Clinica Terapeutica最新文献

{"title":"The Dossanov Intramedullary Telescopic System in the Treatment of Bone Deformities in Children with Osteogenesis Imperfecta. Real-world evidence studies.","authors":"Bolatbek Dossanov, Altyngul Khassenkyzy, Assem Dossanova, Darko Anticevic, Arman Batpen","doi":"10.7417/CT.2026.2023","DOIUrl":"10.7417/CT.2026.2023","url":null,"abstract":"<p><strong>Objectives: </strong>The study aims to evaluate the effectiveness of the Dossanov telescopic implant in the surgical treatment of children with osteogenesis imperfecta (OI).</p><p><strong>Materials and methods: </strong>A real-world evidence (RWE) retrospective and prospective analysis of the surgical treatment of children with type I, III, and IV OI was performed. Group 1 included 10 patients with OI who had a Dossanov telescopic implant installed (prospective analysis). Group 2 included 12 patients with OI who had a Fassier-Duval telescopic rod installed (retrospective analysis). The average period of postoperative dynamic follow-up was 18-24 months. The average time of bone regeneration for Group 1 was 28.13 ± 1.59 days, while in Group 2, it was 31.47±3.2 days (p = 0.0012).</p><p><strong>Results: </strong>The early rehabilitation period was 1.62±1.69 months in Group 1 and 1.97±1.66 months in Group 2 (p < 0.001). The average length of bone growth was 11.87±3.41 mm in Group 1 and 23.87±5.8 mm in Group 2 (p = 0.0002). During the observation period, participants in neither group had complications. In Group 1, after 6 months, bone growth elongation was noted by 5.3±0.7 mm. In Group 2, the elongation was 5.7±0.6 mm (p=0.05). In the period of 6-12 months, the elongation results reached 4.8±2.5 mm in Group 1 and 6.4±1.12 mm in Group 2 (p=0.04).</p><p><strong>Conclusions: </strong>The Dossanov telescopic system is a modern, reliable, and affordable tool, making it a valuable option for correcting deformities in children with OI.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"414-423"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum KL-6 as an Early Predictor of Bronchopulmonary Dysplasia in Preterm Neonates: A Prospective Cohort Study.","authors":"Walaa H Ali, Hanaa H Ahmed, Neveen A Salem, Heba Ezzat Hashem, Mohamed Agha, Iman Shawky Hassan, Amira A El Gammal, Wafaa O Ahmed","doi":"10.7417/CT.2026.2043","DOIUrl":"10.7417/CT.2026.2043","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bronchopulmonary dysplasia (BPD) is a major respiratory morbidity in preterm infants. Early recognition of neonates at risk is essential to guide management and improve prognosis. Serum Krebs von den Lungen-6 (KL-6), has been identified as a promising marker of alveolar epithelial injury. This study evaluated the diagnostic, prognostic and predictive value of serum KL-6 levels for BPD development in preterm neonates and examined their association with clinical and neonatal characteristics.</p><p><strong>Subjects and methods: </strong>A prospective cohort study was conducted on sixty-five preterm infants, of whom sixty-two completed follow-up and were included in the final analysis. preterm infants ≤32 weeks gestation and ≤1500 g birth weight admitted to the Neonatal Intensive Care Unit at Demerdash Hospital, Ain Shams University, Egypt. Serum KL-6 levels were measured on postnatal Days 7 and 14 using enzyme-linked immunosorbent assay (ELISA). Clinical and perinatal data, including ventilation duration, oxygen therapy and hospitalization length, were recorded. BPD diagnosis followed the National Institute of Child Health and Human Development (NICHD) criteria.</p><p><strong>Results and conclusion: </strong>Neonates who developed BPD exhibited significantly elevated KL-6 levels on both Day 7 (p = 0.005) and Day 14 (p < 0.001), as compared to those who didn't develop BPD, respectively. Among BPD group; An optimal cutoff of 254 U/mL yielded 80.8% sensitivity and 80.6% specificity, on Day 14 evaluation. KL-6 correlated inversely with gestational age and birth weight, but positively with oxygen and ventilation duration. Persistently high KL-6 during the first two weeks strongly predicted BPD, suggesting that recurrent KL-6 assessment offers a valuable, non-invasive tool for early identification of at-risk preterm infants.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"572-583"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Single-Stage Laparoscopic Cholecystectomy Combined with Endoscopic Retrograde Cholangiopancreatography (LC + ERCP) for Concurrent Gallstones: A Single-Center Study.","authors":"Huy Quang Nguyen, Hien Thanh Tran, Toan Khai Dang","doi":"10.7417/CT.2026.2040","DOIUrl":"10.7417/CT.2026.2040","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of patients with concurrent gallbladder and common bile duct (CBD) stones remains a topic of debate, especially in resource-limited settings. Single-stage laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) under the same anesthesia has the potential to lower operative risks, reduce hospital stay, and cut healthcare costs.