Basic concepts for sample size calculation: Critical step for any clinical trials!

Managing cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) in Saudi Arabia: what are the current practices?

OBJECTIVE

Cognitive impairment is a common comorbidity, yet overlooked, in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the current practice and perceptions of physicians on recognising and managing cognitive impairment in patients with COPD in Saudi Arabia. This study aimed to investigate current practices and perceptions of physicians in Saudi Arabia regarding the recognition and management of cognitive impairment in COPD patients.

METHODS

An online cross-sectional questionnaire was distributed between March and October 2023 to physicians in Saudi Arabia. The collected responses were analysed using descriptive statistics.

RESULTS

A total of 808 physicians completed the online survey. Of whom, only 19% indicated receiving adequate training for managing cognitive impairment. Although the vast majority of physicians reported that cognitive impairment leads to underestimation of COPD severity (85%) and interferes with self-management (85%), only 11% agreed on the important role of screening. In addition, only half of the study participants aimed to identify possible cognitive impairment, with only 4% screening for cognitive impairment during patients' assessment. The overall confidence level in recognising and managing cognitive impairment was relatively low. The most common barriers contributing to the suboptimal management of cognitive impairment in COPD were poor training (62%), the absence of standardised procedures (63%) and limited knowledge (58%) about cognitive impairment in COPD.

CONCLUSION

The current practice of recognising and managing cognitive impairment in Saudi Arabia is suboptimal. This is likely to be attributed to inadequate training, the absence of standardised procedures, and limited knowledge about cognitive impairment in COPD. Healthcare systems should provide more training and implement a holistic approach to detect and manage cognitive impairment during patients' visits.

How many subjects are enough in a veterinary trial?-Literature review and insights from industrial statisticians

To approve veterinary medicines, regulatory agencies require substantial evidence of safety and effectiveness from well-designed trials. A critical consideration in planning a veterinary trial is to determine the requisite number of subjects needed to achieve the trial objective(s). Sample sizes for preclinical studies usually follow specific guidelines, whereas clinical studies should follow more rigorous requirements to determine the optimal sample size for detecting significant and meaningful treatment effects. This paper presents a descriptive literature review aiming to explore current reported practices in sample size calculation for published veterinary clinical trials. The review included articles published in 12 top-ranking veterinary health journals from January 1, 2013, to June 4, 2023, sourced from PubMed and Medline regarding animal trials. Initially, 294 articles were identified, of which 98 (33 %) focused on veterinary clinical studies. Among these 98 papers, only 24 (24 %) provided detailed methods on sample size calculations, with individual animals as experimental units across at least two arms. The predominant animal species studied in these trials were canines (39 %), cattle (32 %), and swine (21 %), with most studies aiming for a statistical power of at least 80 %. Unlike human clinical trials, the paper found that statistically rigorous sample size calculations were less commonly reported in animal clinical trials. Our paper provides recommendations for veterinary clinical trial practitioners and offers insights into how sample size determination can be properly conducted and reported. Furthermore, this article extends to discuss practical issues in sample size determination for preclinical studies.

The outcome of diabetic retinopathy health education program in patients with type 2 diabetes mellitus: a quasi-experimental study

Diabetic retinopathy (DR) may develop into sight-threatening DR and vision loss if early intervention is not carried out. This study was aimed to assess the effectiveness of DR health education program for patients with type 2 diabetes mellitus (T2DM). The quasi-experimental research design was applied. The intervention group underwent a web-based DR health education program while the control group was followed up the usual way at an ophthalmology clinic for 1 year. Data were analysed using descriptive statistics, repeated measures ANOVA and general linear model to evaluate the mean difference between groups. A total of 180 patients with T2DM were enrolled in the study, with equal number in the control and intervention groups, respectively, with 28% of dropout rate. There was a significant mean difference in knowledge score [F (1178)  = 116.57, P = 0.001], diabetes self-care [F (1178)  = 116.57, P = 0.001] and visual-related quality of life [F (1178)  = 12.70), P = 0.001] between the control and the intervention groups. The intervention group scored the highest in all three categories. Educational interventions positively affected adherence to self-care and visual-related quality of life in type 2 diabetic patients as shown in this study. DRHEP should be considered an added benefit in T2DM management, starting with comprehensive care enrollment.

The role of clinical pharmacist in the management of resistant hypertension

BACKGROUND

Hypertension is a major contributor to global cardiovascular morbidity and mortality. Treatment-resistant hypertension (TRH) presents a significant management challenge, requiring a pharmacist-physician collaborative model to achieve sustained blood pressure (BP) control.

AIM

This study aims to evaluate the impact of a clinical pharmacy interventions on BP control, medication adherence, and patient outcomes in patients with TRH in a primary care setting.

METHODS

A randomized controlled trial was conducted involving 142 patients with TRH at two primary care clinics. Participants were randomly assigned to either the intervention group, receiving clinical pharmacy services including medication reviews and personalized counseling, or the control group, receiving standard care. Medication adherence was assessed using the Medication Adherence Rating Scale, and patient outcomes, including BP control and quality of life (QoL), were measured over a 6-month period.

RESULTS

The intervention group demonstrated a significant improvement in medication adherence compared to the control group (p < 0.001), with an effect size of - 1.75. Clinical parameters, such as BP (mean reduction in BP: 27.9/13.4 mmHg), showed more favorable outcomes in the intervention group (p = 0.003). Furthermore, patients receiving clinical pharmacy services reported higher QoL scores (p < 0.001) and expressed higher satisfaction with medication management.

CONCLUSION

Clinical pharmacy interventions significantly enhance medication adherence and improve patient achievement of target BP goals in TRH patients. Incorporating clinical pharmacy services into routine care can lead to better health management and increased patient QoL. Further research is needed to explore long-term benefits and cost-effectiveness.

Does Health Education Through Videos and E-Leaflet Have a Good Influence on Improving Students' Reproductive Health Knowledge, Attitudes, and Practices? an Intervention Study in Jatinangor, Indonesia

Background

Reproductive health issues remain a serious concern, especially for university students. The problem occurs due to a lack of knowledge about three primary threats to adolescent reproductive health, namely, sexuality, HIV / AIDS, and drug abuse, which will affect the attitudes and practices that university students will adopt related to reproductive health. This study aims to analyze the effect of reproductive health education through videos and e-leaflets on improving students' reproductive health knowledge, attitudes, and practices. The hypothesis for this study was to explore the differences in knowledge, attitudes, and practices before and after the intervention.

Methods

This study used a quasi-experimental design. Purposive sampling was used to select participants from four universities in the Jatinangor District. 166 female first-year university students were divided into the study group through video (n = 83) and the control group through e-leaflet (n = 83). A structured questionnaire assessed reproductive health knowledge, attitude, and behavior before and after the intervention. SPSS version 27.0 was used to analyze the data.

Results

This study showed that university students' knowledge, attitudes, and practice increased significantly after the intervention (p<0.001). The comparison results between the intervention group and the control group did not show a significant difference in knowledge improvement (p>0.001); however, they showed differences in attitude and behavior improvement (p<0.001).

Conclusion

Reproductive health education through video and e-leaflets is equally effective in improving first-year students' knowledge, attitude, and practice. University support is necessary for reproductive health education among students.

Randomized clinical trials and related concepts in clinical research

Clinical research is a key factor in healthcare progress, as it contributes toward improving our knowledge on the prevention, etiology, and treatment of different conditions. Healthcare professionals and researchers should be familiar with this specific terminology and procedures of clinical research to understand and be able to evaluate clinical trial results and make decisions using up-to-date recommendations. To do so, they must be familiar with different methodological aspects: from establishing the type of design, the study population, and the groups to be studied, to understanding the randomization and blinding processes. Additionally, when it comes to communicating the results and publishing them, it is also necessary to know how to do it adequately to ensure transparency. This work includes a description of different concepts commonly used in clinical research, particularly in the clinical trials field, in an attempt to compile different topics by providing a brief and accessible overview.

Efficacy of topical anesthetics of lidocaine, benzocaine, and EMLA in reducing pain during inferior alveolar nerve block in schoolchildren: a randomized controlled trial

OBJECTIVES

This study aimed to evaluate the efficacy of 5% EMLA cream and 8% lidocaine gel in reducing pain during inferior alveolar nerve block (IANB) compared with 20% Benzocaine in children aged 6-10 years.

MATERIALS AND METHODS

This was a triple-blinded, randomized, parallel-group, active-controlled trial with three arms. 45 children were randomly assigned into 3 groups. Group 1: control group, 20% benzocaine gel (n = 15). Group 2: 8% lidocaine gel (n = 15). Group 3: 5% EMLA cream (n = 15). Each topical anesthetic was applied in an amount of 0.3 mL using a cotton swab for 2 min, followed by IANB administration. The following primary outcome measures were considered: pulse rate, the face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale, and the Wong-Baker FACES pain rating scale.

