International Journal of Clinical Practice最新文献

Background

Alcohol has been associated with cardiovascular disease, and excessive amounts are implicated in worsening heart failure outcomes. The knowledge, patterns, and associations of alcohol use among heart failure patients have not been established in Ghana.

Methods

This descriptive, cross-sectional study was conducted at the Ho Teaching Hospital among adult patients with acutely decompensated heart failure in the medical and emergency wards. All patients who presented with heart failure to the facility from September 2022 to August 2023 were recruited. Information needed was obtained using a structured questionnaire. The systolic and diastolic functions were determined using 2D echocardiography.

Results

Among the 315 patients, 33.7% used varying types and quantities of alcohol, with the local gin being the most patronized (62.2%).

Additionally, 65.1% of all heart failure patients who used alcohol also used herbal medicines (mostly orally and alcohol-based), and this was statistically significantly different from the patients who did not use alcohol (p < 0.05). There was a higher proportion of more severe forms of diastolic dysfunction among patients who used alcohol compared to those who did not (χ² = 125.039, p = 0.011), and this was also significantly demonstrated in concomitant alcohol and herbal medication use (χ² = 243.039, p = 0.001).

Conclusion

This study revealed that a third of patients with acute heart failure indulge in alcohol use above acceptable limits, with associated moderate to severe diastolic dysfunction in almost all of them. Herbal medication used in alcohol drinking patients was associated with HFpEF.

Objective

Observational studies indicate that psoriasis (PSO) patients have an increased risk of depression; however, potential confounding factors and reverse causality limit these findings, leaving the exact causal relationship between these two conditions remain to be determined. The objective of this study is to investigate the causal relationship between PSO and depression using a two-sample Mendelian randomization (MR) approach.

Methods

Summary statistics from multiple genomewide association studies (GWAS) in European populations were analyzed using Z-scores to assess correlations between PSO and depression. MR design, which uses genetic variants as instrumental variables, was employed to examine causality, with primary analyses conducted using the inverse variance weighted (IVW) method. Additional MR Steiger (testing causal direction) and colocalization (identifying shared genetic variants) analyses were performed to verify the robustness of genetic variants associated with both conditions.

Results

The results revealed a positive relationship, with genetic susceptibility to PSO correlating to a higher depression risk (OR: 1.348, 95% CI: 1.141–1.592, p = 0.004). This finding was consistently supported by multiple MR methods, including MR-Egger and MR-PRESSO. The MR Steiger method supported a causal link, while colocalization identified a shared causal variant (rs12189871) between the two conditions.

Conclusion

These findings suggest a potential causal relationship between PSO and depression, highlighting the need for depression screening in PSO patients.

Purpose

Depression is a frequent comorbidity in individuals with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes, including an increased risk of exacerbations and death. This study aimed to describe national trends in the prevalence of depression among COPD hospitalizations in Spain, from 2016 to 2023, to assess sex-related differences, to evaluate its impact on hospital outcomes, and to determine how the COVID-19 pandemic modified these associations.

Patients and Methods

We carried out a population-based cohort study using data from the Spanish National Hospital Discharge Database (RAE-CMBD). All admissions of patients aged 40 years or older with a diagnosis of COPD were included. Depression was identified through International Classification of Diseases, Tenth Revision (ICD-10) codes. We analyzed temporal changes and sex-stratified patterns and factors independently associated with in-hospital mortality (IHM).

Results

During the study period, 2,545,151 hospitalizations with COPD were recorded nationwide, of which 106,337 (4.17%) included a diagnosis of depression. The prevalence rose progressively, remaining consistently higher in women. Female patients exhibited greater frequencies of anxiety, obesity, and personality disorders, whereas men showed higher rates of alcohol (17.9% vs. 6.1%; p < 0.001) and tobacco use (58.5% vs. 43.4%; p < 0.001) and a greater proportion of suicide attempts (0.11% vs. 0.06%; p < 0.001). Men were also older (74.1 vs. 73.3 years; p < 0.001) and had higher Charlson Comorbidity Index (CCI) values (1.31 vs. 1.01; p < 0.001). ICU admissions (5.0% vs. 4.6%; p < 0.001) and IHM (7.8% vs. 5.6%; p < 0.001) were more common in men. In multivariable models, older age and greater comorbidity burden were the strongest predictors of IHM in both sexes. COVID-19 infection and dementia increased the odds of death, whereas anxiety and obesity were inversely associated with mortality.

Conclusion

Between 2016 and 2023, depression among COPD hospitalizations in Spain increased steadily, with clear sex-based differences in prevalence, clinical profile, and hospital outcomes. The results emphasize the need to integrate mental health screening and management into routine COPD care.

Background

Patients with critical illnesses frequently experience tachyarrhythmias as a result of excessive sympathetic hyperactivity and high levels of inflammatory cytokines. Ultrashort-acting β-blockers like landiolol are commonly utilized in intensive care units (ICUs) because of their unique features.