</p><p><strong>Methods: </strong>A retrospective review was conducted of 374 consecutive patients who underwent single-stage LC + ERCP between January 2018 and December 2024 at 115 People's Hospital in Ho Chi Minh City, Vietnam. Demographic data, perioperative outcomes, operative time, complication rates, and postoperative recovery were analyzed.</p><p><strong>Results: </strong>The mean age was 60 ± 15 years; 59% were female. The mean total operative time was 123 ± 33 minutes, and the average postoperative hospital stay was 2 ± 1 days. Successful CBD stone clearance was achieved in 100% of patients, with 16% requiring temporary biliary stent placement. Postoperative complications occurred in 4% of patients, all mild pancreatitis, with no bile leakage, bleeding, or mortality. ERCP time >45 minutes, CBD diameter <10 mm, and previous ERCP were significantly associated with post-ERCP pancreatitis.</p><p><strong>Conclusion: </strong>Single-stage LC + ERCP for concurrent gallbladder and CBD stones is safe, effective, and feasible in a tertiary Vietnamese hospital setting. The procedure achieved high success and low complication rates, with shortened hospital stay and minimal morbidity.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"549-553"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut-Liver-Pancreas Axis-Derived Composite Index for Glycemic Stratification in Type 2 Diabetes - A Cross-Sectional Study.","authors":"B Revathi, Aradhana Marathe, Vinod Chandran, Sharada Rai, Gayathri M Rao","doi":"10.7417/CT.2026.2027","DOIUrl":"10.7417/CT.2026.2027","url":null,"abstract":"<p><strong>Background: </strong>Dysregulated gut-derived metabolites such as bile acids (BA) and short-chain fatty acids (SCFAs) have been implicated in altered glycemic control and insulin dynamics in type 2 diabetes. Understanding their combined diagnostic utility may improve metabolic causes and therapeutic strategies.</p><p><strong>Objective: </strong>To evaluate the discriminative power of BA, SCFAs, and a composite gut-liver-pancreas axis-based index in predicting poor glycemic control, and to explore their clustering behaviour using Principal Component Analysis (PCA) in individuals stratified by HbA1c status.</p><p><strong>Methods: </strong>Serum samples were analysed from individuals with varying glycemic control (HbA1c >8% vs ≤8%) for the quantification of BA, SCFAs, and insulin levels were. A composite metabolic index was computed as (Bile Acids × Insulin) / SCFA. PCA was performed to visualize clustering of metabolic signatures. Receiver Operating Characteristic (ROC) curve analysis evaluated the predictive accuracy of individual and composite markers. Regression analysis identified significant predictors of postprandial insulin levels.</p><p><strong>Results: </strong>The composite index demonstrated the highest discriminative performance (AUC = 0.87), outperforming bile acids (AUC = 0.73) and SCFAs (AUC = 0.61) in identifying individuals with poor glycemic control. PCA revealed distinct separation of glycemic subgroups, with insulin and the composite index vectors aligned along PC1, while SCFA contributed orthogonally, indicating inverse metabolic association. Multivariable regression identified HbA1c (β = +3.19, p = 0.02), bile acids (β = +1.62, p = 0.01), and the composite index (β = +0.92, p = 0.005) as positive predictors of insulin, whereas SCFAs were negatively associated (β = -2.24, p = 0.03).</p><p><strong>Conclusion: </strong>The gut-liver-pancreas axis-derived composite index offers superior predictive value for glycemic status compared to individual metabolites. Its integration into metabolic profiling may enhance early identification of dysglycemia and guide targeted interventions.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"446-451"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A personalized medicine approach to Substance Use Disorders (SUDs): widening horizons and wide-ranging innovations.","authors":"Susanna Marinelli, Diana Delfino, Elisabetta Pelagatti, Antonello Ciccarelli, Valeria Piersanti, Pasquale Ricci","doi":"10.7417/CT.2026.2051","DOIUrl":"10.7417/CT.2026.2051","url":null,"abstract":"<p><strong>Objectives: </strong>Addiction and substance use disorders (SUDs) represent intricate conditions shaped by a combination of genetic, environmental, and psychosocial influences. The promise of personalized medicine in addressing these disorders is not only encouraging but also transformative, potentially revolutionary, as it provides customized interventions that consider individual genetic, neurobiological, and psychosocial characteristics. This methodology primarily seeks to optimize treatment effectiveness, decrease relapse rates, and improve overall recovery results.