RESULTS

The mean score of the FLACC behavioral pain assessment scale in group 2 (2.20 ± 1.86) was slightly higher, but this result was not statistically significant p = (0.806). Regarding the Wong-Baker FACES pain rating scale scores, no statistically significant difference was noted between the study groups p = (0.593). After IANB administration, the mean pulse rate was higher in group 3 (102.40 ± 14.28). However, this difference was not statistically significant p = (0.351). In addition, the mean change of the pulse rate from the baseline to this time point was not statistically significant p = (0.638), indicating a smaller physiologic response to the painful stimulus.

CONCLUSION

8% lidocaine gel was not superior to 20% benzocaine nor 5% EMLA in reducing pain during IANB administration.

Modulating the gut microbiota in Crohn's disease: a pilot study on the impact of a plant-based diet with DNA-based monitoring

Introduction

Crohn's Disease (CD) is characterized by chronic intestinal inflammation and dysbiosis. This study aimed to investigate the effects of a plant-based diet (PBD) on gut microbiota composition and inflammation in CD patients and assess the utility of trnL gene sequencing for monitoring dietary adherence.

Methods

Fourteen CD patients participated in a 12-week PBD intervention. Dietary adherence was monitored through self-reported food diaries and trnL sequencing, which detects plant residues in fecal samples. Gut microbiota was analyzed using 16S rRNA sequencing, and fecal calprotectin levels were measured as an indicator of intestinal inflammation.

Results

TrnL sequencing identified 55 plant genera in fecal samples, compared to 41 reported in food diaries, highlighting its accuracy in assessing plant residue diversity. By week 4, participants demonstrated a 1.4-fold increase in plant intake, correlating with a significant increase in microbial diversity. Key genera associated with gut health, such as Faecalibacterium and Bacteroides, increased in abundance. Additionally, fecal calprotectin levels decreased from 472 mg/kg at baseline to 207 mg/kg at week 12, indicating reduced intestinal inflammation.

Discussion

A PBD positively influenced gut microbiota composition and decreased intestinal inflammation in CD patients. The study also demonstrated that trnL sequencing is an effective tool for assessing dietary adherence in clinical settings, offering a more objective measure than self-reported food diaries.

Short-term influence of Immufen™ on mild allergic rhinitis: a randomized, double-blind, placebo-controlled study

Introduction

Allergic rhinitis (AR) is an IgE-mediated reaction to inhaled allergens, and is a prominent health concern affecting approximately 400 million people worldwide. A comprehensive understanding of AR's pathophysiology is imperative for developing novel therapies, especially considering its frequent co-morbidity with asthma and conjunctivitis. The escalating prevalence of AR is correlated with increased urbanization and environmental pollutants, recognized as prominent contributing factors. Dysregulation in immune networks, Th1/Th2 cytokine imbalance, activation of mast cells and eosinophils are implicated in AR progression. Classic AR symptoms include nasal congestion, nasal itching, rhinorrhea, and sneezing which significantly impact the quality of life, social interactions, and workplace productivity.

Methods

This randomized, double-blind, placebo-controlled, three-arm, three-sequence study was aimed to assess the efficacy of supplementation of a co-delivery form of turmeric extract with ashwagandha extract (CQAB) in comparison with a bioavailable curcumin (CGM) and placebo in alleviating AR symptoms and enhancing the quality of life in individuals with mild AR. Participants received either placebo, CGM, or CQAB twice/day for 28 days, and subjective measures were recorded at the baseline and at the end of study.

Results

CQAB supplementation demonstrated a significant (P < 0.05) improvement in Total Nasal Symptom Score (TNSS) compared to placebo and CGM. Furthermore, CQAB administration resulted in enhanced sleep quality (P < 0.05) as evaluated by the BIS questionnaire, heightened energy levels, and decreased fatigue and overall mood disturbance (POMS-SF) compared to both placebo and CGM.

Conclusion

The results suggests that CQAB has the potential to be used as a dietary supplement in alleviating AR discomforts.

Clinical Trial Registration

https://ctri.nic.in/Clinicaltrials/login.php; Identifier CTRI/2021/01/030355.

Insight and empathy in schizophrenia: Impact on quality of life and symptom severity

BACKGROUND

Quality of life has emerged as a powerful indicator of therapeutic success. However, little research has been conducted to study potential factors that influence quality of life in persons with schizophrenia, particularly in low-income developing nations.

AIM

This study aimed to investigate how insight and empathy impacted the quality of life and severity of symptoms in patients.

METHODS

A descriptive cross-sectional research design was conducted on 168 patients with schizophrenia using the PANSS Scale, Schizophrenia Quality of Life Scale R4, the Interpersonal Reactivity Index, and the Birchwood Insight Scale.

RESULTS

Our findings show that the mean score for quality of life was (70.9 ± 9.2), whereas the mean scores for empathy and insight were (60.8 ± 15.8) and (5.8 ± 1.9), respectively. Insight and empathy have predicted effects on QoL (adjusted r square = 0.035, sig = 0.009) and (adjusted r square = 0.012, sig = 0.027), respectively. On the other hand, the regression model also showed a substantial inverse relationship between the severity of the illness and both empathy and insight.

CONCLUSION

The majority of the clients had poor quality of life, low insight, and low empathy. Insight and empathy play a role in anticipating the patient's perceptions of quality of life. They might affect how severe their illness is. Our findings highlight the importance of developing empathy and insight, and therapies that do so may aid patients with low quality of life.

Relative Validity and Reproducibility of a Dietary Screening Tool in Nigerian Health Care

Background

Hypertension and cardiovascular disease burden are rising rapidly in Nigeria. This trend is partly attributed to a transition from healthy to unhealthy dietary patterns. However, health care professionals lack a dietary screening tool to assess patient dietary intake and offer personalized dietary advice.

Objectives

We aimed to develop and validate a food frequency questionnaire (FFQ) that can quickly and accurately assess regional dietary intake for use by health care professionals in a hospital setting in Port Harcourt, Nigeria.

Methods

We recruited 58 patients from a single hospital in Nigeria. The FFQ was administered at baseline and again after 3 wk. To evaluate the validity of the FFQ, we used 3 repeated and nonconsecutive 24-h dietary recalls (24DR) as a reference method. Spearman rank correlations, Wilcoxon signed-rank tests, cross-classification, intraclass correlation coefficients (ICCs), and Bland-Altman analysis were performed in R software version 4.3.1 to assess the relative validity and reproducibility.

Results

The mean correlation coefficient (r s) between the FFQ and 24DR was 0.60 (P < 0.05), and ranged from 0.20 to 0.78. The Wilcoxon signed-rank tests indicated no significant differences in the 19 food groups queried (P > 0.05), except for fats and oils (P < 0.05). The exact agreement for classifying individuals into quartiles ranged from 17% for salt to 88% for processed meats and alcoholic drinks, with 90% of individuals classified into the same or neighboring quartile. Additionally, the Bland-Altman analysis demonstrated acceptable agreement, with >96% of observations within the acceptable limits of agreement for all food groups. For reproducibility, the ICC ranged from 0.31 for stew to 0.98 for fruit, with an mean ICC of 0.77 between the FFQs delivered 2 wk apart.

Conclusions

Our results support the use of the FFQ as a valid and reliable tool for ranking intakes of certain food groups among patients in a hospital setting in Nigeria.The trial was registered at clinicaltrials.gov as NCT05973760.

Interobserver agreement on line-field confocal optical coherence tomography image markers in keratinocyte carcinomas and precursor lesions

Line-field confocal optical coherence tomography (LC-OCT) is a new technology for skin cancer diagnostics. However, the interobserver agreement (IOA) of known image markers of keratinocyte carcinomas (KC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), as well as precursors, SCC in situ (CIS) and actinic keratosis (AK), remains unexplored. This study determined IOA on the presence or absence of 10 key LC-OCT image markers of KC and precursors, among evaluators new to LC-OCT with different levels of dermatologic imaging experience. Secondly, the frequency and association between reported image markers and lesion types, was determined. Six evaluators blinded to histopathologic diagnoses, assessed 75 LC-OCT images of KC (21 SCC; 21 BCC), CIS (12), and AK (21). For each image, evaluators independently reported the presence or absence of 10 predefined key image markers of KCs and precursors described in an LC-OCT literature review. Evaluators were stratified by experience-level as experienced (3) or novices (3) based on previous OCT and reflectance confocal microscopy usage. IOA was tested for all groups, using Conger's kappa coefficient (κ). The frequency of reported image marker and their association with lesion-types, were calculated as proportions and odds ratios (OR), respectively. Overall IOA was highest for the image markers lobules (κ = 0.68, 95% confidence interval (CI) 0.57;0.78) and clefting (κ = 0.63, CI 0.52;0.74), typically seen in BCC (94%;OR 143.2 and 158.7, respectively, p < 0.001), followed by severe dysplasia (κ = 0.42, CI 0.31;0.53), observed primarily in CIS (79%;OR 7.1, p < 0.001). The remaining seven image-markers had lower IOA (κ = 0.06-0.32) and were more evenly observed across lesion types. The lowest IOA was noted for a well-defined (κ = 0.07, CI 0;0.15) and interrupted dermal-epidermal junction (DEJ) (κ = 0.06, CI -0.002;0.13). IOA was higher for all image markers among experienced evaluators versus novices. This study shows varying IOA for 10 key image markers of KC and precursors in LC-OCT images among evaluators new to the technology. IOA was highest for the assessments of lobules, clefting, and severe dysplasia while lowest for the assessment of the DEJ integrity.

