Cleveland Clinic Journal of Medicine最新文献

Although sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used because of their exceptional cardiovascular and renal benefits, their side effects and corresponding management strategies have not been well characterized to date. The latest evidence suggests that class effects of SGLT2 inhibitors include volume depletion, genital fungal infections, and euglycemic diabetic ketoacidosis, while medication-specific side effects include urinary tract infections with dapagliflozin and potential increased risk of amputations with canagliflozin. Management strategies include close monitoring, adjusting medication dosages, and temporarily holding SGLT2 inhibitors when appropriate.

Premature ovarian insufficiency (POI) is loss of ovarian function before age 40. Genetic, autoimmune, and iatrogenic causes are well defined, but 90% of cases are idiopathic. POI prevalence is estimated to be between 3% and 4%, with many cases undiagnosed or untreated. Affected individuals experience prolonged estrogen deficiency unless hormone therapy is instituted to restore physiologic levels. Untreated POI is associated with multiple health risks, including premature death due to cardiovascular disease.

Many patients with infective endocarditis experience neurologic complications such as ischemic strokes, intracranial hemorrhages, or infectious intracranial aneurysms. Although data are scarce, in this review we examine how best to predict, prevent, and manage these serious complications and how they affect the appropriate timing of valve surgery for infective endocarditis.

Early clinical trials suggested that patients treated with glucagon-like peptide-1 (GLP-1) receptor agonists had a slightly increased risk of acute pancreatitis. Consequently, clinicians have avoided using GLP-1 receptor agonists in patients with a history of acute pancreatitis. However, recent large meta-analyses of clinical trial data do not support a class-wide risk. Denying these valuable therapeutic medications to patients with a history of pancreatitis seems unwarranted.

As we advance our understanding of the gut microbiota, the implications of dysbiosis are becoming increasingly apparent. Fecal microbiota transplantation (FMT), a well-established procedure, is recognized for effectively treating recurrent Clostridioides difficile infection, prompting further investigation into its other possible clinical applications. Donor selection and screening are essential to ensure safety and efficacy. Product development and standardization, such as the US Food and Drug Administration-approved live biotherapeutic products Rebyota and Vowst, are helping efforts to evaluate FMT for other gastrointestinal and extraintestinal diseases. However, additional clinical trials are needed to support its use beyond recurrent C difficile infection.

Evidence from well-established studies of breast cancer risk in transgender and gender-diverse (TGD) people is lacking. As a result, current screening guidelines are based on extrapolation from cisgender populations, expert consensus, and retrospective cohort studies. Guideline recommendations focus on knowing patient baseline breast cancer risk and the risks associated with chosen gender-affirming hormone therapy and gender-affirming chest surgery. While existing guidelines are helpful, tailored protocols and research on effective breast cancer screening specific to TGD people are needed.