Postgraduate Medicine最新文献

Introduction: Inspiratory muscle training (IMT) has been widely used in both healthy and diseased populations especially in older adults, and its effects have been proven not only on inspiratory muscle strength but also on dyspnea, exercise capacity, quality of life, and other health parameters.

Aim: This study aims to review the effects of IMT on balance and functional ability of healthy and diseased populations.

Methods: A systematic literature search was conducted on MEDLINE, EMBASE, AMED, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized control trials having participants > 18 years of age and having balance and functional mobility as primary or secondary outcomes were included. Two independent reviewers screened studies against the eligibility criteria, extracted the data, and assessed the quality of evidence. The protocol was prospectively registered on PROSPERO: CRD42021261652.

Results: Ten studies were included in the review out of which eight had balance and six had functional mobility as an outcome measure. There was a significant improvement in balance of the participants after treatment with IMT, however the effect on functional mobility was inconclusive.

Conclusion: The review provided evidence of improvement in balance and functional mobility following inspiratory muscle training in both healthy and diseased adults. Future studies should be conducted to determine the optimal protocol and dosage of treatment.

Background: Aging and type 2 diabetes mellitus (DM) are two different conditions that impair sleep quality. The primary objective of this study was to investigate the impact of sleep quality on geriatric syndromes in older diabetic adults.

Methods: Comprehensive geriatric assessment was performed on 236 patients. The assessment included the Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life Questionnaire (EQ-5D), Mini Mental Statement Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment, and measurement of handgrip strength (HGS).

Results: Of the participants, 55% had DM, and 61.4% had poor sleep quality. Poor sleep prevalence was higher in diabetic patients (68.5%) than in non-diabetics (52.8%). Diabetic patients with poor sleep quality had higher frequencies of chronic pain, recurrent urinary tract infections, confirmed sarcopenia, and frailty (p = 0.015, p < 0.001, p = 0.027, and p < 0.001, respectively), a higher number of comorbidities and higher GDS and BAI scores (p = 0.046, p < 0.001 and p < 0.001, respectively), and lower scores of activities of daily living, HGS, and EQ-5D index (p = 0.023, p = 0.004, and p < 0.001, respectively) compared to diabetic patients with good sleep quality. According to the correlation analysis results, PSQI score had a positive correlation with GDS score (r = 0.461, p < 0.001) and a negative correlation with Mini Nutritional Assessment score (r = -0.317, p < 0.001), skeletal muscle mass index (r = -0.283, p = 0.002) and HGS (r = -0.307, p < 0.001) scores in diabetic older adults.

Conclusion: Poor sleep quality in older diabetic patients has a negative impact on several geriatric syndromes. Our findings suggest that poor sleep quality is an independent risk factor for depression, malnutrition, and lower muscle mass in older diabetic adults. Improving sleep quality may play a crucial role in preventing and managing geriatric syndromes in this population.

Objective: Spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening pathology and cases are especially seen in women under 50 years of age and with relatively fewer cardiovascular risk factors. Although risk factors facilitating the development of SCAD have been defined in the literature, modifiable risk factors remain unclear. In this study, it was aimed to investigate the relationship between the triglyceride glucose index (TyG) and the development of SCAD in the population of young women.

Methods: The results of 281 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters, and coronary angiography results.

Results: The mean age was 45 years and all of them were female. When the groups were compared, the TyG and inflammatory parameters were higher in the SCAD group (p < 0.001). When these two groups with low cardiovascular risk factors were compared in logistic regression analysis, high TyG was found to be an independent predictor of SCAD development in young women (p < 0.001).

Conclusion: As a result, our study shows that the development of these non-atherosclerotic conditions can be predicted by simple biochemical tests in young women with low atherosclerotic cardiovascular risk factors.

Objective: The current study evaluated the relationship between serum vitamin C and chronic kidney disease.

Methods: The database from the National Health and Nutrition Examination Survey (NHANES, 2017-2018) was used to perform a cross-sectional study. Multivariate logistic regression was performed to analyze the relationship between serum vitamin C and chronic kidney disease (CKD), and stratified analysis by sex was performed to assess whether there were sex differences in the association between serum vitamin C and CKD.

Results: Before stratified analysis, multivariate logistic regression showed that serum vitamin C was negatively associated with CKD in all models (All OR > 1, P< 0.05), the risk of CKD decreased by one quantile increase in serum vitamin C (P for trend< 0.001) and low vitamin C status was associated with a higher risk of CKD (All OR > 1, P< 0.05). Stratified analyses by sex showed that the association between serum vitamin C and CKD remained negative in men, but not in women.

