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1.
Int J Nurs Educ Scholarsh ; 22(1)2025 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38459787

RESUMO

OBJECTIVES: This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. METHODS: Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. CONCLUSIONS: Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.


Assuntos
Geriatria , Enfermeiras e Enfermeiros , Estudantes de Enfermagem , Idoso , Humanos , Atitude do Pessoal de Saúde , Competência Clínica
2.
J. optom. (Internet) ; 17(3): [100497], jul.-sept2024. graf, tab
Artigo em Inglês | IBECS | ID: ibc-231871

RESUMO

Purpose: To compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in different age groups. Methods: 12 elderly (ELD: 59.3 ± 3.9 years) and 8 young (YG: 22.1 ± 1.1 years) subjects were recruited. An optometric assessment with the DT was carried out to obtain the subjective refraction at distance. DCs at distance on green, white, and red backgrounds were measured and the following parameters were deduced: dioptric difference between red-green, green-white, red-white focal positions (minima of the DCs), best corrected visual acuity (BCVA), and widths of the DCs for red, green, and white. Results: The DC difference between the green-white focal positions (mean ± standard deviation) was -0.12±0.17 diopters (D) (ELD, p = 0.012) and -0.11±0.12 D (YG, p = 0.039), while the red-white difference was not statistically significant. The DC red-green difference was 0.20±0.16 D (ELD, p = 0.002) and 0.18±0.18 D (YG, p = 0.008). The ELD BCVA with green background was significantly worse than BCVA with red (p = 0.007) and white (p = 0.007). The mean value of the DC's width in ELD for green (1.01±0.36 D) was higher than for red (0.77±0.21 D) and for white (0.84±0.35 D), but with no statistical significance. Conclusion: Both age groups showed a slight focusing preference for red when using white light. Moreover, ELD showed a worse BCVA with a green compared to a red background. Despite these results deduced by DC analyses, these aspects do not compromise the possibility of using the DT in clinical practice both in the young and in the elderly. Furthermore, the difference of about 0.20 D between red-green DC in both groups confirms the clinical appropriateness of the widespread use of 0.25 D step as the standard minimum difference in power between correcting lenses.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Idoso , Visão Ocular , Acuidade Visual , Fundo de Olho , Lentes de Contato , Testes Visuais
3.
An. psicol ; 40(2): 323-334, May-Sep, 2024. tab, graf
Artigo em Inglês | IBECS | ID: ibc-232725

RESUMO

Las percepciones de olvidos recurrentes o episodios de distracción en la vida diaria se denominan quejas subjetivas de memoria (QSM). Su naturaleza se ha estudiado ampliamente en adultos mayores, pero su importancia y relación con el rendimiento neurocognitivo no se han abordado por completo en adultos más jóvenes. Se han sugerido algunos rasgos psicológicos como posibles moderadores de la asociación entre el rendimiento de la memoria objetiva y subjetiva. El primer objetivo de este estudio fue analizar la correspondencia entre la percepción objetiva y subjetiva de los fallos de memoria en jóvenes. En segundo lugar, estudiamos si el rasgo psicológico del neuroticismo podría estar influyendo en esta relación. Para ello, medimos QSM, diferentes dominios cognitivos (memoria episódica y de trabajo y funciones ejecutivas) y neuroticismo en 80 hombres y mujeres jóvenes. Los resultados mostraron que solo la memoria episódica inmediata estaba estadísticamente relacionada con los QSM. Curiosamente, las relaciones negativas entre el rendimiento de la memoria objetiva y subjetiva solo aparecieron en participantes con mayor neuroticismo. Por lo tanto, las quejas de memoria reportadas por los jóvenes podrían reflejar un peor rendimiento de la memoria episódica inmediata, mientras que el neuroticismo jugaría un papel principal en la asociación entre los déficits de memoria y las QSM. Este estudio proporciona datos que pueden ayudar a comprender mejor las QSM en los jóvenes.(AU)


Perceptions of recurrent forgetfulness or episodes of distraction in daily life are referred to as subjective memory complaints (SMCs). Their nature has been extensively studied in older adults, but their significance and relationship with neurocognitive performance have not been fully ad-dressed in younger adults. Some psychological traits have been suggested as possible moderators of the association between objective and subjective memory performance. The first aim of this study was to analyze the corre-spondence between the objective and subjective perception of memory failures in young people. Second, we studied whether the psychological trait of neuroticism could be influencing this relationship. Todo this, we measured SMCs, different cognitive domains (episodic and working memory and executive functions), and neuroticism in 80 young men and women. Results showed that only immediate episodic memory was statisti-cally related to SMCs. Interestingly, the negative relationships between ob-jective and subjective memory performance only appeared in participants with higher neuroticism. Thus, memory complaints reported by young people could reflect poorer immediate episodic memory performance, whereas neuroticism would play a main role in the association between memory deficits and SMCs. This study provides data that can help to bet-ter understand SMCs in young people.(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Neuroticismo , Memória Episódica , Cognição , Transtornos Neurocognitivos , Memória
4.
Front Immunol ; 15: 1398369, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835759

