcomes in Hypertensive Disorders Complicating Pregnancy.
Zhou L, Liu J, Zhou M … +1 more , Xu L
Med Princ Pract · 2024 · PMID 38830347 · Full text
PURPOSE: This study aimed to assess the predictive value of macrophage colony-stimulating factor (M-CSF) in the first trimester for hypertensive disorders complicating pregnancy (HDCP) and its association with disease se...
PURPOSE: This study aimed to assess the predictive value of macrophage colony-stimulating factor (M-CSF) in the first trimester for hypertensive disorders complicating pregnancy (HDCP) and its association with disease severity and adverse pregnancy outcomes. HDCP pose significant risks to both maternal health and fetal health. M-CSF is implicated in the pathogenesis of HDCP by promoting inflammation and endothelial damage. METHODS: Serum levels of M-CSF were measured using an enzyme-linked immunosorbent assay, and clinical characteristics and pregnancy outcomes were compared between groups. RESULTS: Pregnant women with HDCP had significantly higher levels of proteinuria, systolic blood pressure, and diastolic blood pressure compared to those with normal pregnancy. Among patients with HDCP, the severity of disease correlated positively with serum levels of M-CSF. Furthermore, M-CSF levels in the first trimester were significantly associated with adverse pregnancy outcomes. The findings suggest that M-CSF may serve as a potential biomarker for predicting HDCP and its severity, as well as adverse pregnancy outcomes. CONCLUSIONS: Early detection and monitoring of M-CSF levels could aid in identifying high-risk pregnancies and implementing appropriate interventions to improve maternal and fetal outcomes.
Hepatocellular Carcinoma: Prevention, Diagnosis, and Treatment.
Feng F, Zhao Y
Med Princ Pract · 2024 · PMID 38772352 · Full text
Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer globally, poses a substantial health burden. Influenced by risk factors such as hepatitis B or C virus infections, chronic consumption of alcohol, a...
Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer globally, poses a substantial health burden. Influenced by risk factors such as hepatitis B or C virus infections, chronic consumption of alcohol, and metabolic dysfunction, its exact etiology likely involves a complex interplay between viral infection, hepatocyte mutations, and chronic liver diseases like cirrhosis and metabolic dysfunction-associated steatohepatitis, and demographic variables like sex, race, and age. Disease stage significantly impacts the prognosis of HCC. There is significant potential for life-saving and socioeconomic benefits through the implementation of surveillance programs and the introduction of low-cost screening measures for high-risk groups; these screening measures include ultrasound imaging and blood tests. Treatment options for HCC encompass liver resection, transplantation, transarterial chemoembolization, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Despite therapeutic advances, treating advanced HCC remains challenging, emphasizing the need for continued efforts in prevention, early detection, and development of treatments to improve prognosis and long-term survival.
Prognostic Significance of Nuclear Factor Kappa B (p65) among Breast Cancer Patients in Cape Coast Teaching Hospital.
Barnes P, Mensah A, Derkyi-Kwarteng L … +13 more , Adankwa E, Agbo E, Yahaya ES, Amoani B, Adjei G, Ka-Chungu SMA, Akakpo PK, Halm-Lai F, Dankwa K, Amoako-Sakyi D, Nuvor SV, Obiri-Yeboah D, Saahene RO
Med Princ Pract · 2024 · PMID 38723618 · Full text
Breast cancer is the most prevalent cancer among African women, with high mortality rates in Ghana. Nuclear factor kappa B (NF-kB) has been associated with tumor progression in breast cancer. However, its clinical valida...
Breast cancer is the most prevalent cancer among African women, with high mortality rates in Ghana. Nuclear factor kappa B (NF-kB) has been associated with tumor progression in breast cancer. However, its clinical validation is controversial and understudied with no known published data on NF-kB (p65) among breast cancer patients in Ghana and other African countries. This study assessed the prognostic significance of NF-kB (p65) expression and its association with various clinicopathological features in breast cancer patients. Ninety formalin-fixed breast cancer tissues and 15 normal breast tissues were used to determine the expression of NF-kB (p65) using immunohistochemistry. We explored the correlation between expression of NF-kB (p65) and clinicopathological features. NF-kB (p65) was expressed in 86.7% of breast cancer tissues. There was a significant relationship between NF-kB (p65) expression and tumor grade, proliferation index (Ki67), and molecular subtype. High NF-kB (p65) expression in tumor grade 3 was about 10 times that of grade 1 (54.2% vs. 5.1%), and Ki67 > 20 was 79.7% compared to 20.3% for Ki67 ≤ 20. Patients with triple-negative breast cancer (TNBC) had 49.1% overexpression of NF-kB (p65) compared to 17%, 25.4%, and 8.5% for luminal A, luminal B, and HER2 cases, respectively. This study demonstrates that NF-kB (p65) was highly expressed among breast cancer patients at Cape Coast Teaching Hospital, Ghana, especially in TNBC. NF-kB (p65) could serve as a biomarker for cancer stage, progression, prognosis and as a therapeutic target.