Conclusion: There were a negative correlation between serum vitamin C and CKD, low levels of vitamin C were associated with a higher risk of CKD, and these associations were only found in men, but not in women.

Objectives: This study assessed postoperative mortality, morbidity, and complications associated with anesthesia administration for gynecologic oncology abdominal surgery and investigated the risk factors for the development of these complications.

Methods: We conducted a retrospective cohort study analyzing the data of patients who underwent elective gynecologic oncology surgery between 2010 and 2017. The demographic data; comorbidities; preoperative anemia; Charlson Comorbidity Index; anesthesia management; complications; preoperative, intraoperative, and postoperative periods; mortality; and morbidity were investigated. The patients were classified as surviving or deceased. Subgroup analyses of patients with endometrial, ovarian, cervical, and other cancers were performed.

Results: We analyzed 416 patients; 325 survived and 91 were deceased. The postoperative chemotherapy rates (p < 0.001), and postoperative blood transfusion rates (p = 0.010) were significantly higher in the deceased group, while the preoperative albumin levels were significantly lower in the deceased group (p < 0.001). Infused colloid amount was higher in the deceased group of endometrial (p = 0.018) and ovarian cancers (p = 0.017).

Conclusions: Perioperative patient management for cancer surgery requires a multidisciplinary approach led by an anesthesiologist and surgeon. Any improvement in the duration of hospital stay, morbidity, or recovery rate depends on the success of the multidisciplinary team.

Objectives: To substantiate the clinical efficacy and investigate the real-world effectiveness of the herbal medicinal product BNO 1016 in acute rhinosinusitis (ARS) in the context of antibiotic stewardship.

Methods: We performed a meta-analysis of the clinical trials ARhiSi-1 (EudraCT No. 2008-002794-13) and ARhiSi-2 (EudraCT No. 2009-016682-28) comprising 676 patients, analyzing the reduction of the Major Symptom Score (MSS) and improvement of the Sino-Nasal Outcome Test 20 (SNOT-20) by the herbal medicinal product BNO 1016. In addition, we performed a retrospective cohort study including 203,382 patients, comparing the real-life effectiveness of BNO 1016 in reducing ARS-related adverse outcomes in comparison to antibiotics and several other established therapies.

Results: Treatment with BNO 1016 ameliorated symptoms of ARS by reducing MSS by 1.9 points (p < 0.0001) and improved quality of life (QoL) for patients by improving SNOT-20 by 3.5 points (p = 0.001) in comparison to placebo. In patients with moderate/severe symptoms, the positive effects of BNO 1016 were even more pronounced (MSS: -2.3 points (p < 0.0001); SNOT-20: -4.9 points (p = 0.0158)). In addition, treatment with BNO 1016 was as effective or significantly more effective in reducing the risk for adverse ARS-related outcomes such as follow-up antibiotic prescriptions, sick leave ≥7 days or medical appointments due to ARS, especially when compared to antibiotics.

Conclusion: BNO 1016 is a safe and effective treatment for ARS that can help reduce the overuse of antibiotics.

Introduction: A significant number of rotator cuff tear (RCT) patients developed chronic shoulder pain that did not correspond to physiological changes. Central sensitization syndrome (CSS) is a neurophysiological adaptation process that can result in hypersensitivity to peripheral stimuli. Although there is evidence of an association between CSS and musculoskeletal problems, no studies have focused on the association between CSS and RCT. The primary purpose of this study was to examine the prevalence of CSS in patients with RCT. The secondary purpose was to document the associated conditions and comorbidity that were associated with the CSS.

Methods: This was a cross-sectional study of patients with RCT who completed the Central Sensitization Inventory (CSI). Patients with score of ≥ 40/100 were considered positive for CSS. Demographic and clinical data and CSI results were collected to analyze the prevalence and associated factors of CSS in RCT patients.

Results: A total of 404 RCT patients were included, and the CSS prevalence was 39.4%. Compared to the non-CSS group, the CSS group had an odds ratio of 4.13 (95% CI, 2.70-6.32; p＜0.001) for ages 51-60, 3.07 (95% CI, 2.00-4.69; p＜0.001) for symptoms lasting more than 6 months, 6.08 (95% CI, 3.90-9.47; p＜0.001) for nonphysical laborers, 3.69 (95%CI, 2.42-5.61; p＜0.001) for long head of biceps (LHB) abnormality, 2.93 (95% CI, 1.93-4.45; p＜0.001) for concurrent shoulder stiffness, 4.82 (95% CI, 2.55-9.10; p＜0.001) for anxiety or panic episodes, and 2.11 (95% CI, 1.12, 4.00; p＜0.001) for depression.