RESUMO

Introduction: Although many studies have underscored the importance of T cells, phenotypically and functionally, fewer have studied the functions of myeloid cells in COVID disease. In particular, the potential role of myeloid cells such as monocytes and low-density neutrophils (LDNs) in innate responses and particular in the defense against secondary bacterial infections has been much less documented. Methods: Here, we compared, in a longitudinal study, healthy subjects, idiopathic fibrosis patients, COVID patients who were either hospitalized/moderate (M-) or admitted to ICU (COV-ICU) and patients in ICU hospitalized for other reasons (non-COV-ICU). Results: We show that COVID patients have an increased proportion of low-density neutrophils (LDNs), which produce high levels of proteases (particularly, NE, MMP-8 and MMP-9) (unlike non-COV-ICU patients), which are partly responsible for causing type II alveolar cell damage in co-culture experiments. In addition, we showed that M- and ICU-COVID monocytes had reduced responsiveness towards further live Pseudomonas aeruginosa (PAO1 strain) infection, an important pathogen colonizing COVID patients in ICU, as assessed by an impaired secretion of myeloid cytokines (IL-1, TNF, IL-8,…). By contrast, lymphoid cytokines (in particular type 2/type 3) levels remained high, both basally and post PAO1 infection, as reflected by the unimpaired capacity of T cells to proliferate, when stimulated with anti-CD3/CD28 beads. Discussion: Overall, our results demonstrate that COVID circulatory T cells have a biased type 2/3 phenotype, unconducive to proper anti-viral responses and that myeloid cells have a dual deleterious phenotype, through their LDN-mediated damaging effect on alveolar cells and their impaired responsiveness (monocyte-mediated) towards bacterial pathogens such as P. aeruginosa.


Assuntos
COVID-19 , Monócitos , Neutrófilos , Infecções por Pseudomonas , Pseudomonas aeruginosa , SARS-CoV-2 , Humanos , COVID-19/imunologia , Pseudomonas aeruginosa/imunologia , Monócitos/imunologia , Masculino , Feminino , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , SARS-CoV-2/fisiologia , Infecções por Pseudomonas/imunologia , Neutrófilos/imunologia , Idoso , Citocinas/metabolismo , Citocinas/imunologia , Adulto , Estudos Longitudinais , Leucócitos Mononucleares/imunologia , Pulmão/imunologia , Pulmão/patologia , Pulmão/microbiologia
5.
Front Immunol ; 15: 1362152, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835768

RESUMO

Introduction: The effector function of T cells is regulated via immune checkpoints, activating or inhibiting the immune response. The BTLA-HVEM complex, the inhibitory immune checkpoint, may act as one of the tumor immune escape mechanisms. Therefore, interfering with the binding of these proteins can prove beneficial in cancer treatment. Our study focused on peptides interacting with HVEM at the same place as BTLA, thus disrupting the BTLA-HVEM interaction. These peptides' structure and amino acid sequences are based on the gD protein, the ligand of HVEM. Here, we investigated their immunomodulatory potential in melanoma patients. Methods: Flow cytometry analyses of activation, proliferation, and apoptosis of T cells from patients were performed. Additionally, we evaluated changes within the T cell memory compartment. Results: The most promising compound - Pep(2), increased the percentages of activated T cells and promoted their proliferation. Additionally, this peptide affected the proliferation rate and apoptosis of melanoma cell line in co-culture with T cells. Discussion: We conclude that the examined peptide may act as a booster for the immune system. Moreover, the adjuvant and activating properties of the gD-derived peptide could be used in a combinatory therapy with currently used ICI-based treatment. Our studies also demonstrate that even slight differences in the amino acid sequence of peptides and any changes in the position of the disulfide bond can strongly affect the immunomodulatory properties of compounds.


