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1.
Article in English | MEDLINE | ID: mdl-38757705

ABSTRACT

This scoping review aimed to clarify and redefine the concepts of social and physical presence in the context of online livestreaming environments. Physical presence involves technical elements and nonhuman-to-human interaction, factors that inevitably influence social presence, which has human-to-human interactions at its core. Considering one type of presence to the exclusion of the other may not provide sufficiently informed decisions for user consumption. However, most previous studies have only studied either physical or social presence factors; few have systematically examined both to explain their influence. This review examined how the factors under these two presence influenced users' consumption decision-making process in TikTok live-stream retail purchases by synthesizing 60 studies conducted from 2019 to 2023 using Arksey and O'Malley's 5-step framework. Evidence of the specific attributes by which presence affects users' consumption decisions was elicited and reorganized. Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework for scoping review and guided by the joanna briggs institute (JBI) methodological guidelines, the results reveal that out of the 60 studies, 36 were influenced by social presence and 24 by physical presence. When livestreaming online, social presence tends to include the user and anchor perspectives, which prompts users to make consumption decisions. However, online physical presence includes products, technology, and scenes as its main dimensions, and users make consumption decisions through perceptual control. This review clarifies new media livestreaming communication and the key factors influencing users' consumption decision-making systems. It also suggests that integrating online social and physical presence in future research will yield a better understanding of livestreaming purchase decisions.

2.
Clin Nutr ESPEN ; 61: 140-144, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38777425

ABSTRACT

INTRODUCTION: Patients with intestinal failure (IF) are often dependent on PN for provision of calories and nutrients for survival. Similar to chronic intestinal failure (CIF) patients, those who have AIF are also at risk of IFALD, which is a poorly understood but potentially fatal condition. The local incidence of IFALD amongst AIF patients is not known. OBJECTIVES: The primary objective of this study was to determine the incidence of IFALD in AIF patients on short-term PN. Secondary objectives were to analyse patient and PN risk factors of IFALD, and clinical outcomes of length of stay (LOS) and inpatient mortality. DESIGN: This was a retrospective cross-sectional cohort study of hospitalised adult patients with AIF prescribed with short-term PN. All adult patients aged 21 years and above who received PN for at least 5 consecutive days and had normal liver function tests (LFTs) at the time of PN initiation were included in this study. RESULTS: A total of 171 patients were enrolled in this study, with 77 (45%) having deranged LFTs at the end of PN therapy and categorised under the IFLAD group. The patient cohort was predominantly male (92 [54%]) and had a median age of 68 years (IQR 59-76). Patients with IFALD at the end of PN therapy had higher diabetes prevalence (36% vs 26%, p = 0.2) and were on PN for a longer duration (median [IQR]: 12 [8-17] vs 8 [6-15] days, p = 0.003) than those without IFALD. There were no significant differences in patient and PN characteristics between the IFLAD and non-IFALD group. The multivariable models showed that the IFALD cohort had longer hospital stays (HR 0.90, 95% CI 0.65-1.23) and lower odds of inpatient death (OR 0.75, 95% CI 0.12-4.60), though both findings are not statistically significant (p = 0.5, 0.7). CONCLUSION: In this study, IFALD is a common phenomenon in AIF and the incidence was found to be an estimated 50% amongst patients on short-term PN with similar clinical outcomes between the two groups.


