International Journal of General Medicine最新文献

Purpose: Hemophagocytic lymphohistiocytosis (HLH) is a critical syndrome with a high mortality rate. In clinical practice, some patients with fever of unknown origin (FUO) can develop HLH, further complicating the diagnosis and treatment. However, studies on HLH in adults with FUO are limited. This study aimed to investigate the clinical characteristics of adult patients with FUO to facilitate the early identification of those at high risk of developing HLH.

Patients and methods: We collected data from hospitalized patients with FUO between January 2014 and December 2020. Risk factors for HLH in adults with FUO were analyzed using univariate and multivariate analysis.

Results: A total of 988 patients with FUO were included in the study. The incidence of HLH in adults with FUO was 6.4%, with hematological tumors being the primary cause. Multivariate analysis indicated that skin rash and elevated alanine aminotransferase, total bilirubin, triglycerides, lactate dehydrogenase, and ferritin levels were independent risk factors for HLH in adults with FUO.

Conclusion: This study revealed the incidence rate, etiology distribution, and risk factors for HLH in adults with FUO. Comprehensive assessment of clinical and laboratory data at admission can assist in the early identification of FUO patients at risk for HLH.

Objective: This study evaluates whether Huangqin Qingre Chubi Capsule (HQC), a traditional Chinese medicine (TCM) compound, is associated with the risk of re-admission in patients with ankylosing spondylitis (AS).

Methods: In this study, we retrospectively collected the clinical data of 1,296 AS patients. Patients were allocated into HQC and non-HQC groups. Baseline data between the two groups were matched with propensity score matching (PSM). Influencing factors for the risk of re-admission in AS patients were analyzed with the Cox proportional hazards model. The effect of HQC intervention duration on the risk of re-admission was assessed with Kaplan-Meier survival curves. The random walk model and association rule analysis were utilized to determine the correlation between HQC and improvements in immunoinflammatory markers.

Results: The re-admission rate was significantly lower in the HQC group than in the non-HQC group (P < 0.01). The risk of re-admission was significantly lower in patients aged > 40 years (P < 0.01) than in patients aged < 40 years and also markedly lower in HQC users than in non-HQC users (P < 0.01), suggesting that age and the use of HQC were key factors influencing the risk of re-admission. Longer HQC intervention duration was associated with better improvements in ESR, CRP, and C4, and HQC was closely correlated with improvements in ESR, CRP, IgA, and C4.

Conclusion: HQC treatment can reduce the risk of re-admission in AS patients, which may be associated with improvements in ESR, CRP, IgA, and C4. The risk decreases with prolonged HQC treatment.

Background: Ankylosing spondylitis (AS) is a chronic autoimmune disease that affects the spine and peripheral joints, often leading to kyphosis, joint stiffness, and even ankylosis. Sagittal parameters, such as total thoracic kyphosis (TTK), thoracic kyphosis (TK), major thoracic kyphosis (MTK), and thoracolumbar kyphosis (TLK), are crucial indices for evaluating spinal alignment in AS patients and can reflect disease progression. This study aims to explore the relationship between bone mineral density (BMD), sagittal parameters, and joint ankylosis in AS patients.

Methods: A retrospective study was conducted on 147 AS patients. Participants were divided into three groups based on cervical and hip joint mobility. BMD was measured using quantitative computed tomography (QCT). Sagittal parameters (TTK, TK, MTK, TLK) were assessed using X-rays. Ordinal multinomial logistic regression and Spearman correlation analyses were performed to identify factors influencing joint stiffness.

Results: Significant differences in age, BMD, and sagittal parameters (TTK, TK, MTK, TLK) were observed among the groups. Ordinal logistic revealed that BMD (Estimate = 0.012) was negatively correlated with joint stiffness, while TTK (Estimate = 0.020) and TLK (Estimate = 0.030) were positively correlated. Age, TK, and MTK do not have a significant impact on joint stiffness. Spearman analysis showed no correlation between BMD and sagittal parameters (TTK and TLK). Besides, TTK and TLK were correlated.

Conclusion: In AS patients, BMD is an independent protective factor against joint stiffness, whereas sagittal parameters (TTK and TLK) contribute to increased joint stiffness. These findings highlight the importance of monitoring both bone mineral density and key sagittal parameters in clinical practice. Early anti-osteoporosis treatment, alongside interventions targeting abnormal spinal alignment, may help preserve joint mobility and potentially prevent progression to joint ankylosis.

Introduction: Peripartum cardiomyopathy (PPCM) is a pregnancy related cardiomyopathy with a high potential for recovery. One of the contemporary predictors studied in cardiomyopathy is right ventricular (RV) function during initial presentation.

Purpose: This study aimed to determine the role of RV systolic function based on the various RV function parameters by two-dimensional transthoracic echocardiography (2DE) to predict PPCM recovery within 6 months of follow-up and identify the most accurate parameter among them.

Patients and methods: This was a prospective cohort study that include all patients registered in the "Long Term Registry on Patients with Peripartum Cardiomyopathy" at Dr. Hasan Sadikin General Hospital Indonesia during period of September 2014 until December 2022. Right ventricular systolic dysfunction was defined as abnormal value in one or more parameter(s), including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), S', right ventricular free wall longitudinal strain (RVFWLS) and right ventricular global longitudinal strain (RVGLS). Left ventricular ejection fraction was measured on initial examination and after 6-month follow up to define recovery.

