Search Results (33,309)

Polyamide-6 (PA) is a popular textile polymer having desirable mechanical and thermal properties, chemical stability, and biocompatibility. However, PA nanofibers are prone to bacterial growth and user discomfort. ε-Poly-L-lysine (PL) is non-toxic, antimicrobial, and hydrophilic but lacks spinnability due to its low molecular weight. Given its similar backbone structure to PA, with an additional amino side chain, PL was integrated with PA to develop multifunctional nanofibers. This study explores a simple, scalable method by which to obtain PL nanofibers by utilizing the structurally similar PA as the base. The goal was to enhance the functionality of PA by addressing its drawbacks. The study demonstrates spinnability of varying concentrations of PL with base PA while exploring compositions with higher PL concentrations than previously reported. Electrospinning parameters were studied to optimize the nanofiber properties. The effects of PL addition on morphology, hydrophilicity, thermal stability, mechanical performance, and long-term antimicrobial activity of nanofibers were evaluated. The maximum spinnable concentration of PL in PA-based nanofibers resulted in super hydrophilicity (0° static water contact angle within 10 s), increased tensile strength (1.02 MPa from 0.36 MPa of control), and efficient antimicrobial properties with long-term stability. These enhanced characteristics hold promise for the composite nanofiber’s application in medical and protective textiles. Full article

Background: This study evaluates the diagnostic performance of high-sensitivity troponin using point-of-care testing (POCT) devices compared with main laboratory measurements for ruling out non-ST-elevation myocardial infarction (NSTEMI) in emergency department (ED) patients presenting with non-traumatic chest pain. Methods: This multicenter, observational, prospective, non-interventional study was conducted in two Spanish hospitals from 1 June to 31 December 2023 and included adult patients presenting with non-traumatic chest pain admitted to the ED. High-sensitivity troponin levels were measured using both the Siemens Atellica^® VTLi POCT device and main laboratory testing, with data collected on analytical results and measurement times. Results: Of the 201 patients who met the inclusion criteria, a significant correlation was observed between the POCT and laboratory assays. The area under the curve (AUC) of the ROC curve was consistently greater than 0.9, indicating a high diagnostic accuracy for ruling out NSTEMI. In addition, measurement times were significantly reduced using POCT compared to the core laboratory. Conclusion: These results suggest that high-sensitivity troponin POCT devices offer comparable diagnostic performance to traditional laboratory methods for the diagnosis of NSTEMI in the emergency department, potentially speeding up clinical decisions and optimizing resource utilization. Full article

Nowadays, most of the health expenditure is due to chronic patients who are readmitted several times for their pathologies. Personalized prevention strategies could be developed to improve the management of these patients. The aim of the present work was to develop local predictive models using interpretable machine learning techniques to early identify individual unscheduled hospital readmissions. To do this, a retrospective, case-control study, based on information regarding patient readmission in 2018–2019, was conducted. After curation of the initial dataset (n = 76,210), the final number of participants was n = 29,026. A machine learning analysis was performed following several algorithms using unscheduled hospital readmissions as dependent variable. Local model-agnostic interpretability methods were also performed. We observed a 13% rate of unscheduled hospital readmissions cases. There were statistically significant differences regarding age and days of stay (p < 0.001 in both cases). A logistic regression model revealed chronic therapy (odds ratio: 3.75), diabetes mellitus history (odds ratio: 1.14), and days of stay (odds ratio: 1.02) as relevant factors. Machine learning algorithms yielded better results regarding sensitivity and other metrics. Following, this procedure, days of stay and age were the most important factors to predict unscheduled hospital readmissions. Interestingly, other variables like allergies and adverse drug reaction antecedents were relevant. Individualized prediction models also revealed a high sensitivity. In conclusion, our study identified significant factors influencing unscheduled hospital readmissions, emphasizing the impact of age and length of stay. We introduced a personalized risk model for predicting hospital readmissions with notable accuracy. Future research should include more clinical variables to refine this model further. Full article

