International Journal of General Medicine最新文献

Purpose: Glucose metabolism is associated with several endocrine disorders. Anti-diabetes drugs are crucial in controlling diabetes and its complications; nevertheless, few studies have been carried out involving endocrine function. This study aimed to investigate the association between anti-diabetes drugs and endocrine parameters.

Patients and methods: We performed a study of 180 consecutive patients with type 2 diabetes who attended a medical center. Laboratory measurements of metabolic values and endocrine parameters were assessed after a stable treatment regimen of more than 12 weeks. The differences in various endocrine parameters were compared between subjects with or without certain anti-diabetes drugs, with the administrated anti-diabetes drugs being analyzed to find independent risks associated with elevated endocrine parameters.

Results: After maintaining stable treatment, acceptable glycemic control was noted with an average HbA1c of 7.55% in females and 7.43% in males. Participants taking sulfonylurea (55.8 vs 26.34 ng/L, P=0.043), dipeptidyl peptidase-4 inhibitor (DPP4i) (47.14 vs 32.26 ng/L, P=0.096), or sodium-glucose co-transporter 2 inhibitor (SGLT2i) (64.58 vs 28.11 ng/L, P=0.117) had higher plasma renin concentrations compared to those without this drug but the aldosterone levels did not differ, as well as for other adrenal tests and thyroid function. Under linear regression modeling, SGLT2i was found to be independently associated with a risk of high renin level (beta coefficient: 30.186, 95% confidence interval: 1.71─58.662, P=0.038), whereas sulfonylurea only had borderline associations (B: 21.143, 95% CI: -2.729─45.014, P=0.082). Additionally, renin-angiotensin-aldosterone system (RAAS) blockade (B: 36.728, 95% CI: 12.16─61.295, P=0.004) or diuretics (B: 47.847, 95% CI: 2.039─93.655, P=0.041) was also independently associated with increased renin levels.

Conclusion: SGLT2i was the only class of anti-diabetes drugs independently associated with elevated renin levels, with results similar to RAAS blockade and diuretics. Although SGLT2i appears to protect reno- and cardio-function, the clinical impact of increased renin warrants further precise study for verification.

Objective: We aimed to address the predictive value of urinary kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinases-2 (TIMP-2) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for contrast-induced acute kidney injury (CI-AKI) in elderly patients after percutaneous coronary intervention (PCI).

Methods: One hundred thirty-six patients who underwent PCI were separated into the CI-AKI group (n = 36) and the non-CI-AKI group (n = 100) based on CI-AKI occurrence after operation, and their general data were collected. Blood and urine specimens were collected before operation (at the time of admission) and 6 h, 12 h, 24 h and 48 h after the operation and preserved for future use. Serum creatinine (Scr) levels were tested and an estimated glomerular filtration rate (eGFR) was counted. Urinary KIM-1, TIMP-2 and sTREM-1 levels were assessed and the preoperative and general data as well as postoperative urinary KIM-1, TIMP-2 and sTREM-1 levels were compared. The early diagnostic value of urinary KIM-1, TIMP-2 and sTREM-1 at 6 hours postoperatively for CI-AKI was analyzed by receiver operating characteristic (ROC) curve.

Results: After 48 h of operation, Scr in the CI-AKI group was higher versus the non-CI-AKI group. At 24 h and 48 h postoperatively, eGFR in the CI-AKI group was lower versus the non-CI-AKI group; urinary KIM-1 and sTREM-1 in the CI-AKI group were higher in contrast to the non-CI-AKI group; TIMP-2 in the CI-AKI group was higher versus that in the non-CI-AKI group. ROC curve analysis showed that the areas under the curve (AUCs) for urine KIM-1, TIMP-2, and sTREM-1 in diagnosing CI-AKI at 6 hours postoperatively were 0.852 (95% CI: 0.768-0.936), 0.810 (95% CI: 0.723-0.898), and 0.874 (95% CI: 0.804-0.943), and the cut-off values were 45.93 ng/L, 1.63 ng/mL, and 61.48 ng/L, respectively, with sensitivities of 66.70%, 58.30%, and 72.20%, and specificities of 95.00%, 93.00%, and 91.00%, respectively (all P < 0.05).

