Clinical Medicine & Research最新文献

Objective: This study investigated the relationship between corticotropin-releasing hormone (CRH) related hypothalamic-pituitary-adrenal (HPA) axis hormones, chromogranin (CgA), and the acute stage of schizophrenia.Methods: Thirty-eight patients diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) were included in the study. Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Stroop Test, Clinical Global Impression Scale (CGI), Global Assessment of Functioning Scale (GAF), and Wechsler Memory Scale III Visual Reproduction Subtest (WMS III-VRS) were implemented to the patient on the days 1 and 20 of their hospitalization. Blood samples were taken on days 1 and 20 from each patient at 8 AM. Adrenocorticotropic hormone (ACTH), cortisol, CRH, and CgA serum levels were measured.Results: The CRH levels were significantly higher on day 20 than day 1 (P=0.007, t=-2.8). A positive correlation was found between cortisol level and PANSS General (r=0.325; P=0.046) and immediate WMS III- VRS (r=0.424; P=0.008). CgA change between the day 1 and day 20 negatively correlated with the sum of previous psychiatric hospitalization days (r=-0.344, P=0.034). Day 1 ACTH levels were negatively correlated with the sum of previous psychiatric hospitalization days (r=-0.365, P=0.024) and the hospitalization number (r=-0.415, P=0.01).Conclusion: HPA axis hormones measured in the acute phase of schizophrenia can give an idea about the severity of the disease and visual memory functions. However, studies with more subjects and controlling confounders are needed.

Objective: IL-16 has been described as a chemoattractant that activates macrophages, CD4+ T cells, eosinophils, dendritic cells, and monocytes, thus activating the secretion of inflammatory cytokines, including IL-15, IL-1β, and TNF-α. The present study aimed to investigate the IL-16 expression in the serum and elucidate IL-16 significance in the clinical assessment of epithelial ovarian cancer (EOC).Methods: The study adopted an enzyme-linked immunosorbent assay (ELISA) to analyze the expressions of IL-16 in the serum derived from 80 EOC patients and 80 age-matched healthy controls. The association of IL-16 levels with EOC patients' prognosis and clinical factors were determined. The receiver operator characteristic (ROC) analysis was done to determine the accuracy of serum IL-16 in EOC diagnosis.Results: EOC patients demonstrated significantly increased serum IL-16 levels compared to the controls (192.4 ±54.27 pg/mL versus 90.5±41.27 pg/mL, P<0.001, respectively). Elevated IL-16 levels in the serum were remarkably linked with tumor size (P=0.001), FIGO (International Federation of Gynecology and Obstetrics) stage (P=0.001), recurrence (P=0.039), and metastasis of lymph node (P=0.029). Analysis of the Kaplan-Meier survival curve confirmed elevated IL-16 levels in serum is directly associated with poor overall survival (OS) (P=0.032) and progression-free survival (P=0.041). Assessment of univariate and multivariate results demonstrated IL-16 serum levels (HR: 2.996, 95%CI:1.313-4.231, P=0.006) were the independent EOC patients' prognostic factors. Analyses of the ROC curve confirmed AUC of 0.781, 95% CI:0.639-0.923, P<0.001.Conclusion: Elevated IL-16 serum levels are linked with poor prognosis in EOC patients, and IL-16 might be a promising biomarker for the prognosis of EOC among patients.

