Medical Principles and Practice最新文献

Objective: This study aimed to identify a pain phenotype associated with hypervigilance in systemic sclerosis (SSc) and evaluate possible variables that influence pain hypervigilance symptoms.

Methods: This cross-sectional, observational study included healthy controls (HCs) and SSc patients diagnosed with a score of 9 or higher according to the 2013 American College of Rheumatology-European League against Rheumatism classification criteria. The pain hypervigilance symptoms were evaluated using the central sensitization inventory (CSI), while disease activity was assessed using the European Scleroderma Research Group Activity Index (EScSG-AI). Patients were classified by CSI scores. Comparatives were done.

Results: A total of 51 SSc patients (92.2% female, mean age [50.54 years]) and 45 HCs (88.9% female, mean age [52.62]) were included. Education and monthly income were lower for SSc than HCs (p < 0.05). The CSI score ≥40 proportion was 56.9% in SSc and 15.6% in HCs (p < 0.001). Depression-Anxiety-Stress Scale (DASS-21), Epworth Sleepiness Scale (ESS), Global Pittsburgh Sleep Quality Index (PSQI), and EuroQol Five-Dimensional Three-Level Questionnaire (EQ-5D-3L) scores were higher in SSc than HCs (p < 0.05). By using multiple linear regression analysis to determine predictors of CSI score ≥40, the effective variable was EScSG-AI. In multivariate logistic regression analysis, educational level and global PSQI scores were factors associated with CSI score ≥40 in SSc.

Conclusions: CSI score was positively associated with depression, disease activity, stress, anxiety, and poor sleep quality, while it was negatively associated with education and economic status. Pain hypervigilance may affect organ involvement and functioning in SSc. Clinicians should examine its biopsychosocial components.

Background: Ustekinumab is an effective drug in the treatment of inflammatory bowel disease (IBD), but inadequate response or loss of response is reported in several patients. Dose escalation by intravenous reinduction or interval shortening may be a suitable option to recapture response. We undertook a systematic review and meta-analysis to assess the efficacy of dose escalation in IBD patients receiving ustekinumab.

Methods: A systematic literature search was conducted on PubMed, Embase, Clinicaltrails.gov, and Cochrane from inception to June 1, 2024. We conducted a proportional meta-analysis on MetaXL. Our primary outcomes were clinical response and clinical remission.

Results: Twenty-eight articles were included (n = 2,129 patients). Eighteen studies (692 patients out of 1,218) reported clinical response, with pooled prevalence of 55% (95% CI: 46-65%). Out of 1,041 patients, 524 showed clinical remission with pooled prevalence of 51% (95% CI: 42-59%).

Conclusion: This systematic review and meta-analysis showcased promising results, in terms of clinical response and remission, in IBD patients receiving dose escalation of ustekinumab.

Introduction: This study aimed to investigate the expression of cluster of differentiation 44 (CD44) in prostate adenocarcinoma (PAC) compared to benign prostatic hyperplasia (BPH) to address the need for biomarkers that can aid in grading classification and prognosis.

Methods: In this cross-sectional study, the CD44 expression in the tissue samples of the PAC and BPH was examined with hematoxylin and eosin and immunohistochemistry methods. The Gleason scores and grades and percentage of CD44 expression for specimens were determined. Data were analyzed using IBM SPSS version 23.0 software.

Results: This study included 80 PAC and 83 BPH samples. The mean expression of CD44 in PAC samples was significantly lower than in BPH samples (28.59 ± 14.84 vs. 47.82 ± 14.65, p < 0.001). A moderate to strong significant negative correlation was found between CD44 expression and total Gleason scores and Gleason grade groups (r: -0.743, p < 0.001; r: -0.732, p < 0.001, respectively). Ordinal logistic regression showed that lower CD44 expression was associated with higher odds of advanced disease (OR = 0.884, p < 0.001).

Conclusion: This study highlights CD44 expression not only as a potential biomarker for PAC diagnosis but also potential guide to therapeutic decision-making. Patients exhibiting lower CD44 levels may require closer monitoring and more aggressive treatment strategies, while those with higher expression may be candidates for less intensive management. Overall, our findings advocate for further investigation into CD44 as a biomarker for prostate cancer aggressiveness, which could ultimately enhance personalized treatment approaches and improve the patient outcomes.

Objective: Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the clinical value of medical care costs for SC before LC.

Subject and methods: Of the 509 patients who underwent LC, 335 underwent preoperative SC before LC. The electronic medical records were retrospectively reviewed, and the technical fees of SC and endoscopic and/or surgical resection for colorectal neoplasia (CRN) were analyzed.

Results: In the 335 patients with SC before LC, the rate of CRN requiring resection, including advanced adenoma and adenocarcinoma, was 13.1%. The detected rate of CRN requiring resection in the age-groups of <45, 44-55, 55-65, 65-75, ≥75 years was 5.3%, 3.8%, 9.8%, 17.4%, and 22.9%, respectively. Of the 174 patients without SC before LC, 4 patients were diagnosed with resectable colorectal carcinomas after LC. The total technical fees of SC and/or treatment of CRNs among the 335 patients with SC before LC and surgical procedures among the 4 patients with resectable colorectal carcinoma were United States dollar (USD) 84,700 and USD 32,000 USD, respectively. Regarding the technical fee per person, the former group (USD 250) had much economic advantage compared to the latter group (USD 8,000).