Results: A total of 95 patients were included in this study. There were 33 patients (34.7%) with reduced initial RV systolic function. Sixty-four patients (67.4%) recovered within 6 months follow up. The recovery rate of patients with initial RV systolic dysfunction is lower than patients with normal RV systolic function (51.5% vs 75.8%, p = 0.016). This study showed that initial RV systolic dysfunction can predict poor LV function recovery in PPCM patients (OR 0.340; 95% CI:0.120-0.959; p = 0.041). Among all RV function parameters, only FAC (OR 1.076; 95% CI:1.003-1.154; p = 0.040)) and RVGLS (OR 0.768; 95% CI: 0.595-0.991; p = 0.042) emerged as independent predictors of PPCM recovery.

Conclusion: Right ventricular function in terms of FAC and/or RVGLS at initial diagnosis can be used as a predictor for PPCM recovery at 6 months follow-up.

Purpose: To evaluate the use of contrast enhanced mammography (CEM) in suspicious microcalcifications and to discuss strategies to cope with its diagnostic limitations.

Methods: We retrospectively evaluated patients with suspicious calcifications who underwent CEM at our institution. We collected and analyzed morphological findings, enhancement patterns and pathological findings of suspicious microcalcifications on CEM. A small proportion of these cases underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The enhancement patterns of CEM in this study were classified into three categories: enhancement, no enhancement, and indeterminate. CEM imaging was independently analyzed by two breast imaging specialists.

Results: A total of 44 patients with 46 lesions were collected from January 2022 to July 2024. Overall, 20 cases (43.5%) microcalcifications showed enhancement on CEM; 23 (50.0%) showed no enhancement; and 3 (6.5%) were indeterminate. Of the 20 enhancement cases, mass enhancement was seen in 9 (45%), and non-mass enhancement (NME) in 11 (55%). DCE-MRI was performed in 13 cases. One case of invasive ductal carcinoma (IDC) showed enhancement on MRI but was indeterminate on CEM due to the masking effect of background parenchymal enhancement (BPE), and one case of ductal carcinoma in situ (DCIS) lacked enhancement on CEM but had significant enhancement on MRI.

Conclusion: CEM provides additional information on the enhancement associated with breast suspicious microcalcifications. It is not perfect for diagnosis and strategies are needed to cope with its limitations.

[This corrects the article DOI: 10.2147/IJGM.S461352.].

Background: Acute ischemic stroke, especially hemorrhage cerebral infarction (HCI), resulted in the leading causes of mortality and long-term disability across populations. However, fewer researches have focused on the risk factors of first admission and recurrence of HCI.

Methods: The study included 1857 patients who underwent cerebral infarction with or without hemorrhagic transformation. Clinical characteristics were collected, and univariate and multivariate analysis were performed to explore the risk factors. The subgroup analysis of cerebral infarction recurrence was performed. ROC analysis was utilized, and AUCs were showed the diagnostic values of the risk factors.

Results: Compared to the patients with non-hemorrhage cerebral infarction, the patients with hemorrhage cerebral infarction were older and had higher Neutrophil infiltration, AST expression, globulin and BUN, while had lower ALT expression, triglyceride, PT, APTT, homocysteine, d-dimer, CRP and glycosylated hemoglobin. Utilizing univariate and multivariate analysis, age, thrombolytic, Hb, AST and glycosylated hemoglobin were the risk factors between the patients with hemorrhagic cerebral infarction and non-hemorrhagic cerebral infarction. ROC analysis was performed to demonstrate that glycosylated hemoglobin was a diagnostic biomarker for the patients with hemorrhagic cerebral infarction and non-hemorrhagic cerebral infarction (AUC = 0.808). Utilizing univariate and multivariate analysis, age, hypertension history, LDL and MRS Score on admission were the risk factors between non-hemorrhagic cerebral infarction patients with first admission or the cerebral infarction recurrence. ROC analysis was performed to demonstrate MRS Score on admission was a diagnostic biomarker for recurrence of cerebral infarction in patients with non-hemorrhagic cerebral infarction (AUC = 0.708). Utilizing univariate and multivariate analysis, only hypertension history was the risk factors between hemorrhagic cerebral infarction patients with first admission or the cerebral infarction recurrence.

Conclusion: In conclusion, age, hypertension history, LDL and MRS Score on admission were the risk factors between cerebral infarction patients with first admission or the cerebral infarction recurrence.

Introduction: With the incorporation of artificial intelligence (AI), significant advancements have occurred in the field of fetal medicine, holding the potential to transform prenatal care and diagnostics, promising to revolutionize prenatal care and diagnostics. This scoping review aims to explore the recent updates in the prospective application of AI in fetal medicine, evaluating its current uses, potential benefits, and limitations.

Methods: Compiling literature concerning the utilization of AI in fetal medicine does not appear to modify the subject or provide an exhaustive exploration of electronic databases. Relevant studies, reviews, and articles published in recent years were incorporated to ensure up-to-date data. The selected works were analyzed for common themes, AI methodologies applied, and the scope of AI's integration into fetal medicine practice.

Results: The review identified several key areas where AI applications are making strides in fetal medicine, including prenatal screening, diagnosis of congenital anomalies, and predicting pregnancy complications. AI-driven algorithms have been developed to analyze complex fetal ultrasound data, enhancing image quality and interpretative accuracy. The integration of AI in fetal monitoring has also been explored, with systems designed to identify patterns indicative of fetal distress. Despite these advancements, challenges related to the ethical use of AI, data privacy, and the need for extensive validation of AI tools in diverse populations were noted.

Conclusion: The potential benefits of AI in fetal medicine are immense, offering a brighter future for our field. AI equips us with tools for enhanced diagnosis, monitoring, and prognostic capabilities, promising to revolutionize the way we approach prenatal care and diagnostics. This optimistic outlook underscores the need for further research and interdisciplinary partnerships to fully leverage AI's potential in driving forward the practice of fetal medicine.