Background and aim: Tuberculous meningitis (TBM) and cryptococcal meningitis (CM) are easily misdiagnosed due to atypical clinical symptoms. It is difficult for physcians to achieve a rapid and accurate differential diagnosis of TBM in the early stages of disease onset. The aim of this study was to construct a diagnostic prediction model for TBM and CM.Methods: In this retrospective study, 194 patients with TBM and CM were divided into two groups: training group (163 patients) and validation group (31 patients). Univariate and multivariate analyses were performed on the training group patients. The diagnostic factors were selected to construct the differential diagnostic prediction model for TBM and CM, and the prediction model was verified. A receiver operating characteristics curve (ROC) was constructed and used to evaluate the diagnostic value of the novel model.Results: Univariate analysis of clinical characteristics revealed differences in eight parameters (P<0.05) between tuberculous meningitis and cryptococcal meningitis. The multivariate analyses showed there were five independent differential factors including age, disease course, albumin-to-globulin ratio, cerebrospinal fluid protein, and cerebrospinal fluid sugar to blood sugar ratio in this study between TBM and CM, while there was no significant difference in the number of nucleated cells in CSF (P=0.088). A differential diagnosis model for TBM and CM was constructed based on those factors. A ROC was constructed with an area under curve [AUC] of 94.5%, a sensitivity of 85.71%, and specificity of 94.59% in the training group.Conclusion: The novel diagnostic scoring model for TBM and CM has greater differential diagnosis potential than previous reports, which can provide more reliable preliminary diagnosis results for primary hospitals, effectively reduce misdiagnosis, and provide references for early treatment.

Objective: Hippocampal atrophy (HA), the main lesion associated with drug-resistant temporal lobe epilepsy, can be reliably evaluated using conventional magnetic resonance imaging (MRI) with satisfactory lateralization of the epileptogenic focus. Post-processing quantitative techniques permit better evaluation of extratemporal volume abnormalities, including cortical and subcortical gray matter (GM) structures, with more consistent findings in the hemisphere ipsilateral to the epileptogenic focus, including the thalamus and adjacent gyri. We aimed to analyze the relationship between subcortical GM volume and temporal lobe epilepsy associated with hippocampal atrophy (TLE-HA), including hippocampal subfield analysis.Design: A transversal observational study conducted with patients from Clinics Hospital of the Federal University of Paraná, and a group control of healthy participants from Diagnostico Avançado por Imagem - DAPI.Setting: This study was conducted at Diagnostico Avançado por Imagem (Clinical Imaging Institution in Curitiba, Brazil) and Clinics Hospital of the Federal University of Paraná, Brazil.Participants: Patients with TLE-HA referred for surgical planning between September 2013 and August 2018 and individuals without pathologies on MRI scans other than HA were included.Methods: Subcortical GM volumes of the hippocampus, amygdala, and basal ganglia were obtained using automated techniques from the MRI scans of 38 patients with TLE-HA (17 with left TLE-HA) and compared with those of 59 healthy controls.Results: Patients with right TLE-HA demonstrated no significantly lower volumes in the subcortical structures; however, contralateral amygdala enlargement was observed (t = 3.802, P < 0.001). No significant volume loss was observed in the left TLE-HA group, the contralateral hippocampus, or hippocampal subfield comparisons; however, enlargement of the contralateral hippocampal amygdala transitional area was observed (t = 2.57, P = 0.012 for R-TLE-HA; t = 2.20, P = 0.031 for L-TLE-HA).Conclusion: Our findings suggest different patterns of subcortical volume abnormalities in patients with left and right TLE-HA, which may indicate different neural network abnormalities on the ictal side. No significant volume abnormalities existed in the contralateral hippocampus in the TLE-HA group or specific hippocampal subfields in automated analysis. Subtle contralateral amygdala enlargement was present in both groups and may play a specific role in the epileptogenic mechanisms.

