Search Results (6,467)

Obstructive Sleep Apnea afflicts an estimated 1 billion people worldwide. Untreated, Obstructive Sleep Apnea is linked with elevated levels of mortality, decreased quality of life and increased economic costs. However, several large population studies demonstrate that the efficacy of Continuous Positive Airway Pressure therapy, the most frequently prescribed treatment for Obstructive Sleep Apnea, is compromised by frequent refusals and terminations. As a result, healthcare providers are evaluating non-CPAP treatment options. Oral Appliance Therapy has emerged as a leading non-CPAP treatment for patients with Obstructive Sleep Apnea. Historically, healthcare providers have questioned the efficacy of Oral Appliance Therapy. Dozens of Oral Appliances are available to healthcare providers, with many contemporary Oral Appliances featuring improved designs, materials and technologies. This review investigates whether Oral Appliance design matters; do different Oral Appliance designs demonstrate different rates of efficacy? To the best of the authors’ knowledge, this is the first review to exclusively focus on scientific papers that report treatment success with Oral Appliances as a residual Apnea Hypopnea Index of less than 10 events per hour. Out of 272 source papers, the 27 papers included in this review encompass a pooled sample of 3799 patients treated with six distinctly different categories of Oral Appliance designs. Chi-squared and two-sided Fisher’s exact tests indicate significant differences in efficacy amongst Oral Appliance designs. These findings suggest that certain Oral Appliance designs can enable highly efficacious treatment for patients with Obstructive Sleep Apnea. Given these findings, healthcare providers should consider design when selecting an oral device for patients diagnosed with Obstructive Sleep Apnea. Full article

The block-on-ring friction system is one of the more universal methods of measuring the tribological properties of materials, where we are able to compare the properties of different materials using a prescribed counter sample. When preparing for a test, we usually determine the parameters that appear to be optimal for testing a given material for its applications. The question remains whether and how such a choice affects the results obtained. In this paper, tests have been carried out on two commonly used plain bearing alloys, B83 and B89. The T-05 tester used for the tests allows the rotation of the counter sample to be adjusted, and, in this study, this was varied in the range of 50, 100, 150, 200 and 250 rpm. Another parameter variable in the tests was the friction distance, and two distances of 100 and 250 m were used. As the tests were carried out under technically dry friction conditions, it was possible to capture both the effect of the running-in period and the stable friction path. The tests showed that the alloys tested over the longer friction distance of 250 m responded differently to a change in parameters, with alloy B83 showing a sinusoidal variation in wear resistance with a maximum at medium speed, whereas alloy B89 is characterized by a continuous increase in wear with increasing speed. The coefficient of friction is more dependent on speed, and the basic conclusion can be drawn that increasing speed results in a lower coefficient of friction. This research has confirmed the need for the careful selection of test parameters and the difficulty of comparing results when there is even a slight difference in the test parameters used at different test centers. Full article

Background: After the start of the COVID-19 pandemic, general fatigue in patients with long COVID and post-COVID-19 conditions (PCC) became a medical issue. Although there is a lack of evidence-based treatments, Kampo medicine (traditional Japanese medicine) has gained attention in Japan. At an outpatient clinic in Japan specializing in long COVID, 24% of all prescriptions were Kampo medicines, and 72% of Kampo medicine prescriptions were hochuekkito. However, there has been no prospective, quantitative study on the course of fatigue in patients with long COVID and PCC who were prescribed hochuekkito. The aim of this study was to clarify the course of fatigue in those patients. Methods: This study included patients aged 18 years or older with general fatigue who visited the long COVID specialized outpatient clinic at Okayama University Hospital and consented to participate after being prescribed hochuekkito. We reviewed the backgrounds of the patients, and we evaluated the patients’ fatigue assessment scale in person or online. Results: Twenty patients were enrolled in this study from September to December in 2023. The average age of the patients was 42.9 years (SD: 15.8 years) and 12 patients (60%) were female. After hochuekkito administration, the fatigue assessment scale score decreased from 35.9 (SD: 5.9) at the initial visit to 31.2 (SD: 9.4) after 8 weeks, indicating a trend for improvement in fatigue (difference: 4.7; 95% CI: 0.5–8.9). Conclusions: A trend for improvement in fatigue was observed in patients with long COVID and PCC who were prescribed hochuekkito, indicating a potential benefit of hochuekkito for general fatigue in such patients. General fatigue in patients with long COVID or PCC can be classified as post-infectious fatigue syndrome and is considered a condition of qi deficiency in Kampo medicine, for which hochuekkito is appropriately indicated. Full article