Background and Objectives: Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the autoantibody-mediated destruction of platelets. The treatment of ITP aims to maintain a sufficient platelet count to prevent bleeding. First-line treatment options include corticosteroids and intravenous immunoglobulin (IVIg), while second-line treatments include splenectomy, rituximab and other immunosuppressive agents, and thrombopoietin (TPO) receptor agonists. This study aims to discuss the treatment methods and results from 100 patients with ITP at the Muğla Training and Research Hospital through a pharmacological approach. Materials and Methods: Demographic characteristics, clinical findings, bone marrow aspiration and biopsy results, and treatments and treatment responses at the time of diagnosis of the 100 patients with ITP who were treated and followed up in the period 2015–2023 were evaluated retrospectively. Results: In the third month after treatment, the overall response percentage was 100% in patients who received steroids only and 88% in patients who received IVIg treatment alone or in combination with steroids (p > 0.05). The most preferred second-line treatments were splenectomy (41%), eltrombopag (26%), and rituximab (10%). Bone marrow biopsy was performed in 54% of patients, where 35.1% showed increased megakaryocytes, 44.4% adequate megakaryocytes, and 14.8% decreased megakaryocytes. It is noted that eltrombopag and rituximab, in particular, yield higher complete remission rates than immunosuppressive drugs. Conclusions: Considering the side effects of immunosuppressive medications, IVIg, splenectomy, and steroid therapy, the use of new agents such as eltrombopag, which are easily tolerated and have a lower risk of side effects, is expected to increase. Full article

Childhood asthma is a major health issue in Australia, and traffic emissions play a causative role. Two urban planning policies that impact children’s exposure to traffic emissions are considered in terms of the potential health risks to children in a Melbourne suburb with high truck volumes and hospital attendances for childhood asthma. Firstly, the health impact assessment component of the state planning approval of a major road project, and secondly, local government placement of childcare centres and schools in relation to freight routes. Three sources of air quality monitoring data were examined: (i) a Victorian EPA reference site; (ii) a site with planning approval for development into a childcare centre; and (iii) five sites within the boundary of the West Gate Tunnel Project, an AUD 10 billion road and tunnel project. The Australian Urban Research Infrastructure Network data was utilised to assess distances of childcare centres and schools from major truck routes. A range of cconcentration–response functions for childhood asthma (0–18 years) from international systematic meta-analyses and a smaller Australian cross-sectional study were applied to comparative elevations in fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations between the EPA reference monitor (used for project risk assessment) and local roadside data. It was found that comparative elevations in NO₂ concentrations were associated with the following risk increases: developing asthma 13%, active asthma 12%, and lifetime asthma 9%. Overall, 41% of childcare centres (n = 51) and 36% of schools (n = 22) were ≤150 m to a high-density truck route. Truck emissions likely make a substantial contribution to childhood asthma outcomes in the project area. This study exemplifies how current practices may not be commensurate with guiding policy objectives of harm minimisation and equitable protection. Full article

Objectives: In this retrospective observational study, the aim is to establish how the implementation of the use of antimicrobial stewardship programs at the hospital and intensive care unit level in a Sucre Clinic in Sincelejo has had a significant impact on the improvement of the rational use of antibiotics, due to the alarming situation of increasing antibiotic resistance. Materials and methods: The methodology used was to analyze the Excel database of the Clinic in such a way as to compare the data from 2017, the period prior to the implementation of the antimicrobial stewardship program (ASP), with the subsequent evolution between the years 2018 and 2022, in relation to the institutional records of four antibiotics—ceftriaxone3, ciprofloxacin4, meropenem5, and vancomycin6, measured in defined daily dose (DDD). Results: According to the defined daily dose values obtained for the four antibiotics, a reduction in the defined daily dose was identified in the post-implementation period. On the other hand, considering the DDD reported by the World Health Organization for each of the antibiotics, significant differences were verified in comparison with those obtained in the clinic in the hospitalization and intensive care unit services. Conclusions: In conclusion, in the clinic, a reduction in the defined daily dose was verified in the period after the implementation of the antimicrobial stewardship program compared to the previous period, both in the hospitalization and intensive care unit, as well as having a mild-to-large effect with Cohen’s D. Full article