Conclusion: Urinary KIM-1, TIMP-2 and sTREM-1 can respond to early changes in renal function after PCI and have good application value in the early diagnosis of CI-AKI.

Objective: This study investigated the efficacy of comprehensive management and predictable inflammatory markers for idiopathic retroperitoneal fibrosis (iRPF)-related hydronephrosis outcomes.

Methods: Patients with iRPF-related hydronephrosis underwent surgical (ureteral stent and/or nephrostomy tube placement) and medical (corticosteroid-based multiple immunosuppressants) management were classified according to stent-indwelling outcomes. Univariate analysis of clinical profiles was conducted to screen possible predictors of hydronephrosis remission.

Results: In a series of 38 patients, 52.6% achieved hydronephrosis remission and stent/tube removal (stent-free group). The median indwelling time in the stent-free group (12 months) was significantly lower than that in the treatment-failure group (37 months, p<0.05). Mean retroperitoneal mass diameters was significantly reduced (anteroposterior by 11.66 mm (95% CI 2.31-21.01), transverse by 15.41 mm (95% CI 3.37-27.46), suprainferior by 30.53 mm (95% CI 4.87-56.19); p<0.05) during the treatment course, in line with mean renal pelvis width (by 36.2%) and renal function parameters (serum creatinine by 16.9%, blood urea nitrogen by 12.9%). Renal function improved (36.9%) or remained stable (44.7%) in most patients, the mean estimated glomerular filtration rate increasing by 8.7% (from 55.4 mL/min/1.73 m² to 60.2 mL/min/1.73 m²). At the initial diagnosis, median serum immunoglobulin IgG and CRP levels were significantly higher in the stent-free group than in the treatment-failure group (IgG 17.55 g/L vs. 13.50 g/L, CRP 19.60 mg/L vs. 3.15 mg/L; p<0.05). Decline in serum IgG (-5.80 g/L vs. -2.30 g/L), CRP (-18.93 mg/L vs. -1.72 mg/L) and erythrocyte sedimentation rate (-22.00 mm/h vs. -1.50 mm/h) levels in the stent-free group surpassed those in the treatment-failure group (p<0.05).

Conclusion: Comprehensive management benefits iRPF patients with hydronephrosis by preserving renal function. The 24-month scale might guide stent/tube removal. Elevated inflammatory markers (IgG and CRP) at the initial iRPF diagnosis and IgG, CRP, and erythrocyte sedimentationrate (ESR) variations associated with hydronephrosis outcomes.

Objective: Errors in the preparation and administration of intravenous medications are significant contributors to morbidity and mortality rates in medical practice. Early reporting and the implementation of preventive measures can mitigate these errors. This study aims to identify patterns and frequencies of errors in IV medication preparation and administration, along with associated factors, at Omdurman Military Hospital in Khartoum, Sudan.

Methods: This observational, descriptive, cross-sectional study was conducted in the emergency department of Omdurman Military Hospital from January to May 2022. We observed 60 nurses responsible for intravenous drug preparation and administration using a pretested questionnaire and checklist on multiple occasions. The data was analyzed by SPSS and the descriptive and inferential statistics were applied.

Results: Our findings reveal that 98% of the nurses reported a lack of formal training in IV drug preparation and administration. The observed preparation area was characterized as untidy in 59.6% of observations, and 52.5% were conducted in crowded environments. We identified six distinct types of errors during drug preparation, with the most common being the absence of aseptic techniques (63.2%) and the failure to check drug expiry dates before administration (99%). In contrast, five types of administration errors were reported, with the most prevalent being incorrect administration rates (68.7%) and the absence of post-administration side-effect assessments (84.8%). Additionally, 83.3% of nurses did not label the unused portion of a drug intended for the next dose.

Conclusion: This study identifies a total of 11 different types of errors in IV drug preparation and administration, some of which are associated with the hospital's work environment. The lack of formal training among 98% of the nurses stands out as a significant contributor to the increasing frequency of these errors.

