Journal of Clinical Medicine最新文献

Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients with ESRD who underwent traditional transvenous or leadless pacemaker implantation between 2016 and 2021. We compared in-hospital mortality, 30-day readmission rates, complication rates, and healthcare resource utilization between the two cohorts. Results: A total of 6384 (81.2%) patients were included in the transvenous pacemaker cohort, and 1481(18.8%) patients were included in the leadless pacemaker cohort. In patients with ESRD, leadless pacemaker implantation was linked to higher in-hospital complications when compared to transvenous pacemakers. These included the need for blood transfusion (aOR 1.85, 95% CI 1.32-2.60, p < 0.01), vascular complications (aOR 3.6, CI 1.40-9.26, p = 0.01), and cardiac complications (aOR 4.12, CI 1.70-9.98, p < 0.01). However, there were no differences between the two groups in terms of in-hospital mortality and 30-day readmission rates. The median length of stay was longer for leadless pacemaker implantation than transvenous pacemaker implantation (5 days vs. 4 days, p < 0.01). The total hospitalization charges were also higher ($139,826 vs. $93,919, p < 0.01). Conclusions: Although previous studies have demonstrated lower long-term complication rates with leadless pacemakers than transvenous pacemakers, our analysis shows a higher risk of short-term in-hospital complications in ESRD patients, though no differences in in-hospital mortality and 30-day readmissions.

Hypertension in chronic kidney disease patients is very common. The definition of resistant hypertension in the general population is as follows: uncontrolled blood pressure (BP) on three or more hypotensive agents in adequate doses, or when patients are on four or more hypotensive agent categories irrespective of the BP control, with diuretics included in the therapy. However, these resistant hypertension definitions do not apply to the setting of end-stage kidney disease. True resistant hypertension is diagnosed when adherence to treatment and uncontrolled values of BP by ambulatory blood pressure measurement or home blood pressure measurement are confirmed. Due to these limitations, apparent treatment-resistant hypertension (ATRH) is now defined as an uncontrolled blood pressure on three or more antihypertensive medication classes or the introduction and use of four or more medications regardless of blood pressure level. Concerning dialysis patients, data are very limited on hypertension, its epidemiology, and the prevalence of apparent treatment-resistant hypertension in peritoneal dialysis. In this review, therefore, we discuss the hypertension definitions, targets of the therapy in patients on peritoneal dialyses, and their biases and limitations. We present the pathophysiology, diagnosis, and management of high blood pressure in the peritoneally dialyzed population together with published data on the apparent treatment-resistant hypertension prevalence in this population. Peritoneally dialyzed patients represent a unique population of dialyzed subjects; therefore, studies should be conducted on a larger population with a higher quality of drug adherence and target blood pressure values. The definition of resistant hypertension and apparent resistant hypertension in this group should be redefined, which should also consider residual kidney function in relation to both subclinical and clinical endpoints.

Background: With the rapid increase in the aging population, the number of patients complaining of shoulder pain is also increasing. Among shoulder ailments, rotator cuff tears (RCTs) are most frequently observed in middle-aged and elderly individuals. Sarcopenia refers to the decline in muscle mass (lean body mass) and the subsequent decrease in muscle function that is linked to the natural aging process. To the best of our knowledge, there is currently limited information available regarding the association between RCTs and sarcopenia. Methods: The study included only individuals who had undergone dual-energy X-ray absorptiometry and body composition assessments. After applying the exclusion criteria, the participants were divided into sarcopenia and non-sarcopenia groups by the body composition tests. Next, those diagnosed with RCTs were assigned to the experimental group, and those without RCTs were assigned to the control group. The matching was performed using propensity score matching. Sarcopenia was defined as a skeletal muscle index lower than 7.0 kg/m² in males and 5.4 kg/m² in females. Multivariable logistic regression with backward elimination was performed. Results: After propensity score matching, there were no significant differences in age, sex, and bone mineral density between the RCT and control groups. In the univariate analysis, it was observed that most of the baseline data and demographic factors did not exhibit significant differences, except for calcium levels and the presence of chronic kidney injury. According to the multivariable logistic regression analysis of factors related to RCTs, sarcopenia was unrelated to RCTs, but chronic kidney injury and Ca levels were significantly associated. Also, there was also no significant association between sarcopenia and RCT size and severity. Conclusions: In conclusion, we cannot find a significant relationship between sarcopenia and RCTs.