Effectiveness of a dental simulation game on reducing pain and anxiety during primary molars pulpotomy compared with tell-show-do technique in pediatric patients: a randomized clinical trial

BACKGROUND

Dental simulation games are virtual educational games that help children get familiar with different dental procedures. This study aimed to evaluate the pretreatment exposure to the "Baby Panda Dental Care" game in reducing pain and anxiety in comparison with the tell-show-do (TSD) technique during primary molars pulpotomy for patients aged 6-10 years.

MATERIALS AND METHODS

It was a triple-blinded, two-arm, parallel-group, randomized, active-controlled trial. It was done on 60 patients, who were randomly divided into two groups: the control group, TSD technique (n = 30), and the experimental group, "Baby Panda Dental" Care (n = 30). For the TSD technique, children were provided with a verbal explanation followed by a demonstration of the dental treatment in a non-threatening way. The "do" phase is then initiated during performing treatment. For the "Baby Panda dental care" game, children were asked to play for 5 min before treatment, selecting root canal therapy procedures. Pulse rate and RMS pictorial scale were recorded at four time points: (1) at the baseline (t0). (2) After conditioning the child (t1). (3) During treatment (t2). (4) After finishing the treatment (t3). Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain scale was recorded during treatment (t2).

RESULTS

The pulse rate is higher in the control group at t1 (p = 0.012) and t2 (p = 0.015). There was a statistically significant difference in the mean RMS pictorial scale score at t1 (p < 0.001), t2 (p = 0.006), and t3 (p < 0.001), a statistically significant difference was noticed in FLACC behavioral pain assessment between the two groups (p = 0.033).

CONCLUSIONS

The mobile dental game showed better results than the TSD technique, but neither technique did not reduce anxiety and pain effectively during dental treatment.

TRIAL REGISTRATION

The trial was registered at the ISRCTN registry (ISRCTN30470866) on 19/04/2024.

Effect of topical vancomycin powder on surgical site infection prevention in major orthopaedic surgery: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

BACKGROUND

Evidence has been mixed regarding the effect of topical vancomycin (VCM) powder in reducing surgical site infection (SSI).

AIM

To clarify the effect of topical VCM powder for the prevention of SSI in major orthopaedic surgeries.

METHODS

The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to September 25th, 2023. Randomized controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries were included. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measures were overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. Trial sequential analysis (TSA) was performed.

FINDINGS

Eight randomized controlled trials yielded data on 4307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z-curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSIs, VCM powder showed a statistically significant difference in reducing Gram-positive cocci SSI. However, the certainty of this evidence was very low.

CONCLUSION

This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention.

Gait speed in knee osteoarthritis: A simple 10-meter walk test predicts the distance covered in the 6-minute walk test

BACKGROUND

The 6-Minute Walk Test (6MWT) is a common performance-measure in Knee Osteoarthritis (KOA), but the pain and functional impairment characterizing the condition may interfere its adequate performance.

OBJECTIVES

The shorter 10-m Walk Test (10mWT) could predict the distance performed on the 6MWT, therefore decreasing the burden on patients, enhancing efficiency, and reducing space- and time-constraints in clinical settings.

DESIGN

A cross sectional study was conducted.

METHODS

The scores from the 6MWT and the shorter 10mWT of 58 ambulatory subjects with KOA were compared. Correlation, and a univariate regression analysis to explore the predictive ability of the 10mWT, were calculated.

RESULTS

Correlation was excellent (r = 0.913, p-value<0.001), and the predictive equation based on the 10mWT scores (R2 = 0.834, p-value<0.001) estimates the distance walked in the 6MWT with a relative error of 7.62%.

CONCLUSIONS

The 10mWT may be an excellent assessment-tool to predict the distance walked in the 6MWT, due to its low strain on patients and as a means of improving efficiency and reducing time-constraints.

The Nigerian Dietary Screening Tool: A Step toward Improved Patient-Clinician Communication in Nigerian Hospitals: A Pilot Implementation Study

Implementing dietary screening tools into clinical practice has been challenging, including in Nigeria. This study evaluated the impact of the Nigerian dietary screening tool (NiDST) on patient-clinician communication and barriers to and facilitators of implementation. A mixed methods approach was used to collect data from patients (n = 151) and clinicians (n = 20) from outpatient clinics in Nigeria. Patients completed the validated 25-item NiDST prior to outpatient consultations. Both patients and clinicians completed the Measurement Instrument for Determinants of Innovations (MIDI) questionnaire to assess implementation determinants post-consultation. Semi-structured interviews were conducted for in-depth feedback. The fidelity of implementation was 92% for NiDST-reported dietary discussion, with a mean completion time of <6 min and an accepted marginal increase in consultation time (<10 min). For clinicians, 25% reported time constraints and their additional nutritional knowledge as barriers, while facilitators of NiDST implementation were the clarity and completeness of the NiDST, clinical relevance and improved patient-clinician communication, as reported by all the clinicians. Over 96% of patients reported the NiDST as quick to complete, with 90.7% reporting self-reflection on dietary intake. This study demonstrated the NiDST's potential to enhance patient-clinician communication and highlighted major facilitators of implementation in clinical practice to improve dietary discussion in Nigeria.

Machine learning algorithms to the early diagnosis of fetal alcohol spectrum disorders

Introduction

Fetal alcohol spectrum disorders include a variety of physical and neurocognitive disorders caused by prenatal alcohol exposure. Although their overall prevalence is around 0.77%, FASD remains underdiagnosed and little known, partly due to the complexity of their diagnosis, which shares some symptoms with other pathologies such as autism spectrum, depression or hyperactivity disorders.

Methods

This study included 73 control and 158 patients diagnosed with FASD. Variables selected were based on IOM classification from 2016, including sociodemographic, clinical, and psychological characteristics. Statistical analysis included Kruskal-Wallis test for quantitative factors, Chi-square test for qualitative variables, and Machine Learning (ML) algorithms for predictions.

Results

This study explores the application ML in diagnosing FASD and its subtypes: Fetal Alcohol Syndrome (FAS), partial FAS (pFAS), and Alcohol-Related Neurodevelopmental Disorder (ARND). ML constructed a profile for FASD based on socio-demographic, clinical, and psychological data from children with FASD compared to a control group. Random Forest (RF) model was the most efficient for predicting FASD, achieving the highest metrics in accuracy (0.92), precision (0.96), sensitivity (0.92), F1 Score (0.94), specificity (0.92), and AUC (0.92). For FAS, XGBoost model obtained the highest accuracy (0.94), precision (0.91), sensitivity (0.91), F1 Score (0.91), specificity (0.96), and AUC (0.93). In the case of pFAS, RF model showed its effectiveness, with high levels of accuracy (0.90), precision (0.86), sensitivity (0.96), F1 Score (0.91), specificity (0.83), and AUC (0.90). For ARND, RF model obtained the best levels of accuracy (0.87), precision (0.76), sensitivity (0.93), F1 Score (0.84), specificity (0.83), and AUC (0.88). Our study identified key variables for efficient FASD screening, including traditional clinical characteristics like maternal alcohol consumption, lip-philtrum, microcephaly, height and weight impairment, as well as neuropsychological variables such as the Working Memory Index (WMI), aggressive behavior, IQ, somatic complaints, and depressive problems.

Discussion

Our findings emphasize the importance of ML analyses for early diagnoses of FASD, allowing a better understanding of FASD subtypes to potentially improve clinical practice and avoid misdiagnosis.

Effect of Heated Saline Solution on Pain Intensity, Wound Bed Temperature, and Comfort during Chronic Wound Dressing Changes: Crossover Randomized Clinical Trial

OBJECTIVE

To evaluate the use of heated saline solution during wound cleaning on the intensity of pain related to the procedure, the temperature of the wound bed, and the comfort of patients with chronic wounds. Further, to investigate patient preference in relation to the temperature of the solution used for cleaning.

METHODS

Crossover, single-blind, clinical trial with 32 people with chronic wounds. Providers cleaned the wounds with room temperature and heated saline solution. Participants were randomized into group 1 A/B (heated solution first, room temperature second) or group 2 B/A (room temperature solution first, heated solution second), with a 10-minute washout period. Investigators evaluated pain intensity, wound bed temperature, and patient-reported comfort and preference.