Conclusion: Scheduling LC is recognized as an important chance to undergo SC. For the patients aged ≥55 years, colonoscopy is no longer a screening option but a clinical necessity due to the high detected rates of CRN requiring resection.

Objective: Long QT syndrome (LQTS) poses a significant risk of torsade de pointes, particularly in older patients due to age-related changes in cardiac repolarization and increased susceptibility to medication-induced QTc interval prolongation. Despite the increased risk, data on medication-related LQTS remain limited, leading to this study on its prevalence, characteristics, and risk factors, along with QT-prolonging drug use in older patients. The study aimed to identify clinical and medication-related predictors of LQTS and evaluate the burden of co-prescribed QT-prolonging medications in this population.

Subjects and methods: This prospective study at a tertiary care hospital included initial and follow-up ECGs, with medication details were collected. Statistical analyses compared variables, including QTc intervals and medication use, between patients with and without LQTS.

Results: The study included 128 adults aged 65 or older, with 27.3% presenting LQTS on admission, increasing to 42.2% after 7 days of hospitalization. Patients with LQTS had a higher prevalence of QTc interval-prolonging medications, list 1 medications, and atrial fibrillation. Laboratory changes and medication use were observed, with significant increases in QTc interval and list 1 medication administration. Male sex and amiodarone use were identified as predictors of LQTS during hospitalization.

Conclusion: The study reports a high prevalence of prolonged QTc interval and LQTS in older inpatients. Proton pump inhibitors were frequently prescribed despite their QTc-prolonging potential. This underscores the need of close monitoring and awareness of QTc prolongation risks in older patients, advocating for routine ECG assessments and vigilant management of modifiable risk factors, especially the electrolytes.

Aging is an inevitable life process which is accelerated by lifestyle and environmental factors. It is an irreversible accretion of molecular and cellular damage associated with changes in the body composition and deterioration in physiological functions. Each cell (other than stem cells) reaches the limit of its ability to replicate, known as cellular or replicative senescence, and consequently, the organs lose their physiological functions, resulting in overall impairment. Other factors that promote aging include smoking, alcohol, UV rays, sleep habits, food, stress, sedentary lifestyle, and genetic abnormalities. These stress factors can alter our endogenous clock (the circadian rhythm) and the microbial commensals. As a result of the effect of these stressors, the microorganisms that generally support human physiological processes become baleful. The disturbance of natural physiology instigates many age-related pathologies, such as cardiovascular diseases, chronic obstructive pulmonary disorder, cerebrovascular diseases, opportunistic infections, high blood pressure, cancer, diabetes, kidney diseases, dementia, and Alzheimer's disease. The present review covers the three most essential processes of the circadian clock; the circadian gene mechanism and regulation, the mitotic clock (which plays a vital role in the telomere's attrition) and the gut microbiota and their metabolome that drive aging and lead to age-related pathologies. In conclusion, maintaining a synchronized circadian rhythm, a healthy gut microbiome, and telomere integrity is essential for mitigating the effects of aging and promoting longevity. The interplay among these factors underscores the importance of lifestyle choices in enhancing overall health and lifespan.

Introduction: Continuous dialysis in hemodynamically stable patients with acute kidney injury (AKI) may impact outcomes differently than intermittent dialysis. We evaluated differences in patient and kidney outcomes between the two modalities.

Methods: Clinical and 30-day outcome data for inpatients with AKI who were hemodynamically stable and not on ventilation and who received intermittent hemodialysis (IHD) or continuous kidney replacement therapy (CKRT) in public hospitals in Kuwait from January 1 to December 31, 2021, were prospectively collected.

Results: We recruited 229 patients (age: 59.9 years; males, 60.3%; baseline estimated baseline glomerular filtration [eGFR], 56 mL/min). CKRT accounted for 72.9% of cases due to lack of access to water treatment. No statistically significant differences were observed between groups in terms of age, baseline eGFR, sex, comorbidities, cause of AKI, or fluid administration. The intensive care unit contributed 21% of cases, with no significant difference between groups. More IHD patients received diuretics (62.9% vs. 43.1% for CKRT, p = 0.008). At 30 days, 21.8% of patients had died. There was no statistically significant difference in mortality between groups (16.1% for IHD vs. 24% for CKRT, p = 0.2). Final eGFR was 53.2 mL/min, with no difference between groups. Complete kidney recovery was greater with CKRT (33.1% vs. 13.5%, p = 0.009). Baseline eGFR < 60 mL/min did not influence mortality or kidney recovery.

Conclusion: Compared with IHD, CKRT did not lower mortality at 30 days, which is similar to that of randomized trials; however, it was associated with better complete kidney recovery, which was reported in observational studies.