Discover medicine最新文献

{"title":"Effect of attaching ChARM automated respiratory rate counter on actual respiratory rate in children.","authors":"Ahad Mahmud Khan, Md Shafiqul Islam, Nabidul Haque Chowdhury, Salahuddin Ahmed, Fatima Tul Jannat, Md Faizul Ahasan, Rizouan Ur Rashid, Rakib Bhuiyan, Mohammad Sarafat Ullah, Ting Shi, Abdullah H Baqui, Steve Cunningham, Eric D McCollum, Harry Campbell","doi":"10.1007/s44337-026-00595-8","DOIUrl":"10.1007/s44337-026-00595-8","url":null,"abstract":"<p><p>Accurate respiratory rate (RR) measurement is essential for diagnosing and classifying pneumonia in children. The Children's Automated Respiration Monitor (ChARM) can measure RR, but placing the device on the chest may influence a child's breathing. This study evaluated whether ChARM affects RR measurement and identification of fast breathing. We conducted a cross-sectional study in multiple health facilities in Bangladesh (2021-2022). Children aged 0-59 months presenting with suspected pneumonia were enrolled. RR was first measured manually by a physician or a health worker and then using ChARM, while chest movements during both measurements were video recorded. A six-member video expert panel (VEP) reviewed all recordings and derived manual RR. Differences in RR values and fast breathing classifications between the two measurement methods were examined. Of 339 enrolled children, both manual and ChARM measurements were obtained for 294; the remainder could not be assessed because of crying or movement. The child's condition remained same during both measurements in 256 cases. After excluding uninterpretable videos and readings without consensus, VEP-determined RR was available for 217 children. The mean difference in RR between the two measurements was 0.5 breaths per minute (standard error 0.4). RR classification (normal vs. fast breathing) changed in 21 children (9.7%), with moderate agreement between measurements (kappa = 0.749). ChARM did not significantly alter mean RR, though classification changed for a small proportion of children. Because exclusions and non-interpretable videos may have introduced bias, additional studies are required to more definitely evaluate whether device attachment influences RR or fast-breathing classification.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44337-026-00595-8.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"3 1","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary safety data from a randomised trial of early versus standard timing of administration of measles-rubella vaccine in Ugandan infants.","authors":"Gerald Businge, Natalie G Marchevsky, Ezekiel Mupere, Sarah Kelly, Ilona Kakai, Mary Kyohere, Andrew Edielu, Fortunate Ambangira, Brenda Kakayi, Valerie Tusubira, Cleophas Komugisha, Philippa Musoke, Yama F Mujadidi, Merijn W Bijlsma, Kirsty Le Doare, Merryn Voysey","doi":"10.1007/s44337-026-00649-x","DOIUrl":"10.1007/s44337-026-00649-x","url":null,"abstract":"<p><strong>Background: </strong>Measles remains a major cause of child morbidity and mortality in low-resource settings. Young infants are particularly at risk of severe disease, with many lacking protective levels of maternal antibodies by six months. Vaccination before nine months in high-burden settings may confer earlier protection; however, concerns exist about its effectiveness at this age. We present early findings on enrolment, safety, and measles infections following the administration of a registered measles-containing vaccine at six months versus nine months (MR1) with a subsequent booster (MR2) at 12 or 18 months of age.</p><p><strong>Methods: </strong>We conducted an open-label randomised controlled non-inferiority trial at four health facilities in Kampala, Uganda. Infants aged 24-28 weeks were randomly assigned to receive MR at six and 12 months (group A), nine and 18 months (group B) or six and 18 months (group C). Infants were electronically randomised in a 1:1:1 ratio using block randomisation of varying sizes, stratified by site, maternal HIV status and baseline haemoglobin level. Caretakers recorded solicited reactions on paper diary cards, with safety-related events evaluated.</p><p><strong>Findings: </strong>450 infants received MR1 and were enrolled. No differences in local or systemic post-vaccination events between the six and nine months MR1 groups were observed [Local: 21·2% versus 21·9% (<i>p</i> = 0·959), systemic: 29·2% vs. 27·7% (<i>p</i> = 0·845)]. Most local reactions were mild and within the first four days. The majority (5/6) of hospitalisations followed common childhood illnesses, with one non-vaccine-related death six months post-MR1. Sixteen laboratory-confirmed cases of measles (10) and rubella (6), and three clinical measles cases before MR1 were registered. Most measles cases (70·0%) occurred in group C, with no measles cases registered two weeks post-MR2.