Background: Cancer is a major public health concern in the United States, especially among minority populations. Area-level social determinants of health (SDOH) influence cancer outcomes, but the impact of the Minority Health Social Vulnerability Index (MHSVI) on cancer incidence at the county level is less understood.Methods: We analyzed ecological data from the Agency for Health Care Research and Quality for 3,232 counties in 2019. Exposures included MHSVI themes: socioeconomic, household composition, minority status/language, housing/transportation, healthcare infrastructure/access, and medical vulnerability (continuous). Overall MHSVI was categorized into low (.01/.25), moderate (.26/.74), and high (.75/1) percentiles. The outcome was the total number of cancer cases (continuous). Covariates included US regions and rural-urban regions. Unadjusted and adjusted negative binomial regressions with population weighting were performed using STATA/MPv.17; P values ≤0.05 were considered statistically significant.Results: A total of 3,232 counties were analyzed, with an average of 2,817.9 (SD:7,733.5) cancer cases, ranging from 16 to 201,547. All variables were significantly associated with cancer cases in unadjusted analyses. Adjusted analysis showed increased cancer incidence in moderate (IRR:0.94, 95%CI:0.92-0.96, P<0.001) and high (IRR:0.86, 95%CI:0.84-0.88, P<0.001) MHSVI areas compared to low MHSVI areas. Regional differences were observed, with increased cancer incidence in the Northeast (IRR:1.18, 95%CI:1.15-1.22, P<0.001), South (IRR:1.03, 95% CI:1.01-1.05, P<0.001), and West (IRR:0.92, 95%CI:0.90-0.94, P<0.001) compared to the Midwest. Rural areas had a slight increase in cancer incidence compared to urban areas (IRR:1.03, 95%CI:1.01-1.04, P<0.001).Conclusions: Our study highlights the significant association between MHSVI and cancer incidence at the county level. Regional and rural-urban differences were evident, emphasizing the need for targeted interventions addressing SDOH to reduce cancer disparities.

Objectives: To provide a comprehensive review of post-cholecystectomy complications, including their classification, diagnostic approaches, and clinical management, with a focus on imaging modalities and their role in improving patient outcomes.Design: This review integrates current evidence from relevant studies and clinical guidelines to categorize and describe early and late complications after cholecystectomy. Imaging findings, management strategies, and multidisciplinary considerations are emphasized.Setting: Data were synthesized from peer-reviewed literature and case studies involving post-cholecystectomy patients in diverse clinical settings.Participants: Patients undergoing laparoscopic or open cholecystectomy and subsequently presenting with complications such as bile duct injuries, bile leaks, vascular injuries, or stone-related conditions.Methods: A systematic approach was employed to identify common and rare complications. Each complication was categorized by anatomical location, timing of presentation, and severity. The diagnostic utility of imaging modalities, including ultrasound, computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography was critically evaluated.Results: Post-cholecystectomy complications significantly impact morbidity. Early complications include bile duct injuries, bile leaks, vascular injuries, and infectious processes. Late complications, such as bile duct strictures, retained stones, and Mirizzi syndrome are associated with higher diagnostic complexity. Imaging modalities play a crucial role in early detection and management, with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography offering superior diagnostic and therapeutic potential.Conclusion: Post-cholecystectomy complications require timely recognition and multidisciplinary management. Imaging studies are indispensable for accurate diagnosis and treatment planning. This review highlights key complications and their imaging characteristics, aiding clinicians in optimizing patient outcomes.

Reversible cerebral vasoconstriction syndrome (RCVS) is a relatively rare and underdiagnosed neurological condition that has similar clinical presentation to other neurological emergencies. Antidepressants such as selective serotonin reuptake inhibitors can be a secondary cause of RCVS. We present the case of a healthy young woman, with long term escitalopram use, who presented with bilateral neurological deficits and was found to have RCVS, whose symptoms improved remarkably after intra-arterial calcium channel blocker treatment. We discuss risk factors, theorized mechanisms, presentation, diagnostic tools, and management of RCVS. Our case should serve as a corollary for physicians to consider RCVS as a differential diagnosis for thunderclap headache, especially in patients with selective serotonin reuptake inhibitor use.