The Emerging Role of AI in Patient Education: Correspondence.
Daungsupawong H, Wiwanitkit V
Med Princ Pract · 2024 · PMID 38714187 · Full text
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Retrospective Cohort Study Comparing the Clinical Profile and Outcomes of Critically Ill Pregnant Patients in Kuwait during the COVID-19 Pandemic Waves.
Alazmi E, Akbar Z, Aldarweesh M … +3 more , Almuzayen K, Husain E, Alharmi J
Med Princ Pract · 2024 · PMID 38643766 · Full text
OBJECTIVES: COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 virus). This virus evolved into several variants, each with different severity. There are surges in the...
OBJECTIVES: COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 virus). This virus evolved into several variants, each with different severity. There are surges in the number of infected patients, commonly described as "waves." In Kuwait, three waves occurred. Our study describes and compares the clinical presentation and outcomes of critically ill pregnant patients infected with different variants. METHODS: This was a retrospective cohort study in two intensive care units (ICU) dedicated to patients with COVID-19. The wave periods were retrieved from the Kuwait Ministry of Health. RESULTS: The total number of ICU admissions during the study period was 74 patients. Most cases occurred during the third wave (n = 47/74, 63.5%). Most patients did not have comorbidities. The most common presenting symptoms were fever 62.2%, dyspnea 71.6%, and dry cough 74.3%. Low oxygen saturation 35.1% and maternal tachycardia 75.7% were observed in most patients. Cesarean section was the most common route of delivery, with maternal indication accounting for most cases 78.84%. Eight patients (13.69%) underwent dialysis, and thirty-one (41.9%) needed extracorporeal membrane oxygenation. Most patients required ventilatory support 66.21%. Almost all patients were unvaccinated 97.01%. Maternal mortality was mainly noted in the third wave (13.23%). CONCLUSIONS: In Kuwait, the number of admissions and the rate of maternal complications, morbidity, and mortality increased with successive waves.
Comparison of BAP65, DECAF, PEARL, and MEWS Scores in Predicting Respiratory Support Need in Hospitalized Exacerbation of Chronic Obstructive Lung Disease Patients.
Acet-Öztürk NA, Aydin-Güçlü Ö, Yildiz MN … +6 more , Demirdöğen E, Görek Dilektaşli A, Coşkun F, Uzaslan E, Ursavaş A, Karadağ M
Med Princ Pract · 2024 · PMID 38626747 · Full text
OBJECTIVE: Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models...
OBJECTIVE: Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models, diagnostic accuracy is variable within and between models. SUBJECTS AND METHODS: We compared the prognostic performance of the BAP65 score, DECAF score, PEARL score, and modified early warning score (MEWS) in hospitalized patients with ECOPD, to estimate ventilatory support need. RESULTS: This cross-sectional study consisted of 139 patients. Patients in need of noninvasive or invasive mechanical ventilation support are grouped as ventilatory support groups (n = 54). Comparison between receiver operating characteristic curves revealed that the DECAF score is significantly superior to the PEARL score (p = 0.04) in discriminating patients in need of ventilatory support. DECAF score with a cutoff value of 1 presented the highest sensitivity and BAP65 score with a cutoff value of 2 presented the highest specificity in predicting ventilatory support need. Multivariable analysis revealed that gender played a significant role in COPD exacerbation outcome, and arterial pCO and RDW measurements were also predictors of ventilatory support need. Within severity indexes, only the DECAF score was independently associated with the outcome. One-point increase in DECAF score created a 1.43 times higher risk of ventilatory support need. All severity indexes showed a correlation with age, comorbidity index, and dyspnea. BAP65 and DECAF scores also showed a correlation with length of stay. CONCLUSION: Objective and practical classifications are needed by clinicians to assess prognosis and initiate treatment accordingly. DECAF score is a strong candidate among severity indexes.