</p><p><strong>Conclusion: </strong>We provide further evidence on the safety of administering a measles-containing vaccine at six months of age.<i>Trial registration</i>: The trial was registered on 31st October 2024 with Clinicaltrials.gov with the identifier NCT06667206.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44337-026-00649-x.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"3 1","pages":"92"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical factors associated with venous thromboembolism in multiple myeloma patients treated with daratumumab.","authors":"Naveen G Subramanian, Fleur M Aung, Zachary E Hunzeker, Krina K Patel, Hans C Lee, Shida Jin, Elliana Young, Roland L Bassett, Cristhiam M Rojas Hernandez","doi":"10.1007/s44337-026-00568-x","DOIUrl":"10.1007/s44337-026-00568-x","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) is a common cause of morbidity and mortality in patients with multiple myeloma (MM). There has been little evidence investigating the factors associated with VTE during therapy with daratumumab-containing regimens.</p><p><strong>Objectives: </strong>Our study examined the association of different clinical, medication- and procedure-related factors on the development of VTE events.</p><p><strong>Methods: </strong>We performed a retrospective chart review of multiple myeloma patients treated at our institution with daratumumab-containing regimens and who developed VTE within 12 months of starting daratumumab. We collected the information on clinical factors, cancer therapy, antithrombotic medications, and central venous access procedures during the observation period. A univariate logistic regression was done first to identify variables associated with VTE, after which those variables were entered into a multivariate analysis.</p><p><strong>Results: </strong>Among patients with MM who received a daratumumab-containing regimen, the incidence of VTE was 9.6% at 12 months from the initiation of daratumumab. We found that the number of PICC line insertions and the presence of multiple medical comorbidities were associated with VTE development.</p><p><strong>Conclusions: </strong>We conclude that VTE is frequent during therapy for MM, particularly in the presence of certain risk factors such as use of multiple PICC line insertions and recent infections. Our observations do not imply causality and limited by the retrospective design, small number of VTE events and lack of time-to-event analysis in the study.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"3 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed cerebral ischaemia after subarachnoid haemorrhage: pathophysiology, diagnosis and neurotherapeutic opportunities.","authors":"S Thilak, P Brown, E Lawrence, S Gopal, R Mullhi, C Chacko, Z Ahmed, R Chelvarajah, J Pooni, T Veenith","doi":"10.1007/s44337-025-00302-z","DOIUrl":"10.1007/s44337-025-00302-z","url":null,"abstract":"<p><p>Delayed cerebral ischaemia is a serious complication following aneurysmal subarachnoid haemorrhage (aSAH), leading to poor outcomes. This review discusses the pathophysiology of DCI, focusing on the role of cerebral vasospasm, reduction in the cerebral blood flow and the factors that affect the vasospasm and DCI. Biomarkers play a crucial role in DCI's recognition, risk stratification, and outcome prediction. Goal-directed management aims to ameliorate the reduced cerebral blood flow, restore circulation and substrate delivery, and protect neurons. These strategies include the maintenance of cerebral blood flow and restoring substrate delivery by optimising oxygenation and maintaining normoglycaemia. Neuroprotective agents, such as calcium channel blockers like nimodipine, play a crucial role by reducing neuronal calcium influx and improving collateral circulation. Multimodal monitoring, incorporating techniques like transcranial Doppler, continuous EEG, and intracranial pressure monitoring, is essential for guiding treatment decisions and evaluating the efficacy of interventions. In the future, research should focus on a comprehensive approach to DCI management with pharmacological interventions and individualised treatment strategies.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7618874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with respiratory symptoms in an urban population: findings from BOLD study in Karachi, Pakistan.","authors":"Asaad Ahmed Nafees, Adeel Ahmed Khan, Unaib Rabbani, Aysha Zahidie, Rooman Ul Haq, Muhammad Irfan, Andre Amaral","doi":"10.1007/s44337-025-00432-4","DOIUrl":"10.1007/s44337-025-00432-4","url":null,"abstract":"<p><strong>Objective: </strong>Our study investigated the prevalence and risk factors of respiratory symptoms (RS) in an adult population aged ≥ 40 years in urban Karachi, Pakistan.