Subject(s)
Intestinal Failure , Length of Stay , Liver Diseases , Parenteral Nutrition , Humans , Male , Female , Retrospective Studies , Cross-Sectional Studies , Middle Aged , Aged , Liver Diseases/mortality , Liver Diseases/epidemiology , Risk Factors , Intestinal Failure/therapy , Incidence , Hospital Mortality , Adult , Liver Function Tests
3.
Front Immunol ; 15: 1346178, 2024.
Article in English | MEDLINE | ID: mdl-38680487

ABSTRACT

Introduction: Natural killer/T cell lymphoma (NKTL) is an aggressive malignancy associated with poor prognosis. This is largely due to limited treatment options, especially for relapsed patients. Immunotherapies like immune checkpoint inhibitors (ICI) and anti-CD38 therapies have shown promising but variable clinical efficacies. Combining these therapies has been suggested to enhance efficacy. Methods: We conducted a case study on a relapsed NKTL patient treated sequentially with anti-CD38 followed by ICI (anti-PD1) using cytometry analyses. Results and Discussion: Our analysis showed an expected depletion of peripheral CD38+ B cells following anti-CD38 treatment. Further analysis indicated that circulating anti-CD38 retained their function for up to 13 weeks post-administration. Anti-PD1 treatment triggered re-activation and upregulation of CD38 on the T cells. Consequently, these anti-PD1-activated T cells were depleted by residual circulating anti-CD38, rendering the ICI treatment ineffective. Finally, a meta-analysis confirmed this counterproductive effect, showing a reduced efficacy in patients undergoing combination therapy. In conclusion, our findings demonstrate that sequential anti-CD38 followed by anti-PD1 therapy leads to a counterproductive outcome in NKTL patients. This suggests that the treatment sequence is antithetic and warrants re-evaluation for optimizing cancer immunotherapy strategies.


Subject(s)
ADP-ribosyl Cyclase 1 , Immune Checkpoint Inhibitors , Humans , ADP-ribosyl Cyclase 1/antagonists & inhibitors , ADP-ribosyl Cyclase 1/metabolism , ADP-ribosyl Cyclase 1/immunology , Immune Checkpoint Inhibitors/therapeutic use , Lymphoma, Extranodal NK-T-Cell/therapy , Lymphoma, Extranodal NK-T-Cell/immunology , Lymphoma, Extranodal NK-T-Cell/drug therapy , Membrane Glycoproteins/antagonists & inhibitors , Male , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Middle Aged , Female , Treatment Outcome
4.
Animals (Basel) ; 14(6)2024 Mar 21.
Article in English | MEDLINE | ID: mdl-38540077

ABSTRACT

Neoschoengastia gallinarum is widely distributed in Asia, preferentially parasitising birds, and heavy infestations have clinical impacts on domestic fowl. In common with other trombiculid mites, the genetic diversity and potential variation in host preferences or pathology induced by N. gallinarum are poorly understood. This study aimed to unravel the geographical variation and population structure of N. gallinarum collected from galliform birds in Peninsular Malaysia and Thailand by inference from concatenated mitochondrial-encoded cytochrome c oxidase subunit I (COI), and nuclear-encoded internal transcribed spacer 2 (ITS2) and 18S ribosomal DNA gene sequences, including a comparison with previously published data from southeastern China. Our multi-locus sequence analysis revealed three monophyletic clades comprising (A) specimens from Peninsular Malaysia, (B) the samples from Thailand together with a minority of Chinese sequences, and (C) the majority of sequences from China. Similarly, most species delimitation approaches divided the specimens into three operational taxonomic units. Analysis of molecular variance revealed 96.41% genetic divergence between Malaysian and Thai populations, further supported by the absence of gene flow (Nm = 0.01). In conclusion, despite the two countries sharing a land border, populations of N. gallinarum from Peninsular Malaysia and Thailand appear to be genetically segregated and may represent distinct cryptic species.

5.
J Int Med Res ; 52(1): 3000605231214464, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38216150

ABSTRACT

An increasing number of reports have described the pathogenic nature of several non-classical Bordetella spp. Among them, Bordetella hinzii and Bordetella pseudohinzii have been implicated in a myriad of respiratory-associated infections in humans and animals. We report the isolation of a genetically close relative of B. hinzii and B. pseudohinzii from the sputum of a woman in her early 60s with extensive bronchiectasis who presented with fever and brown colored sputum. The isolate had initially been identified as Bordetella avium by API 20NE, the identification system for non-enteric Gram-negative rod bacteria. Sequencing of the 16S rDNA, ompA, nrdA, and genes used in the Bordetella multilocus sequence typing scheme could not resolve the identity of this Bordetella isolate. Whole-genome single nucleotide polymorphism analysis positioned the isolate between B. hinzii and B. pseudohinzii in the phylogenetic tree, forming a distinct cluster. Whole-genome sequencing enabled the further identification of this rare organism, and should be considered for wider applications, especially the confirmation of organism identity in the clinical diagnostic microbiology laboratory.


