American Journal of Medicine最新文献

英文中文

Clinically Guided Adaptive Machine Learning Update Strategies for Predicting Severe COVID-19 Outcomes 用于预测严重 COVID-19 结果的临床指导性自适应机器学习更新策略。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.011

Mehmet Ulvi Saygi Ayvaci PhD , Varghese S. Jacobi PhD , Young Ryu PhD , Saikrishna Pannaga Srikar Gundreddy , Bekir Tanriover MD, MPH, MBA, FAST

Background

Machine learning algorithms are essential for predicting severe outcomes during public health crises like COVID-19. However, the dynamic nature of diseases requires continual evaluation and updating of these algorithms. This study aims to compare three update strategies for predicting severe COVID-19 outcomes postdiagnosis: “naive” (a single initial model), “frequent” (periodic retraining), and “context-driven” (retraining informed by clinical insights). The goal is to determine the most effective timing and approach for adapting algorithms to evolving disease dynamics and emerging data.

Methods

A dataset of 1.11 million COVID-19 patients from diverse U.S. regions was used to develop and validate an XGBoost algorithm for predicting severe outcomes upon diagnosis. Data included patient demographics, vital signs, comorbidities, and immunity-related factors (prior infection and vaccination status) from January 2007 to November 2021. The study analyzed the performance of the three update strategies from March 2020 to November 2021.

Results

Predictive features changed over the pandemic, with comorbidities and vitals being significant initially, and geography, demographics, and immunity-related variables gaining importance later. The “naive” strategy had an average area under the curve (AUC) of 0.77, the “frequent” strategy maintained stability with an average AUC of 0.81, and the “context-driven” strategy averaged an AUC of 0.80, outperforming the “naive” strategy and aligning closely with the “frequent” strategy.

Conclusions

A context-driven approach, guided by clinical insights, can enhance predictive performance and offer cost-effective solutions for dynamic public health challenges. These findings have significant implications for efficiently managing healthcare resources during evolving disease outbreaks.

背景：机器学习算法对于预测 COVID-19 等公共卫生危机的严重后果至关重要。然而，疾病的动态特性要求对这些算法进行持续评估和更新。本研究旨在比较预测 COVID-19 诊断后严重后果的三种更新策略："天真"（单一初始模型）、"频繁"（定期再训练）和 "情境驱动"（根据临床见解进行再训练）。目的是确定最有效的时机和方法，使算法适应不断变化的疾病动态和新出现的数据：方法：利用来自美国不同地区的 111 万 COVID-19 患者数据集，开发并验证了一种 XGBoost 算法，用于预测诊断后的严重后果。数据包括 2007 年 1 月至 2021 年 11 月期间患者的人口统计学特征、生命体征、合并症和免疫相关因素（既往感染和疫苗接种情况）。研究分析了 2020 年 3 月至 2021 年 11 月期间三种更新策略的性能：结果：预测特征在大流行期间发生了变化，合并症和生命体征最初很重要，而地理、人口统计学和免疫相关变量后来变得越来越重要。天真 "策略的平均AUC为0.77，"频繁 "策略保持稳定，平均AUC为0.81，而 "情境驱动 "策略的平均AUC为0.80，优于 "天真 "策略，与 "频繁 "策略接近：结论：以临床洞察力为指导的情境驱动方法可以提高预测性能，为应对动态的公共卫生挑战提供具有成本效益的解决方案。这些发现对于在疾病爆发演变期间有效管理医疗资源具有重要意义。

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引用次数: 0

Timeless Caves, Sacred Spaces, Cardiology Clinics 永恒的洞穴、神圣的空间、心脏病诊所。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.032

Daniel Zheng MA

引用次数: 0

A Rare Case of Stiff Person Syndrome: From Spasms to Bedbound.

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2025.01.029

Alaine Pu Yin Teu, Stephen Ching-Tung So

引用次数: 0

Physical Health and Mental Fatigue Disability Associated with Long COVID: Baseline Results from a US Nationwide Cohort 与长期新冠肺炎相关的身体健康和精神疲劳障碍：美国全国队列的基线结果。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2023.08.009

Bryan Lau PhD, MHS, ScM, Eryka Wentz MA, Zhanmo Ni MHS, Karine Yenokyan PhD, Candelaria Vergara MD, Shruti H. Mehta PhD, MPH , Priya Duggal PhD, MPH

Background

Persistent symptoms after severe acute respiratory disease coronavirus 2 (SARS-COV-2; long COVID) occur in 10%-55% of individuals, but the impact on daily functioning and disability remains unquantified.