RESULTS

The heated solution was preferred (P = .04) and more often referred to as comfortable (P = .04) by the participants. There was no difference in pain intensity before and after cleaning with room temperature (2.03; P = .155) and heated saline (2.25; P = .44). The heated solution increased the temperature of the wound bed by 0.5 °C.

CONCLUSIONS

Although heating saline solution could be an important comfort measure during dressing changes, quantitatively, the temperature of the solution did not significantly change the temperature of the wound bed nor the intensity of pain patients experienced.

Empowering healthcare professionals in West Africa-A feasibility study and qualitative assessment of a dietary screening tool to identify adults at high risk of hypertension

Dietary risks significantly contribute to hypertension in West Africa. Food frequency questionnaires (FFQs) can provide valuable dietary assessment but require rigorous validation and careful design to facilitate usability. This study assessed the feasibility and interest of a dietary screening tool for identifying adults at high risk of hypertension in Nigeria. Fifty-eight (58) consenting adult patients with hypertension and their caregivers and 35 healthcare professionals from a single-centre Nigerian hospital were recruited to complete a 27-item FFQ at two-time points and three 24-hour recalls for comparison in a mixed method study employing both quantitative questionnaires and qualitative techniques to elicit free form text. Data analyses were conducted using R software version 4.3.1 and NVivo version 14. The trial was registered with ClinicalTrials.gov: NCT05973760. The mean age of patients was 42.6 ± 11.9 years, with an average SBP of 140.3 ± 29.8 mmHg and a BMI of 29.5 ± 7.1 Kg/m2. The adherence rate was 87.9%, and the mean completion time was 7:37 minutes. 96.6% of patients found the FFQ easy to complete, comprehensive, and valuable. A minority reported difficulty (3.4%), discomfort (10.3%), and proposed additional foods (6.9%). Healthcare professionals considered the dietary screening tool very important (82.9%) and expressed a willingness to adopt the tool, with some suggestions for clarification. Patients and healthcare professionals found the screening tool favourable for dietary counselling in hypertension care. The tailored dietary screening tool (FFQ) demonstrated promising feasibility for integration into clinical care as assessed by patients and healthcare professionals. Successful implementation may benefit from proactive time management and addressing training needs. This user-centred approach provided key insights to refine FFQ and set the foundation for ongoing validity testing and evaluation in clinical practice.

Dietary assessment and prevention of hypertension in Nigeria: Protocol for a retrospective cross-sectional study for the development and validation of a food frequency questionnaire for clinical use

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. With a transition from whole foods to processed foods in Nigeria, diet plays a key driver of hypertension. To combat this, the national nutritional guidelines in Nigeria were implemented, but their translation into actionable tools for clinicians remains a challenge. Currently, there are no simple dietary assessment tools that are concise and suitable to be incorporated into clinical care without requiring extensive data analysis while still providing personalised dietary support to their patients. This study aims to deliver a clinically tested and validated short dietary assessment tool for clinicians, patients, and researchers across Nigeria to provide personalised dietary advice for patients with hypertension. The study will be conducted in two phases: Phase 1 (n = 75) will investigate the feasibility of the short FFQ and its agreement with 24-hour dietary recalls (3x) in a clinical setting in Nigeria. During the analysis of Phase 1 data, a scoring system will be developed based on the associations between individual food items in the FFQ and measures of hypertension. Phase 2 (n = 50) will assess the acceptability of the FFQ and validate the association between the FFQ score and hypertension. Expected outcomes: The development of a clinically tested and validated short food frequency questionnaire that will be ready to use by clinicians, patients, and researchers across Nigeria to support the prevention and management of hypertension. This study will contribute to knowledge on dietary assessment and hypertension prevention by developing a validated and acceptable FFQ, which will be valuable for clinicians and researchers for personalised dietary recommendations to combat hypertension in Nigeria.

The effect of manual therapy on diaphragm function in adults with asthma: Protocol for a randomized controlled trial

Background

Diaphragm dysfunction is prevalent among individuals with asthma due to lung hyperinflation and hyperventilation in asthma paroxysm. This study was designed to evaluate the effect of the manual diaphragm release technique (MDRT) on diaphragm function in individuals with asthma.

Methods

Adults with diagnosed stable asthma (n = 24), will be recruited from the General Hospital of Kifissia "Agioi Anargyroi" in Athens, Greece. The volunteers who meet the inclusion criteria will be randomly allocated to two groups: (a) the experimental group (n = 12) that will receive 12 sessions of MDRT in conjunction with breathing retraining exercises (BRE), and (b) the control group (n = 12) that will receive 12 sessions of BRE. Measurements will occur at three time points: before the initiation of treatment sessions (week 0), followed by 12 treatment sessions (week 6), and three months from the beginning of the trial (week 12). The main outcomes will be the diaphragm excursion (ultrasonography) and chest expansion (inch tape), with secondary outcomes the maximal respiratory pressures (digital pressure manometer), dysfunctional breathing (Nijmegen questionnaire), asthma control (ACT), dyspnea (Borg scale) and quality of life (SF-12v2).

Discussion

The proposed protocol is the first to examine the effectiveness of MRDT on diaphragm's function in individuals with asthma. Manual Therapy (MT) is a low-cost alternative and supplementary therapy to standard treatment procedures that might improve the biomechanics of respiration in pulmonary rehabilitation.

Trial Registration

Registered on Clinical Trials.gov (ID: NCT05709054).

Protocol version

29/09/2023.

A Simple Guide to Randomized Controlled Trials

Randomized controlled trials represent the cornerstone for the regulatory approval of drugs and evidence-based medicine and policy. Compared with observational studies random assignment of participants to each study arm guarantees an equal distribution of potential confounders thus achieving impartiality in the evaluation of between group differences and allowing for causal inferences to be drawn. These complex and costly medical experiments are tightly regulated and require substantial planning with great attention to several methodological aspects ranging from allocation concealment and blinding to sample size estimation, statistical analysis, and handling of protocol deviations. This brief guide offers useful insights into the design, conduct, and interpretation of clinical trial findings for beginners.

Effect of three modalities on emergence agitation among post-traumatic stress disorder patients undergoing laparoscopy: a randomized controlled study

BACKGROUND AND AIM

Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls.

METHODS

This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05.

RESULTS

Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation-agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 - 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932-1536.448), p<0.001) and group 3 was protected against agitation.

CONCLUSION

Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.

Effects of Experiential Learning Program of Community Health Workers on Health Literacy and Preventive Behaviors of Emerging Infectious Diseases and Re-Emerging Infectious Diseases of Respiratory System

INTRODUCTION/OBJECTIVE

Community health workers (CHWs) can be extremely important in many facets of healthcare, especially for marginalized communities. Health Literacy and Preventive Behaviors of Emerging Infectious Diseases and Re-emerging Infectious Diseases of the Respiratory System were important for CHWs in Preventing and Control Diseases.

METHODS

This quasi-experimental research; a 2 pretest-post group design, aimed to investigate the result of the experiential learning program of the CHWs toward health literacy and preventive behaviors of the infection of emerging and re-emerging diseases of the respiratory system. The samples are 66 CHWs working in Ngao District, Lampang Province which were divided into 2 groups; the experimental and control groups, 33 subjects for each group. The tools used in this research consisted of an experiential learning program for 6 weeks and a questionnaire concerning health literacy and preventive behaviors of emerging and re-emerging diseases in the respiratory system.

RESULTS

The experimental group had the mean score of health literacy regarding the prevention of emerging and re-emerging diseases of the respiratory system at the highest level (X ¯  = 4.52, SD = 0.16) which was higher than before receiving the program which was a high level (X ¯  = 3.61, SD = 0.32) at the significant level of P < .001 while the preventive behavior concerning the emerging and re-emerging diseases in the respiratory system was at the highest level (X ¯  = 4.63, SD = 0.41)and higher than the control group which was at a high level (X ¯  = 4.36, SD = 0.50) at the significant level of P < .001.

CONCLUSIONS

The research results could be a guideline for developing the CHW's potential effectively and proficiently.

Clinical trial designs and endpoints

Trials should be designed with consideration of the individual disease context and research question. Many different approaches may be justified. In this chapter, we therefore consider some of the principal components of trial design in general and within the context of the emerging field of gene and cell therapies. Many aspects of developing a trial protocol require striking a balance between scientific rigor and practicalities for which the voice of patients and their families should form an integral part. We outline the importance of the acceptability of trial designs to participants, the determination of a target population and eligibility criteria, stratification methods that ensure a balanced control of variance across the trial, adequate controls to answer research questions including considerations of placebo allocation, blinding, and endpoints.

A randomised, double-blind, comparative study of preoperative magnesium sulphate versus zinc sulphate gargle for prevention of postoperative sore throat following endotracheal intubation

Background and Aims

Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h.

Methods

After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data.

Results

The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5-23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2-37.7) in contrast to 13.6% (95% CI 3.5-23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively.