Depression and anxiety are two common mental health issues that require serious attention, as they have significant impacts on human well-being, with both being emotionally and physically reflected in the increasing number of suicide cases globally. The World Health Organization (WHO) estimated that about 322 million people around the world experienced mental illnesses in 2017, and this number continues to increase. Cortisol is a major stress-controlled hormone that is regulated by the hypothalamic–pituitary–adrenal (HPA) axis. The HPA axis has three main components, including the hypothalamus, pituitary gland, and adrenal gland, where cortisol, the primary stress hormone, is released. It plays crucial roles in responding to stress, energy balance, and the immune system. The cortisol level in the bloodstream usually increases when stress develops. Molecularly imprinted polymers (MIPs) have been highlighted in terms of creating artificial bioreceptors by mimicking the shape of detected biomolecules, making natural bioreceptor molecules no longer required. MIPs can overcome the limitations of chemicals and physical properties reducing over time and the short-time shelf life of natural bioreceptors. MIPs’ benefits are reflected in their ease of use, high sensitivity, high specificity, reusability, durability, and the lack of requirement for complicated sample preparation before use. Moreover, MIPs incur low costs in manufacturing, giving them a favorable budget for the market with simple utilization. MIPs can be formulated by only three key steps, including formation, the polymerization of functional monomers, and the creation of three-dimensional cavities mimicking the shape and size of targeting molecules. MIPs have a high potential as biosensors, especially working as bioanalytics for protein, anti-body, antigen, or bacteria detection. Herein, this research proposes an MIP-based cortisol biosensor in which cortisol is imprinted on methyl methacrylate (MMA) and methacrylic acid (MAA) produced by UV polymerization. This MIP-based biosensor may be an alternative method with which to detect and monitor the levels of hormones in biological samples such as serum, saliva, or urine due to its rapid detection ability, which would be of benefit for diagnosing depression and anxiety and prescribing treatment. In this study, quantitative detection was performed using an electrochemical technique to measure the changes in electrical signals in different concentrations of a cortisol solution ranging from 0.1 to 1000 pg/mL. The MIP-based biosensor, as derived by calculation, achieved its best detection limit of 1.035 pg/mL with a gold electrode. Tests were also performed on molecules with a similar molecular structure, including Medroxyprogesterone acetate and drospirenone, to ensure the sensitivity and accuracy of the sensors, demonstrating a low sensitivity and low linear response. Full article

Background: Patients with peripheral artery disease (PAD) and diabetes face high risks of comorbidities, tissue loss, and cardiovascular events. As global type 2 diabetes (T2DM) prevalence rises, so does its incidence in symptomatic patients with PAD, though this population is under-studied in Australia. This cross-sectional analysis sought to characterize PAD patients with diabetes regarding prevalence, major complications, medication use, and prescribing patterns, comparing them to non-diabetic PAD patients. We also examined PAD complications in relation to diabetic control. Methods: This cross-sectional study looked at the baseline data from 105 PAD participants in the TEAM-PAD randomized controlled trial that were analyzed using descriptive statistics, prevalence odds ratios and regression analysis. Participants were recruited between June 2023 and August 2024 from public clinics, private surgeons, and Concord Repatriation General Hospital, Sydney. Results: Diabetes prevalence was 52.83% (n = 56) with 29.5% (n = 31) of participants with T2DM having uncontrolled hyperglycemia (HbA1c ≥ 7%), which was weakly negatively correlated with age (r = −0.372, p = 0.039). Participants with T2DM were twice as likely to have a history of coronary artery disease (POR 2.43; 95% with a 95% confidence interval (CI) between 1.09–5.43, and over three times as likely to have tissue loss (POR 3.39; 95% CI 1.22–9.43). The odds of polypharmacy (≥5 medications) were 10 times greater in participants with T2DM (POR 10.8; 95% CI 2.31–50.4), affecting 96.4% of this group. Conclusions: Diabetes prevalence and associated complications were higher than previous estimates, underscoring the challenges in managing diabetes and polypharmacy in participants with PAD. A multidisciplinary approach may improve outcomes. Full article