Methods

To characterize disability associated with long COVID, we analyzed baseline data from an online, US-based cohort study. Adult participants included those reporting a history of COVID-19 (n = 8874) or never having COVID-19 (n = 633) without prior disability. The main outcomes were self-reported physical mobility, instrumental activities of daily living (IADL), and mental fatigue disability, assessed by measuring 5 disability components: difficulty walking a quarter mile or climbing 10 stairs (mobility), difficulty doing light or heavy housework (IADL), and Wood Mental Fatigue Inventory score (mental fatigue).

Results

Of 7926 participants with long COVID, 65% were classified with at least one disability, as compared with 6% and 14% for resolved COVID and no COVID, respectively. Additionally, 22% were classified as disabled in all 3 categories. Age, prior comorbidity, increased body mass index, female sex, COVID-19 hospitalization, non-white/multi-race were associated with higher disability burden. Dizziness and heavy limbs at infection were associated with disability regardless of hospitalization. Dyspnea and tremors were associated with disability in non-hospitalized individuals. Vaccination was protective against disability.

Conclusions

We observed a high burden of new disability associated with long COVID, which has serious implications for individual and societal health. Longitudinal evaluation of COVID-19 patients is necessary to identify patterns of recovery and treatment options.

背景：10%-55%的人出现严重急性呼吸系统疾病冠状病毒2型（严重急性呼吸综合征冠状病毒2型；长期新冠肺炎）后的持续症状，但对日常功能和残疾的影响仍未量化。方法：为了描述与长期新冠肺炎相关的残疾，我们分析了一项基于美国的在线队列研究的基线数据。成年参与者包括报告有新冠肺炎病史（n=8874）或从未患有新冠肺炎（n=633）但无残疾的人。主要结果是自我报告的身体活动能力、日常生活工具性活动（IADL）和精神疲劳残疾，通过测量5个残疾组成部分进行评估：行走四分之一英里或爬10级楼梯的困难（活动能力）、做轻或重家务的困难（IADL，结果：在7926名长期新冠肺炎患者中，65%的患者至少有一种残疾，而新冠肺炎和无新冠肺炎的患者分别为6%和14%。此外，22%的人在所有三个类别中都被归类为残疾人。年龄、既往合并症、体重指数增加、女性、新冠肺炎住院治疗、非白人/多种族与较高的残疾负担相关。无论是否住院，感染时头晕和四肢沉重都与残疾有关。呼吸困难和震颤与非住院患者的残疾有关。接种疫苗可以预防残疾。结论：我们观察到与长期新冠肺炎相关的新残疾负担很高，这对个人和社会健康有严重影响。对新冠肺炎患者进行纵向评估对于确定康复模式和治疗方案是必要的。

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引用次数: 0

Unraveling the Mechanisms Behind Exercise Intolerance and Recovery in Long COVID 揭示长期 COVID 运动不耐受和恢复背后的机制。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.04.023

Patricia Palau MD, PhD , Beatriz Calvo , Clara Sastre BSN, RN , Eloy Domínguez MD, PhD , Paloma Marín PhD , Cristina Flor PhD , Julio Núñez MD, PhD , Laura López PhD

Background

Patients suffering from long COVID may exhibit autonomic dysregulation. However, the association between autonomic dysregulation and exercise intolerance and the impact of therapeutic interventions on its modulation remains unclear. This study investigated the relationship between heart rate recovery at the first minute (HRR1), a proxy for autonomic imbalance, and exercise intolerance in patients with long COVID. Additionally, the study aimed to assess the effects of a 12-week home-based inspiratory muscle training program on autonomic modulation in this patient population.

Methods

This study is a post hoc subanalysis of a randomized trial in which 26 patients with long COVID were randomly assigned to receive either a 12-week inspiratory muscle training program or usual care alone (NCT05279430). The data were analyzed using Pearson's correlation and linear mixed regression analysis.