</p><p><strong>Methods: </strong>A population based cross-sectional study was conducted. Multi-stage cluster random sampling technique was used to enroll 1052 participants. Questionnaire based on the Burden of Obstructive Lung Disease (BOLD) study protocol was used to assess chronic cough, chronic phlegm, wheezing and shortness of breath (SOB). Logistic regression analyses were conducted to determine the risk factors associated with RS.</p><p><strong>Results: </strong>The overall weighted prevalence of RS in our study was; chronic cough: 12% (95% CI: 9.7-14.8), chronic phlegm: 11.8% (95% CI: 9.4-14.7), wheezing in last 12 months: 11.5% (95% CI: 9.4-14.0), and shortness of breath (SOB): 30.4% (95% CI: 25.6-35.7). Increasing age and ever smoker were significant risk factors for all RS. Females had higher risk of chronic cough. Lower level of education and higher BMI were associated with wheezing and SOB. Exposure to passive smoking was found to be significant risk factor for SOB.</p><p><strong>Conclusion: </strong>We found a higher prevalence of respiratory symptoms among adult population in urban Karachi, specifically about 30.4% reported shortness of breath (SOB). Certain preventable risk factors (smoking and being exposed to passive smoking) were identified. Targeted interventions such as community education and localized air quality monitoring could help mitigate the burden of respiratory symptoms.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44337-025-00432-4.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"2 1","pages":"194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal skeletal muscle and myocardial vasoreactivity manifests prior to heart failure in a diabetic cardiomyopathy rat model.","authors":"Sadi Loai, Hai-Ling Margaret Cheng","doi":"10.1007/s44337-025-00192-1","DOIUrl":"https://doi.org/10.1007/s44337-025-00192-1","url":null,"abstract":"<p><strong>Background: </strong>Microvascular dysfunction (MVD) is a recognized sign of disease in heart failure progression. Intact blood vessels exhibit abnormal vasoreactivity in early stage, subsequently deteriorating to rarefaction and reduced perfusion. In managing heart failure with preserved ejection fraction (HFpEF), earlier diagnosis is key to improving management. In this study, we applied a steady-state blood-pool magnetic resonance imaging (MRI) method to investigate if it can sensitively detect abnormal leg muscle vasoreactivity, a sign of MVD, posited to manifest before structural and functional cardiac changes emerge in a diabetes model of HFpEF.</p><p><strong>Methods: </strong>Male and female Sprague-Dawley rats were maintained on either a high-fat, high-sugar diet or a control diet for 6 months after the induction of diabetes (<i>n</i> = 5 per group). Beginning at month 1 or 2 post-diabetes and every 2 months thereafter, rats underwent steady-state blood-pool MRI to assess vasoreactivity in the heart or skeletal muscle, respectively. A T1-reducing blood-pool agent was administered and the T1 relaxation time dynamically measured as animals breathed in elevated CO₂ levels to modulate vessels.</p><p><strong>Results: </strong>In male rats, the normally unresponsive heart to 10% CO₂ revealed a pro-vasoconstriction response beginning at 5 months post-diabetes. Abnormal leg skeletal muscle vasoreactivity appeared even earlier, at 2 months: the usual vasodilatory response to 5% CO₂ was interrupted with periods of vasoconstriction in diseased rats. In female rats, differences were observed between healthy and diseased animals only in the first 2 months post-diabetes and not later. In the heart, vasodilation to 10% CO₂ seen in healthy females was abolished in diabetic females. In skeletal muscle, 5% CO₂ was suboptimal in inducing reproducible vasoreactivity, but young diabetic females responded by vasodilation only.</p><p><strong>Conclusions: </strong>Abnormal vasoreactivity presented earlier than overt functional changes in both heart and skeletal muscle in diabetic cardiomyopathy, and steady-state blood-pool MRI offered early diagnosis of microvascular dysfunction.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"2 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated serum cortisol levels and associated factors among postpartum mothers in Mbarara district, rural south western Uganda.","authors":"Catherine Atuhaire, Taseera Kabanda, Daniel Atwine, Godfrey Zari Rukundo, Judith Byaruhanga, Samuel Maling, Francis Bajunirwe","doi":"10.1007/s44337-025-00486-4","DOIUrl":"10.1007/s44337-025-00486-4","url":null,"abstract":"<p><strong>Background: </strong>Serum cortisol is often elevated in postpartum mothers, but data on its prevalence and associated factors remain limited in many settings. The current study aimed at examining the factors associated with elevated serum cortisol levels among postpartum mothers in Mbarara district, rural southwestern Uganda.