Background/Objectives: Low back pain is one of the most prevalent pathologies. Several studies relate its chronification to certain psycho-emotional characteristics, such as self-efficacy or the patient's lack of confidence in the ability to move. Determine the reliability and validity of the OPTIMAL-confidence scale in people with chronic low back pain and describe the confidence in the movement capacity of this population. Methods: Design: A validation study was designed to evaluate the psychometric properties of the OPTIMAL-Confidence Questionnaire in a population with chronic low back pain. A descriptive observational study in a population with chronic low back pain and a healthy population was designed to describe the confidence in the movement capacity of the population with chronic low back pain.

Settings: Health centers of primary care from a region of northwestern Spain.

Participants: The final sample was 122 patients diagnosed with chronic low back pain. The sampling was completed with 30 additional healthy subjects.

Instruments: OPTIMAL-confidence questionnaire, Numerical Pain Rating Scale, Chronic Pain Self-efficacy Scale, and ad hoc questionnaire to collect socio-demographic and clinical variables. Results: Cronbach's alpha for the OPTIMAL-confidence questionnaire was 0.91. The association of OPTIMAL-confidence with the self-efficacy, pain intensity, and movement ability scales was moderate and significant (p < 0.001). Regarding the low back pain population, significant differences were observed in confidence levels according to age and the need for walking aids (p < 0.009). The OPTIMAL-confidence questionnaire also showed significant discrimination between the low back pain group and the no back pain group (p < 0.001). The confidence interval was 95%. Conclusions: The population with low back pain shows less confidence in their ability to perform movements, compared to the general population. OPTIMAL is an instrument that can discriminate between patients who present chronic low back pain and those who do not.

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is a significant burden on health and economic systems worldwide. Improved VTE management calls for the integration of biomarkers into diagnostic algorithms and scoring systems for risk assessment, possible complications, and mortality. This literature review discusses novel biomarkers with potential diagnostic and prognostic value in personalized VTE management. The pathophysiology of thrombosis starts with cell interactions in the vascular environment and continues with more complex, recently discussed processes such as immunothrombosis and thromboinflammation. Their clinical applicability is in the use of complete blood count (CBC)-derived immuno-inflammatory indices as attractive, readily available biomarkers that reflect pro-thrombotic states. Indices such as the neutrophil-to-lymphocyte ratio (NLR = neutrophil count divided by lymphocyte count), platelet-to-lymphocyte ratio (PLR = platelet count divided by lymphocyte count), and systemic immune-inflammation index (SII = NLR multiplied by platelet count) have demonstrated predictive value for thromboembolic events. Nevertheless, confounding data regarding cutoffs that may be implemented in clinical practice limit their applicability. This literature review aims to investigate neutrophil and platelet interactions as key drivers of immunothrombosis and thromboinflammation while summarizing the relevant research on the corresponding CBC-derived biomarkers, as well as their potential utility in day-to-day clinical practice.

Background/Objectives: To evaluate the clinical and radiologic outcomes of arthroscopic augmented partial repair (APR) with acellular dermal matrix versus arthroscopic superior capsular reconstruction (SCR) in massive rotator cuff tears. Methods: The study included a total of 49 patients with massive rotator cuff tears who underwent arthroscopic APR (26 patients) and SCR (23 patients) between March 2018 and June 2021. Clinical scores, visual analog scores, and range of motion were collected preoperatively and postoperatively until the last follow-up. Preoperative and postoperative simple radiographs were evaluated for arthropathic changes and acromiohumeral distances (AHDs). Magnetic resonance imaging was performed to assess the integrity of repaired structures at 12 months postoperatively. Results: The average age of patients was 63.9 years (range 53-74 years), and the mean clinical follow-up period was 2.6 years (range 2.1-2.9). The average UCLA scores improved from 18.0 to 33.2 and from 16.3 to 32.1 in APR and SCR groups at the last follow-up, respectively. For the ranges of motion, the APR group consistently showed better external rotation ranges from the postoperative 6th month until the last follow-up (p < 0.05), and the APR group revealed better ranges of motion in forward flexion, abduction, and external rotation compared to the SCR group (p < 0.05). Postoperative AHD showed better improvement in the APR group than the SCR group (p < 0.05). Re-tears were found in two patients in each group (p > 0.05). Conclusions: Both APR and SCR groups showed comparable improvement in clinical outcomes in massive rotator cuff tears, while the APR group showed statistically significant improvement in the range of motion compared to the SCR group, especially for external rotations.

We note with interest the commentary by Pennington and Thompson (P&T) regarding our detailed update on the management of primary cutaneous melanoma in 2024 [...].