Trigeminal neuralgia is the most common form of craniofacial neuropathic pain with an incidence of 4 to 29 per 100,000 people per year. Acute trigeminal neuralgia pain crises are characterized by increased pain frequency and severity and can impact oral intake and sleep, as well as mood. The diagnosis of acute trigeminal neuralgia is clinical and supported by magnetic resonance imaging demonstrating morphological changes in the trigeminal neurovascular bundle on the ipsilateral side of the pain. Patients often present to the hospital seeking relief from acute exacerbations, making it essential for physicians to understand the management of an acute pain crisis, which differs from the chronic management, especially as there may be limited neurology or pain specialist support after hours. The need for improved knowledge of the treatment of acute trigeminal neuralgia is evidenced by opioids being the most prescribed analgesia despite little efficacy in treating it, a lack of evidence supporting their use and concerning side-effects. This article summarizes the evidence behind pharmacological therapy with fosphenytoin, phenytoin, and lidocaine as rescue medications in acute trigeminal neuralgia through the case of a male patient, age 58 years, who experienced complete resolution of pain following administration of phenytoin.

Objectives: Although acute respiratory syndrome is the main manifestation of COVID-19 disease, one of the characteristics of the disease is acute kidney injury (AKI). This study aimed to assess the prevalence of kidney dysfunction and para-clinical outcomes in hospitalized COVID-19 patients and its relationship with mortality.Methods: This cross-sectional analytical study was carried out on 715 patients aged older than 16-years with a diagnosis of COVID-19 admitted to the tertiary teaching Imam Reza Hospital, Mashhad, Iran from February 2020 to February 2021. During hospitalization, these patients were evaluated for AKI based on the Kidney Disease Improving Global Outcomes classification and mortality. Demographic variables and laboratory data were extracted from the hospital information systems electronic database. The significant risk factors for the incidence of AKI were analyzed using SPSS software in the present study.Results: The mortality rate of the included patients was 18.9%, which expired during hospitalization. Mortality was higher among patients with stage 1-2 AKI (34.1%) and stage 3 AKI (44.9%) compared to patients without AKI (8.7%). Individuals in different stages of AKI were significantly older relative to the non-AKI patients; hence, aging could be considered as the predictor of AKI. Leukocytosis, lactate dehydrogenase (LDH), and blood urea nitrogen (BUN) were indicated as significant risk factors for the incidence of AKI.Conclusions: It was found that the prevalence of AKI was 37.2% in hospitalized COVID-19 patients, and there was an association between mortality and the incidence of AKI.

Objective: To determine the rates of simultaneous antinuclear antibodies (ANA) screening and extractable nuclear antigen (ENA) testing that do not follow recommendations.Design, Setting, and Participants: Retrospective cohort study of adult patients (≥18 years) with a HEp-2 ANA or ENA ordered in the Marshfield Clinic Health System.Main Outcome(s) and Measure(s): Counts of patients having simultaneous ANA and ENA laboratory testing or ENA testing without ANA screening. Relevant ENA positivity in ANA negative patients. Secondary measures included relative timing of ANA and ENA ordering, potential cost savings of unnecessary testing, and provider ordering characteristics including specialty and provider type.Results: Of 58,627 cohort patients, 39,155 (66.8%) were women, and the mean (SD) age at first laboratory testing was 48.7 (19.0) years. The negative ANA with positive ENA rate was 2%. Further stratification identified only 23 diagnosed autoimmune connective tissue diseases (AI-CTDs) in this 2%, with a resulting negative ANA with relevant positive ENA rate of 0.37%. Simultaneous ANA and ENA testing occurred in 8.3% of patients, and an ENA only was ordered in 24.2% of patients. The simultaneous or non-sequential ordering of ANA and ENA testing resulted in significant health care costs of $2,293,251.80 over 20,112 unique patients.Conclusions and Relevance: A significant percentage of providers do not follow recommendations to sequentially order ANA and ENA testing on patients with suspected AI-CTDs. Significant saving in health care spending without failure to diagnose AI-CTDs can be achieved if ANA testing is performed first, followed by ENA testing when suspecting AI-CTDs in patients.