Non-O Blood Group Is Associated with High Thrombus Burden and Poor Short- and Long-Term Prognosis in ST-Segment Elevation Myocardial Infarction Patients.
Toprak K, Kaplangöray M, Omar MB … +4 more , Dursun A, Toprak İH, Acar O, Demirbağ R
Med Princ Pract · 2024 · PMID 38615658 · Full text
INTRODUCTION: This study investigated how non-O blood groups relate to thrombus burden (TB) and prognosis in ST-segment elevation myocardial infarction (STEMI) patients, aiming to shed light on their association with thr...
INTRODUCTION: This study investigated how non-O blood groups relate to thrombus burden (TB) and prognosis in ST-segment elevation myocardial infarction (STEMI) patients, aiming to shed light on their association with thrombotic complications in cardiovascular diseases. METHODS: Retrospectively, 1,180 STEMI patients undergoing primary percutaneous coronary intervention were included. The study population was divided into groups according to TB status and the groups were compared in terms of basic clinical characteristics, laboratory parameters and ABO blood group types. In addition, short-term (30 days) and long-term (12 months) clinical outcomes were assessed to evaluate the prognostic implications. RESULTS: The analysis revealed a significant association between non-O blood groups and increased TB in STEMI patients (p = 0.001). Non-O blood group was independently associated with high TB (OR: 1.726, 95% confidence interval [CI]: 1.279-2.330, p < 0.001). Additionally, patients with non-O blood groups had higher short and long-term mortality rates (hazard ratio [HR]: 2.480, 95% CI: 1.361-4.520, p = 0.003; HR: 2.347, 95% CI: 1.433-3.844, p = 0.001; respectively). CONCLUSIONS: This study emphasizes the significance of the ABO blood group system in STEMI outcomes, associating non-O blood groups with higher TB and poorer clinical outcomes. While proposing personalized treatment strategies based on blood group status to improve reperfusion interventions and outcomes, additional trials are needed to comprehensively evaluate their impact.
and Exhibit Anti-Inflammatory, Antioxidant, and Anti-Androgen Effect in Rat Model of Experimental Polycystic Ovarian Syndrome.
Okay G, Kırıcı P, Mavral N … +3 more , Utkan Korun ZE, Annac E, Kaplan S
Med Princ Pract · 2024 · PMID 38599178 · Full text
OBJECTIVE: Chronic inflammation is considered to be of key importance in the pathogenesis of polycystic ovarian syndrome (PCOS). Ganoderma lucidum polysaccharide (GLP) and Hypericum perforatum (HP) have been reported to...
OBJECTIVE: Chronic inflammation is considered to be of key importance in the pathogenesis of polycystic ovarian syndrome (PCOS). Ganoderma lucidum polysaccharide (GLP) and Hypericum perforatum (HP) have been reported to have anti-inflammatory and antioxidant activities. We studied the effects of these agents on ovarian tissue in a rat model of experimental PCOS. MATERIALS AND METHODS: Forty-two Sprague-Dawley female rats were divided into 6 groups with 7 animals in each group as listed below: Group 1: Control, Group 2: PCOS, Group 3: PCOS + HP, Group 4: HP only, Group 5: PCOS+ GLP, Group 6: GLP only. At the end of the experimental procedures, all the animals underwent bilateral oophorectomy and blood samples were collected. Ovarian tissue and blood samples were used for biochemical and histopathological analysis. RESULTS: Follicle degeneration in the PCOS group showed a statistically significant increase compared to the other groups (p < 0.05). Cystic follicles were significantly reduced in the PCOS+GLP and PCOS+HP groups as compared to the PCOS group. Levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were elevated in PCOS rats (p < 0.01). Levels of sex hormone binding globulin (SHBG) levels were diminished (p < 0.01). Levels of malondialdehyde (MDA) and insulin-like growth factor 1 (IGF-1) were increased in PCOS rats as compared to the other groups (p < 0.02, p < 0.02, respectively). GLP supplementation diminished the levels of IGF-1 and MDA. GLP or HP supplementation increased reduced glutathione (GSH). CONCLUSION: GLP and HP treatment normalizes SHBG levels while correcting PCOS-induced hyperandrogenemia. Both herbs regulate the redox balance by decreasing the levels of MDA and increasing the level of GSH.