Introduction: Antibiotic resistance is a major public health problem in Europe. Most antibiotics are sold only by prescription in Poland, and it is mainly up to physicians to decide whether to start antibiotic treatment. Therefore, we analyzed the factors influencing the prescribing of antibiotics for upper respiratory tract infections by primary care physicians in Poland, attitudes toward antibiotic resistance, and knowledge of the principles of antibiotic use. Methods: We conducted a CAWI (Computer-Assisted Web Interview) survey, carried out using a proprietary survey distributed online. Results: A total of 528 doctors participated in the study. The result of the physical examination and additional tests, as well as the recommendations of scientific societies are the most important in deciding whether to start antibiotic therapy. Patient pressure (p < 0.011) and workload (p = 0.021) significantly influenced the decision to prescribe an antibiotic among primary care physicians and physicians in the course of specialization, who fear of legal consequences (p < 0.001). The habits of other physicians (p < 0.001) working at the same facility appeared to be additionally important. Conclusions: The decision to implement antibiotic therapy in upper respiratory tract infections is influenced by several factors that depend on the doctor (including place of work and seniority) and the patient (clinical symptoms, expectation of antibiotic prescription). The physician’s level of knowledge contributes to reducing antibiotic prescribing. Considering the factors associated with the level of knowledge and awareness, together with a high prevalence of self-medication with antibiotics in Polish population, there is a strong need to design educational interventions aimed at reducing inappropriate antibiotic prescribing and preventing antibiotic resistance in Poland. Full article

Background: Narcolepsy impacts both patients and society, yet there is limited data on its socioeconomic consequences. Methods: This retrospective longitudinal cohort study used pseudonymized patient-level data from Swedish registers and included narcolepsy patients from January 2015–December 2019 and age–sex matched controls. All patients received an index date corresponding to their first narcolepsy diagnosis. Results: This study included 466 incident narcolepsy patients and 2330 matched controls. During the years studied, healthcare resource utilization was 2–5 times higher for incident narcolepsy patients compared to matched controls (p < 0.0001). Modafinil, stimulants, and antidepressants were prescribed more often to incident narcolepsy patients (p < 0.0001). Work productivity was significantly impacted, as incident narcolepsy patients took 7.0–10.5 more sick leave days than their matched controls (p < 0.0001) and had an average of 14.8 net days of disability leave (associated with indirect costs of EUR 1630) versus only 5.8 days among matched controls (EUR 638) during the year of the index (p = 0.027). After controlling for age, sex, and the Charlson comorbidity index, the odds of disability leave were 3.3 times higher in incident narcolepsy patients. Conclusions: This study provides evidence of the magnitude of the substantial societal economic burden due to narcolepsy in Sweden, evidenced by higher healthcare resource utilization and indirect costs. Full article