Subject(s)
Bordetella Infections , Bordetella , Bronchiectasis , Respiratory Tract Infections , Humans , Animals , Female , Bordetella Infections/diagnosis , Bordetella Infections/microbiology , Phylogeny , Bordetella/genetics , Bronchiectasis/complications , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/microbiology
6.
Chem Rec ; 24(1): e202300092, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37144668

ABSTRACT

The vanadium redox flow battery (VRFB) is a highly regarded technology for large-scale energy storage due to its outstanding features, such as scalability, efficiency, long lifespan, and site independence. This paper provides a comprehensive analysis of its performance in carbon-based electrodes, along with a comprehensive review of the system's principles and mechanisms. It discusses potential applications, recent industrial involvement, and economic factors associated with VRFB technology. The study also covers the latest advancements in VRFB electrodes, including electrode surface modification and electrocatalyst materials, and highlights their effects on the VRFB system's performance. Additionally, the potential of two-dimensional material MXene to enhance electrode performance is evaluated, and the author concludes that MXenes offer significant advantages for use in high-power VRFB at a low cost. Finally, the paper reviews the challenges and future development of VRFB technology.

10.
J Neuroeng Rehabil ; 20(1): 56, 2023 05 01.
Article in English | MEDLINE | ID: mdl-37127574

ABSTRACT

BACKGROUND: Compensatory movements are commonly observed in older adults with stroke during upper extremity (UE) motor rehabilitation, which could limit their motor recovery. AIM: This study aims to develop a compensation-aware virtual rehabilitation system (VRS) that can detect compensatory movements and improve the outcome of UE rehabilitation in community-dwelling older adults with stroke. METHODS: The VRS development includes three main components: (1) the use of thresholds for determining compensatory movements, (2) the algorithm for processing the kinematic data stream from Kinect to detect compensation in real-time, and (3) the audio-visual feedback to assist older adults with stroke to be aware of the compensation. Two studies were conducted following the VRS development, where Study 1 identified the value of thresholds for determining compensatory movements in two planar motor exercises, and Study 2 provided preliminary validation for the developed VRS by comparing two groups undergoing VR training or conventional training (CT) in a community rehabilitation center. RESULTS: The VRS could effectively detect all determined compensatory movements and timely trigger feedback in response to the detected compensatory movements. The VR participants showed significant improvements in Fugl-Meyer Assessment-Upper Extremity (FMA-UE, p = 0.045) and Wolf Motor Function Test (WMFT, p = 0.009). However, the VR and CT groups had no significant differences in outcome measures. CONCLUSION: The VRS demonstrates the ability to detect compensation and the potential of assisting older adults with stroke to improve motor functions. Suggestions are given for further improvements of the VRS to support the older adult with stroke to reduce compensation.


Subject(s)
Stroke Rehabilitation , Stroke , Telerehabilitation , Humans , Independent Living , Recovery of Function/physiology , Upper Extremity
11.
J Vis Exp ; (195)2023 05 05.
Article in English | MEDLINE | ID: mdl-37212555