Assuntos
Ativação Linfocitária , Melanoma , Receptores Imunológicos , Membro 14 de Receptores do Fator de Necrose Tumoral , Linfócitos T , Humanos , Melanoma/imunologia , Melanoma/tratamento farmacológico , Receptores Imunológicos/metabolismo , Receptores Imunológicos/imunologia , Membro 14 de Receptores do Fator de Necrose Tumoral/metabolismo , Membro 14 de Receptores do Fator de Necrose Tumoral/imunologia , Linfócitos T/imunologia , Linfócitos T/metabolismo , Ativação Linfocitária/efeitos dos fármacos , Feminino , Masculino , Pessoa de Meia-Idade , Proliferação de Células/efeitos dos fármacos , Idoso , Linhagem Celular Tumoral , Adulto , Apoptose/efeitos dos fármacos , Peptídeos/farmacologia , Peptídeos/imunologia , Gangliosídeos/imunologia
6.
Front Immunol ; 15: 1413729, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835774

RESUMO

Background: Sepsis is a major contributor to global morbidity and mortality, affecting millions each year. Notwithstanding the decline in sepsis incidence and mortality over decades, gender disparities in sepsis outcomes persist, with research suggesting higher mortality rates in males. Methods: This retrospective study aims to delineate gender-specific clinical biomarker profiles impacting sepsis progression and mortality by examining sepsis cases and related clinical data from the past three years. Propensity score matching was used to select age-matched healthy controls for comparison. Results: Among 265 sepsis patients, a significantly higher proportion were male (60.8%, P<0.001). While mortality did not significantly differ by gender, deceased patients were significantly older (mean 69 vs 43 years, P=0.003), more likely to have hypertension (54% vs 25%, P=0.019), and had higher SOFA scores (mean ~10 vs 4, P<0.01) compared to survivors. Principal Component Analysis (PCA) showed clear separation between sepsis patients and healthy controls. 48 serum biomarkers were significantly altered in sepsis, with Triiodothyronine, Apolipoprotein A, and Serum cystatin C having the highest diagnostic value by ROC analysis. Gender-stratified comparisons identified male-specific (e.g. AFP, HDLC) and female-specific (e.g. Rheumatoid factor, Interleukin-6) diagnostic biomarkers. Deceased patients significantly differed from survivors, with 22 differentially expressed markers; Antithrombin, Prealbumin, HDL cholesterol, Urea nitrogen and Hydroxybutyrate had the highest diagnostic efficiency for mortality. Conclusion: These findings enhance our understanding of gender disparities in sepsis and may guide future therapeutic strategies. Further research is warranted to validate these biomarker profiles and investigate the molecular mechanisms underlying these gender differences in sepsis outcomes.


Assuntos
Biomarcadores , Sepse , Humanos , Sepse/mortalidade , Sepse/sangue , Sepse/diagnóstico , Masculino , Feminino , Biomarcadores/sangue , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Adulto , Idoso de 80 Anos ou mais
7.
Front Immunol ; 15: 1402724, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835783

RESUMO

Background and objective: Acute ischemic stroke (AIS) is a leading cause of mortality, severe neurological and long-term disability world-wide. Blood-based indicators may provide valuable information on identified prognostic factors. However, currently, there is still a lack of peripheral blood indicators for the prognosis of AIS. We aimed to identify the most promising prognostic indicators and establish prognostic models for AIS. Methods: 484 subjects enrolled from four centers were analyzed immunophenotypic indicators of peripheral blood by flow cytometry. Least absolute shrinkage and selection operator (LASSO) regression was applied to minimize the potential collinearity and over-fitting of variables measured from the same subject and over-fitting of variables. Univariate and multivariable Cox survival analysis of differences between and within cohorts was performed by log-rank test. The areas under the receiving operating characteristic (ROC) curves were used to evaluate the selection accuracy of immunophenotypic indicators in identifying AIS subjects with survival risk. The prognostic model was constructed using a multivariate Cox model, consisting of 402 subjects as a training cohort and 82 subjects as a testing cohort. Results: In the prospective study, 7 immunophenotypic indicators of distinct significance were screened out of 72 peripheral blood immunophenotypic indicators by LASSO. In multivariate cox regression, CTL (%) [HR: 1.18, 95% CI: 1.03-1.33], monocytes/µl [HR: 1.13, 95% CI: 1.05-1.21], non-classical monocytes/µl [HR: 1.09, 95% CI: 1.02-1.16] and CD56high NK cells/µl [HR: 1.13, 95% CI: 1.05-1.21] were detected to decrease the survival probability of AIS, while Tregs/µl [HR:0.97, 95% CI: 0.95-0.99, p=0.004], BM/µl [HR:0.90, 95% CI: 0.85-0.95, p=0.023] and CD16+NK cells/µl [HR:0.93, 95% CI: 0.88-0.98, p=0.034] may have the protective effect. As for indicators' discriminative ability, the AUC for CD56highNK cells/µl attained the highest of 0.912. In stratification analysis, the survival probability for AIS subjects with a higher level of Tregs/µl, BM/µl, CD16+NK cells/µl, or lower levels of CD56highNK cells/µl, CTL (%), non-classical monocytes/µl, Monocytes/µl were more likely to survive after AIS. The multivariate Cox model showed an area under the curve (AUC) of 0.805, 0.781 and 0.819 and 0.961, 0.924 and 0.982 in the training and testing cohort, respectively. Conclusion: Our study identified 7 immunophenotypic indicators in peripheral blood may have great clinical significance in monitoring the prognosis of AIS and provide a convenient and valuable predictive model for AIS.