Conclusion

Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle.

Efficacy and safety of traditional Chinese medicine for cancer-related fatigue: a systematic literature review of randomized controlled trials

BACKGROUND

Cancer-related fatigue (CRF) is an extremely common and long-term condition that affects the physical and mental health of oncology patients. While the treatment for CRF with western medicine and non-pharmacological therapy remains uncertain and challenging, traditional Chinese medicine (TCM) has become a trending option for the patients. Based on the findings from randomized controlled trials (RCTs), this study aims to identify and evaluate the evidence about the efficacy and safety of TCM for CRF.

METHODS

A systematic literature search was conducted according to the PRISMA literature research guidelines. Seven electronic databases including PubMed, the Cochrane Library, Embase, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI) and Wanfang database were searched to identify RCTs which investigated TCM in the treatment of CRF published since inception to December 2022. RCTs comparing TCM with no treatment, placebo, or pharmacological interventions were considered eligible for this review. The Consolidated Standards of Reporting Trials Statement extensions for Chinese herbal medicine Formulas (CONSORT-CHM) and the Cochrane Collaboration's Risk of Bias tool were used in this review to evaluate the quality and the risk of bias of all included trials.

RESULTS

A total of 82 RCTs were included in this review, regardless of whether they were published in English or Chinese. After data extraction and results evaluation, 78 trials demonstrated overall efficacy in using TCM for CRF patients compared with the control group, in which 33 trials showed that the efficacy rate was statistically significant (p < 0.05 or p < 0.01). TCM was also shown to be beneficial in improving the scores of relevant scales (e.g., PFS, QoL, TCM syndrome score, other fatigue scales etc.) or physical tests indicators (e.g., cytokines, blood test etc.). The most common herbs found in Chinese medicine were Astragali Radix, Ginseng Radix and Codonopsis Radix. Some TCM products, such as Kangai Injection, Buzhong Yiqi Decoction and Shenqi Fuzheng Injection could provide a reference for medication in this review. A range of non-serious, reversible adverse effects associated with the use of TCM was also reported. However, the result of evaluation showed that none of the trials fully met all the CONSORT-CHM criteria, the quality of included trials was generally poor and the risk of bias was mostly uncertain.

CONCLUSION

There is some evidence supporting the efficacy and safety of TCM in managing CRF in this systematic review. However, no clear conclusion can be made due to the inadequate reporting of efficacy and adverse reactions. In view of some concerns about the existing evidence after the evaluation, it is essential to standardize the comprehensive identification and efficacy measurement standards, improve the quality of RCTs and conduct more multicomponent therapies to provide an updated reference for CRF patients medication in the future. The protocol of this systematic review has been registered on PROSPERO (CRD42023413625). [ https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023413625 ].

Protective effect and possible mechanisms of resveratrol in animal models of osteoporosis: A preclinical systematic review and meta-analysis

Resveratrol (RES) has extensively been utilized to treat osteoporosis (OP) in animal models. However, the anti-OP effects of RES have not been tested during clinical application due to the lack of evidence and poor knowledge of the underlying mechanisms. Moreover, there is little preclinical evidence to support the use of RES in the management of OP. In the present paper, we conducted a preclinical systematic review and meta-analysis to assess the efficacy of RES in animal OP models. The potential mechanisms underlying the efficacy of RES against OP were summarized. The online databases PubMed, CNKI, EMBASE, Wanfang, Web of Science, Chinese Biomedical Literature, Cochrane Library, and Chinese VIP were retrieved from inception to December 2021. The CAMARADES 10-item quality checklist was utilized to assess the risk of bias of the included studies. STATA 12.0 software was employed to analyze the data. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Thirteen studies containing 248 animals were included yielding a mean risk of bias score of 5.54 (range 4-7). The pooled estimates showed that the administration of RES could significantly elevate the bone mineral density (BMD) both at femur (SMD = 2.536; 95% CI = 1.950-3.122; p < 0.001) and lumbar spine (SMD = 1.363; 95% CI = 0894-1.832; p < 0.001), bone volume over total volume (BV/TV) (SMD = 2.543; 95% CI = 2.023-3.062; p < 0.001), trabecular linear density (Tb.N) (SMD = 2.724; 95% CI = 2.186-3.262; p < 0.001) and trabecular thickness (Tb.Th) (SMD = 1.745; 95% CI = 1.294-2.196; p < 0.001), while serum phosphorus (S-P) (SMD = -2.168; 95% CI = -2.753 to -1.583; p < 0.001) and trabecular separation (Tb.Sp) (SMD = -2.856; 95% CI = -4.218 to -1.494; p < 0.001) were significantly reduced in animal OP models. No significant change in serum calcium (S-Ca) (SMD = -2.448; 95% CI = -5.255-0.360; p = 0.087) was observed after RES treatment. Furthermore, RES could significantly improve the bone biomechanical indexes: bone maximum load (BML) (SMD = 2.563; 95% CI = 1.827-3.299; p < 0.001) and connectivity density (Conn.D) (SMD = 1.512; 95% CI = 0.909-2.116; p < 0.001) and decrease the structural model index (SMI) (SMD = -2.522; 95% CI = -3.243 to -1.801; p < 0.001). Overall, the present study revealed that RES has huge prospects as a medicine or dietary supplement for the clinical treatment of OP. High-quality studies with stringent designs and larger sample sizes are warranted to substantiate our conclusion.

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial)

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

Dose escalation randomised study of efmarodocokin alfa in healthy volunteers and patients with ulcerative colitis

BACKGROUND

The interleukin-22 cytokine (IL-22) has demonstrated efficacy in preclinical colitis models with non-immunosuppressive mechanism of action. Efmarodocokin alfa (UTTR1147A) is a fusion protein agonist that links IL-22 to the crystallisable fragment (Fc) of human IgG4 for improved pharmacokinetic characteristics, but with a mutation to minimise Fc effector functions.

METHODS

This randomised, phase 1b study evaluated the safety, tolerability, pharmacokinetics and pharmacodynamics of repeat intravenous dosing of efmarodocokin alfa in healthy volunteers (HVs; n=32) and patients with ulcerative colitis (n=24) at 30-90 µg/kg doses given once every 2 weeks or monthly (every 4 weeks) for 12 weeks (6:2 active:placebo per cohort).

RESULTS

The most common adverse events (AEs) were on-target, reversible, dermatological effects (dry skin, erythema and pruritus). Dose-limiting non-serious dermatological AEs (severe dry skin, erythema, exfoliation and discomfort) were seen at 90 μg/kg once every 2 weeks (HVs, n=2; patients, n=1). Pharmacokinetics were generally dose-proportional across the dose levels, but patients demonstrated lower drug exposures relative to HVs at the same dose. IL-22 serum biomarkers and IL-22-responsive genes in colon biopsies were induced with active treatment, and microbiota composition changed consistent with a reversal in baseline dysbiosis. As a phase 1b study, efficacy endpoints were exploratory only. Clinical response was observed in 7/18 active-treated and 1/6 placebo-treated patients; clinical remission was observed in 5/18 active-treated and 0/6 placebo-treated patients.

CONCLUSION

Efmarodocokin alfa had an adequate safety and pharmacokinetic profile in HVs and patients. Biomarker data confirmed IL-22R pathway activation in the colonic epithelium. Results support further investigation of this non-immunosuppressive potential inflammatory bowel disease therapeutic.

TRIAL REGISTRATION NUMBER

NCT02749630.

Knowledge, attitude, and practice of medication therapy management: a national survey among pharmacists in Indonesia

Introduction

The use of medication therapy management (MTM) is a proven method for reducing medication errors. MTM services rely heavily on pharmacists as service providers, particularly in community health centers (CHCs). Thus, understanding the knowledge, attitudes, and practices (KAP) of MTM among pharmacists in CHCs is crucial to the strategy for the implementation of MTM program in Indonesia. This study aimed to assess the level of KAP regarding MTM among pharmacists working at CHCs and its associated factors and investigate pharmacists' perceptions of the barriers and facilitators of MTM provision in the future.

Methods

A cross-sectional online survey was conducted. The respondents were pharmacists working at CHCs in 28 provinces in Indonesia. Descriptive statistics were used to summarize the responses. Demographic differences were determined using Chi-square and Kruskal-Wallis tests, and associations were identified using multivariable ordinal regression for knowledge and multivariable logistic regression for attitude and practice. Barriers and facilitators were determined from codes and categories of frequency derived from pharmacists' responses to the open-ended questions.

Results

Of the 1,132 pharmacists, 74.9% had a high level of knowledge, 53.6% had a positive attitude, and 57.9% had a positive practice toward MTM. Gender, practice settings, province of CHCs, years of practice, and experience in MTM services were factors associated with the KAP level. Respondents perceived that the chronic disease conditions in Indonesia, MTM service features, and current practices were facilitators of MTM provision. The lack of interprofessional collaboration, staff, pharmacist knowledge, patient cooperation, facilities/drug supply/documentation systems, stakeholder support, and patient compliance were the most common barriers to MTM implementation in the future.