The Predictive Value of Plasma Sodium and Other Laboratory Parameters in Determining Complicating Appendicitis in Children.
Zvizdic Z, Jonuzi A, Glamoclija U … +1 more , Vranic S
Med Princ Pract · 2024 · PMID 38593764 · Full text
OBJECTIVE: Finding a reliable preoperative predictor of complicated acute appendicitis (AA) has been a challenging diagnostic problem. The present study aimed to identify potential factors that may predict complicated AA...
OBJECTIVE: Finding a reliable preoperative predictor of complicated acute appendicitis (AA) has been a challenging diagnostic problem. The present study aimed to identify potential factors that may predict complicated AA in the pediatric emergency department (ED) based on routine, widely available laboratory tests on admission to the ED, including plasma sodium concentration. METHODS: We retrospectively reviewed clinical and laboratory data of pediatric patients with AA who underwent emergency surgery at our department between January 2020 and December 2022. The patients were divided into two groups: histopathologically proven complicated AA (n = 80) and noncomplicated AA (n = 155). RESULTS: Complicated AA was associated with reduced plasma sodium and chloride concentrations (p < 0.001, both), decreased values of lymphocytes (p = 0.002), elevated C-reactive protein (CRP) (p < 0.001), and elevated values of white blood cells (WBC) and neutrophils (p = 0.012 and 0.001, respectively). In binomial logistic regression, increased levels of CRP and WBC and decreased levels of sodium were predictors of complicated AA. The area under the receiver operating characteristic curve was 0.825 (95% confidence interval: 0.764, 0.886). CONCLUSION: We identified mild hyponatremia and elevated CRP and WBC values as potential markers for distinguishing complicated from uncomplicated pediatric AA with implications for surgical approaches for treating complicated AA and conservative approaches for treating uncomplicated AA.
Additive Effects of Citrus Juice Flavonoid Naringenin and Statins on Human Ether-a-go-go-Related Gene Channels Expressed in Oocytes.
Isaev D, Yang KS, Oz M
Med Princ Pract · 2024 · PMID 38593751 · Full text
OBJECTIVE: Naringenin, a major flavonoid found in citrus juice, has been shown to inhibit human ether-a-go-go-related gene (HERG) channels and cause QT prolongation. Statins, the most commonly used class of cholesterol r...
OBJECTIVE: Naringenin, a major flavonoid found in citrus juice, has been shown to inhibit human ether-a-go-go-related gene (HERG) channels and cause QT prolongation. Statins, the most commonly used class of cholesterol reducing drugs, have also been reported to inhibit HERG channels and prolong QT interval in patients using these drugs. However, the interaction between naringenin and statins on the function of HERG channels has not been studied. MATERIALS AND METHODS: In the present study, we expressed HERG channels in Xenopus oocytes, tested the effects of naringenin and statins separately, and combined on HERG channels. RESULTS: When 30 µ<sc>m</sc> naringenin was added to statins (1 µ<sc>m</sc> rosuvastatin or 3 µ<sc>m</sc> atorvastatin), significantly greater inhibition of HERG was demonstrated, compared to the inhibition caused by statins alone. CONCLUSIONS: The results indicate that an additive interaction occurs between naringenin and statins; this could pose an increased risk of arrhythmias by decreasing repolarization reserve.
Outcome of Colorectal Robotic Surgery in Newly Established Robotic Surgery Center: A Case Series.
Alkhamis AA, Soliman DM, Alsadder KA … +5 more , Busalha HM, Alrashed AS, Alshaban BH, Alsafran SK, Almazeedi SM
Med Princ Pract · 2024 · PMID 38569485 · Full text
INTRODUCTION: The robotic platform compared to laparoscopy has proven to have similar postoperative outcomes; however, its adoption in the Middle East has been slow and there are limited data regarding outcomes with its...