Approximately 2.8 million cases of bacterial antimicrobial resistance (AMR) infections result in over 35,000 deaths annually in the U.S. AMR is driven largely by inappropriate prescribing of antibiotics, especially in clinics serving rural communities or underserved populations. Antibiotic Stewardship Programs (ASPs) improve prescribing practices, but many rural clinics lack fully functional ASPs. This pilot study evaluated the impact of an algorithm-driven protocol on antibiotic prescribing in a rural primary care setting. We conducted a pre–post quasi-experimental study at a Federally Qualified Health Center (FQHC), focusing on upper respiratory infections, urinary tract infections, and sexually transmitted infections. Eligible patients were enrolled in the study during their primary care visits. The primary outcome was the frequency of guideline-concordant treatment, analyzed using descriptive statistics and Chi-square tests. Among 201 patients (101 pre-intervention, 100 post-intervention), the pre-intervention group consisted of 77% females and 47% African Americans, while the post-intervention group consisted of 72% females and 46% African Americans. The intervention was associated with a 12.6% decrease in the number of antibiotic prescriptions discordant with clinical guidelines (37.6% to 25%) from the pre- to post-intervention periods. This corresponded to an odds ratio of 0.55 (95% CI: 0.30–1.01, p = 0.054). Although not statistically significant at α = 0.05, this numerical decrease suggests potential benefits of algorithm-driven protocols in improving antibiotic stewardship in resource-limited settings. Longer study periods may further elucidate these benefits. Full article

Background/Objectives: Despite an improved knowledgebase, effective intervention, and guidelines, many patients with depression do not receive adequate treatment and treatment discontinuation and non-response are common. It was intended to explore the challenges clinicians face while managing depression in their clinical practice and their suggestions for solutions. Methods: It was an online survey of 137 psychiatrists in 18 countries including both high and low economies, using a pre-designed questionnaire; with both quantitative and qualitative measures. Results: Antidepressant prescribing appeared close to the evidence-based guidelines. There was frequent use of other medications alongside antidepressants since treatment initiation. There were many challenges in managing depression, such as treatment non-response, resistance, and discontinuation; side effects, mostly sexual problems; inadequate psychological intervention; availability and affordability of treatment modalities; comorbidities, especially substance use and personality disorders; stigma; and lack of education and training. Suggested approaches for solutions included personalized treatment, quicker follow-up, psychoeducation, blending psychological intervention into routine clinical practice, improving continuity of care, and preventing treatment discontinuation. Support from governments for improving access, making interventions affordable, and providing socio-occupational support is essential. Training and development of professionals, public education providing information, and dealing with stigma are still relevant. Conclusions: The results indicated a need for reviewing current practices in managing depression, optimizing it with available resources, and preventing treatment discontinuation, and non-response. Making treatment available and affordable, public education fighting stigma to improve treatment acceptability, and research addressing gaps in interventions, especially for treatment resistance and psychotherapy are other approaches that may improve depression management. Full article

Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry’s role in misrepresenting opioid risks—leading to over USD 50 billion in legal settlements—has included targeted marketing to vulnerable populations. This study examines Janssen Pharmaceuticals’ “Imagine the Possibilities Pain Coalition” (IPPC), which aimed to increase opioid use among veterans with chronic non-cancer pain. Insights from this public health industry document analysis offer guidance for military medicine and healthcare policymaking. Methods: Using the Opioid Industry Document Archive (OIDA), housed at Johns Hopkins University and the University of California, San Francisco, researchers conducted retrospective content analysis. Documents referencing veterans were identified through keyword searches on Johns Hopkins’ SciServer portal and reviewed using CoCounsel, an AI-based legal document platform using a human-in-the-loop approach. Relevant documents were examined by the authors to extract material aligned with the research focus. Results: The IPPC employed strategies to influence opioid prescribing for veterans. These included educational materials that minimized addiction risks and exaggerated long-term benefits and empathy-driven narratives prioritizing immediate pain relief over potential harms. Ghostwriting ensured favorable perspectives on opioids in scientific literature, aligning with broader industry strategies to promote opioids for chronic pain. Conclusions: The targeted marketing of opioids to veterans has exacerbated the opioid crisis, as documented in government reports and litigation. Rigorous oversight of industry-funded coalitions and evidence-based practices are critical to insulating military healthcare from corporate influence and addressing the opioid crisis among veterans. Full article