Assuntos
Citometria de Fluxo , Imunofenotipagem , AVC Isquêmico , Humanos , Feminino , Masculino , AVC Isquêmico/sangue , AVC Isquêmico/mortalidade , AVC Isquêmico/diagnóstico , AVC Isquêmico/imunologia , Citometria de Fluxo/métodos , Prognóstico , Idoso , Pessoa de Meia-Idade , Estudos Prospectivos , Biomarcadores/sangue , Idoso de 80 Anos ou mais
8.
Int J Public Health ; 69: 1607063, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835806

RESUMO

Objectives: This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age. Methods: We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]). Results: Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women's mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20-0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41-1.06). Conclusion: Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.


Assuntos
COVID-19 , Fatores Socioeconômicos , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , Suíça/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Fatores Sexuais , Hospitalização/estatística & dados numéricos , Disparidades nos Níveis de Saúde , SARS-CoV-2 , Adulto Jovem , Adolescente , Fatores Etários , Teste para COVID-19/estatística & dados numéricos
9.
Int J Chron Obstruct Pulmon Dis ; 19: 1225-1232, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835808

RESUMO

Purpose: The use of inhaled bronchodilators is the mainstay of treatment for patients with chronic obstructive pulmonary disease (COPD). Although the soft mist inhaler (SMI) was developed to overcome the disadvantages of pressurized metered dose and drug powder inhalers, misuse during handling has been frequently observed in many studies. However, few studies have focused on SMI misuse among patients with COPD. Thus, we aimed to assess and identify the risk factors associated with SMI misuse among patients with COPD. Patient and Methods: In this prospective, observational, cross-sectional study, we enrolled patients with COPD who were undergoing SMI treatment between January 2018 and March 2020. An advanced nurse practitioner assessed the participants' handling of the device by using a check list. Results: Among 159 participants, 136 (85.5%) reported inhaler misuse. Duration of COPD and COPD assessment test (CAT) scores were positively associated with inhaler misuse; adherence and education level were negatively associated with inhaler misuse. In the multivariable analysis, a low educational level (less than high school), high CAT score (≥ 10), and short duration of COPD (≤ 2 years) were identified as risk factors for SMI misuse. Conclusion: SMI misuse remains common among patients with COPD. Therefore, clinicians should pay close attention to their patients using SMIs, especially in the early period after the diagnosis of COPD.


Assuntos
Broncodilatadores , Nebulizadores e Vaporizadores , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Masculino , Feminino , Estudos Transversais , Fatores de Risco , Idoso , Estudos Prospectivos , Pessoa de Meia-Idade , Broncodilatadores/administração & dosagem , Broncodilatadores/efeitos adversos , Administração por Inalação , Adesão à Medicação , Desenho de Equipamento , Medição de Risco , Escolaridade , Pulmão/fisiopatologia , Pulmão/efeitos dos fármacos
10.
F1000Res ; 13: 296, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38835937

RESUMO

Background: Pulmonary involvement is a major cause of internal organ complication and the leading cause of death in patients with systemic sclerosis (SSc). This study aimed to demonstrate the characteristics of pulmonary function (PF) in Thai patients with SSc and the association between PF and body mass index (BMI) and anti-topoisomerase (anti-Scl70). Methods: All patients diagnosed with SSc in our tertiary care teaching hospital database between 2016 and 2021 were reviewed and analyzed. Results: Of 211 SSc patients, 128 patients who underwent the PF test were enrolled; 102 (79.7%) were female. The mean age was 54 years. The median BMI for all patients was 21.7 kg/m 2. Regarding anti-Scl70, 10.9% of patients were positive, 7.8% were negative, and the status was unreported for 81.3%. The mean (SD) forced expiratory volume in one second (FEV1) forced vital capacity (FVC) ratio was 0.8 (0.1). The mean (SD) % predicted values of FEV1, FVC, and diffusing capacity of the lungs for carbon monoxide (DLCO) were 76.3 (16.3), 69.1 (15.8), and 75.5 (22.8), respectively. A restrictive spirometry pattern (RSP) was found in 78.8% of the patients. DLCO had a moderate positive linear correlation with FVC (r=0.50, p <0.001) and a moderate negative linear correlation with BMI (r=-0.36, p <0.001). However, there was no correlation between FVC and BMI. There was no statistical difference in demographic data or the presence of anti-Scl70 among patients with or without RSP. Conclusions: RSP is common among Thai patients with SSc. However, the power of using demographic data and the presence of anti-Scl70 to determine the probability of pulmonary involvement remains limited.