Background: Although extensive research on appropriate treatments has been conducted, how nurses provide care to patients at the end-of-life (EOL) is unclear, particularly among intensive care unit (ICU) nurses in Saudi Arabia. Purpose: To explore intensive care unit nurses’ experiences in providing end-of-life care in Saudi Arabia. Methods: This study utilized an exploratory, descriptive, qualitative approach. A purposive sampling technique was used to recruit ICU nurses (n = 10) working in ICUs at a tertiary teaching hospital in Riyadh, Saudi Arabia. Using a semi-structured interview guide, ten individual interviews were conducted. Data were analyzed using thematic analysis. The trustworthiness of this study was ensured by following Lincoln and Guba’s (1985) criteria. Findings: Four major themes related to ICU nurses’ experiences of providing EOL care emerged, including: “feeling challenged but driven”, “holistic caring”, “collaborative working ethics”, and “caring for the undying and dying”. Conclusions: This study adds to the body of knowledge about the experience of ICU nurses caring for EOL patients. It offers valuable insights into challenges, coping strategies, holistic caring, collaboration, and the management of critical or dying patients at EOL in the ICUs. Full article

Background: Intestinal intussusception is defined as the invagination of one segment of the intestine into the lumen of an adjacent intestinal segment, resulting in the mechanical intestinal obstruction of multifactorial origin with a high risk of morbidity and mortality. It is a rare pathology in adults with a nonspecific clinical presentation. We present the case of a 26-year-old male patient who was admitted postoperatively after multiple extra institutional surgical interventions due to polytrauma secondary to a work-related accident that caused high-impact trauma by a solids mixer. However, he was referred to our institution due to suspected vascular trauma in the right femoral artery. During his hospital stay, he developed intolerance to oral intake associated with pain, abdominal distension, and persistent emetic episodes despite medical management. Consequently, an abdominal CT scan with double contrast was requested, revealing intestinal intussusception secondary to intestinal adhesions, which required new surgical management with a favorable resolution; Discussion: Intussusception in the adult population is rare and is primarily caused by an identifiable structural lesion. It is one of the most challenging pathologies in terms of diagnosis and management due to its nonspecific presentation. However, when postoperative symptoms indicating intestinal obstruction appear, a computed tomography scan is considered the imaging modality of choice for diagnosing intussusception in adults; Conclusions: The development of postoperative peritoneal adhesions is a common cause of intestinal obstruction that can lead to complications such as intestinal intussusception, requiring additional interventions. Therefore, it is vital to identify their presence to reduce morbidity and mortality. Full article

Background: Neck circumference (NC) has been proposed as an indicator of upper trunk adiposity and a potential indicator of metabolic risk. The objective was to evaluate NC and its correlation with body fat percentage (BF%) and other indicators of adiposity in children with normal weight, overweight, and obesity. Methods: In a cross-sectional study, 112 children 5 to 10 years of age were included in the outpatient clinic from a public hospital. Measures of weight and height to calculate BMI (kg/m²), NC, mid-upper arm circumference, waist circumference, and tricipital skinfold thickness. Body composition measurements were performed using an electrical bioimpedance device (BIA). The relationship between anthropometric variables and BF% obtained by BIA was determined using Spearman correlation tests. Multivariate models were constructed with BF% as the dependent variable and anthropometric parameters as independent. Results: In the entire group, there was a direct correlation between NC and BF% (r = 0.50, p < 0.001), but lost statistical significance in the case of normal weight. The relationship maintained its significance in subjects from the overweight and obesity groups. In multivariate models, BMI exhibited the highest correlation with BF%, followed by waist circumference and mid-upper arm circumference; for NC, the R² value was 0.30 (p < 0.001). Conclusions: Neck circumference is useful in the screening of population groups with the advantage of not requiring any specialized instruments for its measurement other than a tape measure. BMI and waist circumference were the best indicators of general and central adiposity, respectively. Full article