Background: On-demand personalized drug production is currently not addressed with large-scale drug manufacturing. In our study, we focused primarily on identifying possible active pharmaceutical ingredients (APIs) for 3D Printing (3DP) in the current healthcare setting. Methods: We conducted a retrospective cross-sectional study in the Netherlands using three different sources; community pharmacies (n = 5), elderly care homes (n = 3), and the Erasmus MC Sophia Children’s Hospital. The primary endpoint was the percentage of prescriptions of medication manipulated before administration, thereby being a candidate for 3DP. Around a million prescriptions were analyzed in our study. Results: This study shows that around 3.0% of the prescribed drugs dispensed by Dutch community pharmacies were manipulated before administration, while around 10.5% of the prescribed drugs in the Erasmus MC Sophia Children’s Hospital were manipulated prior to administration. Conclusions: With our study, we show that the most manipulated drugs come from the groups of constipation, psychopharmaceutical, cardiovascular, and anti-infectant drugs. Successful introduction of a compounded API drug by 3DP does not only rely on the API, but it also comes with an optimal balance between technical, economic as well as societal impact factors. Our study gives direction for potential future research on the introduction of 3DP of medicine in the healthcare setting. Full article

Background: Prader–Willi Syndrome (PWS) is a rare, genetic, multi-systemic disorder. Its main characteristics are muscular hypotonia, behavioral problems, intellectual disability, endocrine deficiencies, hyperphagia, and a high risk of morbid obesity and related comorbidities. This study aimed to investigate the rate of comorbidity, prescription of endocrine medications, and mortality in individuals with PWS compared to the general population. Methods: The association between PWS and outcomes were investigated in a matched cohort study of individuals born in the period of 1930–2018 with data from Swedish national health and welfare registers. Each individual was matched with 50 non-PWS comparisons. The associations between PWS, outcomes and prescribed endocrine medications were estimated through Cox proportional hazard models, presented as Hazard Ratios (HR) with 95% Confidence Intervals (CIs). Results: Among 360 individuals (53% men) with PWS, 16% had diabetes mellitus, 6% heart failure, 4% vein thrombosis, 2% atrial fibrillation, 2% coronary heart disease, and 1% pulmonary embolism. Individuals with PWS had an increased rate of heart failure (HR: 23.85; 95% CI: 14.09–40.38), diabetes mellitus (HR: 17.49; 95% CI: 12.87–23.74), vein thrombosis (HR: 10.44; 95% CI: 5.69–19.13), pulmonary embolism (HR: 5.77; 95% CI: 2.27–14.67), atrial fibrillation (HR: 5.19; 95% CI: 2.48–10.86), and coronary heart disease (HR: 3.46; 95% CI: 1.50–7.97) compared to non-PWS individuals. Somatotropin was prescribed in 63%, antidiabetics in 18%, and thyroid hormones in 16% of the PWS individuals (<1%, 2%, and 3%, respectively, in non-PWS individuals). The rate of mortality was fifteen times higher in PWS than in non-PWS, with a mean age at death of 42 years. Conclusions: The rates of diabetes mellitus and cardiovascular comorbidities were higher in individuals with PWS. As expected, the prescription of somatotropin was high, but the endocrine prescription pattern also reflected the high prevalence of diabetes mellitus and thyroid illness. Although the mean age at death was older than previously reported, a higher awareness and intensified efforts to avoid obesity, as well as the prevention and early treatment of cardiovascular and endocrine comorbidity, are crucial aims in the care of people with PWS. Full article