INTRODUCTION: The robotic platform compared to laparoscopy has proven to have similar postoperative outcomes; however, its adoption in the Middle East has been slow and there are limited data regarding outcomes with its use in small newly established robotic colorectal programs. Our aim was to report our experience and outcomes of robotic colorectal surgery performed by fellowship-trained robotic colorectal surgeons and compare them to larger, more experienced centers. METHODS: This is retrospective review of data collected between November 2021 and March 2023 from a tertiary health care referral center. The series included 51 patients who had elective or urgent robotic colorectal surgery. Patients who had emergency surgery were excluded. The outcomes were overall morbidity, serious morbidity, mortality, conversion to open, length of hospital stay, and quality of oncological specimen. RESULTS: The overall morbidity was 31.4% (n = 16 patients). Only 9.8% (n = 5) had serious morbidity of which three required interventions under general anesthesia. The median length of hospital stay was 6 days (IQR = 4), and there was no mortality. Of 17 rectal cancer resections, 88% had complete mesorectal excision, 15 of them were R0 resections, median lymph node harvested was 14 (IQR = 7) and two cases were converted to open. All the colon cancer resections had R0 resection, median lymph nodes harvested was 21 (IQR = 4) and none were converted to open. CONCLUSIONS: The implementation and integration of robotic colorectal surgery at a newly established center in a small country, when led by fellowship-trained robotic colorectal surgeons, is safe and effective in terms of morbidity, mortality, conversion to open and specimen pathological quality.
IGFBP5 Promotes Neuronal Apoptosis in a 6-OHDA-Toxicant Model of Parkinson's Disease by Inhibiting the Sonic Hedgehog Signaling Pathway.
Guo S, Lei Q, Yang Q … +1 more , Chen R
Med Princ Pract · 2024 · PMID 38565090 · Full text
INTRODUCTION: Parkinson's disease (PD) is the most common neurodegenerative disease worldwide. Studies have shown that insulin-like growth factor-binding protein 5 (IGFBP5) may contribute to methamphetamine-induced neuro...
INTRODUCTION: Parkinson's disease (PD) is the most common neurodegenerative disease worldwide. Studies have shown that insulin-like growth factor-binding protein 5 (IGFBP5) may contribute to methamphetamine-induced neurotoxicity and neuronal apoptosis in PC-12 cells and rat striatum. Here, we studied the expression and role of IGFBP5 in the 6-OHDA-toxicant model of PD. METHODS: PC-12 and SH-SY5Y cells were exposed to 50 μ<sc>m</sc> 6-OHDA for 24 h. qRT-PCR, western blotting, CCK-8 assay, EdU staining, annexin V staining, and immunofluorescence were performed to study the effects of IGFBP5-specific siRNAs. The effects of IGFBP5 on a rat 6-OHDA model of PD were confirmed by performing behavioral tests, tyrosine hydroxylase (TH) immunofluorescence staining, and western blotting. RESULTS: In the GSE7621 dataset, IGFBP5 was highly expressed in the substantia nigra tissues of PD patients compared to healthy controls. In PC-12 and SH-SY5Y cells, IGFBP5 was upregulated following 6-OHDA exposure in a dose-dependent manner. Silencing of IGFBP5 promoted PC-12 and SH-SY5Y proliferation and inhibited apoptosis under 6-OHDA stimulation. Silencing of IGFBP5 relieved 6-OHDA-induced TH-positive neuron loss. Hedgehog signaling pathway was predicted as a downstream signaling pathway of IGFBP5. Negative regulation between IGFBP5 and sonic hedgehog (SHH) signaling pathway was confirmed in vitro. The effects of IGFBP5 silencing on SH-SY5Y cells were partially reversed using cyclopamine, a direct inhibitor of the SHH signaling pathway. In addition, silencing of IGFBP5 attenuated motor deficits and neuronal damage in 6-OHDA-induced PD rats. CONCLUSION: Elevated IGFBP5 expression may be involved in 6-OHDA-induced neurotoxicity through regulation of the SHH signaling pathway.
Discordance in Phenotypic and Genotypic Susceptibility Testing for Streptomycin Due to Nonsynonymous/Nonsense/Deletion Frame-Shift Mutations in among Clinical Isolates in Kuwait.
Al-Mutairi NM, Ahmad S, Mokaddas E
Med Princ Pract · 2024 · PMID 38560979 · Full text
OBJECTIVE: Increasing reports of resistance to newer antituberculosis drugs have prompted the search for other alternative drugs. Streptomycin (STR) could be used for the treatment of drug-resistant tuberculosis if susce...