Background: Dyslipidemia in Sub-Saharan Africa has been on the disproportionate rise among diabetes patients across various contextual settings due to its patterns and associated factors. This study determined the patterns and factors associated with dyslipidemia among diabetes patients attending Hoima Regional Referral Hospital (HRRH).

Methods: This was a hospital-based cross-sectional study conducted at HRRH between October 2022 and January 2023, enrolled 375 adult diabetes patients consecutively from diabetic outpatient clinic. Data on socio-demographic, behavioral, medical history, physical examination, and laboratory diagnoses were collected and summarized using descriptive statistics. Patterns of dyslipidemia were presented as a proportion of each lipid profile either singly or in combination expressed as a percentage. In the bivariate analysis, variables with p-values <0.2, crude odds ratios of ≥2 or ≤0.5, or those with biological plausibility were included in a multiple logistic regression model. Factors with p-values <0.05 were considered statistically significant. All analyses were conducted using Stata version 17.

Findings: Of the 375 diabetes patients, 260 (69.3%) had abnormal total cholesterol (TC), and 185 (49.3%) had two lipid profile abnormalities. The majority of the patients were female, 235 (62.7%), and 38 (10.1%) had a diagnosis of coronary heart disease (CHD). Additionally, 134 (35.7%) were overweight, and 39 (10.4%) were obese. Female patients had higher odds of dyslipidemia (Adjusted Odds Ratio [AOR] = 2.2, 95% CI: 1.02-4.86, p = 0.045). Those with coronary heart disease (CHD) had increased odds of dyslipidemia (AOR = 4.1, 95% CI: 1.51-11.07, p = 0.006). All diabetes patients who were overweight or obese had dyslipidemia (p < 0.001).

Conclusion: The most common pattern of dyslipidemia in patients with diabetes was elevated total cholesterol, followed by high low-density lipoprotein, associated with overweight, obesity, female gender, and CHD. Routine screening of lipid profiles, BMI, and CHD in diabetic clinics is crucial for early intervention and improved outcomes.

Objective: This study aimed to investigate the clinical significance of heat shock protein 60 (HSP60) expression in ovarian cancer and evaluate its correlation with patient survival outcomes.

Methods: A total of 260 ovarian cancer patients diagnosed between 2017 and 2019 were enrolled. Immunohistochemistry was performed to assess HSP60 expression in tumor tissues. Patients were categorized into high- or low-HSP60 expression groups based on immunohistochemical staining intensity. The correlation between HSP60 expression status and the clinicopathological features of ovarian cancer patients was analyzed. Kaplan-Meier survival curves and Cox regression models were utilized to evaluate overall survival and disease-free survival.

Results: HSP60 expression was significantly higher in ovarian cancer tissues compared to normal ovarian tissues. High HSP60 expression was associated with larger tumor size, advanced FIGO stage, and increased lymph node metastasis. Patients with high HSP60 expression exhibited significantly shorter overall survival and disease-free survival than those with low expression. Multivariate Cox analysis identified HSP60 as an independent prognostic factor for both overall survival and disease-free survival.

Conclusion: High HSP60 expression is associated with poor prognosis and aggressive tumor characteristics in ovarian cancer. HSP60 may serve as a valuable biomarker for prognosis and a potential therapeutic target. Further randomized clinical trials are warranted to explore its role in ovarian cancer progression and treatment strategies.

Background: Gene methylation in cells is an important factor in tumorigenesis, and radiotherapy can change DNA methylation in cells. In this study, complete genome methylation sequencing (BS-Seq) technology was used to analyze the genome-wide methylation of patients with cervical cancer before and after radiotherapy.

Methods: Three pairs of cervical squamous cell carcinoma samples were collected from patients before and after radiotherapy in July 2020. Genome-wide DNA methylation profiles were generated using WGBS. Bioinformatics analysis was conducted to identify differential methylation regions (DMRs) and their associated genes and pathways. The study focused on the methylation changes of LHX2, LHX5, and LHX9 genes, assessing their expression levels using qRT-PCR and correlating these changes with cervical cancer stages.

