International Journal of General Medicine最新文献

Background and hypothesis: Chronic kidney disease (CKD) is a major prognostic factor in COVID-19. Little is known about the significance of newly detected renal impairment (RI) for COVID-19 patient outcomes. This study assessed the effect of prior CKD and RI at admission on in-hospital mortality in COVID-19 patients.

Methods: A total of 5191 consecutive patients with COVID-19 admitted between March 6, 2020 and May 31, 2021, to the University Hospital in Krakow were analyzed. The main outcome was in-hospital death from any cause compared between the three study groups - patients with a prior history of CKD (group A), no history of CKD and eGFR on admission <60 mL/min/1,73 m2 (group B), and no history of CKD and eGFR on admission >60 mL/min/1,73 m2 (group C).

Results: Of 5191 patients, 2348 (45.2%) were women and 2409 (46.4%) were older than 65 years (mean age of 61.98±16.66 years). There were 483 (9.3%) patients in group A, 1009 (22.2%) in group B and 3699 (68.5%) in group C. Groups A and B were older and had higher cardiometabolic burden compared to group C. Multivariable logistic regression showed that older age, higher CRP, WBC, D-dimer levels, HF, and being in groups A or B were associated with higher in-hospital mortality. Group B had the highest risk (OR 3.003, CI 2.298-3.926) compared to group A (OR 2.020, CI 1.636-2.494) and group C (reference).

Conclusion: COVID-19 patients with prior CKD and newly detected RI have higher odds of in-hospital death compared to those with normal kidney function. Special attention is needed for newly detected RI cases in COVID-19 patients.

The intestinal microecology is comprises intestinal microorganisms and other components constituting the entire ecosystem, presenting characteristics of stability and dynamic balance. Current research reveals intestinal microecological imbalances are related to various diseases. However, fundamental research and clinical applications have not been effectively integrated. Considering the importance and complexity of regulating the intestinal microecological balance, this study provides an overview of the high-risk factors affecting intestinal microecology and detection methods. Moreover, it proposes the definition of intestinal microecological imbalance and the definition, formulation, and outcomes of gut microecological prescription to facilitate its application in clinical practice, thus promoting clinical research on intestinal microecology and improving the quality of life of the population.

Purpose: To describe the correlative relationship between fundus vascular characteristics and the severity of coronary artery stenosis.

Patients and methods: A total of 1447 patients scheduled for hospitalization at Beijing Anzhen Hospital Union Hospital for coronary angiography to assess coronary artery conditions between February 2022 and December 2022 were selected. Of these, 1418 cases were ultimately obtained, with 29 cases excluded due to failure to complete coronary angiography or fundus photography. Severity of coronary artery stenosis was assessed using Gensini score. Fundus images were obtained via non-dilated fundus photography, and retinal arteriovenous diameters, arteriovenous ratios, curvatures, and dimensions were subsequently measured automatically using a computer program.

Results: Pearson's correlation coefficients between the Gensini Score and fundus vascular characteristics were found to be as follows: The diameters of the superior temporal artery (-0.08), The diameters of the superior temporal vein (-0.03), the arteriovenous diameter ratio (-0.10), the retinal arterial dimension (-0.09), the retinal vein dimension (-0.06), the retinal arterial curvature (-0.06), the retinal vein curvature (-0.01). The area under the curve (AUC) for logistic regression modeling with the Gensini Score binarized (dichotomized into two categories based on a cutoff of 4 points) as the dependent variable and fundus vascular characteristics as the independent variable was 0.59 ± 0.05 (95% CI). The AUC for logistic regression modeling with the combination of fundus vascular characteristics and clinical information (sex, age, height, weight, smoking history, creatinine, total cholesterol, fasting blood glucose) yielded an AUC of 0.71 ± 0.07 (95% CI).

Conclusion: Coronary stenosis is inversely correlated with fundus vascular characteristics. The combination of fundus vascular characteristics with a limited amount of clinical data (sex, age, height, weight, smoking history, creatinine, total cholesterol, fasting blood glucose) may serve as a non-invasive tool for predicting the presence or absence of severe stenosis in coronary arteries.

Allergic rhinitis (AR) is a prevalent allergic disease that imposes significant economic burdens and life pressures on individuals, families, and society, particularly in the context of accelerating globalization and increasing pathogenic factors. Current clinical therapies for AR include antihistamines, glucocorticoids administered via various routes, leukotriene receptor antagonists, immunotherapy, and several decongestants. These treatments have demonstrated efficacy in alleviating clinical symptoms and pathological states. However, with the growing awareness of AR and rising expectations for improvements in quality of life, these treatments have become associated with a higher incidence of side effects and an elevated risk of drug resistance. Furthermore, the development of AR is intricately associated with dysregulation of the immune system, yet the underlying pathogenetic mechanisms remain incompletely understood. In contrast, widely available natural plant molecules offer multiple targeting pathways that uniquely modify the typical pathophysiology of AR through immunomodulatory processes. This review presents a comprehensive analysis of both in vivo and in vitro studies on natural plant molecules that modulate immunity for treating AR. Additionally, we examine their specific mechanisms of action in animal models to provide new insights for developing safe and effective targeted therapies while guiding experimental and clinical applications against AR.