</p><p><strong>Materials and methods: </strong>This research is centered around findings spanning the 1996-2026 time span, to underscore the essential pathways and innovations through which personalized or precision medicine can significantly enhance, and possibly revolutionize, the treatment of addiction disorders, particularly SUDs, in addition to the novel complexities such innovations entail.</p><p><strong>Results: </strong>Genetic and biomarker-guided treatments, the definition of genetic risk factors for addiction, neuroimaging and neurobiological profiling are key components of personalized medicine SUDs research, and they are poised to revolutionize such a crucial area of research. To that end, however, it is crucial to recognize both the new opportunities and clinical potentials and the persistent challenges that must be addressed before these innovative strategies can be fully utilized for the benefit of potentially millions of patients and the collective welfare of society, considering the detrimental effects of addiction and SUDs not only on individual users but also on the broader community.</p><p><strong>Conclusions: </strong>Personalized medicine can revolutionize addiction treatment by enhancing precision, effectiveness, and patient-centered interventions. Further research and policy-/law-making updates are crucial to fully realize its clinical capabilities.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"631-637"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric Nutritional Risk Index as a Predictor of Sarcopenia in Egyptian Patients with Viral Hepatitis-Related Liver Cirrhosis.","authors":"Marwa Ahmed Mohamed, Ossama Ashraf Ahmed, Ahmed Samir Allam, Asmaa Magdy Mohamed Salama, Elham Arif, Yomna Neamt Allah Atfeer Ismail Al-Kabany, Ahmed Mohamed Naguib Amer","doi":"10.7417/CT.2026.2035","DOIUrl":"10.7417/CT.2026.2035","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a prevalent yet underdiagnosed complication in elderly patients with liver cirrhosis, associated with poor outcomes and increased frailty. In low-resource settings, the use of advanced imaging techniques for sarcopenia assessment is often limited. The Geriatric Nutritional Risk Index (GNRI) is a simple tool that may serve as a surrogate marker for sarcopenia, particularly in high-risk populations such as elderly cirrhotic patients with viral hepatitis.</p><p><strong>Objective: </strong>To evaluate the clinical utility of the GNRI in predicting sarcopenia and its severity in elderly Egyptian patients with viral hepatitis-related liver cirrhosis, and to explore its correlations with liver function scores and physical performance indices.</p><p><strong>Methods: </strong>This cross-sectional study included 90 elderly patients (aged ≥ 60 years) with viral hepatitis-related cirrhosis. Sarcopenia was diagnosed and staged according to EWGSOP2 criteria, incorporating measurements of muscle strength (handgrip), muscle mass (calf circumference), and physical performance (gait speed, KATZ index). GNRI was calculated using serum albumin and body weight. Liver disease severity was assessed using Child-Pugh and ALBI scores. Correlations between GNRI, sarcopenia components, and liver scores were analyzed, and diagnostic accuracy of GNRI and Child score in predicting severe sarcopenia was evaluated.</p><p><strong>Results: </strong>The prevalence of sarcopenia in the cohort was 95.5%, with 42.2% classified as having severe sarcopenia. GNRI showed significant positive correlations with muscle strength (r = 0.536, p < 0.001), gait speed (r = 0.377, p = 0.001), and negative correlations with Child score (r = -0.240, p = 0.023) and ALBI score (r = -0.380, p < 0.001). A GNRI ≤ 87 was identified as an independent predictor of severe sarcopenia (OR = 4.15, p = 0.011). GNRI demonstrated high specificity (100%) but limited sensitivity (24.4%) for severe sarcopenia (AUC = 0.658).</p><p><strong>Conclusions: </strong>GNRI is a practical and cost-effective tool for predicting sarcopenia and functional decline in elderly patients with viral hepatitis-related liver cirrhosis. Its integration with functional performance assessments offers a comprehensive approach for early detection and risk stratification. GNRI may serve as a valuable screening tool, particularly in resource-limited hepatology settings.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"502-516"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Medication Adherence Using Psychosocial Factors: A Comprehensive Analysis through Regression and Path Models.","authors":"Abdullah Mohammed Abdullah Saggah","doi":"10.7417/CT.2026.2047","DOIUrl":"10.7417/CT.2026.2047","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify psychosocial determinants of medication adherence among hypertensive patients and examine urban-rural disparities.