Clinics and Practice最新文献

Background: The increasing incidence of spondylodiscitis and its potentially severe consequences when not promptly diagnosed highlight the need for further research to improve treatment guidelines, reduce mortality and morbidity and improve the quality of life in patients who suffer from persistent physical limitations. Methods: We collected data from 103 patients, with 8 patients lost to follow-up, who were diagnosed with vertebral osteomyelitis, disk infection or discitis between 2009 and 2018. The primary outcome was the 1-year mortality rate in patients treated with either conservative or surgical intervention, with both groups receiving antibiotic treatment. A standardized questionnaire was used to assess health-related quality of life after treatment by evaluating the European Quality of Life 5 Dimension 5 Level version (EQ-5D-5L) and the European Quality of Life Visual Analog Scale (EQ-VAS). In addition, we used the Oswestry Disability Index (ODI) and the Parker Mobility Score to identify backpain-related limitations after treatment. Results: The group receiving surgical treatment had a significantly lower 1-year mortality rate (22%) than did those who were treated conservatively, who had a 4-fold greater risk for death after a year following first diagnosis of SD and treatment. With respect to quality of life, 39 patients answered the standardized questionnaires during follow-up, and the questionnaire results revealed no significant difference in limitations in daily life or in health-related quality of life, with a median Parker Mobility Score of 9 for the conservatively treated patients compared with 7.5 for the surgically treated patients. This difference between the groups was not statistically significant, with a p value of 0.216 > α. A similar result was obtained in the evaluation of the ODI, with a medial index of 30% in the conservatively treated group compared with 24% in the surgical group, which was not statistically significant as indicated by a p value of 0.360 > α. Conclusions: The early surgical approach when treating spondylodiscitis is advantageous for identifying the underlying infection and initiating appropriate antibiotic therapy, therefore reducing mortality and resulting in a greater likelihood of full recovery than the conservative treatment does.

Background: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient's medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can offer valuable insights to improve patient care by guiding clinical decision-making. Artificial Intelligence (AI) and, in particular, Generative AI (GAI), are promising tools in this regard, particularly after the introduction of Large Language Models. The European Federation of Internal Medicine (EFIM) recognizes the transformative impact of AI in leveraging clinical data and advancing the field of internal medicine. This position paper from the EFIM explores how AI can be applied to achieve the goals of P6 Medicine principles in internal medicine. P6 Medicine is an advanced healthcare model that extends the concept of Personalized Medicine toward a holistic, predictive, patient-centered approach that also integrates psycho-cognitive and socially responsible dimensions. An additional concept introduced is that of Digital Therapies (DTx), software applications designed to prevent and manage diseases and disorders through AI, which are used in the clinical setting if validated by rigorous research studies.

Methods: The literature examining the relationship between AI and Internal Medicine was investigated through a bibliometric analysis. The themes identified in the literature review were further examined through the Delphi method. Thirty international AI and Internal Medicine experts constituted the Delphi panel.

Results: Delphi results were summarized in a SWOT Analysis. The evidence is that through extensive data analysis, diagnostic capacity, drug development and patient tracking are increased.

Conclusions: The panel unanimously considered AI in Internal Medicine as an opportunity, achieving a complete consensus on the matter. AI-driven solutions, including clinical applications of GAI and DTx, hold the potential to strongly change internal medicine by streamlining workflows, enhancing patient care and generating valuable data.

We thank Haq and Khan for their thoughtful commentary [...].

We would like to thank Leivaditis et al [...].

Background: Uterus transplantation (UTx) is a proven treatment for individuals affected by absolute uterine factor infertility (AUFI) who desire biological motherhood. Despite the fact that over 130 procedures have been performed worldwide in the past decade, UTx remains relatively unfamiliar, even among healthcare professionals. This study aimed to identify knowledge gaps regarding and evaluate attitudes toward UTx among Hungarian obstetricians/gynecologists and transplantation providers, in anticipation of the first procedure to be performed in the country. Methods: A Microsoft Forms^® questionnaire was distributed electronically among Hungarian medical professionals via e-mail, including members of the Hungarian Society of Obstetrics and Gynaecology and the Hungarian Transplantation Society. Additionally, participants of the "Update 2024" OB/GYN conference (held 28-29 November 2024, in Visegrád, Hungary) were invited to complete the survey through a QR code displayed during the event. Results: A total of 290 medical professionals completed the survey (response rate: 27.6%, 290/1050). Most of the respondents specialized in obstetrics and gynecology (81.7%, n = 237), with the remainder representing transplantation fields (18.3%, n = 53). Over half (56.6%, n = 161) reported they would recommend UTx to patients with AUFI, and 64.1% (n = 186) agreed that UTx should be available as a treatment option. The medical risks associated with the procedure were deemed acceptable for both living donors (58.0%, n = 168) and recipients (54.8%, n = 159). Conclusions: This is the first study to explore perceptions of UTx among Hungarian medical professionals. The findings suggest there is a generally favorable professional attitude toward its future clinical implementation.