ABSTRACT

Endothelial cells line the inner surface of all blood and lymphatic vessels, creating a semi-permeable barrier regulating fluid and solute exchange between blood or lymph and their surrounding tissues. The ability of a virus to cross the endothelial barrier is an important mechanism that facilitates virus dissemination in the human body. Many viruses are reported to alter endothelial permeability and/or cause endothelial cell barrier disruption during infection, which is able to cause vascular leakage. The current study describes a real-time cell analysis (RTCA) protocol, using a commercial real-time cell analyzer to monitor endothelial integrity and permeability changes during Zika virus (ZIKV) infection of the human umbilical vein endothelial cells (HUVECs). The impedance signals recorded before and after ZIKV infection were translated to cell index (CI) values and analyzed. The RTCA protocol allows the detection of transient effects in the form of cell morphological changes during a viral infection. This assay could also be useful for studying changes in the vascular integrity of HUVECs in other experimental setups.


Subject(s)
Zika Virus Infection , Zika Virus , Humans , Human Umbilical Vein Endothelial Cells/metabolism , Zika Virus/physiology , Electric Impedance
12.
Am J Obstet Gynecol ; 229(2): 143.e1-143.e9, 2023 08.
Article in English | MEDLINE | ID: mdl-37178856

ABSTRACT

BACKGROUND: Vaginal estrogen is considered to be the standard of care for recurrent urinary tract infection prevention in women with hypoestrogenism. However, literature supporting its use is limited to small clinical trials with narrow generalizability. OBJECTIVE: This study aimed to assess the association between vaginal estrogen prescription and the frequency of urinary tract infections over the following year in a diverse population of women with hypoestrogenism. Secondary objectives included evaluation of medication adherence and predictors of postprescription urinary tract infection. STUDY DESIGN: This multicenter retrospective review included women who were prescribed vaginal estrogen for the indication of recurrent urinary tract infection from January 2009 through December 2019. Recurrent urinary tract infection was defined as having ≥3 positive urine cultures (separated by at least 14 days) in the 12 months preceding the index vaginal estrogen prescription. Patients were asked to fill their prescriptions and continue care within Kaiser Permanente Southern California system for at least 1 year. Exclusion criteria included anatomic abnormalities, malignancy, or mesh erosion of the genitourinary tract. Data on demographics, medical comorbidities, and surgical history were collected. Adherence was captured through refill data after the index prescription. Low adherence was defined as no refills; moderate adherence was defined as 1 refill; high adherence was defined as ≥2 refills. Data were abstracted from the electronic medical record system using the pharmacy database and diagnosis codes. A paired t test was used to compare pre- and postprescription urinary tract infections over the year preceding and following the vaginal estrogen prescription. A multivariate negative binomial regression was used to evaluate predictors of postprescription urinary tract infection. RESULTS: The cohort included 5638 women with a mean (±standard deviation) age of 70.4 (±11.9) years, body mass index of 28.5 (±6.3) kg/m2, and baseline urinary tract infection frequency of 3.9 (±1.3). Most of the participants were White (59.9%) or Hispanic (29.7%) and postmenopausal (93.4%). The mean urinary tract infection frequency in the year following the index prescription decreased to 1.8 (P<.001) from 3.9 in the year preceding the prescription, which is a 51.9% reduction. During the 12 months after the index prescription, 55.3% of patients experienced ≤1 urinary tract infections, and 31.4% experienced no urinary tract infections. Significant predictors of postprescription urinary tract infection included age of 75 to 84 years (incident rate ratio, 1.24; 95% confidence interval, 1.05-1.46) and >85 years (1.41; 1.17-1.68), increased baseline urinary tract infection frequency (1.22; 1.19-1.24), urinary incontinence (1.14; 1.07-1.21), urinary retention (1.21; 1.10-1.33), diabetes mellitus (1.14; 1.07-1.21), and moderate (1.32; 1.23-1.42) or high medication adherence (1.33; 1.24-1.42). Patients with high medication adherence demonstrated more frequent postprescription urinary tract infections than patients with low adherence (2.2 vs 1.6; P<.0001). CONCLUSION: In this retrospective review of 5600 women with hypoestrogenism who were prescribed vaginal estrogen for the prevention of recurrent urinary tract infections, the frequency of urinary tract infection decreased by more than 50% in the following year. Baseline urinary tract infection frequency, increasing age, urinary incontinence or retention, and diabetes were associated with an increased risk of postprescription urinary tract infection. The paradoxical finding that women with moderate and high medication adherence experienced the lowest-magnitude reduction in urinary tract infection frequency may represent unobserved selection or unmeasured confounding.