</p><p><strong>Methods: </strong>In this cross-sectional study, 385 hypertensive patients from urban and rural areas completed a comprehensive questionnaire assessing demographic characteristics, psychosocial factors, and medication adherence measured by the Morisky Medication Adherence Scale (MMAS-8). Multiple statistical approaches, including logistic regression, path analysis, and structural equation modeling, were employed to examine direct and indirect relationships between predictors and medication adherence.</p><p><strong>Results: </strong>52.7% of participants demonstrated high medication adherence, with significantly higher rates in urban (62%) than rural (43%) populations. Multivariate analysis identified family support (AOR=2.34, 95% CI: 1.76-3.12), self-efficacy (AOR=1.87, 95% CI: 1.38-2.54), and health literacy (AOR=1.93, 95% CI: 1.42-2.61) as significant positive predictors of adherence, while perceived stigma (AOR=0.63, 95% CI: 0.48-0.83) and cultural beliefs about traditional remedies (AOR=0.58, 95% CI: 0.43-0.78) were significant barriers. Path analysis revealed that psychosocial factors mediated the relationship between education level and medication adherence, with health literacy accounting for 42% of this relationship. Significant urban-rural differences were observed in the strength of associations between psychosocial factors and adherence.</p><p><strong>Conclusions: </strong>This study provides novel insights into the complex interplay between demographic characteristics, psychosocial determinants, and medication adherence among hypertensive patients in Saudi Arabia. The identified urban-rural disparities and cultural influences highlight the need for tailored interventions that address specific psychosocial barriers in different contexts. Our findings suggest that comprehensive approaches enhancing health literacy, self-efficacy, and family support while addressing cultural beliefs could significantly improve medication adherence.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"606-617"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Access to Dietitian Services in Dubai's Private Ambulatory Care: Multi-Stakeholder Insights and Implications for Chronic Disease Management.","authors":"Natacha Ajaka","doi":"10.7417/CT.2026.2036","DOIUrl":"10.7417/CT.2026.2036","url":null,"abstract":"<p><strong>Background: </strong>Non-communicable diseases (NCDs) such as diabetes and cardiovascular disorders are rising in the UAE, requiring cost-effective, preventive strategies. Nutrition interventions led by dietitians have demonstrated clinical and economic value in managing chronic conditions. However, access to these services remains restricted in Dubai's private ambulatory care due to insurance, referral, and recognition barriers. This study was conducted to assess the perceived value, accessibility, and reform potential of dietitian services in Dubai's private sector, with a specific focus on the feasibility and impact of direct patient access to dietitians without physician referral.</p><p><strong>Methods: </strong>A cross-sectional mixed-methods study surveyed four stakeholder groups - physicians (n=22), dietitians (n=35), outpatients (n=43), and insurance professionals (n=21). Quantitative data evaluated service utilization, referral trends, satisfaction, and outcomes, while qualitative responses captured barriers and reform recommendations. Descriptive and thematic analysis methods were used.</p><p><strong>Results: </strong>Sixty percent of patients accessed dietitians without a physician referral, while 35% were self-referred. Key barriers included lack of insurance coverage (48-65%), referral delays, and undervaluation of dietitians. However, 85% of patients expressed satisfaction, and 78% reported improved health outcomes. Stakeholders recognized direct access as a potential strategy to reduce hospitalizations, lower medication usage, and improve preventive engagement.</p><p><strong>Conclusion: </strong>Direct access to dietitian services offers a viable, evidence-based reform for enhancing chronic disease management and reducing healthcare costs in Dubai's private sector. To unlock these benefits, policy reforms must address insurance coverage, professional integration, and systematic outcome tracking.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"517-524"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male ritual circumcision and female genital mutilation: a medico-legal comparison is possible?","authors":"Giuseppe Pulin, Fortunato Pititto, Roberto Bellacicco, Elisa Paladini, Francesco Merlanti, Maricla Marrone","doi":"10.7417/CT.2026.2050","DOIUrl":"10.7417/CT.2026.2050","url":null,"abstract":"<p><strong>Introduction: </strong>Male ritual circumcision (MRC) and female genital mutilation (FGM) are traditional practices involving irreversible modification of the genitalia, deeply embedded in cultural and religious contexts but subject to radically different medico-legal and ethical evaluations. While MRC is generally tolerated or regulated within European legal systems as an expression of religious freedom, FGM is universally condemned as a serious violation of human rights. This paper examines whether a meaningful medico-legal comparison between these two practices is possible.