OBJECTIVE: Increasing reports of resistance to newer antituberculosis drugs have prompted the search for other alternative drugs. Streptomycin (STR) could be used for the treatment of drug-resistant tuberculosis if susceptibility of Mycobacterium tuberculosis isolate to STR could be accurately detected. We performed phenotypic and genotypic drug susceptibility testing (DST) of 118 M. tuberculosis isolates for STR. MATERIALS AND METHODS: Fifty pansusceptible and 68 multidrug-resistant M. tuberculosis (MDR-TB) isolates were used. Phenotypic DST for STR, rifampicin, isoniazid, and ethambutol was performed by mycobacteria growth indicator tube 960 System. Genotypic DST was done by GenoTypeMTBDRplus assay for rifampicin and isoniazid and by PCR-sequencing of rpsL, rrs, and gidB genes for STR. MDR-TB isolates were genotyped by spoligotyping. RESULTS: Phenotypic DST identified 50 isolates susceptible to all four drugs (pansusceptible). Sixty-one of 68 MDR-TB isolates were resistant to STR. Genotypic testing for rifampicin and isoniazid yielded expected results. Fifty pansusceptible and 7 STR-susceptible MDR-TB isolates contained no mutation in rpsL or rrs, while 47, 2, and 1 STR-resistant isolate contained rpsL, rrs, and rpsL + rrs mutations, respectively. Of the remaining 11 STR-resistant MDR-TB, 9 isolates contained deletion frame-shift/nonsynonymous mutations in gidB. Surprisingly, 13 pansusceptible isolates also contained deletion frame-shift/nonsense/nonsynonymous mutations in gidB. Also, 30 of 68 MDR-TB but only 2 of 50 pansusceptible isolates belonged to the Beijing genotype. CONCLUSIONS: Our data show that, like rifampicin, ethambutol, and pyrazinamide, STR also exhibits discordant phenotypic and genotypic DST results for some M. tuberculosis isolates. Hence, STR should be included in therapy regimens only if both phenotypic and genotypic resistance testing indicate susceptibility to avoid amplification of resistance and drug toxicity.
The Emerging Role of AI in Patient Education: A Comparative Analysis of the Accuracy of Large Language Models for Pelvic Organ Prolapse.
Rahimli Ocakoglu S, Coskun B
Med Princ Pract · 2024 · PMID 38527444 · Full text
INTRODUCTION: This study aimed to evaluate the accuracy, completeness, precision, and readability of outputs generated by three large language models (LLMs); these are GPT by OpenAI, BARD by Google, and Bing by Microsoft...
INTRODUCTION: This study aimed to evaluate the accuracy, completeness, precision, and readability of outputs generated by three large language models (LLMs); these are GPT by OpenAI, BARD by Google, and Bing by Microsoft, in comparison to patient education material on pelvic organ prolapse (POP) provided by the Royal College of Obstetricians and Gynecologists (RCOG). METHODS: A total of 15 questions were retrieved from the RCOG website and input into the three LLMs. Two independent reviewers evaluated the outputs for accuracy, completeness, and precision. Readability was assessed using the Simplified Measure of Gobbledygook (SMOG) score and the Flesch-Kincaid Grade Level (FKGL) score. RESULTS: Significant differences were observed in completeness and precision metrics. ChatGPT ranked highest in completeness (66.7%), while Bing led in precision (100%). No significant differences were observed in accuracy across all models. In terms of readability, ChatGPT exhibited higher difficulty than BARD, Bing, and the original RCOG answers. CONCLUSION: While all models displayed a variable degree of correctness, ChatGPT excelled in completeness, significantly surpassing BARD and Bing. However, Bing led in precision, providing the most relevant and concise answers. Regarding readability, ChatGPT exhibited higher difficulty. We observed that while all LLMs showed varying degrees of correctness in answering RCOG questions on patient information for POP, ChatGPT was the most comprehensive, but its answers were harder to read. Bing, on the other hand, was the most precise. The findings highlight the potential of LLMs in health information dissemination and the need for careful interpretation of their outputs.
Pharmaceutical Polygon Fingerprinting Matrix System: A Potential Tool for Pharmaceutical Quality Control.
Elamrawy F, Helal NA, Abou-Taleb BA … +3 more , Elagouri G, Vattelana O, Nounou MI
Med Princ Pract · 2024 · PMID 38508158 · Full text
BACKGROUND: We describe a new discriminatory system for evaluating the quality of pharmaceuticals, the Pharmaceutical Polygon Fingerprint Matrix system (PharmP-FM). PharmP-FM uses both qualitative and quantitative finger...