Assuntos
Pulmão , Escleroderma Sistêmico , Humanos , Feminino , Escleroderma Sistêmico/fisiopatologia , Escleroderma Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tailândia/epidemiologia , Pulmão/fisiopatologia , Testes de Função Respiratória , Índice de Massa Corporal , Adulto , Capacidade Vital , Idoso , Volume Expiratório Forçado , População do Sudeste Asiático
11.
Front Cell Infect Microbiol ; 14: 1382755, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836058

RESUMO

Introduction: Pneumonia is a common infection in the intensive care unit (ICU), and gram-negative bacilli are the most common bacterial cause. The purpose of the study was to investigate the risk factors for 30-day mortality in patients with gram-negative bacillary pneumonia in the ICU, construct a predictive model, and stratify patients based on risk to assess their short-term survival. Methods: Patients admitted to the ICU with gram-negative bacillary pneumonia at Fujian Medical University Affiliated First Hospital between January 2018 and September 2020 were selected. Patients were divided into deceased and survivor groups based on whether death occurred within 30 days. Multifactorial logistic regression analysis was used to identify independent risk factors for 30-day mortality in these patients, and a predictive nomogram model was constructed based on these factors. Patients were categorized into low-, medium-, and high-risk groups according to the model's predicted probability, and Kaplan-Meier survival curves were plotted to assess short-term survival. Results: The study included 305 patients. Lactic acid (odds ratio [OR], 1.524, 95% CI: 1.057-2.197), tracheal intubation (OR: 4.202, 95% CI: 1.092-16.169), and acute kidney injury (OR:4.776, 95% CI: 1.632-13.978) were identified as independent risk factors for 30-day mortality. A nomogram prediction model was established based on these three factors. Internal validation of the model showed a Hosmer-Lemeshow test result of X2=5.770, P=0.834, and an area under the ROC curve of 0.791 (95% CI: 0.688-0.893). Bootstrap resampling of the original data 1000 times yielded a C-index of 0.791, and a decision curve analysis indicated a high net benefit when the threshold probability was between 15%-90%. The survival time for low-, medium-, and high-risk patients was 30 (30, 30), 30 (16.5, 30), and 17 (11, 27) days, respectively, which were significantly different. Conclusion: Lactic acid, tracheal intubation, and acute kidney injury were independent risk factors for 30-day mortality in patients in the ICU with gram-negative bacillary pneumonia. The predictive model constructed based on these factors showed good predictive performance and helped assess short-term survival, facilitating early intervention and treatment.


Assuntos
Unidades de Terapia Intensiva , Pneumonia Bacteriana , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Pneumonia Bacteriana/mortalidade , Pneumonia Bacteriana/microbiologia , Medição de Risco , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Negativas/microbiologia , Nomogramas , Estudos Retrospectivos , Estimativa de Kaplan-Meier , Curva ROC , Prognóstico , Adulto
12.
Front Cell Infect Microbiol ; 14: 1388385, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836059

RESUMO

Objectives: This study aimed to determine whether combined of pathogen detection strategies, including specimen acquisition, culture conditions, and molecular diagnostics, can improve treatment outcomes in patients with periprosthetic joint infections (PJI). Methods: This retrospective study included suspected PJI cases from three sequential stages at our institution: Stage A (July 2012 to June 2015), Stage B (July 2015 to June 2018), and Stage C (July 2018 to June 2021). Cases were categorized into PJI and aseptic failure (AF) groups based on European Bone and Joint Infection Society (EBJIS) criteria. Utilization of pathogen diagnostic strategies, pathogen detection rates, targeted antibiotic prescription rates, and treatment outcomes were analyzed and compared across the three stages. Results: A total of 165 PJI cases and 38 AF cases were included in this study. With the progressive implementation of the three optimization approaches across stages A, B and C, pathogen detection rates exhibited a gradual increase (χ2 = 8.282, P=0.016). Similarly, utilization of targeted antibiotic therapy increased stepwise from 57.1% in Stage A, to 82.3% in Stage B, and to 84% in Stage C (χ2 = 9.515, P=0.009). The 2-year infection control rate exceeded 90% in both stages B and C, surpassing stage A (71.4%) (χ2 = 8.317, P=0.011). Combined application of all three optimized protocols yielded the highest sensitivity of 91.21% for pathogen detection, while retaining higher specificity of 92.11%. Conclusion: The utilization of combined pathogen diagnostic strategies in PJI can increase pathogen detection rates, improve targeted antibiotic prescription, reduce the occurrence of antibiotic complications, and achieve better treatment outcomes.