</p><p><strong>Methods: </strong>A narrative, non-systematic review was conducted, drawing on historical sources, forensic and medical literature, bioethical analyses, and European legal frameworks. The comparison focuses on consent, parental authority, assessment of harm, protection of bodily integrity, and the role of cultural and religious justification.</p><p><strong>Discussion: </strong>Despite significant differences in extent of injury, health consequences, and intent, both MRC and FGM are performed on minors incapable of providing informed consent and result in permanent bodily alteration. The medico-legal tolerance of MRC is largely grounded in its perceived proportionality of harm, potential health benefits, and cultural recognition, whereas FGM is characterized by intrinsic harm, lack of medical benefit, and its function in controlling female sexuality. The divergent legal treatment reflects not only objective assessments of medical risk but also normative and political choices regarding which cultural practices are deemed compatible with fundamental rights.</p><p><strong>Conclusions: </strong>The comparison between MRC and FGM exposes a persistent asymmetry in medico-legal and ethical standards applied to non-consensual genital modification of minors. While FGM remains rightly subject to absolute prohibition, MRC continues to challenge the coherence of child-protection principles in pluralistic societies. Greater emphasis on bodily integrity, proportionality, and the possibility of deferring non-therapeutic interventions until personal autonomy can be exercised is needed to reconcile cultural freedom with the paramount interest of the child.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"627-630"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Threshold Dose-Response Relationship Between Duration of Premature Rupture of Membranes and Maternal, Neonatal, and Laboratory Evidence of Infection: A Systematic Review and Meta-Analysis.","authors":"Iman Shawky Hassan, Aziza Hussein Nassef, Mariam Salah Mohamed Emam, Mohammad Abd Elhameed Alwaseef, Kareem Salah Eldin Fekry Madbouly, Narmen Hamadelnil Ibrahim Eltrafi, Naglaa Fathi Mohammed Agaba, Shaimaa Ali Barakat, Asmaa R Ali, Amal Mahmoud Abd El Ghany Othman, Mai Nabil Ageez, Abdulmabod Omar, Rana Mahmoud Youssef Mohamed Breika, Doaa Helmy Abd Elkader Yousef, Rania Fakhry Abdulrazek Okasha, Nawal S Gouda, Eman Hashish, Doaa Fouad Ali, Hanan Shehata Mohamed, Rehab Mohamed Ateya, Haidy Mahmoud Nasr, Hanan A Hegazy, Abd Elhalim Mohamed Abd Elhalim, Hala S M Abdelmotogaly, Ramy Saleh Abdelghany","doi":"10.7417/CT.2026.2052","DOIUrl":"10.7417/CT.2026.2052","url":null,"abstract":"<p><strong>Objective: </strong>To identify the continuous dose-response relationship between the duration of premature rupture of membranes (PROM) and the probability of neonatal and maternal infectious morbidity.</p><p><strong>Methods: </strong>This meta-analysis and systematic review synthesise data from 15 studies worldwide involving more than 70,000 mother-neonate pairs. A two-step random-effects model of PROM duration as a continuous dose, using restricted cubic splines, was used to estimate specific risk thresholds.</p><p><strong>Results: </strong>The analysis established a progressive, non-linear escalation of risk. The onset of statistical risks at 16 hours is the early-onset pneumonia (Adjusted OR 1.86, 95% CI: 1.152.99). At the age of 18 hours, the incidence of culture-proven sepsis in neonates was 4.0%, and the odds ratio for maternal fever was significantly higher (AOR 36.6). The analysis of the ROC curves revealed a critical mathematical pivot point at 37 hours, after which complications escalate exponentially. Latency greater than 48 hours was the most significant independent predictor of culture-proven sepsis, with an increased risk of 8.2 (p < 0.001). Histologic chorioamnionitis was detected in 39% of mothers, and in many cases, they are clinically silent. Considerable heterogeneity (I2 > 60%) was mainly caused by gestational age disparities in cohorts of extremely preterm and term babies.</p><p><strong>Conclusion: </strong>PROM latency risk is not a threat but accelerates with time. Although 18 hours will be an acceptable early warning level, the range of 37 to 48 hours is a high-risk period that needs aggressive treatment. International guidelines need to be reviewed to reflect this non-linear trend, especially regarding pregnancy, where the risks of delivery are low compared to the rising risk of latency.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"642-651"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}