Conclusion

Most of the pharmacists had high knowledge of MTM; however, only half had positive attitudes and practices toward MTM. Information about factors associated with the KAP level suggests that direct involvement is essential to improve pharmacists' understanding and view of MTM. Pharmacists also perceived barriers to the MTM provision in the future, such as interprofessional and pharmacist-patient relationships. A training program is needed to improve the KAP of MTM and develop skills for collaborating with other healthcare professionals and communicating with patients.

Recent advances in dosage form design for the elderly: a review

INTRODUCTION

With the increase in the elderly population and the prevalence of multiple medical conditions, medication adherence, and efficacy have become crucial for the effective management of their health. The aging population faces unique challenges that need to be addressed through advancements in drug delivery systems and formulation technologies.

AREAS COVERED

The current review highlights the recent advances in dosage form design for older individuals, with consideration of their specific physiological and cognitive changes. Various dosage forms, such as modified-release tablets/capsules, chewable tablets, and transdermal patches, can be tailored to meet the specific needs of elderly patients. Advancements in drug delivery systems, such as nanotherapeutics, additive manufacturing (three-dimensional printing), and drug-food combinations, improve drug delivery and efficacy and overcome challenges, such as dysphagia and medication adherence.

EXPERT OPINION

Regulatory guidelines and considerations are crucial in ensuring the safe utilization of medications among older adults. Important factors to consider include geriatric-specific guidelines, safety considerations, labeling requirements, clinical trial considerations, and adherence and accessibility considerations.

Comparison of Masticatory Efficiency and Patient Satisfaction of Injection-Molded Conventional Complete Dentures and Biofunctional Prosthetic System Dentures: A Parallel Randomized Clinical Trial

Introduction Complete loss of natural teeth severely compromises the masticatory efficiency of geriatric patients and directly affects their general health. Biofunctional prosthetic system (BPS) has been developed as an alternate method of denture fabrication to match the higher expectations of patients. Studies comparing BPS dentures with injection-molded conventional complete dentures (IM-CCD) are lacking. Our study aimed to compare the masticatory efficiency and patient satisfaction of BPS dentures with IM-CCD. Methods This trial was designed as a randomized, prospective, single-center, double-blinded study with two parallel arms (BPS group and IM-CCD group) having an equal allocation (1:1). Completely edentulous patients aged 45-80 who visited our outpatient department between January and August 2018 were screened and enrolled according to our inclusion and exclusion criteria. Random sequence generation was done using an online randomization program. Allocation concealment was done using sequentially labeled opaque envelopes. The participants and the outcome assessors were blinded. A single operator performed all the clinical procedures in both groups under the guidance of the instructor. The age and gender of the patients were recorded for demographic data at baseline. Primary outcomes were assessed six weeks after denture insertion. The number of denture adjustments required during the first six weeks after denture delivery was recorded as the secondary outcome. Masticatory efficiency was evaluated by the volumetric single-sieve method. An abbreviated version of the Oral Health Impact Profile questionnaire for edentulous patients (OHIP-EDENT) was used for patient satisfaction scores. The total OHIP-EDENT score was calculated by adding all the responses to the 19 questions (ranging from 0 to 38). Individual domain scores were calculated by adding the response to all the questions in that domain. All the data obtained were tested for normality using the Kolmogorov-Smirnov test. Data were analyzed using either unpaired Student's T-test or Mann-Whitney U test for normal and non-normal data, respectively. The gender characteristics of the sample were compared using Chi-Square test. Results Two patients in the IM-CCD group and one patient in the BPS group were lost to follow-up. Hence only the secondary outcome data were analyzed for these patients. Primary outcome data of patients who were lost to follow-up were excluded from the analysis. No significant differences (p>0.05) were found between the two groups for age and gender characteristics of the samples. Masticatory efficiency for both peanut and carrot was found to be significantly higher (p<0.05) in the BPS group than in the IM-CCD group. No significant differences (p>0.05) in the mean scores were observed between the two groups for total OHIP-EDENT scores or the individual domain scores. No significant differences (p>0.05) were observed between the groups for the number of denture adjustments done. Conclusion Within the limitations of the trial, it can be concluded that the BPS dentures significantly improved the masticatory efficiency for both hard (carrots) and soft (peanuts) foods compared to the IM-CCD. However, there was no difference between the masticatory-related complaints domain scores between the two dentures. No significant differences were found between BPS dentures and IM-CCD with respect to overall patient satisfaction scores or post-insertion denture adjustments.

Evaluate the Effectiveness of a Group Psychoeducational Intervention in Reducing the Level of Cancer-Related Fatigue in Women Receiving Chemotherapy for Breast Cancer: A Randomized Controlled Trial

Background

One of the most debilitating symptoms in breast cancer survivors is cancer-related fatigue (CRF). CRF weakens patients' physical, cognitive, and occupational functions. It is associated with poorer quality of life and may reduce recurrence-free and overall survival. This study aimed to evaluate the efficacy of a group psychoeducational intervention in improving CRF in breast cancer patients.

Materials and Methods

Fifty breast cancer patients who suffered from CRF were randomly assigned to receive a group psychoeducational intervention or control group. This study was designed as an eight weeks clinical trial. The psychoeducational intervention mainly consisted of concentrative movement therapy and energy conservation strategies. Primary outcome measures were the changes in the Fatigue Visual Analogue scale, Cancer Fatigue scale, and Piper Fatigue scale at the study endpoint. Measure assessments were made on four occasions: at baseline, after the intervention, one week, and four weeks post intervention. Statistical analysis was performed using SPSS26.

Results

The intervention improved CRF significantly (P < 0.001). All subscales of the Cancer Fatigue scale and the sensory, affective, and cognitive subscales of the Piper Fatigue scale showed statistically significant effects (P < 0.001) at all time points. However, the behavioral subscale of the Piper Fatigue scale was different only at the end of the study (P < 0.001).

Conclusions

The group psychoeducational intervention improved CRF significantly. All the sensory, behavioral, physical, affective, and cognitive subscales improved. Accessible and confirmatory treatment can help patients to cope with fatigue in communities.

Outcomes of a QST Protocol in Healthy Subjects and Chronic Pain Patients: A Controlled Clinical Trial

Chronic pain is an important cause of disability with a high burden to society. Quantitative sensory testing (QST) is a noninvasive multimodal method used to discriminate the function of nerve fibers. The aim of this study is to propose a new, reproducible, and less time-consuming thermal QST protocol to help characterize and monitor pain. Additionally, this study also compared QST outcomes between healthy and chronic pain subjects. Forty healthy young/adult medical students and fifty adult/elderly chronic pain patients were evaluated in individual sessions including pain history, followed by QST assessments divided into three proposed tests: pain threshold, suprathreshold, and tonic pain. In the chronic pain group, a significantly higher pain threshold (hypoesthesia) and a higher pain sensibility (hyperalgesia) were demonstrated at threshold temperature when compared to healthy participants. The sensitivity to the suprathreshold and tonic stimulus did not prove to be significantly different between both groups. The main results demonstrated that the heat threshold QST tests can be helpful in evaluating hypoesthesia and that the sensitivity threshold temperature test can demonstrate hyperalgesia in individuals with chronic pain. In conclusion, this study demonstrates the importance of using tools such as QST as a complement to detect changes in several pain dimensions.

Oral application of magnesium-L-threonate enhances analgesia and reduces the dosage of opioids needed in advanced cancer patients-A randomized, double-blind, placebo-controlled trial

PURPOSE

To investigate the effects of oral administration of magnesium-L-threonate, a novel magnesium compound, on the analgesic effect of opioids in patients with advanced cancer.

METHODS

We performed a prospective, randomized, double-blind trial at a tertiary hospital in Shanghai, China. Eligible cancer patients who took opioids orally were assigned randomly to receive L-TAMS capsules (1.5 g or 2.0 g according to weight) or a placebo (starch capsules). The primary outcome was the increase in the daily oral dose of morphine in each of the two groups, measured at 7, 14, 21, 30, 60, and 90 days during this trial.

RESULTS

A total of 116 patients from the oncology and pain departments, including inpatients and outpatients, were screened; 83 were enrolled. The increases in daily morphine doses began to differ from day 30 (L-TAMS group 9.85 mg/d vs. Placebo group 20.49 mg/d, p < 0.05); the differences persisted on day 60 (L-TAMS group 15.96 mg/d vs. Placebo group 29.06 mg/d, p < 0.05) and on day 90 (L-TAMS group 21.20 mg/d vs. Placebo group 40.44 mg/d, p < 0.01).

CONCLUSIONS

L-TAMS outperforms a placebo in enhancing the analgesic effect of opioids and reducing the necessary opioid dosage. Moreover, L-TAMS can significantly relieve opioid-induced constipation. These advantages may be beneficial to patients with advanced cancer.