Assuntos
Antibacterianos , Infecções Relacionadas à Prótese , Humanos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais
13.
Front Endocrinol (Lausanne) ; 15: 1304436, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836223

RESUMO

Introduction: The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients. Methods: We performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts. Results: The incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57-1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001). Conclusion: Results suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient's receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic.


Assuntos
Amputação Cirúrgica , COVID-19 , Humanos , COVID-19/epidemiologia , Amputação Cirúrgica/estatística & dados numéricos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Privação Social , Pé Diabético/cirurgia , Pé Diabético/epidemiologia , Incidência , Pandemias , SARS-CoV-2 , Idoso de 80 Anos ou mais
14.
Front Endocrinol (Lausanne) ; 15: 1397062, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836224

RESUMO

Background and aims: A prothrombotic state was demonstrated in patients with Cushing's syndrome and is involved in the development and progression of cardiovascular and renal damage in hypertensive patients. This study was designed to examine the relationships between cortisol secretion and the hemostatic and fibrinolytic systems in hypertension. Methods: In 149 middle-aged, nondiabetic, essential hypertensive patients free of cardiovascular and renal complications, we measured hemostatic markers that express the spontaneous activation of the coagulation and fibrinolytic systems and assessed daily cortisol levels (8 AM, 3 PM, 12 AM; area under the curve, AUC-cortisol) together with the cortisol response to dexamethasone overnight suppression (DST-cortisol). Results: Plasma levels of D-dimer (D-dim), prothrombin fragment 1 + 2 (F1 + 2), and von Willebrand factor (vWF) were progressively and significantly higher across tertiles of AUC-cortisol and DST-cortisol, whereas no differences were observed in fibrinogen, tissue plasminogen activator, plasminogen activator inhibitor-1, antithrombin III, protein C, and protein S. D-dim, F1 + 2, and vWF were significantly and directly correlated with age and both AUC-cortisol and DST-cortisol. Multivariate regression analysis showed that both AUC-cortisol and DST-cortisol were related to plasma D-dim, F1 + 2, and vWF independently of age, body mass index, blood pressure, and renal function. Conclusion: Greater daily cortisol profile and cortisol response to overnight suppression are independently associated with a prothrombotic state in hypertensive patients and might contribute to the development of organ damage and higher risk of cardiovascular complications.


Assuntos
Dexametasona , Hidrocortisona , Hipertensão , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Hidrocortisona/sangue , Hipertensão/sangue , Hipertensão/complicações , Adulto , Trombose/sangue , Trombose/etiologia , Fator de von Willebrand/metabolismo , Fator de von Willebrand/análise , Ritmo Circadiano/fisiologia , Idoso , Biomarcadores/sangue
15.
Front Endocrinol (Lausanne) ; 15: 1325320, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836225

RESUMO

Background: Creatinine-cystatin C ratio (CCR) has been demonstrated as an objective marker of sarcopenia in clinical conditions but has not been evaluated as an osteoporosis marker in individuals with normal renal function. Methods: We selected 271,831 participants with normal renal function from UK Biobank cohort. Multivariable linear/logistic regression and Cox proportional hazards model were used to investigate the phenotypic relationship between CCR and osteoporosis in total subjects and gender-stratified subjects. Based on the genome-wide association study (GWAS) data, linkage disequilibrium regression (LDSC) and Mendelian randomization (MR) analysis were performed to reveal the shared genetic correlations and infer the causal effects, respectively. Results: Amongst total subjects and gender-stratified subjects, serum CCR was positively associated with eBMD after adjusting for potential risk factors (all P<0.05). The multivariable logistic regression model showed that the decrease in CCR was associated with a higher risk of osteoporosis/fracture in all models (all P<0.05). In the multivariable Cox regression analysis with adjustment for potential confounders, reduced CCR is associated with the incidence of osteoporosis and fracture in both total subjects and gender-stratified subjects (all P<0.05). A significant non-linear dose-response was observed between CCR and osteoporosis/fracture risk (P non-linearity < 0.05). LDSC found no significant shared genetic effects by them, but PLACO identified 42 pleiotropic SNPs shared by CCR and fracture (P<5×10-8). MR analyses indicated the causal effect from CCR to osteoporosis/fracture. Conclusions: Reduced CCR predicted increased risks of osteoporosis/fracture, and significant causal effects support their associations. These findings indicated that the muscle-origin serum CCR was a potential biomarker to assess the risks of osteoporosis and fracture.


