Clinical Medicine & Research最新文献

Background: Cancer and heart failure (HF) are significant causes of morbidity and mortality worldwide. Moreover, there is increasing evidence of a relationship between HF and cancer. Although oncology has experienced significant advancements in cancer therapies, patients with a combination of these conditions represent an important clinical challenge due to varying outcomes among different demographic populations. Therefore, understanding these trends is crucial for targeted interventions.Aims: This study analyzed two decades of mortality data to examine the trends, patterns, and disparities in cancer-related and cancer with HF-related deaths across the United States (US).Methods: Mortality data from 1999 to 2020 were obtained using CDC WONDER, identifying cancer and cancer with HF-related deaths in adults age ≥25 years via ICD-10 codes. Demographic and regional distributions of mortality were analyzed utilizing statistical methods. Joinpoint regression analysis was used to determine trends in age-adjusted mortality rates (AAMR) and annual percentage changes (APC).Results: Between 1999 and 2020, there were 13,880,876 cancer-related deaths in the US, including 567,657 with HF listed as a cause of death. The AAMR for cancer-related deaths decreased from 343.7 to 252.4 per 100,000 (APC: -1.61% [95% CI: -1.70, -1.57] from 1999 to 2018, then -0.62% to 2020). Cancer with HF-related deaths initially declined (AAMR: 15.0 to 10.2 from 1999-2013) but increased from 2013 to 2020 (APC: +6.03%). Males had higher mortality rates than females for both conditions. Cancer-related mortality was highest among non-Hispanic (NH) Whites and Hispanics, while cancer with HF-related mortality was highest among NH Whites and NH American Indians/Alaska Natives. Geographically, the South had the most cancer-related deaths (37.3%), while the Midwest led in cancer with HF-related deaths (4.5%).Conclusions: Cancer-related mortality has declined overall, whereas mortality for cancer with co-existing heart failure has risen since 2013 after an initial decline. Disparities persist, with the highest burden in NH Whites, males, and those in rural or underserved areas. The findings underscore the need for focused interventions aimed at reducing mortality related to cancer and cancer with heart failure, particularly among the vulnerable population.

Eosinophilic fasciitis (EF) is a rare fibrosing disorder caused by an autoimmune response to an unknown trigger. Many possible triggers have been suggested including strenuous exercise, drug or chemical exposure, and preceding infection. We present a case of a female patient, age 69 years, who developed EF following SARS-CoV-2 infection. There have been several advances in the diagnosis and management of EF since it was first described 50 years ago. EF is a mimic of scleroderma, but key clinical features can be used to differentiate between the two diagnoses. Laboratory abnormalities include eosinophilia, elevated inflammatory markers, and hypergammaglobulinemia. A full thickness biopsy of the skin including muscle and fascia is recommended to confirm the diagnosis. Imaging modalities such as ultrasound and magnetic resonance imaging have been increasingly used in the diagnosis and follow-up of EF. Corticosteroids remain the first line in treatment of EF. Combination of steroids and methotrexate have shown the best possible outcome. Early diagnosis is important for better treatment response.

Background: Subclinical hypothyroidism (SCH) is of particular importance due to its high prevalence and its association with cognitive deficits. Patients often express complaints of neuropsychological symptoms and cognitive impairments including lack of attention. Also, patients treated with levothyroxine (LT-4) often report persistent complaints related to mental slowing or lack of attention despite normal TSH levels.Purpose: To investigate the effects of different ranges of TSH on sustained attention in SCH.Methods: Included in the study were 136 participants that were divided into four groups: Group 1, 35 healthy individuals; Group 2, 33 newly diagnosed patients with SCH; Group 3, 36 patients on LT-4 with uncontrolled or elevated TSH; Group 4, 32 euthyroid patients (ongoing LT-4). Laboratory measurements and clinical assessment were done. Rapid visual processing (RVP) task was performed on standardized battery (Cambridge Automated Neuropsychological Test Battery).Results: There was significant impairment in sustained attention (P=<0.05) in Group 2 patients who had neuropsychological symptoms and SCH diagnosed with a TSH range of ≥2.5mIU/L.Conclusion: Our findings encourage screening for sustained attention along with thyroid profile in those who report neuropsychological symptoms. TSH mean range of ≥2.5 mIU/L was established as a more reasonable threshold for evaluating sustained attention and initiating LT-4 in SCH.

The main function of high-density lipoprotein (HDL) is to remove low-density lipoprotein (LDL) from blood vessels through reverse cholesterol transport. In addition, HDL has anti-inflammatory and antioxidant properties. Low HDL level is an independent risk factor for development of coronary artery disease. To manage patients with low HDL levels, general measures such as lifestyle modification, controlling acute metabolic syndrome, and participating in regular endurance exercise are essential. Smoking cessation is a must, and it will often improve HDL levels by 5% to 10%. While statin therapy is the backbone therapy for controlling LDL levels, it also results in elevation of HDL levels by at least 5%. Specific pharmacologic interventions to improve HDL level and function have been disappointing. Cholesteryl ester transfer protein (CETP) is the key metabolic pathway to transfer HDL to LDL; thus, CETP inhibitors result in elevation of HDL levels. Several products were tested in large controlled studies, such as dalcetrapib and evacetrapib; neither resulted in any clinical benefit. Anacetrapib only resulted in very limited benefit and is no longer under active development. The most recent study utilized apolipoprotein A1 infusion in high-risk patients shortly after acute myocardial infarction. There was no benefit in the primary end point of myocardial infarction, stroke, or death. In patients with low HDL, a strategy of having LDL as low as can be possibly achieved may be the most appropriate approach.