Background: Homer scaffold protein 1 (homer1) may harbor neuroprotective effects against acute brain injury. This study aimed to investigate the prognostic role of serum homer1 in human aneurysmal subarachnoid hemorrhage (aSAH).

Methods: A total of 209 patients with aSAH and 100 controls were encompassed in this prospective cohort study. Serum homer1 levels were quantified at admission in all patients, on post-aSAH days 1, 3, 5, 7, 10, and 14 in 83 patients and at recruitments in controls. The modified Fisher scale (mFisher) and World Federation of Neurological Surgeons Scale (WFNS) were used for severity assessment. Glasgow Outcome Scale (GOS) scores of 1-3 at post-aSAH 90 days indicated poor prognosis.

Results: Serum homer1 levels of patients were abruptly elevated at admission, peaked at day 3, and afterwards decreased from day 5 until day 14 after aSAH, and were markedly higher during 14 days than those of controls. Serum homer1 levels were linearly and independently correlated with WFNS scores, mFisher scores, continuous GOS scores, ordinal GOS scores, poor prognosis risk and delayed cerebral ischemia (DCI) likelihood. DCI partially mediated association of serum homer1 levels with poor prognosis. The prognosis model was composed of the four independent predictors, that is serum homer1 levels, DCI, WFNS scores and mFisher scores. As demonstrated by a series of statistical methods, the model had a good performance.

Conclusion: Serum homer1 levels are significantly elevated in acute phase after aSAH, and are strongly related to heightened bleeding intensity, poor 90-day prognosis and DCI. Nevertheless, associational mechanism of serum homer1 and poor prognosis mediated by DCI needs to be further deciphered.

Purpose: Gallstones (GS), a prevalent disorder of the biliary tract, markedly impair patients' quality of life. This study aims to construct predictive models employing diverse machine learning algorithms to elucidate risk factors linked to gallstone formation.

Patients and methods: This study integrated data from the National Health and Nutrition Examination Survey (NHANES) with a cohort of 7868 participants from Wuxi People's Hospital and Wuxi Second People's Hospital, including 830 individuals diagnosed with gallstones. To develop our predictive model, we employed four algorithms-Logistic Regression, Gaussian Naive Bayes (GNB), Multi-Layer Perceptron (MLP), and Support Vector Machine (SVM). The models were validated internally through k-fold cross-validation and externally using independent datasets. Furthermore, we substantiated the link between relative fat mass (RFM) and gallstone formation by employing four logistic regression models, conducting subgroup analyses, and applying restricted cubic spline (RCS) curves.

Results: The logistic regression algorithm demonstrated superior predictive capability for all risk factors associated with gallstone occurrence compared to other machine learning models. SHAP analysis identified RFM, weight-to-waist index (WWI), waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) as prominent predictors of gallstone occurrence, with RFM emerging as the primary determinant. A fully adjusted multivariate logistic regression analysis revealed a robust positive association between RFM and gallstones. Subgroup analysis further indicated that subgroup factors did not alter the positive relationship between RFM and gallstone prevalence.

Conclusion: Among the four algorithmic models, logistic regression proved most effective in predicting gallstone occurrence. The model developed in this study offers clinicians a valuable tool for identifying critical prognostic factors, facilitating personalized patient monitoring and tailored management.

Objective: To observe how osteoarthritis (OA) and degree of fatigue affect are associated with pain levels in patients with fibromyalgia syndrome (FMS).

Methods: A cross-sectional study was conducted involving FMS patients. Data regarding the clinical features of the patients, including scores for pain-Visual Analogue Scale (VAS), Fatigue Scale-14 (FS-14) and other patient information, was collected. A multivariable logistic regression model was constructed to determine whether there is a true association between OA, degree of fatigue, and pain level in FMS patients. Restricted cubic spline (RCS) analysis was used to explore a potential non-linear relationship between degree of fatigue scores and pain levels in FMS patients. An interaction analysis based on the main regression model was performed to examine the interaction between OA and degree of fatigue.

Results: Among the FMS patients, the presence of OA was identified as a risk factor associated with higher pain-VAS scores (OR=2.777, 95% CI=1.377-5.601, P=0.004); furthermore, higher degree of fatigue scores on the FS-14 were found to be significantly associated with high pain level (OR=1.145, 95% CI=1.054-1.243, P=0.001). The RCS analysis demonstrated a linear relationship between increasing FS-14 scores and an elevated risk of high pain levels among FMS patients (P-non-linear=0.119, P-overall=0.008). The interaction analyses revealed a significant association between OA and degree of fatigue, which were related to the pain level of patients with FMS synergistically.

Conclusion: Patients with FMS experience coexisting OA and a high degree of fatigue, which interact synergistically, being correlated with increased pain levels.

Trial registration: The study was approved by the Clinical Research Ethics Committee of the China-Japan Friendship Hospital (2022-KY-079) and registered on ClinicalTrials.gov (NCT05508516) on August 17th, 2022.

