Postgraduate Medical Journal最新文献

Background: As traditional lipid-lowering drugs, the role of statins in reducing the incidence of cholelithiasis remains controversial. The aim of this study is to utilize the single nucleotide polymorphisms (SNPs) related to the target of statins, HMGCR, to simulate the effect of statins and explore the causal relationship between statins and cholelithiasis.

Methods: Drug-targeted Mendelian randomization (MR) was first applied to study the causal relationship between the application of statins and the risk of cholelithiasis. Subsequently, we explored the causal relationship between other lipid-lowering drugs such as ezetimibe and PCSK9 inhibitors and the incidence of cholelithiasis. Thereafter two-sample MR analyses were conducted to examine the associations of lipids with the risk of cholelithiasis.

Results: The Low-Density Lipoprotein Cholesterol (LDL-C)-reducing SNPs near the HMGCR gene (rs10066707, rs12916, rs2006760, rs5909, and rs2303152), which mimic the effects of statins, were associated with a decreased risk of cholelithiasis (OR 0.445, 95% CI 0.339-0.585, P < 0.001). However, other lipid-lowering drugs such as ezetimibe and PCSK9 inhibitors, when reducing the same level of LDL-C, cannot reduce the incidence of cholelithiasis. Moreover, multivariable MR analyses showed that neither LDL-C nor High-Density Lipoprotein Cholesterol (HDL-C) had a significant impact on cholelithiasis risk.

Conclusion: These facts shows that statins are associated with a decreased risk of cholelithiasis, and this association is unlikely to be mediated by lipid-lowering effects. Further clinical trials and basic experimental validation is needed to validate their relationship and underlying mechanisms.

Cardiology remains one of the most competitive medical specialties in the UK. This article provides practical guidance for aspiring cardiologists preparing for Higher Specialty Training applications. It outlines strategies to maximize portfolio scores, prepare effectively for interviews and adapt to recent changes in the scoring framework. The guidance also simultaneously supports the development of core skills essential for a successful career in cardiology.

Background: This study aimed to evaluate the effectiveness of a culturally adapted, interactive, and personalized digital cognitive behavioral therapy (CBT-I) for individuals with co-morbid insomnia and sleep apnea (COMISA), and to compare the treatment outcomes with those of insomnia alone.

Methods: This secondary analysis utilized data from a prior randomized controlled trial. The efficacy of digital CBT-I (dCBT-I) on insomnia severity and mental health was assessed in both COMISA and insomnia-only groups at postintervention and at 1-, 3-, and 6-month follow-ups.

Results: Among 38 insomnia participants who completed the dCBT-I, 20 underwent sleep studies (4 males, 16 females; mean age 52.3 ± 13.0 years). Seven were diagnosed as mild-to-moderate obstructive sleep apnea (COMISA), and 13 did not (insomnia alone). Compared with baseline, the insomnia severity index scores significantly decreased at postintervention and the 1-, 3-, and 6-month follow-ups in both the COMISA and insomnia alone groups (P < .05), with large effect sizes (Cohen's d > 1.0). No significant differences were observed between the two groups in insomnia severity index scores at baseline, postintervention, and at 1-, 3-, and 6-month follow-ups (P > .05). Mixed-effects models indicated no significant group × time interaction on insomnia severity index scores (P > .05). Wake time after sleep onset, sleep efficiency of the sleep diaries, and health questionnaire (PHQ-9) scores also improved significantly postintervention and at follow-up in both groups.

Conclusions: This self-guided, culturally adapted, and personalized dCBT-I effectively improved insomnia severity, sleep quality, and depressive symptoms among individuals with COMISA. While treatment effects were comparable between COMISA and insomnia-alone groups, the observed numerical differences may reflect limited statistical power. Larger studies are warranted to determine whether individuals with comorbid obstructive sleep apnea respond differently to dCBT-I. Key messages What is already known on this topic: Cognitive behavioral therapy for insomnia may improve outcomes in patients with comorbid insomnia and sleep apnea. What this study adds: This study shows that an interactive, personalized, and culturally adapted digital cognitive behavioral therapy for insomnia program is also effective for comorbid insomnia and sleep apnea patients. How this study might affect research, practice, or policy: These findings support broader implementation of tailored digital cognitive behavioral therapy for insomnia in the treatment of comorbid insomnia and sleep apnea.

Background: Female genital mutilation (FGM) is still a prevalent practice in Egypt. Healthcare workers (HCWs) are often involved in performing the FGM procedure. Understanding FGM-related attitudes can help prevent this harmful practice.

Objective: To assess knowledge and attitudes of medical students about FGM.

Methods: A cross-sectional study recruiting 560 medical students using a structured self-administered questionnaire for data collection.

Results: Females represented 59.5% and those of urban residence represented 54.5%. FGM was accepted by 30% of males compared to 22.2% of females with a significant odds ratio of 1.497 (95% CI = 1.020-2.197). Participants from rural areas (OR = 1.809, 95% CI: 1.232-2.658) and those whose fathers (OR = 2.509, CI = 1.685-3.738) and mothers (OR = 2.422, 95% CI = 1.643-3.571) lacked university education showed significantly higher acceptance of FGM. Medical students cited religion (89.1%) and female chastity (84.5%) as the main reasons for supporting FGM. They rejected the practice primarily due to the risk of serious complications (67.7%) and the belief that it is a harmful social custom (63.4%). A total of 88% of participants reported knowing the long-term consequences of FGM, including psychological trauma (63.2%), reduced sexual pleasure (38.8%), and marital problems (23.2%). Among participants, 48.2% reported that FGM violates the law, 20.9% believed religion supports it, and 15.4% supported its continuation.