BACKGROUND: We describe a new discriminatory system for evaluating the quality of pharmaceuticals, the Pharmaceutical Polygon Fingerprint Matrix system (PharmP-FM). PharmP-FM uses both qualitative and quantitative fingerprinting techniques to assess the quality of pharmaceutical formulations and dosage forms, the system expands on the Expert System for Drug Development, which was initially created to evaluate the suitability of powder for direct compression. PharmP-FM creates a graphical representation of the product's pharmaceutical quality using a set of input parameters. The performance index (PI), normalized parameter index (NPI), and formulation index (FI) are among the system's output parameters. The objective of this study was to evaluate the performance of PharmP-FM by examining its ability to identify variations in pharmaceutical quality across products. METHODOLOGY: We examined the application of PharmP-FM in assessing batch-to-batch variability of weight-loss supplement capsules and the quality of multisource brand products of levothyroxine tablets. RESULTS: PharmP-FM exhibits potential promise as a pharmaceutical quality assessment tool. Its user-friendly nature and adaptability to different formulations and dosage forms make it a versatile discriminatory system. Additionally, PharmP-FM is an open-ended and scalable system that can incorporate additional parameters and accommodate products of varying complexities. CONCLUSION: This study supports the potential of PharmP-FM as a tool for pharmaceutical quality assessment.
In vitro Activity of Dalbavancin and Fourteen Other Antimicrobial Agents against Toxigenic Clinical Isolates in a Greek Tertiary-Care Hospital.
Maraki S, Mavromanolaki VE, Stafylaki D … +2 more , Iliaki-Giannakoudaki E, Kasimati A
Med Princ Pract · 2024 · PMID 38508157 · Full text
OBJECTIVE: Clostridioides difficile is a major cause of healthcare-associated diarrhea worldwide. For years, metronidazole and vancomycin were considered the standard treatment for C. difficile infection. However, they a...
OBJECTIVE: Clostridioides difficile is a major cause of healthcare-associated diarrhea worldwide. For years, metronidazole and vancomycin were considered the standard treatment for C. difficile infection. However, they are increasingly being associated with treatment failure and recurrence. In this study, we investigated the in vitro activity of dalbavancin and fourteen other antimicrobials against 155 toxigenic C. difficile isolates originating from patients with C. difficile-associated diarrhea. MATERIALS AND METHODS: Antimicrobial susceptibility was evaluated by the MIC Test Strip, and the results were interpreted using both the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. RESULTS: C. difficile isolates were fully susceptible to metronidazole, vancomycin, amoxicillin/clavulanate, piperacillin/tazobactam, and tigecycline. All isolates were dalbavancin susceptible by the CLSI breakpoint (≤0.25 μg/mL) compared with 97.4% susceptibility by the EUCAST breakpoint (≤0.125 μg/mL). Dalbavancin demonstrated significantly lower MIC and MIC values compared to vancomycin (0.047 vs. 0.38 and 0.125 vs. 0.5, respectively, p < 0.001). Resistance rates to penicillin, ampicillin, cefoxitin, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, and tetracycline were 20%, 14.2%, 100%, 75.5%, 0.6%, 51%, 36.1%, 3.2%, and 14.8%, respectively. Multidrug-resistant phenotypes were detected among 41.3% of the isolates. CONCLUSION: Dalbavancin exhibited potent activity against the isolates tested. As C. difficile is an important healthcare-associated pathogen, continued surveillance is required to monitor for development of resistance.
Oral Rinses: Some Kill and Some Cripple .
Darmani H, Al-Saleh DRH
Med Princ Pract · 2024 · PMID 38498997 · Full text
INTRODUCTION: Oral healthcare professionals play a crucial role in guiding patients toward evidence-based choices among the many available oral rinses. In this study, we explored how specific oral rinse formulations affe...