Most drugs excreted in urine are not filtered by wastewater treatment plants and end up in aquatic systems. At concentrations measured in waters, toxic effects on species have been described. Second, most of the drug consumption is attributable to primary care prescriptions. We thus present here, an ecotoxicity classification of the most sold drugs in primary care in Switzerland. Three datasets were combined: (1) surveyed ecotoxic drugs by the Swiss National Surface Water Quality Monitoring Programme and its European equivalent, (2) the top 50 drugs by sale in primary care in Switzerland, and (3) active pharmaceutical ingredient (API) concentrations in Lake Geneva and the rivers of the canton of Vaud between 2017 and 2022. We classified APIs into five categories from the safest to the least safe: (1) APIs found in concentrations (C) <10× their environmental quality standard (EQS·10⁻¹), (2) EQS·10⁻¹ < C < EQS and not listed by the Swiss or the EU Watch List, (3) EQS·10⁻¹ < C < EQS and listed, (4) C > EQS and not listed, and (5) C > EQS and listed. We obtained full ecotoxicological data for 35 APIs. Fifteen APIs were designated as safe (category (1):paracetamol, tramadol, amisulpride, citalopram, mirtazapine, metformin, gabapentin, lamotrigine, primidone, candesartan, irbesartan, atenolol, hydrochlorothiazide, ofloxacin, sulfadiazine), eleven as intermediately safe, and nine were of concern (azithromycin, ciprofloxacin, clarithromycin, sulfamethoxazole, carbamazepine, diclofenac, ibuprofen, iomeprol, iopromide). Full data were available for only one-third of the drugs most sold in primary care. Where data do exist, we observed significant differences in environmental impact among the same class of drugs. Our classification could therefore help guide doctors to adopt more eco-friendly prescriptions. Full article

Hepatitis C virus (HCV) is a global public health problem, but advancements in HCV treatment have improved the cure rate. This study evaluated the effectiveness of direct-acting antivirals (DAAs) in HCV-infected patients from May 2021 to April 2023 in collaboration with tertiary care hospitals in West Bengal. The HCV viral load was monitored via qRT-PCR. Sanger sequencing was performed to determine the HCV genotypes. The clinicians prescribed the patient treatment regime. The maximum number of patients in the study population (N = 398) were compensated cirrhosis patients (46.28%). The overall SVR rate of the study population was 94.47%. The decompensated cirrhosis patients experienced the lowest SVR rate (88.89%). The maximum number of patients were prescribed sofosbuvir/daclatasvir (63.77%), and the lowest SVR rate (93.23%) was observed with this treatment regime. In the study population, GT-3 was the predominant (67.43%) circulating genotype, followed by GT-1 and -4. Among 398 patients, 22 (5.53%) were non-responsive to DAA treatment. Out of these 22 non-responder patients, 77.27% (n = 17) were GT-3-infected (3a:10; 3b:07), followed by GT-1 (1c: 04; 1b: 01). Thus, increasing numbers of DAA non-responsive cases among HCV GT-3-infected and decompensated cirrhosis patients may pose serious threats in the future. Full article

Background/Objectives: Dermatophytosis due to Trichophyton (T.) indotineae has spread worldwide, and the acquisition of new drug resistances is making this threat challenging to face. We report four cases of dermatophytosis caused by T. indotineae and perform a systematic review of case reports to explore the most relevant clinical and demographic features and the treatment patterns of this infection. Methods: A literature search, using the PubMed database and following PRISMA guidelines, was performed up to the 6th of December 2024. Articles were included if written in English and presented in the form of case reports/series involving human subjects, with detailed information and T. indotineae infection confirmed by internal transcribed spacer sequencing. Results: Initially, 255 records were identified, and 30 articles were finally selected, including 64 patients, mainly from the Asian continent. Most patients were healthy and/or immunocompetent (65.52%), and the mean disease duration suggested long-lasting lesions. At least two different body sites were generally involved, with a predilection for lower body areas (groins included), as also observed in our patients (all from South Asia). Review results indicated itraconazole as the most commonly prescribed final medication. Treatment with itraconazole led to complete remission in three of our patients (one patient was lost to follow-up). Conclusions: T. indotineae infection should be suspected in case of extensive and/or recalcitrant dermatophytosis, especially in patients with a travel history to Asian countries. Further research is needed to develop rapid, inexpensive, and accurate techniques for the identification of T. indotineae and drug-resistant strains and to define the optimal preventive and treatment strategies. Full article