Introduction: Hepatic hydrothorax (HH) is a severe cirrhosis complication requiring early diagnosis and appropriate management. This study aimed to assess the impact of HH on the disease severity and mortality of cirrhotic patients and compare their clinical and biological profiles with those of patients without HH. Materials and Methods: This retrospective study involved 155 patients diagnosed with cirrhosis, of whom 31 had HH. The diagnosis of HH was based on imaging techniques such as X-ray, ultrasound, and thoracic CT scans. The severity of cirrhosis was evaluated using the Child-Pugh, MELD, MELD-Na, and MELD 3.0 scoring systems. Results: Of the included patients, 83.87% (n = 26) were men, with a 20% incidence of HH. The main etiology was chronic alcohol use. The pleural fluid localization revealed similar numbers of patients with bilateral and right pleural distribution. Patients with HH were predominantly classified in Child-Pugh-Turcotte class C. The MELD, MELD-Na, and MELD 3.0 scores had higher median values in the group of patients with hepatic hydrothorax. Still, death occurred at lower MELD scores when compared with cirrhotic patients without HH (MELD score > 22.5 for patients with HH vs. MELD > 32.5 for patients without HH). (The cirrhotic patients with HH presented lower serum albumin, cholesterol, and triglyceride levels and higher bilirubin, INR, and creatinine values. The mortality rate was higher in the group with HH-58,06% versus 20.97% in the control group (cirrhotics without HH). Conclusions: Hepatic hydrothorax is a serious complication of cirrhosis that requires early recognition and proper management, supported by using biomarkers and scoring systems.

Acute cardiovascular disorders are incriminated in up to 33% of maternal deaths, and the presence of sickle cell anemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year-old Caribbean woman with known SCA who developed a vaso-occlusive crisis at 36 weeks of gestation that required emergency Cesarean section. In the early postpartum period, she experienced fever with rapid onset of acute respiratory distress in the context of COVID-19 infection that required tracheal intubation and mechanical ventilatory support with broad-spectrum antibiotics and blood exchange transfusion. Shortly thereafter, transthoracic echocardiography documented severe biventricular dysfunction associated with raising levels of cardiac troponin and ECG signs of myocardial ischemia. Medical treatment with incremental dobutamine and noradrenaline infusion failed to improve cardiac output and blood gas exchange. After consultation with the regional cardiac center, a prompt decision was made to provide cardiac and respiratory support via implantation of femoral cannula and initiation of veno-arterial extracorporeal membrane oxygenation (ECMO, Cardiohelp^®). Under stable ECMO, the patient was transferred by helicopter to a specialized cardiac center. There were no signs of ongoing hemolysis, and progressive recovery of the right and left ventricular function facilitated forward blood flow through the aortic valve. Three days after implantation, ECMO was weaned, and the cannula were removed. One day later, the patient's chest X-rays showed partial resolution of lung edema. The patient was successfully extubated, and non-invasive ventilation with pulmonary rehabilitation was initiated to speed up her functional recovery.

Background: In the rooming-in system, mothers and their healthy newborns stay together for 24 h a day; however, many women in the early postpartum period often find it challenging to balance their recovery from childbirth with the demands of caring for their newborns. This study aims to investigate the need for postpartum women to entrust their newborns to medical staff for care, and the relationship of this need with perceived pain, fatigue, and anxiety. Methods: The study uses the Need to Entrust a Newborn under the Care of the Staff (NEN) scale and the Numerical Rating Scale (NRS) to assess participants' levels of pain, fatigue and anxiety. These scales were chosen to provide a comprehensive assessment of participants' needs and experiences. Results: The results of the study reveal that fatigue levels among study participants were significantly high, with an Me of 7.0 (IQR = 4.0), exceeding the reportable levels of both pain (Me = 6.0, IQR = 5.0) and anxiety (Me = 5.0, IQR = 6.0) The need for support during the day and at night was at a similar level and strongly correlated (rho = 0.723; p < 0.001). Pain levels showed a significant positive correlation with the need to entrust the newborn both during the day (rho = 0.296; p < 0.001) and at night (rho = 0.332; p < 0.001). During the daytime, the correlation of fatigue with the need for staff support was rho = 0.423 (p < 0.001), while overnight, this increased to rho = 0.485 (p < 0.001). Anxiety significantly correlated with the need for staff support, both during daytime (rho = 0.422; p < 0.001) and overnight (rho = 0.431; p < 0.001). Multiparas reported significantly lower results of anxiety (U(Z) = -13.224, p < 0.001). Conclusions: The need to entrust newborns to the care of maternity rooming-in staff is strong but is often unmet in many facilities. Further research should be conducted to explore solutions, and plan future actions to alleviate the burdens on postpartum women and facilitate their recovery.