Results

The mean age was 50.4 ± 12.2 years, and 11 (42.3%) were women. Baseline HRR1 was significantly correlated with maximal functional capacity (peakVO₂) (r = 0.402, P = .041). Patients with lower baseline HRR1 (≤22 bpm) exhibited higher resting heart rates and lower peakVO₂. Inspiratory muscle training led to a more substantial increase in peakVO₂ in patients with lower HRR1 at baseline (P = .019). Additionally, a significant improvement in HRR1 was observed in the IMT group compared to the usual care group after 12-week (Δ +9.39, 95% CI = 2.4-16.4, P = .010).

Conclusion

Lower baseline HRR1 is associated with exercise intolerance in long COVID patients and may serve as a valuable criterion for identifying individuals likely to benefit more from a home-based inspiratory muscle training program.

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引用次数: 0

Disseminated Herpes Zoster in an Immunocompromised Patient: Challenges for Preventing Transmission Before Diagnosis 免疫力低下患者的播散性带状疱疹：诊断前预防传播的挑战。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.010

Shiori Kitaya MD, PhD , Reina Iyobe MD , Hajime Kanamori MD, PhD

引用次数: 0

Epstein-Barr Virus Related Mixed Cryoglobulinemic Vasculitis with Multi-System Involvement. 与爱泼斯坦-巴氏病毒相关的多系统受累混合型冷球蛋白血症血管炎

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2025.01.024

Lauren Davis, Aria Jalalian, Obed Agyei, David Cohen, Arezoo Ghaneie

引用次数: 0

Factors Associated with Cognitive Impairment in Patients with Persisting Sequelae of COVID-19 与 Covid-19 持续后遗症患者认知障碍相关的因素。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.01.021

Aaron Bonner-Jackson PhD , Rohun Vangal BS , Yadi Li MEd , Nicolas Thompson MS , Shinjon Chakrabarti , Kamini Krishnan PhD

Objective

Quantify cognitive deficits in patients with postacute sequelae of COVID-19 (PASC) and identify key variables related to cognitive impairment in PASC.

Method

Patients with polymerase chain reaction-confirmed COVID-19 underwent a comprehensive neuropsychological evaluation. The comparison group included patients without neurological disorders determined by the neuropsychologist to be cognitively intact. Cognitive impairment was defined as impairment (Composite T ≤35) in 1 of 6 cognitive domains. The PASC group was split into impaired or intact based on the above criteria. Multivariable logistic regression models assessed predictors including demographics, COVID-19 severity, clinical characteristics, and mood.

Results

There were 210 patients with PASC, predominantly female (73.3%, P < .001), without other demographic differences when compared with 369 normal controls. Patients with PASC were more likely to have cognitive impairment (odds ratio 3.61; 95% confidence interval, 2.36-5.54; P < .001) compared with controls, with significantly lower scores in domains of memory, language, processing speed, visuospatial function, executive function (P < .001), and higher depressive (P = .004) and anxiety symptoms (P = .003). Patients with PASC who demonstrated cognitive impairment (n = 93) had higher body mass index compared with those with PASC without cognitive impairment (n = 117), without differences in other predictors.

Conclusion

Patients with PASC are almost 4 times more likely to evidence cognitive dysfunction compared with normal controls. Forty-four percent of patients with PASC demonstrated cognitive deficits about 7 months from infection. Estimated premorbid intelligence significantly correlated with impairment. Higher body mass index was the only metric shown to differentiate those with PASC and cognitive impairment from those with PASC who were cognitively intact.

摘要量化 Covid-19 急性后遗症（PASC）患者的认知障碍，并确定与 PASC 认知障碍相关的关键变量：聚合酶链反应（PCR）确诊为Covid-19的患者接受了全面的神经心理学评估。对比组包括无神经系统疾病的患者，这些患者经神经心理学家认定认知功能完好。认知障碍的定义是六个认知领域之一出现障碍（复合 T ≤ 35）。根据上述标准，PASC 组被分为认知功能受损组和认知功能完好组。多变量逻辑回归模型评估了包括人口统计学、Covid-19 严重程度、临床特征和情绪在内的预测因素：与正常对照组相比，PASC 患者出现认知功能障碍的可能性几乎高出 4 倍。44%的PASC患者在感染后7个月左右出现认知障碍。估计的病前智力与认知障碍有明显的相关性。较高的体重指数（BMI）是区分认知障碍患者与认知功能正常的认知障碍患者的唯一指标。

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引用次数: 0

A Critical Review on the Long-Term COVID-19 Impacts on Patients With Diabetes 关于 COVID-19 对糖尿病患者长期影响的批判性评论。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.02.029