Subject(s)
Diabetes Mellitus , Urinary Incontinence , Urinary Tract Infections , Humans , Female , Middle Aged , Aged , Aged, 80 and over , Urinary Tract Infections/epidemiology , Urinary Tract Infections/prevention & control , Retrospective Studies , Medication Adherence , Estrogens/therapeutic use
13.
J Vis Exp ; (194)2023 04 07.
Article in English | MEDLINE | ID: mdl-37092849

ABSTRACT

Zika virus (ZIKV) is a mosquito-borne virus belonging to the genus Flavivirus. ZIKV infection has been associated with congenital brain abnormalities and potentially Guillain-Barré syndrome in adults. Research on ZIKV to understand the disease mechanisms is important to facilitate vaccine and treatment development. The method of quantifying viruses is crucial and fundamental in the field of virology. The focus forming assay (FFA) is a virus quantification assay that detects the viral antigen with antibodies and identifies the infection foci of cells using the peroxidase immunostaining technique. The current study describes the virus propagation and quantification protocol using both 24-well and 96-well (high throughput) formats. Compared with other similar studies, this protocol has further described foci size optimization, which can serve as a guide to expand the use of this assay for other viruses. Firstly, ZIKV propagation is performed in Vero cells for 3 days. The culture supernatant containing ZIKV is harvested and quantitated using the FFA. Briefly, the virus culture is inoculated onto Vero cells and incubated for 2-3 days. Foci formation is then determined after optimized staining processes, including cell fixation, permeabilization, blocking, antibody binding, and incubation with peroxidase substrate. The stained virus foci are visualized using a stereo microscope (manual counting in 24-well format) or software analyzer (automated counting in 96-well format). The FFA provides reproducible, relatively fast results (3-4 days) and is suitable to be used for different viruses, including non-plaque-forming viruses. Subsequently, this protocol is useful for the study of ZIKV infection and could be used to detect other clinically important viruses.


Subject(s)
Flavivirus , Zika Virus Infection , Zika Virus , Animals , Chlorocebus aethiops , Humans , Vero Cells , Colorimetry
14.
Biomedicines ; 11(2)2023 Feb 20.
Article in English | MEDLINE | ID: mdl-36831177

ABSTRACT

The reemergence of the Zika virus (ZIKV) infection in recent years has posed a serious threat to global health. Despite being asymptomatic or mildly symptomatic in a majority of infected individuals, ZIKV infection can result in severe manifestations including neurological complications in adults and congenital abnormalities in newborns. In a human host, ZIKV is primarily recognized by RIG-like receptors and Toll-like receptors that elicit anti-viral immunity through the secretion of type I interferon (IFN) to limit viral survival, replication, and pathogenesis. Intriguingly, ZIKV evades its host immune system through various immune evasion strategies, including suppressing the innate immune receptors and signaling pathways, mutation of viral structural and non-structural proteins, RNA modulation, or alteration of cellular pathways. Here, we present an overview of ZIKV recognition by the host immune system and the evasion strategies employed by ZIKV. Characterization of the host-viral interaction and viral disease mechanism provide a platform for the rational design of novel prophylactic and therapeutic strategies against ZIKV infection.