Results: MCG was the main way of genomic DNA methylation in the three patients. The DNA methylation level and methylation density on each chromosome varied greatly. As revealed by comparison of methylation before and after radiation in the three patients, 1287, 1261 and 789 differential methylation genes were identified, respectively. 3) Combined with clinical treatment, methylation level difference and correlation enrichment analysis, it was found that LHX2, LHX5 and LHX9 were closely related to the occurrence and development of cervical cancer. After 5-Aza-DC and radiotherapy, the methylation of the CpG islands in LHX2, LHX5 and LHX9 genes in these patients was decreased (p < 0.01), and the mRNA and protein expression levels were relatively increased (p < 0.01).

Conclusion: In our present work, genome-wide DNA methylation maps of cervical cancer tissues before and after radiotherapy were successfully constructed. We found that LHX5 and LHX9 genes are closely related to cervical cancer. LHX5 and LHX9 have a negative effect on cervical cancer. The migration ability of LHX9 silenced cells was significantly enhanced after irradiation.

Objective: To investigate the correlation between premature ventricular contraction (PVC) frequency and heart rate (HR) in Chinese adults, with an emphasis on sex-specific differences in clinical characteristics.

Patients and methods: This retrospective study analyzed 24-hour Holter monitoring data from 478 inpatients at the First People's Hospital of Yibin between January 2021 and December 2022. The inclusion criteria were age ≥18 years, ≥20 hours of Holter recording, frequent PVCs (≥ 500 PVCs), and complete clinical profiles. Patients were stratified into three groups on the basis of the hourly correlation between PVC counts and HR: fast heart rate-related PVC (F-HR-PVC), slow heart rate-related PVC (S-HR-PVC), and independent heart rate-related PVC (I-HR-PVC). Heart rate variability (HRV) indices were assessed to evaluate autonomic nervous system activity.

Results: Among the 478 patients, 267 were males and 211 were females with a mean age of 65.7±13.0 years. The mean PVC burden was 5.7±7.0%, and the mean left ventricular ejection fraction (LVEF) was 59.1±8.7%. In males, the F-HR-PVC group was most common (45.3%), while in females, the I-HR-PVC group was most prevalent (50.2%). Despite these observed differences, a chi-square test did not reveal statistically significant differences in the distribution of VPC profiles between sexes (P=0.167). Analysis of clinical characteristics and Holter indices across sex groups showed significant differences in males, particularly in age, maximum heart rate, and minimum heart rate (P < 0.05). In females, significant intergroup differences were observed in VPC burden (P < 0.05).

Conclusion: Although no significant sex differences were observed in the correlation between PVC frequency and HR, the study suggests a potential gender influence on VPC characteristics. These findings may inform future research and have implications for the development of sex-specific diagnostic and therapeutic strategies for PVCs.

Background: Atherosclerosis is a systemic vascular disease commonly affecting coronary and carotid arteries, particularly in diabetes mellitus (DM). This study assessed the association of DM with significant carotid artery stenosis (CAS) among the coronary artery disease (CAD) population undergoing isolated elective coronary artery bypass graft (CABG) surgery.

Methods: A prospective cross-sectional study evaluated 100 Bangladeshi CAD patients who underwent isolated elective CABG from January 2017 to September 2019. Initially, a univariate analysis curtails the risk patterns, followed by a Pearson correlation analysis of significant CAS and glycated haemoglobin (HbA1c).

Results: Although the majority of patients were male, females were higher in the diabetic than non-diabetic group (38.1% vs 15.5%; p=0.01). Overall, ~38% of diabetic patients had significantly higher ≥50% CAS. Further, 28.6% and 9.5% of the diabetic sample had 50-70% and >70% CAS, respectively, which is significantly (p =0.02) higher than the non-diabetic sample (8.6% and 1.7%, respectively). Additionally, diabetes was significantly more associated with both unilateral (31.0% vs 22.4%) and bilateral (45.2% vs 22.4%) CAS than the non-diabetic population (p=0.006). The Pearson correlation coefficient shows a significant positive association between higher glycated haemoglobin levels and >50% CAS (correlation coefficient 0.270; p = 0.007).

Conclusion: We found higher HbA1c had a significant positive correlation with >50% CAS in diabetic patients undergoing elective CABG, recommending preoperative carotid screening, especially elderly individuals.