Background: The German–Austrian guideline on the treatment of carotid stenosis recommends specialist neurological assessment (NA) before and after carotid endarterectomy (CEA) or carotid artery stenting (CAS). This study analyzes the determinants of NA and the association of NA with the perioperative rate of stroke or death. Materials and Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the nationwide German statutory quality assurance carotid database. Patients were classified as asymptomatic (group A), elective symptomatic (group B), and others (group C: emergency (C1), simultaneous operation (C2), and other indications (C3)). The primary outcome event (POE) of this study was any in-hospital stroke or death. Adjusted odds ratios for pre- and post-NA and the POE were calculated using multivariable regression analyses. Results: We analyzed 228,133 patients (54% asymptomatic, 68% male, mean age 72 years) undergoing CEA or CAS between 2012 and 2018. Age and sex were not associated with the likelihood of pre-NA or post-NA. The multivariable regression analysis showed an inverse association between pre-NA and POE (adjusted odds ratio (aOR) 0.47; 95% CI 0.44–0.51, p < 0.001), and a direct association of post-NA and POE (aOR 4.39; 95% CI 4.04–4.78, p < 0.001). Conclusions: Pre- and postinterventional specialist NA is strongly associated with the risk of any in-hospital stroke or death after CEA or CAS in Germany. A relevant confounding by indication or reversed causation cannot be ruled out. Nevertheless, to improve the quality assurance of treatment, the NA recommended in the guideline should be carried out consistently. Full article

Epidermal growth factor receptor 2 (HER2) has been widely recognized as one of the targets for bladder cancer immunotherapy. The key to implementing personalized treatment for bladder cancer patients lies in achieving rapid and accurate diagnosis. To tackle this challenge, we have pioneered the application of deep learning techniques to predict HER2 expression status from H&E-stained pathological images of bladder cancer, bypassing the need for intricate IHC staining or high-throughput sequencing methods. Our model, when subjected to rigorous testing within the cohort from the People’s Hospital of Wuhan University, which encompasses 106 cases, has exhibited commendable performance on both the validation and test datasets. Specifically, the validation set yielded an AUC of 0.92, an accuracy of 0.86, a sensitivity of 0.87, a specificity of 0.83, and an F1 score of 86.7%. The corresponding metrics for the test set were 0.88 for AUC, 0.67 for accuracy, 0.56 for sensitivity, 0.75 for specificity, and 77.8% for F1 score. Additionally, in a direct comparison with pathologists, our model demonstrated statistically superior performance, with a p-value less than 0.05, highlighting its potential as a powerful diagnostic tool. Full article

Background: Ki-67 immunostaining is commonly used in neuroendocrine tumors to estimate the proliferative index and for grading. This study investigates its association with the invasiveness of follicular-derived thyroid carcinomas (TCs). Methods: A retrospective analysis of patients with TC at three McGill University teaching hospitals between January 2018 and November 2023 was conducted. The inclusion criteria included patients with malignant thyroid tumors and accessible Ki-67 LI data from final pathology specimens. The data collected included patient demographics, Ki-67 LI values, and different invasiveness attributes, such as molecular mutations, the histological subtype, lymphovascular invasion (LVI), extrathyroidal extension (ETE), and positive lymph nodes (LNs). Results: In total, 212 patients met the inclusion criteria, of which 80.7% were females and 19.3% were males. The Ki-67 LI ranged from 1% to 30%, with the majority of the cases within the range of 1–15%. A significant association was observed between higher Ki-67 LI and high-risk histological subtypes of thyroid carcinoma (p < 0.001). Similarly, Ki-67 LI was significantly associated with LVI and positive LN metastasis (p < 0.001 and p = 0.036, respectively). However, no significant association was found between the Ki-67 LI and gene mutations or ETE (p = 0.133 and p = 0.190, respectively). Using percentiles to establish a cutoff, patients with a Ki-67 LI higher than 6.7 showed a higher likelihood of being associated with invasive features. Conclusion: Elevated Ki-67 LI can serve as an indicator of aggressiveness in follicular-derived TC, especially when associated with distinct histological subtypes, LVI and positive LNs. Full article