Assuntos
Biomarcadores , Creatinina , Cistatina C , Análise da Randomização Mendeliana , Osteoporose , Humanos , Feminino , Masculino , Osteoporose/genética , Osteoporose/sangue , Osteoporose/epidemiologia , Pessoa de Meia-Idade , Biomarcadores/sangue , Creatinina/sangue , Cistatina C/sangue , Cistatina C/genética , Idoso , Estudo de Associação Genômica Ampla , Polimorfismo de Nucleotídeo Único , Adulto , Densidade Óssea/genética , Fatores de Risco
16.
Front Endocrinol (Lausanne) ; 15: 1383993, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836227

RESUMO

Background: Stress hyperglycemia ratio (SHR) has shown a predominant correlation with transient adverse events in critically ill patients. However, there remains a gap in comprehensive research regarding the association between SHR and mortality among patients experiencing cardiac arrest and admitted to the intensive care unit (ICU). Methods: A total of 535 patients with their initial ICU admission suffered cardiac arrest, according to the American Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were stratified into four categories based on quantiles of SHR. Multivariable Cox regression models were used to evaluate the association SHR and mortality. The association between SHR and mortality was assessed using multivariable Cox regression models. Subgroup analyses were conducted to determine whether SHR influenced ICU, 1-year, and long-term all-cause mortality in subgroups stratified according to diabetes status. Results: Patients with higher SHR, when compared to the reference quartile 1 group, exhibited a greater risk of ICU mortality (adjusted hazard ratio [aHR] = 3.029; 95% CI: 1.802-5.090), 1-year mortality (aHR = 3.057; 95% CI: 1.885-4.958), and long-term mortality (aHR = 3.183; 95% CI: 2.020-5.015). This association was particularly noteworthy among patients without diabetes, as indicated by subgroup analysis. Conclusion: Elevated SHR was notably associated with heightened risks of ICU, 1-year, and long-term all-cause mortality among cardiac arrest patients. These findings underscore the importance of considering SHR as a potential prognostic factor in the critical care management of cardiac arrest patients, warranting further investigation and clinical attention.


Assuntos
Bases de Dados Factuais , Parada Cardíaca , Hiperglicemia , Unidades de Terapia Intensiva , Humanos , Masculino , Feminino , Parada Cardíaca/mortalidade , Parada Cardíaca/sangue , Hiperglicemia/mortalidade , Hiperglicemia/sangue , Idoso , Pessoa de Meia-Idade , Unidades de Terapia Intensiva/estatística & dados numéricos , Prognóstico , Estados Unidos/epidemiologia
17.
Front Endocrinol (Lausanne) ; 15: 1376357, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836226

RESUMO

Objective: The triglyceride-glucose (TyG) index, a reliable substitute indicator of insulin resistance (IR), is considered an independent risk factor for long-term outcomes in patients with cardiovascular disease. However, studies investigating the association between TyG and atherosclerotic cardiovascular disease (ASCVD) are limited and lack direct evidence. We aim to examine the relationship between the TyG index and ASCVD through a comprehensive cross-sectional study. Methods: Overall, 7212 participants from the 1999-2004 National Health and Nutrition Examination Survey were included. The baseline TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Restricted cubic spline (RCS) regression, univariate logistic regression, and multivariate logistic regression analysis were used to evaluate the association between the TyG index and ASCVD. Results: In the overall population, a multivariate logistic regression analysis showed that the TyG level was not only positively associated with ASCVD [OR (95%CI): 1.29 (1.01,1.64), P=0.042], coronary artery disease (CAD) [OR (95%CI): 1.82(1.33,2.48), P<0.001], and stroke [OR (95%CI): 2.68(1.54,4.69), P=0.002], but also linearly correlated with all three (P-overall<0.001; P-non-linear >0.05). Although the TyG index was not associated with peripheral arterial disease (PAD) [OR (95%CI): 1.00 (0.73,1.36), P>0.900], it showed a U-shaped correlation with PAD (P-overall <0.001; P-non-linear= 0.0085), and the risk of PAD was minimized when TyG=8.67. By incorporating the TyG index into the baseline risk model, the accuracy of ASCVD prediction was improved [AUC: baseline risk model, 0.7183 vs. baseline risk model + TyG index, 0.7203, P for comparison=0.034]. The results of the subgroup analysis were consistent with those of the main analysis. Conclusion: The TyG index was independently associated with ASCVD, CAD, and stroke, suggesting that it may serve as a valid indicator for predicting ASCVD in the entire population.