Community Health Workers as Patient-Site Facilitators in Adult Hearing Aid Services via Synchronous Teleaudiology: Feasibility Results from the Conexiones Randomized Controlled Trial

OBJECTIVES

The purpose of this study was to investigate the feasibility of Community Health Workers (CHWs) as patient-site facilitators in teleaudiology-facilitated hearing aid services to improve hearing aid rehabilitation outcomes for older Hispanic/Latino adults in a medically underserved, rural, US-Mexico border community.

DESIGN

A total of 28 adults (aged 55 to 89) with bilateral hearing loss participated in this study. Individuals were randomized to one of two teleaudiology intervention arms that differed at the level of the patient-site facilitator. Participants in the experimental group were assisted locally by trained CHW facilitators. Participants in the control group were assisted locally by trained university student facilitators. Synchronous (real-time) teleaudiology hearing aid services took place with participants located at a rural community health center and the clinician located a university 70 miles away. The results of this feasibility study are presented within the reach, effectiveness, adoption, implementation fidelity, and maintenance implementation framework.

RESULTS

Regarding reach, the participants in this study population are historically under-represented in research (primarily low-income Hispanic/Latino older adults). A total of 57 individuals were recruited, 47 were consented and assessed for eligibility and 28 individuals met inclusion criteria and were randomized. The average age of participants was 73.9 years, (range: 55 to 89 years) and most individuals were female (75%). Most participants (86%) reported having incomes less than $20,000 annually. Effectiveness results (via the Self Efficacy for Situational Communication Management Questionnaire) showed that both groups (CHW and control) significantly improved listening self-efficacy from pre-fitting baseline and no difference between groups was observed. Regarding datalogging, at the short-term follow-up, participants in the CHW group wore their hearing aids for more hours/day on average compared with participants in the control group. Implementation fidelity was high for both groups. Long-term maintenance of CHW-supported teleaudiology appears feasible given that training and institutional support is in place.

CONCLUSIONS

Teleaudiology-delivered hearing aid services were feasible when facilitated locally by trained CHWs. Future efficacy and effectiveness research is warranted with CHWs and teleaudiology, potentially leading to a significant reduction in barriers for rural and medically under-resourced communities.

The effect of treadmill walk with abdominal bracing versus usual care on functional limitation and fear-avoidance behaviours in the management of non-specific low back pain—a randomized control study

Background

The use of a combined abdominal bracing technique concurrently with treadmill walking exercise seems not to have been widely investigated, The use of either abdominal bracing and treadmill walk as a single individual method of treatment has proven to be of immense benefit in athletic training and amelioration of pain and functional limitation among different age groups suffering from chronic low back pain. Thus, the need to investigate whether the combination of abdominal bracing and treadmill walking would produce greater benefits than when the exercises are carried out in isolation in the management of chronic low back pain patients.

Study design

The study was a randomized control.

Participants

Thirty-three participants who met the inclusion criteria with age from 18 to 65 participated in the study.

Aim

This study aimed to compare the effects of treadmill walk with and without abdominal bracing versus usual care on pain, functional limitation and fear-avoidance behaviours among patients with non-specific chronic low back pain.

Methods

Thirty-three non-specific chronic low back pain (NSCLBP) patients were randomized into three groups treadmill walk without abdominal bracing (TWW), treadmill walk with abdominal bracing (TWAB) and usual care (UC). Interventions were carried out for 6 weeks.

Outcome measure

Pre and post-intervention scores of pain intensity, functional limitation, and fear-avoidance belief were assessed with box numerical pain rating scales, Oswestry disability index and Fear-Avoidance Belief Questionnaire, respectively.

Results

Pre-intervention scores of pain intensity functional disability and fear-avoidance belief did not show significant differences among the groups (P >0.05). Within-group analysis with paired t-test showed that pain intensity and functional limitation were significantly reduced after 6 weeks of intervention among the 3 groups. Fear-avoidance belief recorded statistical reduction among the 2 treadmill procedures (TWAB and TWW) groups (P<0.05) but not in the usual care groups (P>0.05). Participants in the TWW group showed greater improvement than those in TWAB in terms of reduction in pain intensity (24.17±16.49), functional limitation (7.00±5.97, P = 0.001) and fear- avoidance (30.83±17.90, P = 0.003)

Conclusion

Treadmill walk with and without abdominal bracing as well as usual care could be effective in reducing pain. However, treadmill walk without abdominal bracing was more effective in improving back function in terms of reduction in pain intensity, functional limitation (as reported by the Oswestry scale) and reducing fear-avoidance behaviour (as reported by fear-avoidance belief scores).

Trial registration

PACTR, PACTR201910691645076. Registered on 22 October 2019.

Optimizing Drug Response Study Design in Patient-Derived Tumor Xenografts

Patient-derived tumor xenograft (PDX) models were used to evaluate the effectiveness of preclinical anticancer agents. A design using 1 mouse per patient per drug (1 × 1 × 1) was considered practical for large-scale drug efficacy studies. We evaluated modifiable parameters that could increase the statistical power of this design based on our consolidated PDX experiments. Real studies were used as a reference to investigate the relationship between statistical power with treatment effect size, inter-mouse variation, and tumor measurement frequencies. Our results showed that large effect sizes could be detected at a significance level of .2 or .05 under a 1 × 1 × 1 design. We found that the minimum number of mice required to achieve 80% power at an alpha level of .05 under all situations explored was 21 mice per group for a small effect size and 5 mice per group for a medium effect size.

The efficacy and safety of an adapted opioid-free anesthesia regimen versus conventional general anesthesia in gynecological surgery for low-resource settings: a randomized pilot study

INTRODUCTION

There is scarce data on the safety and efficacy of opioid-free anesthesia (OFA), in resource-limited settings due to the non-availability of dexmedetomidine, the reference OFA agent. We aimed to demonstrate the feasibility, efficacy and safety of a practical OFA protocol not containing dexmedetomidine, adapted for low-resource environments in very painful surgeries like gynecological surgery.

METHODS

We conducted a randomized pilot study on ASA I and II women undergoing elective gynecological surgery at a tertiary care hospital in Cameroon. Patients were matched in a ratio of 1:1 into an OFA and a conventional general anesthesia (CGA) group. The OFA protocol entailed the intravenous (IV) magnesium sulfate, lidocaine, ketamine, dexamethasone, propofol, and rocuronium, followed by isoflurane and a continuous infusion of a calibrated mixture of magnesium sulfate, ketamine and clonidine. The CGA protocol was IV dexamethasone, diazepam, fentanyl, propofol, and rocuronium, followed by isoflurane and reinjections of fentanyl propofol and a continuous infusion of normal saline as placebo. The primary endpoints were the success rate of OFA, isoflurane consumption and intraoperative anesthetic complications. The secondary endpoints were postoperative pain intensity, postoperative complications, patient satisfaction assessed using the QoR-40 questionnaire and the financial cost of anesthesia.

RESULTS

We enrolled a total of 36 women undergoing gynecological surgery; 18 in the OFA group and 18 in the CGA group. The success rate of OFA was 100% with significant lesser consumption of isoflurane in the OFA group, no significant intraoperative complication and better intraoperative hemodynamic stability in the OFA group. Postoperatively, compared to the CGA group, the OFA group had statistically significantly less pain during the first 24 h, no morphine consumption for pain relief, had less hypoxemia during the first six hours, less paralytic ileus, less nausea and vomiting, no pruritus and better satisfaction. The mean financial cost of this adapted OFA protocol was statistically significant lesser than that of CGA.

CONCLUSION

This OFA regimen without dexmedetomidine for a low-resource setting has a promising success rate with few perioperative complications including mild intraoperative hemodynamic changes, decrease postoperative complications, pain, and opioid consumption in patients undergoing elective gynecology surgery.

TRIAL REGISTRATION

This study was registered at clinicaltrials.gov on 03/02/2021 under the registration number NCT04737473.

Can Anthocyanins Reduce Delayed Onset Muscle Soreness or Are We Barking Up the Wrong Tree?

Exercise-induced muscular overload can trigger delayed onset muscle soreness (DOMS). DOMS is related to the indiscriminate use of analgesics and nonsteroidal anti-inflammatory drugs without proper guidance, decreased physical exercise adherence and degenerating sports performance, increased risk of injury, and reduced muscle strength and function. Dietary anthocyanins have been extensively studied as potential natural treatments for DOMS, but the indication, dosage, and form of use remain highly variable. Therefore, this review aims to synergize and present evidence relating to the effect of anthocyanins on DOMS in clinical studies. Notably, the results of anthocyanin supplementation for DOMS were found to be inconclusive. The use of protocols with lower anthocyanin doses yielded better results than those with high-dose supplements, suggesting that anthocyanin-rich foods are more accessible as therapeutic tools, leading to the conclusion that these foods could be used to prevent and treat DOMS. However, consumption protocols for this purpose are not yet well established, and the answer is dependent on the methodological quality of future studies.