Conclusion: Medical students showed a considerable acceptance of FGM, which was affected by gender, residence, and parental education. Participants had good knowledge about its negative consequences, but they still had a positive attitude towards it. Key messages Egypt has one of the highest global prevalence rates of FGM despite its criminalization in 2008. A significant proportion of cases are performed by healthcare professionals. This study explores the underlying cultural, religious, and social factors that shape the perceptions of future physicians, whose views may directly impact the continuation or prevention of FGM. Results will support targeted awareness campaigns for young healthcare professionals.

Background: The National Residency Match Program considers a successful Couples Match when both parties match, regardless of location. However, there is a dearth of data on Couples Match outcomes compared to normal Match Outcomes.

Objective: To compare the success rates, geographic preferences, and application preparation between Couples Match and traditional Match applicants within the specialty of internal medicine.

Methods: An anonymous, cross-sectional, two-part REDCap survey was designed for standard and Couples Match residents. This survey was distributed via email to 437 academic United States internal medicine program directors from 1 October 2022 to 31 December 2023. Questions focused on post-match satisfaction, pre-application priorities, and number of interviews conducted. Around 248 residents completed the survey across the 437 internal medicine residency programs initially contacted.

Results: 64% (52/82) of Couples Match participants felt the need to make compromises to ensure dual matching. Compared to standard applicants, Couples Match applicants were significantly less likely to match in their top three ranked programs (89% vs. 67%, P < 0.01). When asked how to rate their perceived stress during the match process on a scale of 1-10, Couples Match respondents reported significantly higher perceived stress than their standard match counterparts (7.85 ± 1.30 vs. 7.13 ± 1.74) (P < 0.001).

Conclusions: We found that Couples Match applicants had differing pre-match priorities, significantly less likelihood of matching in their top three programs, and significantly higher perceived levels of stress. Our study highlights the unique needs and stressors of medical students who are applying to internal medicine through the Couples Match. Key messages What is already known on this topic: While the NRMP Couples Match boasts a high overall success rate, little is known about specialty-specific outcomes, applicant satisfaction, or the personal and professional compromises made by couples, particularly within internal medicine. What this study adds: This is the first national study to quantify internal medicine Couples Match outcomes, revealing that these applicants face significantly higher stress, are less likely to match at top-choice programs, and frequently compromise on prestige, geography, and personal priorities to match with their partner. How this study might affect research, practice, or policy: These insights underscore the need for tailored advising, informed program recruitment strategies, and potential policy considerations to better support the unique constraints faced by Couples Match applicants-enhancing both resident well-being and match satisfaction.

Objective: To determine the frequency of traumatic injuries in polo players in England.

Methods: The survey included data on body location and reason for injury derived from accident reports using a retrospective cohort design from 26 participating English polo clubs between the years 2018 and 2024.

Results: The study population included injuries in 236 polo players. The most common injury site was the limb (arm, hand, leg, wrist, shoulder) 47.9% (95% CI: 41.4-54.5), and face or head 38.6% (95% CI: 32.3-45.1), of which 12.1% (95% CI: 6.2-20.6) affected the eyes. The most common reason to require hospital treatment was injury sustained to the eyes, 45.5% (95% CI: 16.7-76.6), followed by limb 36.9% (95% CI: 27.6-47.0), and face or head 35.4% (95% CI: 23.9-48.2) (proportional difference P = .006). The most common sites to suffer an injury by the ball or stick and require hospital treatment were the head or face, 38.1% (95% CI: 23.6-54.4), eyes, 37.5% (95% CI: 8.5-75.5), and limb, 19.2% (95% CI: 9.6-32.5) (proportional difference P ≤ .001). The most common injury requiring hospital treatment that involved the horse was to the eyes, 66.7% (95% CI: 1.0-91.0). There was a significant proportional difference for eye injuries caused by the horse requiring hospital treatment compared to face/head (57.7%, 95% CI: 28.8-86.6, P < .001) or limb injuries (58.9%, 95% CI: 30.3-87.7, P < .001).

Conclusion: Traumatic injury to the eyes while playing polo is the most common reason for requiring hospital treatment. As the head is already protected by mandating helmet use, we now advise similar regulation for eye protection by directing the wearing of sports glasses, goggles, or face guards. Key messages What is already known on this topic: Polo is regarded as a high-risk sport, which may result in traumatic injuries, the most serious affecting the head. Wearing of helmets is required during play to reduce this risk. What this study adds: Traumatic eye injuries during play are common and sustained from either the stick, ball, or fall from the horse. While the head is reasonably protected with helmets, injuries to the eyes while playing polo are the most common reason for requiring hospital treatment. How this study might affect research, practice or policy: As helmets are already mandated while playing polo, we now advocate the compulsory use of eye protection (sports glasses, goggles or face guards) for all polo players.