American Journal of Medicine最新文献

Background: Clinical details of long COVID are still not well understood because of potential confounding with a wide range of pre-existing comorbidities.

Methods: The present study used datasets from a nationwide, cross-sectional, online survey. We determined which prolonged symptoms were more likely to be associated with post-COVID condition after adjusting for a wide range of comorbidities and baseline characteristics. This study also used the EuroQol 5 Dimension 5 Level (EQ-5D-5L) and Somatic Symptom Scale-8 to assess health-related quality of life (QOL) and somatic symptoms in individuals with a previous history of COVID-19, defined as the diagnosis of COVID-19 made at least 2 months prior to the online survey.

Results: In total, 19,784 respondents were included for analysis; of these, 2397 (12.1%) had a previous history of COVID-19. The absolute difference of adjusted prevalence of symptoms attributed to prolonged symptoms after COVID-19 ranged from -0.4% to +2.0%. Headache (adjusted odds ratio [aOR]: 1.22; 95% confidence interval [95% CI]:1.07-1.39), chest discomfort (aOR:1.34, 95% CI:1.01-1.77), dysgeusia (aOR: 2.05, 95% CI: 1.39-3.04), and dysosmia (aOR: 1.96, 95% CI: 1.35-2.84) were independently associated with a previous history of COVID-19. Individuals with a previous history of COVID-19 had lower health-related QOL scores.

Conclusions: After adjusting for potential comorbidities and confounders, clinical symptoms, such as headache, chest discomfort, dysgeusia, and dysosmia, were found to be independently associated with a previous history of COVID-19, which was diagnosed 2 or more months previously. These protracted symptoms might have impacted QOL and the overall somatic symptom burden in subjects with a previous history of COVID-19.

Background: Breast implants interfere with myocardial perfusion imaging (SPECT) and echocardiographic windows leading to increased false positive results. To validate this concept, we hypothesized that patients with breast implants should have higher positive cardiac testing and coronary angiogram with lower percutaneous coronary intervention (PCI) rates compared to women without a breast implant.

Methods: Using ICD 10 codes for breast implants, abnormal results of cardiac functional study, coronary angiogram, and percutaneous coronary interventions, we evaluated any association between these parameters in adult women with breast implants utilizing the National Inpatient Sample (NIS) database.

Results: A total of 45,015 women had abnormal cardiac functional studies. A total of 1,871,335 women 18 or older underwent coronary angiography. From those, 865,020 underwent percutaneous coronary intervention (PCI). Women with breast implants with abnormal cardiac functional tests were 10 years younger (55.06 vs 65.06 years, p<0.001). Furthermore, the breast implant cohort had a higher adjusted abnormal cardiac functional study (OR1.78, CI 1.11-2.26, p=0.02). Adult women with breast implants also had a significantly higher rate of adjusted coronary angiography (OR: 1.3, CI: 1.17-1.44, P<0.001) but a lower rate of PCI (35.7% vs 46.2%, P<0.001, unadjusted OR: 0.65, CI 0.54-0.78, adjusted OR 0.79, CI 0.65-0.98, P=0.01).

Conclusions: Women with breast implants had higher adjusted positive cardiac functional studies, and a higher adjusted rate of coronary angiography but lower rates of PCI consistent with our hypothesis that breast implant interference can increase abnormal cardiac testing leading to an increase in the utilization of coronary angiography.

Background and aim: Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis outcomes. This study aimed to examine the association of Social Vulnerability Index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes in patients with acute pancreatitis.

Methods: This study included acute pancreatitis patients hospitalized between 1/1/2008 and 12/31/2021 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I-IV: IV representing the highest vulnerability).

Result: In 824 eligible patients [age of 53.0 ± 10 years and 48.2% females], with 993 acute pancreatitis-related hospitalizations, we noted a significant association in patients residing in communities with higher SVI, a higher prevalence of no/federal/state insurance (P < .001) and underserved ethnic/racial background (P < .001). We observed a significant association of alcohol withdrawal in patients with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (odds ratios: 1.62 [95% CI: 1.19-2.22]; P = .003). However, we observed no association of SVI with severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.

Conclusions: We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks, despite no differences in severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.

Background: Few GIM-specific heart failure transition of care (TOC) programs exist. We thus piloted a TOC program for heart failure patients discharged from GIM that incorporates a remote patient management program, Medly.

Methods: This single-centre, prospective proof-of-concept study described sociodemographic and medical characteristics of included patients, and computed summary statistics to describe clinical and workload outcomes.

Results: Ten patients (median age: 85) enrolled. There were no heart failure-related deaths, re-hospitalizations, or ED visits within 90 days of hospital discharge. One urgent GIM clinic visit was needed.

Conclusion: This post-GIM TOC pathway appears to effectively support heart failure patients. Further studies should assess this innovation's scalability.