15.
Nanoscale Adv ; 5(4): 992-1010, 2023 Feb 14.
Article in English | MEDLINE | ID: mdl-36798507

ABSTRACT

The current COVID-19 pandemic, with its numerous variants including Omicron which is 50-70% more transmissible than the previously dominant Delta variant, demands a fast, robust, cheap, and easily deployed identification strategy to reduce the chain of transmission, for which biosensors have been shown as a feasible solution at the laboratory scale. The use of nanomaterials has significantly enhanced the performance of biosensors, and the addition of CNTs has increased detection capabilities to an unrivaled level. Among the various CNT-based detection systems, CNT-based field-effect transistors possess ultra-sensitivity and low-noise detection capacity, allowing for immediate analyte determination even in the presence of limited analyte concentrations, which would be typical of early infection stages. Recently, CNT field-effect transistor-type biosensors have been successfully used in the fast diagnosis of COVID-19, which has increased research and commercial interest in exploiting current developments of CNT field-effect transistors. Recent progress in the design and deployment of CNT-based biosensors for viral monitoring are covered in this paper, as are the remaining obstacles and prospects. This work also highlights the enormous potential for synergistic effects of CNTs used in combination with other nanomaterials for viral detection.

16.
Ann Oper Res ; 325(1): 743-765, 2023.
Article in English | MEDLINE | ID: mdl-36533276

ABSTRACT

The newly emergent social live streaming services (SLSSs) provide the sport consumers with a synchronised and more interactive viewing experience. In order to help the sport SLSSs firms understanding and engaging with the viewers effectively, this research aims to classify the sports SLSS viewers based on their engagement behaviour, and identify the perceived value and value contribution of each group of viewers. Firstly, 52,545 sports SLSSs viewers' viewing duration time is predicted by a feedforward neural network. Second, the predicted viewing duration time and other extracted viewer behavioural data (number of messages, number of virtual gifts, and value of virtual gifts) are analysed through two-step clustering in SPSS, and classified viewers into four types. Semi-structured interviews were then conducted to understand how each type of viewer co-creates value. The results identified four groups of viewers, namely content consumers, super co-creators, co-creators, and tourists, and identified their distinct value co-creations and perceived value. This study sheds light on combining engagement behaviour and value co-creation literature to classify the sports viewers in the context of SLSSs. This understanding assists the decision-making processes of marketers and operators to promote viewers' co-creation effectively.

17.
J Psychol ; 157(1): 48-70, 2023.
Article in English | MEDLINE | ID: mdl-36328776

ABSTRACT

The COVID-19 pandemic has changed our lives. As many industries face a complete stand-still, it also highlights the need to maintain family satisfaction (FS) during this challenging time, empirical research on achieving this remains scant. This study elucidates how marital status influences employees' religiosity, work-family enrichment (WFE) and FS. Data from 295 employees was examined using the analyzed using the partial least squares method structural equation modeling (PLS-SEM) multigroup analysis. Results suggest that religiosity has a positive significant relationship on the bidirectionality of WFE. The multigroup analysis indicates a significant difference in how single and married employees interpret work-family experience. We extend family-work interfaces by incorporating both the construct of marital status and religiosity. It advances the body of knowledge in understanding work-family interfaces, especially in times of the pandemic.


Subject(s)
COVID-19 , Pandemics , Humans , Surveys and Questionnaires , Personal Satisfaction , Marriage
18.
Int J Infect Dis ; 125: 216-226, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36336246