Methods

Electronic databases (Cochrane Library, PubMed, Web of Science, and Embase) were searched for randomized controlled trials (RCTs) from inception to September 1, 2025 assessing the efficacy of landiolol in critically ill patients. The primary outcome was new-onset arrhythmias. All-cause mortality, heart rate (HR), length of ICU and hospital stay, and need for norepinephrine following landiolol therapy were the secondary outcomes. Trial sequential analysis (TSA) was performed to further evaluate the robustness of findings. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method.

Results

Nine studies totaling 836 patients were included. Overall, our meta-analysis exhibited that landiolol might considerably lower the incidence of new-onset arrhythmias when compared to the control treatment (9 studies [836 patients]; odds ratio [OR], 0.44; 95% confidence interval [CI] 0.23 to 0.82; p = 0.01), and TSA agreed with this finding. We also observed that landiolol could reduce HR (mean difference [MD], −6.41, 95% CI, −8.63 to −4.18, p < 0.001). However, there was no considerable decrease in requirement of norepinephrine dose (MD, 0.04, 95% CI, −0.01 to 0.09, p = 0.11), length of hospital stay (MD, −0.87, 95% CI, −7.40 to 5.65, p = 0.79), or all-cause mortality (OR, 1.10, 95% CI, 0.62 to 1.96, p = 0.75). Additionally, the length of ICU stay in the landiolol group was longer than that in the control group (MD, 0.19; 95% CI 0.01 to 0.37; p = 0.03).

Conclusion

New-onset arrhythmias and HR were significantly reduced in critical illness patients receiving landiolol.

Background

The incidence of chronic kidney disease (CKD) is on the rise globally. The aim of this study was to characterize the profile of inpatients in the nephrology department of a hospital in Southern Anhui Province, China, during 2007–2022.

Methods

We constructed a retrospective cohort of inpatients from the nephrology department of a hospital and retrieved basic information through the Medical Record Management System (MRMS), including sex, age, length of hospital stay, diagnosis, and outcome of treatment.

Results

This cross-sectional study involved 35,963 inpatients. Both the total number of hospitalized patients and the average age of inpatients from 2007 to 2022 presented a significant increasing trend (p < 0.001). The number of cases aged 40–60 years old is the largest, followed by the cases aged 60–80 years old. CKD is the main cause of hospitalization. Among the causes of CKD, the number of cases with diabetic kidney disease (DKD) had exceeded chronic glomerulonephritis (CGN) and become the main cause for the hospitalization of CKD patients starting from 2016. The average hospitalized day presented a downward trend (11.4 ± 0.5 vs. 9.6 ± 1.2 days, p = 0.002), and the improvement rate presented an upward trend (90.7 ± 4.7% vs. 96.6 ± 1.7%, p = 0.008) from 2007 to 2022.

Conclusion

The renal disease spectrum of hospitalization is changing with variations over time in the nephrology department of our hospital. Understanding the change of the CKD spectrum is crucial to develop effective public health strategies to control the burden of CKD and improve the average hospitalized day.

Background

Gastric cancer (GC) displays profound molecular heterogeneity, leading to divergent therapeutic responses and prognoses. Programmed cell death (PCD) pathways and the tumor microenvironment (TME) are critical determinants of GC progression, yet their interplay and clinical significance remain insufficiently understood.

Methods

We conducted integrative multiomics analyses using bulk RNA-seq data from TCGA-STAD (426 tumors, 35 normals) and single-cell RNA-seq (GSE167297; 4 tumor/normal pairs). PCD-based molecular subtypes were identified through consensus clustering. Drug sensitivity (pRRophetic), immune infiltration (ESTIMATE/CIBERSORT), and functional enrichment (GSVA/clusterProfiler) were systematically evaluated. A prognostic risk model was established via LASSO-Cox regression and externally validated in GSE26901.

Results

Two distinct PCD-associated subtypes were identified. Cluster 1, characterized by elevated PCD activity, enriched KRAS signaling and interferon response, showed a poorer prognosis; whereas Cluster 2 exhibited favorable survival with activation of E2F and mTORC1 pathways. Cluster 1 demonstrated higher immune and stromal scores but lower tumor purity, along with upregulation of immune checkpoints (PDCD1, CD40LG). Drug sensitivity profiling revealed subtype-specific vulnerabilities, including heightened sensitivity of Cluster 1 to cJQ1_2172. A nine-gene prognostic model (5 year AUC = 0.73) robustly predicted survival, with NRP1 identified as an independent risk factor (HR = 1.91, p < 0.05).

Conclusions

This study delineates the PCD–TME crosstalk underlying GC heterogeneity and proposes a clinically relevant molecular classification and prognostic tool. Our findings highlight subtype-specific therapeutic vulnerabilities and underscore the potential of targeting PCD pathways to advance precision oncology in GC.