</p><p><strong>Methods: </strong>We conducted a facility based cross sectional study among mothers between 6 weeks and 6 months after childbirth. Using consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities, Mbarara Regional Referral Hospital and Bwizibwera Health Center IV, a county level health facility in rural southwestern Uganda. The blood cortisol levels were measured using a chemiluminescence with the use of a standard, commercially available competitive immunoassay (Diagnostic Products Corp. Nichols Institute Diagnostics, San Juan Capistrano, CA). Postpartum depression (PPD) was diagnosed using the Mini-International Neuropsychiatric Interview (MINI) version 7.0.2, based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria.</p><p><strong>Results: </strong>We enrolled 309 postpartum mothers, and the prevalence of elevated serum cortisol levels was 26.2% (95% CI 22.0-31.4). Elevated serum cortisol levels were significantly associated with PPD (AOR = 2.9, 95% CI 1.6-5.3, <i>p</i> < 0.001), health facility level attended by the mother (AOR = 3.8, 95% CI 1.9-7.6, <i>p</i> = 0.001), pre-diabetes (AOR = 2.5, 95% CI 1.3-5.0, <i>p</i> = 0.008) and diabetes mellitus status (AOR = 4.0, 95% CI 1.8-8.9, <i>p</i> = 0.001), and decreased involvement in physical activity (AOR = 0.3, 95% CI 0.1-0.7, <i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>In this study of elevated serum cortisol levels was significantly associated with postpartum depression, attending a rural healthcare facility, having pre-diabetes or diabetes mellitus status, and reduced physical activity. These findings underscore the need for targeted holistic interventions addressing both physical and mental health challenges in postpartum women.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"2 1","pages":"275"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel recommender framework with chatbot to stratify heart attack risk.","authors":"Tursun Wali, Almat Bolatbekov, Ehesan Maimaitijiang, Dilbar Salman, Yasin Mamatjan","doi":"10.1007/s44337-024-00174-9","DOIUrl":"10.1007/s44337-024-00174-9","url":null,"abstract":"<p><p>Cardiovascular diseases are a major cause of mortality and morbidity. Fast detection of life-threatening emergency events and an earlier start of the therapy would save many lives and reduce successive disabilities. Understanding the specific risk factors associated with heart attack and the degree of association is crucial in the clinical diagnosis. Considering the potential benefits of intelligent models in healthcare, many researchers have developed a variety of machine learning (ML)-based models to identify patients at risk of a heart attack. However, the common problem of previous works that used ML concepts was the lack of transparency in black-box models, which makes it difficult to understand how the model made the prediction. In this study, an automated smart recommender system (Explainable Artificial Intelligence) for heart attack prediction and risk stratification was developed. For the purpose, the CatBoost classifier was applied as the initial step. Then, the SHAP (SHapley Additive exPlanation) explainable algorithm was employed to determine reasons behind high or low risk classification. The recommender system can provide insights into the reasoning behind the predictions, including group-based and patient-specific explanations. In the final step, we integrated a Large Language Model (LLM) called BioMistral for chatting functionally to talk to users based on the model output as a digital doctor for consultation. Our smart recommender system achieved high accuracy in predicting a patient risk level with an average AUC of 0.88 and can explain the results transparently. Moreover, a Django-based online application that uses patient data to update medical information about an individual's heart attack risk was created. The LLM chatbot component would answer user questions about heart attacks and serve as a virtual companion on the route to heart health, our system also can locate nearby hospitals by applying Google Maps API and alert the users. The recommender system could improve patient management and lower heart attack risk while timely therapy aids in avoiding subsequent disabilities.</p>","PeriodicalId":520361,"journal":{"name":"Discover medicine","volume":"1 1","pages":"161"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}