Background/Objectives: Recently, epigenetic mechanisms have been recognized as crucial in atopic dermatitis development. The emphasis of this research was on expanding existing knowledge about the epigenetic aspects of atopic dermatitis, as well as identifying new molecules that could serve as disease biomarkers. Methods: The research was conducted as a cross-sectional study examining two groups: the group with atopic dermatitis (50 patients) and the control group (50 healthy adults). The serum levels of total immunoglobulin E (IgE) and eosinophil count (Eos%) were performed in routine laboratory analyses, and the detection of microRNAs from peripheral blood was performed using RT-PCR. Results: Analysis of selected miRNA expressions in patients with atopic dermatitis and controls revealed that only the expression and the relative expression of miRNA-146a were statistically significantly higher in patients with atopic dermatitis than in the control group (p = 0.042 and p = 0.021, respectively). There was a weak positive correlation between miRNA-146a expression and the eosinophilia/IgE level (r = 0.22 and r = 0.25, respectively). MiRNA-21, miRNA-29b, miRNA-143 and miRNA-223 were significantly upregulated in patients with higher SCORAD (p < 0.001, p < 0.001, p < 0.001 and p = 0.015, respectively). ROC curve analysis revealed the specificity of miRNA-146a as 82% and the sensitivity as 62%. The area under the ROC curve (AUC) was 0.7, indicating its diagnostic potential. Conclusions: Our findings imply that miRNA-146a might serve as a biomarker of atopic dermatitis, suggesting its relevance in the development of the disease, while miRNA-21, miRNA-29b, miRNA-143 and miRNA-223 may have an impact on disease progression. Our findings provide a preliminary basis that should precede validation through larger, multicentric studies and use in diagnostics, targeted personalized treatments and monitoring of treatment efficacy in atopic dermatitis.

Objectives: Evaluate the agreement and interobserver variability between manual segmentation and the ellipsoid formula in estimating single kidney volume (SKV) in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: In this retrospective study, 130 unenhanced CT scans of ADPKD kidneys were analyzed. Three radiologists (one senior, two juniors) measured SKV using manual segmentation and the ellipsoid formula. Statistical analyses included intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman analysis, and paired t-tests to compare measurement values and computation times. Results: Both methods showed excellent interobserver agreement (ICC ≥ 0.977). No significant difference was observed in volume estimates between the two techniques (Wilcoxon p = 0.295). Bland-Altman analysis confirmed strong agreement between methods for the senior radiologist. The ellipsoid method was significantly faster for all readers (p < 0.05). Conclusions: The ellipsoid formula is a reliable, time-efficient alternative to manual segmentation for SKV estimation in ADPKD, offering comparable accuracy with reduced resource demands in clinical settings.

Background: Achieving low-density lipoprotein cholesterol (LDL-C) goals is essential for secondary prevention after atherosclerotic ischemic stroke or transient ischemic attack (TIA). This study assessed the prevalence of LDL-C goal attainment and identified associated determinants post-ischemic stroke/TIA. Methods: A cohort of Thai patients discharged on statin therapy after admission with acute ischemic stroke or TIA was evaluated for LDL-C goal attainment within 12 months post-discharge. Logistic regression determines factors associated with LDL-C goal attainment, and the generalized linear model confirmed the association between covariates and LDL-C reduction. Results: Among 487 patients (85.8% with ischemic stroke), the prevalence of LDL-C goal attainment differed across LDL-C target levels: 9.9% for <55 mg/dL, 29.0% for <70 mg/dL, 70.4% for <100 mg/dL, and 17.5% for ≥50% reduction from baseline. Logistic regression identified high-intensity statins as a significant predictor of goal attainment at <70 mg/dL (OR 1.91, 95% CI 1.09-3.34), <100 mg/dL (OR 1.64, 95% CI 1.01-2.67), and ≥50% reduction (OR 2.32, 95% CI 1.14-4.73), but not <55 mg/dL (OR 1.65, 95% CI 0.72-3.79). In the generalized linear model, high-intensity statin and baseline LDL-C were significant determinants of LDL-C reduction. Conclusions: LDL-C target attainment after ischemic stroke/TIA is modest overall, and remains low for the more stringent targets (<55 mg/dL). High-intensity statins improve goal attainment and produce greater LDL-C reductions, supporting wider use of more aggressive lipid-lowering strategies in this high-risk population.

Background: The number of publications related to rivaroxaban is growing, making it difficult for scientists to review relevant materials.

Objectives: This bibliometric analysis is focused on highlighting hot spots and new trends associated with rivaroxaban studies and provides references and guidance for further research.

Methods: A comparison between countries, journals, authors, and organizations was performed. Microsoft Excel 2021 and VOSviewer were used to process and visualize data extracted from Web of Science. The time range was set from 1991 to late 2024. A total of 6979 articles were analyzed and bibliometric maps of co-citations of references and co-occurrences of the keywords were built.

Results: Relative research interest increased until 2021, when it started to drop. The new trends in publications related to rivaroxaban are associated with a comparison of NOAC therapy outcomes with previously used vitamin K antagonists (warfarin). The research was focused also on new NOAC representatives, medical conditions treated with NOAC, and safety of the therapy. New trending topics are related to ABCB1, peripheral artery disease, direct-acting oral anticoagulants, PCI, and SARS-CoV-2.

Conclusions: This bibliometric analysis showed that increasing attention is being paid to the medical conditions treated with NOACs and issues related to the safety of this therapy.