INTRODUCTION: Oral healthcare professionals play a crucial role in guiding patients toward evidence-based choices among the many available oral rinses. In this study, we explored how specific oral rinse formulations affect the viability and modulate critical virulence traits of the opportunistic fungal pathogen Candida albicans. MATERIALS AND METHODS: We assessed the effects of these oral rinses on the production of germ tube, production of phospholipase and hemolysin, as well as biofilm formation. RESULTS: We found that oral rinses containing cetylpyridinium chloride (CPC) and chlorhexidine (CHX) showed the greatest fungicidal activity with the lowest minimum fungicidal concentrations (0.38% and 0.78%, respectively). Oral rinses based on zinc chloride and sodium fluoride with Miswak bark extract (MIS) or essential oils (EO) had much lower fungicidal activity (8-16 times lower) compared to CHX and CPC. However, they had a significantly greater impact on the virulence traits of C. albicans. They reduced germ tube production by 86-89% (vs. 42% for CHX and 29% for CPC), completely inhibited phospholipase and hemolysin production, and together with the CPC-based oral rinse, exerted the greatest reductions in biofilm formation across all tested concentrations. This was in contrast to both the controls and CHX, which had a minimal effect on biofilm formation. CONCLUSION: By inhibiting the virulence factors, the oral rinse can have a crippling effect on C. albicans, weakening this opportunistic pathogen and hindering its potential to cause infection.
Social Media Misinformation about Pregnancy and COVID-19 Vaccines: A Systematic Review.
Malik M, Bauer-Maison N, Guarna G … +1 more , D'Souza RD
Med Princ Pract · 2024 · PMID 38484723 · Full text
OBJECTIVE: The objectives of this study were to identify common social media misconceptions about COVID-19 vaccination in pregnancy, explain the spread of misinformation, and identify solutions to guide clinical practice...
OBJECTIVE: The objectives of this study were to identify common social media misconceptions about COVID-19 vaccination in pregnancy, explain the spread of misinformation, and identify solutions to guide clinical practice and policy. METHODOLOGY: A systematic review was conducted and the databases Embase and Medline were searched from December 2019 to February 8, 2023, using terms related to social media, pregnancy, COVID-19 vaccines and misinformation. The inclusion criteria were original research studies that discussed misinformation about COVID-19 vaccination during pregnancy on social media. The exclusion criteria were review articles, no full text, and not published in English. Two independent reviewers conducted screening, extraction, and quality assessment. RESULTS: Our search identified 76 articles, of which 3 fulfilled eligibility criteria. Included studies were of moderate and high quality. The social media platforms investigated included Facebook, Google Searches, Instagram, Reddit, TikTok, and Twitter. Misinformation was related to concerns regarding vaccine safety, and its association with infertility. Misinformation was increased due to lack of content monitoring on social media, exclusion of pregnant women from early vaccine trials, lack of information from reputable health sources on social media, and others. Suggested solutions were directed at pregnancy care providers (PCPs) and public health/government. Suggestions included: (i) integrating COVID-19 vaccination information into antenatal care, (ii) PCPs and public health should increase their social media presence to disseminate information, (iii) address population-specific vaccine concerns in a culturally relevant manner, and others. CONCLUSION: Increased availability of information from reputable health sources through multiple channels could increase COVID-19 vaccine uptake in the pregnant population and help combat misinformation.
Diagnostic Methods for Helicobacter pylori.
Costa LCMC, das Graças Carvalho M, La Guárdia Custódio Pereira AC … +3 more , Teixeira Neto RG, Andrade Figueiredo LC, Barros-Pinheiro M
Med Princ Pract · 2024 · PMID 38484713 · Full text
Helicobacter pylori infection is a significant global health concern. It cannot be diagnosed based solely on the patient's medical history and symptoms, and laboratory and imaging tests are often required to confirm the...
Helicobacter pylori infection is a significant global health concern. It cannot be diagnosed based solely on the patient's medical history and symptoms, and laboratory and imaging tests are often required to confirm the diagnosis. Both noninvasive and invasive methods are available for diagnosing H. pylori infection, including conventional and advanced detection techniques. It is not uncommon for patients to present with false-negative results due to the use of inadequate investigation methodologies, which prevents the adoption of appropriate clinical management. Thus, an analysis of the literature regarding the methods of diagnosis of H. pylori, with its advantages and disadvantages, is necessary. Publications in specialized scientific journals will undoubtedly contribute to facilitating access by professionals interested in the topic providing greater knowledge and potentially clinically useful guidance. In this review, the authors have sought to analyze and summarize the invasive and noninvasive methods, their applications, limitations, and the conditions that affect the sensitivity of the tests used for diagnosing H. pylori, an essential step for the successful treatment of this infection. It is essential to treat all patients infected with H. pylori. This represents a significant change in the approach, as the treatment was recommended previously only for patients showing symptoms of infection. Therefore, it is crucial to understand the limitations of traditional diagnostic methods and help raise awareness among healthcare professionals about the latest advances in diagnosing this important bacterium.
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