Assuntos
Aterosclerose , Glicemia , Inquéritos Nutricionais , Triglicerídeos , Humanos , Feminino , Masculino , Triglicerídeos/sangue , Pessoa de Meia-Idade , Glicemia/análise , Estudos Transversais , Aterosclerose/sangue , Aterosclerose/epidemiologia , Adulto , Idoso , Fatores de Risco , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Resistência à Insulina
18.
Front Endocrinol (Lausanne) ; 15: 1374496, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836229

RESUMO

Aims: The present study aimed to investigate the accuracy of the Glunovo® real-time continuous glucose monitoring system (rtCGMS). Methods: We conducted a 14-day interstitial glucose level monitoring using Glunovo® rtCGMS on thirty hospitalized patients with type 2 diabetes. The flash glucose monitoring (FGM) was used as a self-control. Consistency tests, error grid analysis, and calculation of the mean absolute relative difference (MARD) were performed using R software to assess the accuracy of Glunovo® rtCGMS. Results: Glunovo® exhibited an overall MARD value of 8.89% during hospitalization, compared to 10.42% for FGM. The overall percentages of glucose values within ±10%/10, ± 15%/15, ± 20%/20, ± 30%/30, and ±40%/40 of the venous blood glucose reference value were 63.34%, 81.31%, 90.50%, 97.29%, and 99.36% for Glunovo®, respectively, compared with 61.58%, 79.63%, 88.31%, 96.22% and 99.23% for FGM. The Clarke Error Grid Analysis showed that 99.61% of Glunovo® glucose pairs and 100.00% of FGM glucose pairs within zones A and B. Conclusion: Our study confirms the superior accuracy of Glunovo® in monitoring blood glucose levels among hospitalized patients with type 2 diabetes.


Assuntos
Automonitorização da Glicemia , Glicemia , Diabetes Mellitus Tipo 2 , Hospitalização , Humanos , Diabetes Mellitus Tipo 2/sangue , Feminino , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/instrumentação , Masculino , Pessoa de Meia-Idade , Glicemia/análise , Estudos Prospectivos , Idoso , Adulto , Monitoramento Contínuo da Glicose
20.
Cell Mol Biol (Noisy-le-grand) ; 70(6): 171-177, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38836663

RESUMO

Chronic heart disease (CHD) is still a major global cause of morbidity and mortality, necessitating effective therapeutic interventions to mitigate its progression. Omega-3 fatty acids (FAs) have garnered attention for their potential anti-inflammatory and endothelial-protective properties in CHD management. The present study aims to assess the efficacy of Omega-3 FA supplementation on markers of inflammation and endothelial function in patients with CHD. To achieve this, we used the relevant keywords to search international databases (Web of Science, PubMed, Embase, and Scopus) and extract publications evaluating the effectiveness of omega-3 FA supplementation on inflammation markers and endothelial function in patients with CHD. STATA (version 15) and the random and fixed-effects models were used to evaluate the collected data. Thirteen clinical trial studies met inclusion criteria, with a total sample size of 853 individuals (406 cases and 447 controls). The cases had a mean age of 58 ± 10.3 years. The pooled results indicated that omega-3 Omega-3 FA supplementation significantly reduced the level of circulating IL-6 (SMD = -0.47, 95% CI -1.29 to 0.35, %, p < 0.001), hs-CRP (SMD = -0.21, 95% CI -0.70 to 0.28, p = 0.01), and TNF-α (SMD = -0.56, 95% CI -1.14 to 0.01, p < 0.001) in patients with CHD. Also, findings revealed that a daily supplement of omega-3 significantly increased FMD by 0.34% (95% CI: 0.14-0.54%, p < 0.001) as compared with placebo by a fixed-effect model in patients with CHD. These findings underscore the potential therapeutic utility of omega-3 fatty acid supplementation in modulating inflammation and endothelial dysfunction in patients with CHD.


Assuntos
Biomarcadores , Suplementos Nutricionais , Ácidos Graxos Ômega-3 , Inflamação , Humanos , Pessoa de Meia-Idade , Biomarcadores/sangue , Doença Crônica , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Graxos Ômega-3/farmacologia , Cardiopatias/tratamento farmacológico , Cardiopatias/sangue , Inflamação/tratamento farmacológico , Inflamação/sangue , Idoso
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