Introduction: Despite its ubiquity, pruritus is frequently underreported and inadequately handled in healthcare settings, such as Somalia. This study aimed to investigate the prevalence of pruritus and their impact on sleep quality among hemodialysis patients in Somalia.

Methods and materials: Between February and April 2024, a cross-sectional study was done at the Mogadishu Somali Turkish Training and Research Hospital. Two hundred and ninety-nine routine hemodialysis patients had participated. The 12-item Pruritus Severity Scale (12-PSS) was used to assess pruritus severity, and the Pittsburgh Sleep Quality Index was used for sleep quality. Descriptive tests and logistic regressions were applied for analysis.

Results: The mean age of participants was 56.65 ± 12, ranging from 19 to 81 years. 76.9% of patients reported pruritus, with 68% moderate and 24.3% severe. The mean 12-PSS score was 10.32 ± 2.16. Pruritus was associated with comorbidities (OR: 2.791, P < 0.001) and duration of hemodialysis (OR: 0.609, P < 0.003). The average PSQI score was 8.69 ± 5.8, and 61.9% of patients were classified as bad sleepers. Poor sleep quality was substantially associated with pruritus (P < 0.001). We found R2 = 0.10, F (5,293) = 4.38, p < 0.001, in the multiple regression between pruritus and age, sex, duration of hemodialysis and sessions of hemodialysis per week. Also, age group, sex, presence of comorbidities, duration of hemodialysis, sessions of hemodialysis per week, and pruritus have shown R2 = 0.34, F (6,292) = 26, p < 0.001.

Conclusion: Pruritus is associated with poor sleep and patients who were living with co-morbidities and patients who were going to hemodialysis for a long time tend to develop pruritus. Effective pruritus management is critical for better patient outcomes and quality of life.

Purpose: Crohn's disease (CD) is a chronic inflammatory disorder with periods of exacerbation and remission. We aim to evaluate the systemic immune-inflammation index (SII) as a prognostic biomarker in CD and its utility in predicting disease activity and severity.

Patients and methods: This retrospective study analyzed CD patients using the Harvey-Bradshaw index (HBI) for disease stratification and the Simple Endoscopic Score for Crohn's Disease (SES-CD) for post-treatment evaluation. Data analysis was conducted using R software. Serological indices underwent predictive analysis through the receiver operating characteristic (ROC) curve. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression identified independent prognostic factors to construct nomograms. Model validation was performed using the Concordance index (C-index), calibration analysis and decision curve analysis (DCA).

Results: In this study, 254 patients with Crohn's disease (CD) were enrolled, including 171 males and 83 females, with ages ranging from 13 to 74. SII was significantly elevated in active CD (p<0.001), correlating with disease severity (p<0.001). Although SII decreased in patients with mucosal healing (p<0.001), its prognostic accuracy (AUC=0.719) was lower than other biomarkers. However, SII emerged as an independent predictor for CD activity and severity with higher efficacy (AUC=0.774 and 0.807). The CD activity and severity prediction nomograms showed high C-indices (0.8038 and 0.8208), indicating strong predictive performance.

Conclusion: SII is a valuable biomarker for assessing CD severity and monitoring mucosal healing post-treatment. The SII-based nomograms offer a reliable model for evaluating CD progression, aiding in personalized treatment approaches and enhancing clinical decision-making. We recommend randomized controlled trials (RCTs) or studies with larger sample sizes to improve the model.

Background: Hypertrophic cardiomyopathy (HCM) is the most common hereditary cardiomyopathy, with variable pathogenesis, clinical presentation, and prognosis. Although mutations in genes encoding sarcomere proteins have been reported to explain the genetic etiology of 40%-60% of HCM patients, the etiology of approximately 1/3 of HCM patients remains unknown. Whole-exome sequencing (WES) is an effective method for identifying the genes that cause genetic diseases. In the present study, WES and systematic genetic screening were performed to determine the genetic causes of HCM in Chinese HCM family.

Materials and methods: Peripheral blood genomic DNA was collected from 9 family members of a Chinese Han HCM pedigree, including an HCM proband. Candidate variants obtained by WES were verified using Sanger sequencing, pathogenic mutation screening was conducted among family members, and the mutations were systematically analyzed using bioinformatics.

Results: WES revealed a novel heterozygous missense mutation, c.20233 C>T (p.R6745C), located in exon 80 of the HCM-related gene TTN, which may be a pathogenic mutation in the family. In addition, this mutation was predicted to damage protein function. WES combined with Sanger sequencing results showed that the other two HCM patients in this family carried this TTN mutation, while none of the healthy family members carried the mutation except for a 3 years old girl.

Conclusion: In this study, a new pathogenic mutation of TTN was found in a Chinese family with HCM, and disease-causing gene carriers in the family members were identified through pedigree screening. These findings have theoretical and application value for understanding the genetic basis of HCM, as well as for early risk stratification and early prevention and intervention of patients, and highlight the important role of genetic testing in the diagnosis and treatment of genetic diseases.