ABSTRACT

OBJECTIVES: This study reported SARS-CoV-2 whole genome sequencing results from June 2021 to January 2022 from seven genome sequencing centers in Malaysia as part of the national surveillance program. METHODS: COVID-19 samples that tested positive by reverse transcription polymerase chain reaction and with cycle threshold values <30 were obtained throughout Malaysia. Sequencing of SARS-CoV-2 complete genomes was performed using Illumina, Oxford Nanopore, or Ion Torrent platforms. A total of 6163 SARS-CoV-2 complete genome sequences were generated over the surveillance period. All sequences were submitted to the Global Initiative on Sharing All Influenza Data database. RESULTS: From June 2021 to January 2022, Malaysia experienced the fourth wave of COVID-19 dominated by the Delta variant of concern, including the original B.1.617.2 lineage and descendant AY lineages. The B.1.617.2 lineage was identified as the early dominant circulating strain throughout the country but over time, was displaced by AY.59 and AY.79 lineages in Peninsular (west) Malaysia, and the AY.23 lineage in east Malaysia. In December 2021, pilgrims returning from Saudi Arabia facilitated the introduction and spread of the BA.1 lineage (Omicron variant of concern) in the country. CONCLUSION: The changing trends of circulating SARS-CoV-2 lineages were identified, with differences observed between west and east Malaysia. This initiative highlighted the importance of leveraging research expertise in the country to facilitate pandemic response and preparedness.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , SARS-CoV-2/genetics , Malaysia/epidemiology , COVID-19/epidemiology , Genomics , Pandemics
19.
J Rubber Res ; 25(5): 413-419, 2022.
Article in English | MEDLINE | ID: mdl-36320319

ABSTRACT

Commercially available carboxylated acrylonitrile butadiene latex (XNBR) was physically blended with natural rubber latex (NR) at varying blend ratios to investigate its effect on the mechanical properties and morphology. Methyl methacrylate grafted natural rubber latex (MG) was added to the latex blends as a third polymer to study whether it could enhance the mechanical properties of the latex blend films. It was found that the tensile strength of the blend films irrespective of composition decreased when the two latexes were blended as compared to the virgin latex films. The modulus 300 decreased while the elongation at break and tear strength of the blend films increased gradually as the ratio of NR increased in the blend films. It was found that the MG did not enhance the mechanical properties of the XNBR/NR blend films under the current experimental condition. AFM phase imaging analysis revealed enhanced polymer distribution and evidence of NR-MG-XNBR interactions.

20.
Urogynecology (Phila) ; 28(12): 825-833, 2022 12 01.
Article in English | MEDLINE | ID: mdl-36409639

ABSTRACT

IMPORTANCE: Currently available evidence for efficacy of postoperative antibiotics to prevent postoperative urinary tract infection (UTI) conflicts. Oral antibiotics rely on patient adherence and can cause unwanted systemic effects. Gentamicin is a broad-spectrum antibiotic with rapid bactericidal activity and, when administered intravesically, has no systemic absorption through intact urothelium. OBJECTIVE: We aimed to determine whether a single intravesical instillation of gentamicin at the conclusion of urogynecologic surgery would reduce the proportion of women treated for UTI within 6 weeks postoperatively compared with sham instillation. STUDY DESIGN: This was a multicenter, randomized (stratified by study site, route of prolapse repair ±suburethral sling, with balanced 1:1 randomization), participant-masked, sham-controlled, study. The primary outcome was the proportion of participants treated with antibiotics for UTI within 6 weeks postoperatively. An adjusted multivariable logistic regression model was constructed to determine predictors of postoperative UTI treatment. RESULTS: Three hundred seventy participants were randomized (gentamicin, 185; sham, 185), and data from 363 participants were analyzed (gentamicin, 183; sham, 180). Nineteen women in the gentamicin group and 20 women in the sham group were treated for UTI within 6 weeks postoperatively (10.4% vs 11.1%, P = 0.87). There were no adverse events related to the instillations. Increasing age (odds ratio, 1.028 [1.000-1.057]) and number of intraoperative transurethral instrumentations (odds ratio, 1.342 [1.080-1.668]) were independent predictors of postoperative UTI treatment. CONCLUSIONS: In women undergoing urogynecologic surgery, postoperative intravesical gentamicin did not reduce the incidence of postoperative UTI. The number of intraoperative transurethral instrumentations is an important, potentially modifiable risk factor for postoperative UTI treatment.


Subject(s)
Suburethral Slings , Urinary Tract Infections , Humans , Female , Gentamicins/adverse effects , Administration, Intravesical , Urinary Tract Infections/epidemiology , Suburethral Slings/adverse effects , Anti-Bacterial Agents/adverse effects
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