Conclusions: The prevalence of CSS in patients with RCT was relatively high at 39.4%. The CSS was associated with higher age, female gender, and clinical findings of symptoms lasting over six months, nonphysical laborers, abnormal LHB, concurrent shoulder stiffness, anxiety, and depression.

Background and objectives: Dermatologic lesions that occur primarily or are secondary to disease are among the most common reasons for referral to the Pediatric Emergency Department (PED). This study aims to reveal the clinical features, diagnostic distribution, and management of patients who presented to the PED with dermatologic lesions.

Methods: The study was a retrospective cross-sectional study involving children aged 0-18 years who presented to Gazi University Faculty of Medicine, PED, in 2018 with dermatologic lesions. The SPSS-20 program was used for data analysis.

Results: A total of 1590 patients, 57.8% (919) male, were included in the study. The median age was 75 (minimum: 4 days; maximum: 17 years, 11 months) months. The frequency of dermatologic lesions was 4.33% (433/10,000). Allergic and infectious dermatologic lesions, which are the two most common skin lesions in all age groups, were seen in 46.2% (735) and 30.5% (485) (patients, respectively. Urticaria (n = 588, 37%) was the most common in allergic rashes, and viral rashes (n = 162, 10.2%) were the most common in infectious rashes. Ninety-four percent (1495) of the patients were discharged from the PED. Two patients were hospitalized and followed up as dermatologic emergencies.

Conclusion: Urticaria and viral eruptions are common dermatologic lesions in our PED. Both conditions are easily recognized and treated by physicians. Most lesions do not require hospitalization. Dermatologic emergencies, although rare, should be well-known to physicians.

Background and aims: Coronary small vessel disease (CSVD) is often associated with significant percutaneous coronary intervention (PCI) related complications, complex lesions, complex PCI, and poor long-term prognosis. We designed this retrospective study to clarify the characteristics, risk factors, and prognostic analyses of CSVD in Chinese populations.

Methods: A total of 986 patients who underwent coronary angiography and stent implantation at the First Affiliated Hospital of Zhejiang University School of Medicine were evaluated. Patients were grouped into CSVD or non-small vessel disease (non-CSVD) according to stent diameter. Clinical data, coronary angiography, and long-term follow-up were recorded. Multivariate logistic regression, the Kaplan-Meier method, Log-rank Test, and Cox regression model were used for statistical analysis.

Results: Alcohol consumption (OR = 0.420, 95% CI: 0.299-0.588, P < 0.001) was implicated as a negative CSVD correlation factor. CSVD was more likely to be associated with multi-vessel lesions (79.2% vs. 49.4%, P < 0.001), bifurcation lesions (24.0% vs. 12.4%, P < 0.001), chronic total obstruction lesions (29.5% vs. 9.4%, P < 0.001), and long lesions (55.2% vs. 35.7%, P < 0.001), which reduced the efficacy of revascularization (70.1% vs. 85.1%, P < 0.001). In the follow-ups, cardiac death (2.3% vs. 0.4%, P = 0.008), stroke (1.9% vs. 0.3%, P = 0.007), target lesion revascularization (5.8% vs. 2.9%, P = 0.029), target vessel revascularization (6.8% vs. 3.4%, P = 0.016), and non-target vessel revascularization (7.8% vs. 4.0%, P = 0.012) were all substantially higher in CSVD patients. Troponin I level (OR = 1.008, 95% CI: 1.004-1.012, P < 0.001), complete revascularization (OR = 0.292, 95% CI: 0.160-0.531, P < 0.001), and aspirin administration (OR = 0.041, 95% CI: 0.013-0.131, P < 0.001) were independent predictors of MACE events of all patients.

Conclusion: Compared to non-CSVD, CSVD was associated with more complex lesions, had worse revascularization efficacy, and a poorer prognosis.

Chronic kidney disease (CKD) remains a pathologic entity with constantly rising incidence and high rates of morbidity and mortality, which are associated with serious cardiovascular complications. Moreover, the incidence of end-stage renal disease tends to increase. The epidemiological trends of CKD warrant the development of novel therapeutic approaches aiming to prevent its development or retard its progression through the control of major risk factors: type 2 diabetes mellitus, arterial hypertension, and dyslipidemia. Contemporary therapeutics such as sodium-glucose cotransporter-2 inhibitors and second-generation mineralocorticoid receptor antagonists are utilized in this direction. Additionally, experimental and clinical studies present novel drug categories that could be employed in managing CKD, such as aldosterone synthesis inhibitors or activators guanylate cyclase, while the role of melatonin should be further tested in the clinical setting. Finally, in this patient population, the use of hypolipidemic agents may provide incremental benefits.