Objective: There are two types of criteria for diagnosing gestational diabetes mellitus (GDM). The first is based on measurement of three values on the glucose tolerance test (GTT) and making a diagnosis when any value is abnormal (individual time-point criterion). The second is based on creating a weighted average of the three values and using the average to split glycemic status into normal gestational glycemia (NGG), impaired gestational glycemia (IGG), gestational diabetes (GDM), or high-risk gestational diabetes (hGDM) (unified criterion). There is no information currently regarding how these two criteria relate to each other in the diagnosis of GDM. This study aimed to make this comparison.Design: Cross-sectional study.Setting: Publicly available data on a cohort of women in pregnancy.Participants: Pregnant women from the cohort.Methods: The cross-classification of diagnosis by two criteria was evaluated. The individual time-point criterion had a binary outcome (GDM yes/no), while the unified criterion had the four aforementioned outcomes.Results: Within the low risk (non-GDM) category by the individual time-point criterion, 1 in 85 women would have been deemed at high risk by the unified criterion. More importantly, within the high risk (GDM) category by the individual time-point criterion, 1 in 2 women would have been deemed at low risk by the unified criterion.Conclusion: The standard criterion is not equivalent to the unified criterion in terms of risk estimation. This is important as the unified criterion correlates with area under the GTT curve known to be associated with glucose excursion and is predictive of the net effect of insulin resistance and beta-cell function.

Management of humeral head fractures presents numerous challenges, particularly in cases of separation fractures, which are relatively rare and often caused by high-energy trauma. Due to the complexity of these fractures and the absence of a standardized treatment algorithm, surgical intervention can be technically intricate and fraught with postoperative complications. In young patients, the decision to pursue open reduction and internal fixation must be meticulously made to achieve optimal outcomes while minimizing long-term sequelae. We present a rare case of a man, age 25 years, sustaining a complex proximal humerus fracture. The patient presented with a proximal humerus fracture involving a head-splitting pattern comprising five fragmented pieces, necessitating careful anatomical reduction and fixation. Despite the technical challenges encountered during surgery, including the meticulous reconstruction of the humeral head "puzzle" using headless screws, the postoperative recovery was relatively uneventful. While some restrictions in range of motion were noted postoperatively, the absence of early complications like osteonecrosis bodes well for the patient's long-term functional prognosis. This is a thought-provoking case accentuating that by apposite surgical techniques and tailored treatment strategy to individual young patients, successful management of humeral head fractures can be achieved while minimizing potential complications and optimizing functional recovery in this challenging patient population.

Leptospirosis is a zoonotic disease caused by spirochetes from the species Leptospira Weil's disease, the more severe manifestation of leptospirosis, is characterized by a combination of jaundice, renal injury, and hemorrhages. Diagnosing severe leptospirosis in patients with acute life-threatening multi-organ dysfunction at presentation can be challenging because of the non-specific clinical manifestations. This report describes a case of severe leptospirosis with jaundice, acute renal dysfunction, severe thrombocytopenia, pulmonary hemorrhage, and unusual manifestations, including rhabdomyolysis, acalculous cholecystitis, and pancreatitis, which required a comprehensive diagnostic evaluation of possible causes to confirm the diagnosis. The case highlights the importance of clinicians considering leptospirosis in the differential diagnosis of a patient with cryptogenic sepsis who develops multiple organ dysfunction.

Exercise stress testing is crucial for assessing myocardial ischemia. However, artifacts from algorithmic interpretation and limitations of linked median algorithms can lead to false-positive findings. A female patient, age 63 years, underwent treadmill stress testing for atypical chest pain. Linked median analysis showed narrow complex tachycardia at 270 bpm during the stress test. Having supraventricular tachycardia (SVT) with a heart rate of 260 bpm would be extremely uncommon in a patient 63 years of age, especially without symptoms. The patient was initially planned for inpatient admission, but the raw electrocardiogram (ECG) confirmed sinus tachycardia. This case emphasizes the need for verification of synthesized ECG to avoid false-positive arrhythmia diagnoses.

Sodium chlorite is a household and industrial cleaning agent that can cause oxidative stress leading to methemoglobinemia and severe hemolysis when ingested. There is a scarcity of published literature reporting this in humans. We report a case of intentional sodium chlorite ingestion for homeopathic purposes that resulted in methemoglobinemia and hemolysis, requiring admission to the intensive care unit. Following successful treatment with methylene blue, the patient developed worsening hemolytic activity. Outpatient testing later revealed she was non- glucose-6-phosphate dehydrogenase (G6PD) deficient. Hemolysis precipitated by methylene blue is an underrecognized side effect that can be observed in individuals both with and without G6PD deficiency.