Introduction: Extracorporeal membrane oxygenation (ECMO) improves infant survival outcomes after cardiac arrest. If not feasible at the place of arrest, victims must be transported to a suitable room to perform ECMO while effective, sustained resuscitation maneuvers are performed. The objective of this simulation study was to compare the quality of resuscitation maneuvers on an infant manikin during simulated transfer on a stretcher (stretcher test) within a hospital versus standard stationary resuscitation maneuvers (control test). Methods: A total of 26 nursing students participated in a randomized crossover study. In pairs, the rescuers performed two 2 min tests, consisting of five rescue breaths followed by cycles of 15 compressions and two breaths. The analysis focused on CPR variables (chest compression and ventilation), CPR quality, the rate of perceived exertion and the distance covered. Results: No differences were observed in the chest compression quality variable (82 ± 10% versus 84 ± 11%, p = 0.15). However, significantly worse values were observed in the test for ventilation quality on the stretcher (18 ± 14%) compared to the control test (28 ± 21%), with a value of p = 0.030. Therefore, the overall CPR quality was worse in the stretcher test (50 ± 9%) than in the control test (56 ± 13%) (p = 0.025). Conclusions: Infant CPR performed by nursing students while walking alongside a moving stretcher is possible. However, in this model, the global CPR quality is less due to the low ventilation quality. Full article

Despite the high prevalence of TP53 pathogenic variants (PV) carriers in the South and Southeast regions of Brazil, germline genetic testing for hereditary breast cancer (HBC) is not available in the Brazilian public health system, and the prevalence of Li-Fraumeni syndrome (LFS) is not well established in other regions of Brazil. We assessed the occurrence of TP53 p.R337H carriers among women treated for breast cancer (BC) between January 2021 and January 2022 at public hospitals of Brasilia, DF, Brazil. A total of 180 patients who met at least one of the NCCN criteria for HBC underwent germline testing; 44.4% performed out-of-pocket germline multigene panel testing, and 55.6% were tested for the p.R337H variant by allelic discrimination PCR. The median age at BC diagnosis was 43.5 years, 93% had invasive ductal carcinoma, 50% had estrogen receptor-positive/HER2 negative tumors, and 41% and 11% were diagnosed respectively at stage III and IV. Two patients (1.11%) harbored the p.R337H variant, and cascade family testing identified 20 additional carriers. The TP53 p.R337H detection rate was lower than that reported in other studies from south/southeast Brazil. Nonetheless, identifying TP53 PV carriers through genetic testing in the Brazilian public health system could guide cancer treatment and prevention. Full article

Spinal muscular atrophy (SMA) is a neuromuscular and neurodegenerative disease caused by the homozygous deletion of SMN1 exon 7 in 95% of cases. The prognosis for SMA patients has improved with the development of disease-modifying therapies, all of which are available in Croatia. The best treatment outcomes occur when therapy is applied before symptoms appear, making newborn screening (NBS) for SMA a crucial factor. Since SMA NBS is the first genetic test performed in our laboratory, for successful implementation of the program, we had to overcome logistical and organizational issues. Herein, we present the results of the SMA NBS during the one-year pilot project in Croatia and verify the suitability of the Targeted qPCR^™ SMA assay for SMA NBS. The pilot project started on 1 March 2023 in the Department for Laboratory Diagnostics of the University Hospital Center Zagreb. A total of 32,655 newborns were tested. Five SMA patients were detected, and their diagnoses were confirmed by the multiplex ligation-dependent probe amplification (MLPA) assay. There have been no false positive or false negative results, to our knowledge so far. The incidence of SMA determined during the pilot study is consistent with the SMA incidence data from other European countries. Full article