Music Therapy as a Form of Nonpharmacologic Pain Modulation in Patients with Cancer: A Systematic Review of the Current Literature

Simple Summary

Cancer is a condition that affects millions of people worldwide each year. Treatments include pharmacologic and surgical interventions that can pose great risks to the physical and mental health of patients. The objective of this systematic review is to consolidate the literature surrounding the use of music therapy as a low-risk and effective pain management adjunct to traditional cancer therapy. This analysis reveals that the use of music therapy thus far has provided a nearly unanimous positive effect on cancer patients, with the potential to provide both physical and psychosocial benefits. The apparent adverse effects appear to be negligible, and music therapy should be considered when creating a cancer care plan.

Abstract

Aims and Objectives: To consolidate and summarize the current literature surrounding the use of music therapy as an effective noninvasive adjunct to conventional cancer therapy, especially as a low-risk alternative for pain management and anesthetic use in cancer patients. Background: Current studies have proposed that music therapy may be effective as a noninvasive adjunct to conventional cancer therapy in managing numerous outcomes in cancer patients. However, the findings of these investigations have not been consolidated and analyzed on a large scale. Therefore, focusing a systematic review on the effects of music therapy as an adjunct to conventional cancer therapy would give a better understanding of which intervention approaches are associated with better clinical outcomes for cancer patients. Design: A systematic review. Methods: A review of randomized controlled trials to evaluate the effectiveness of music therapy in physical, cognitive, and psychosocial outcomes for cancer patients alone or in conjunction with standard therapy was implemented. We conducted searches using the PubMed/MEDLINE, CINAHL, and Cochrane Library databases for all articles meeting the search criteria up until the time of article extraction in May, 2022. Only studies published in English were included. Two reviewers independently extracted data on participant and intervention characteristics. The main outcome variables included pain, anxiety, quality of life, mood, sleep disorders, fatigue, heart rate, blood pressure, respiratory rate, and oxygen saturation. Results: Of the 202 initially identified articles, 25 randomized controlled trials met the inclusion criteria for evaluation. Of the 25 studies, 23 (92.0%) reported statistically and clinically significant improvements across the outcome variables. Two of the studies (8.00%) found no significant positive effect from music therapy in any of the aforementioned outcomes variables. Conclusion: Music therapy, both as a standalone treatment and when used in conjunction with other pharmacologic and nonpharmacologic modalities, has a generally beneficial effect across several physiologic and psychosocial aspects of cancer.

CMV and EBV Co-Infection in HIV-Infected Children: Infection Rates and Analysis of Differential Expression of Cytokines in HIV Mono- and HIV-CMV-EBV Co-Infected Groups

(1) Background: CMV and EBV co-infections can affect the HIV disease progression by modulating the immune system. The disease dynamics can differ in HIV-positive adults and children. In Pakistan, HIV is rapidly expanding, especially in children; however, the prevalence of CMV and EBV co-infection and the effect on immune modulation in HIV-positive children are not known. This study aimed to bridge this gap by estimating the rate of active CMV and EBV co-infection in HIV-positive children, followed by the analysis of differential expression of cytokines in HIV mono- and HIV/CMV/EBV co-infected children. (2) Methods: DNA samples from 319 HIV-positive children, previously recruited as part of a study to investigate the HIV outbreak in Larkana, Pakistan, in 2019, were screened for CMV and EBV through qPCR. Subsequently, differences in HIV viral loads and CD4 counts were analyzed between the HIV mono- and HIV/CMV/EBV co-infected groups. The RNA samples were used to determine the differential expression of both pro- and anti-inflammatory cytokines in the mono- and co-infected groups using RT-qPCR, while unpaired T-test and Pearson correlation test were applied to, respectively, analyze the differential cytokine expression and correlation between cytokine in the two groups. (3) Results: Of 319 samples, the rate of active EBV and CMV co-infection in HIV-positive children was observed in 79.9% and 38.9%, respectively. A significant difference was observed in HIV viral load between HIV mono- and co-infected groups. IFN-γ expression was found to be lower in the HIV mono-infected group, while higher in all other three co-infected groups. Meanwhile, mRNA expression of TGF-β1 was found to be lower in HIV mono- and HIV-CMV-EBV co-infected groups, while higher in HIV-CMV and HIV-EBV co-infected groups. IFN-γ and IL-2 exhibited a significant positive correlation in all except HIV-CMV co-infected group. (4) Conclusions: The study suggests that the presence of EBV/CMV co-infection can affect the HIV viral loads and expression of certain cytokines (IFN-γ and TGF-β1), which may affect the HIV disease dynamics in infected children.

Diagnostic Accuracy for Periprosthetic Joint Infection Does Not Improve by a Combined Use of Glucose and Leukocyte Esterase Strip Reading as Diagnostic Parameters

The diagnosis of periprosthetic infections (PJI) can be challenging in clinical practice because the clinical presentations of aseptic loosening and low-grade infections are similar. Semiquantitative evaluation of leukocyte esterase (LE) in synovial fluid using a urine strip test has already established itself as a diagnostic method over the past decade. The analysis of LE in synovial fluid leads to a high number of false-positive test results. In the present study, the value of a combined semiquantitative determination of glucose and LE in synovial fluid to improve the diagnosis of PJI was investigated. Over a 4-year period, 145 synovial samples were collected from patients who developed joint effusion after arthroplasty. LE and glucose test strips were considered as an index test for the diagnosis of PJI. A ++ or +++ LE and a negative glucose test strip reading were considered as positive test results. Modified diagnostic criteria for PJI as recommended by the Musculoskeletal Infection Society (MSIS) served as the reference test, except that intraoperative findings were excluded. Forty-six out of 145 samples were classified as septic complication according to the reference test. In regard to PJI, our data showed that combined use of LE and glucose strip test reading displayed a 98.0% specificity (95% confidence interval (CI): 95.2% to 100%), a 50% sensitivity (95% CI: 35.6% to 64.4%), a 92% positive predictive value (95% CI: 81.4% to 100.0%), and an 80.3% negative predictive value (95% CI: 73.2% to 87.4%). In contrast, the exclusive analysis of LE on the urine strip to diagnose PJI demonstrated a 90.9% specificity (95% CI: 85.2% to 96.6%), a 67.4% sensitivity (95% CI: 53.8% to 80.9%), a 77.5% positive predictive value (95% CI: 64.6% to 90.4%), and an 85.7% negative predictive value (5% CI: 79.0% to 92.4%). A combination of LE and glucose test pad reading is considered superior as a potential “rule-in” method for the diagnosis of PJI compared with LE test pad analysis alone. However, combined LE and glucose synovial fluid testing also demonstrated lower test sensitivity and thus diagnostic accuracy compared with LE analysis alone. Therefore, combined glucose and LE test pad analysis does not represent a sufficient diagnostic standard to exclude PJI with certainty.

Dental follicle mesenchymal stem cells ameliorated glandular dysfunction in Sjögren's syndrome murine model

OBJECTIVE

Dental mesenchymal stem cells (MSCs) are potential for use in tissue regeneration in inflammatory diseases due to their rapid proliferating, multilineage differentiation, and strong anti-inflammatory features. In the present study, immunoregulatory and glandular tissue regeneration effects of the dental follicle (DF)MSCs in Sjögren's Syndrome (SS) were investigated.

METHODS

Dental follicle (DF) tissues were obtained from healthy individuals during tooth extraction, tissues were digested enzymatically and DFMSCs were cultured until the third passage. DFMSCs were labeled with Quantum dot 655 for cell tracking analysis. The induction of the SS mouse model was performed by the injection of Ro60-273-289 peptide intraperitoneally. DFMSCs were injected intraperitoneally, or into submandibular, or lacrimal glands. Splenocytes were analyzed for intracellular cytokine (IFN-γ, IL-17, IL-10) secretion in T helper cells, lymphocyte proliferation, and B lymphocyte subsets. Histologic analysis was done for submandibular and lacrimal glands with hematoxylin-eosin staining for morphologic examination.

RESULTS

The systemic injection of DFMSCs significantly reduced intracellular IFN-γ and IL-17 secreting CD4+ T cells in splenocytes (p<0.05), and decreased inflammatory cell deposits and fibrosis in the glandular tissues. DFMSCs differentiated to glandular epithelial cells in submandibular and lacrimal injections with a significant reduction in lymphocytic foci. The results showed that few amounts of DFMSCs were deposited in glandular tissues when applied intraperitoneally, while high amounts of DFMSCs were located in glandular tissues and differentiated to glandular epithelial cells when applied locally in SS murine model.

CONCLUSION

DFMSCs have the potential for the regulation of Th1, Th17, and Treg balance in SS, and ameliorate glandular dysfunction. DFMSCs can be a beneficial therapeutic application for SS.