Sumel Ashique M.Pharm , Neeraj Mishra PhD , Ashish Garg PhD , Sweta Garg PhD , Arshad Farid PhD , Shweta Rai M.Pharm , Gaurav Gupta PhD , Kamal Dua PhD , Keshav Raj Paudel PhD , Farzad Taghizadeh-Hesary MD

Background

The world is currently grappling with the potentially life-threatening coronavirus disease 2019 (COVID-19), marking it as the most severe health crisis in the modern era. COVID-19 has led to a pandemic, with the World Health Organization (WHO) predicting that individuals with diabetes are at a higher risk of contracting the virus compared to the general population. This review aims to provide a practical summary of the long-term impacts of COVID-19 on patients with diabetes. Specifically, it focuses on the effects of SARS-CoV-2 on different types of diabetic patients, the associated mortality rate, the underlying mechanisms, related complications, and the role of vitamin D and zinc in therapeutic and preventive approaches.

Methods

Relevant literature was identified through searches on PubMed, Web of Science, and Science Direct in English, up to April 2023.

Results

COVID-19 can lead to distressing symptoms and pose a significant challenge for individuals living with diabetes. Older individuals and those with pre-existing conditions such as diabetes, coronary illness, and asthma are more susceptible to COVID-19 infection. Managing COVID-19 in individuals with diabetes presents challenges, as it not only complicates the fight against the infection but also potentially prolongs the recovery time. Moreover, the virus may thrive in individuals with high blood glucose levels. Various therapeutic approaches, including antidiabetic drugs, are available to help prevent COVID-19 in diabetic patients.

Conclusions

Diabetes increases the morbidity and mortality risk for patients with COVID-19. Efforts are globally underway to explore therapeutic interventions aimed at reducing the impact of diabetes on COVID-19.

背景：目前，全世界都在努力应对可能危及生命的冠状病毒病 2019（COVID-19），这已成为当代最严重的健康危机。世界卫生组织（WHO）预测，与普通人群相比，糖尿病患者感染该病毒的风险更高。本综述旨在对 COVID-19 对糖尿病患者的长期影响进行实用性总结。具体而言，它侧重于 SARS-CoV-2 对不同类型糖尿病患者的影响、相关死亡率、潜在机制、相关并发症以及维生素 D 和锌在治疗和预防方法中的作用：方法：通过在PubMed、Web of Science和Science Direct上搜索到截至2023年4月的相关英文文献：COVID-19可导致令人痛苦的症状，并对糖尿病患者构成重大挑战。老年人和原有糖尿病、冠心病和哮喘等疾病的患者更容易感染COVID-19。管理 COVID-19 给糖尿病患者带来了挑战，因为这不仅会使抗感染变得复杂，还有可能延长康复时间。此外，病毒可能会在血糖水平较高的人群中大量繁殖。目前已有包括抗糖尿病药物在内的多种治疗方法帮助糖尿病患者预防 COVID-19：结论：糖尿病会增加 COVID-19 患者的发病率和死亡率。全球正在努力探索旨在减少糖尿病对 COVID-19 影响的治疗干预措施。

{"title":"A Critical Review on the Long-Term COVID-19 Impacts on Patients With Diabetes","authors":"Sumel Ashique M.Pharm , Neeraj Mishra PhD , Ashish Garg PhD , Sweta Garg PhD , Arshad Farid PhD , Shweta Rai M.Pharm , Gaurav Gupta PhD , Kamal Dua PhD , Keshav Raj Paudel PhD , Farzad Taghizadeh-Hesary MD","doi":"10.1016/j.amjmed.2024.02.029","DOIUrl":"10.1016/j.amjmed.2024.02.029","url":null,"abstract":"<div><h3>Background</h3><div><span><span>The world is currently grappling with the potentially life-threatening coronavirus disease 2019 (COVID-19), marking it as the most severe health crisis in the modern era. COVID-19 has led to a pandemic, with the World Health Organization (WHO) predicting that individuals with diabetes are at a higher risk of contracting the virus compared to the general population. This review aims to provide a practical summary of the long-term impacts of COVID-19 on patients with diabetes. Specifically, it focuses on the effects of SARS-CoV-2 on different types of diabetic patients, the associated </span>mortality rate, the underlying mechanisms, related complications, and the role of </span>vitamin D and zinc in therapeutic and preventive approaches.</div></div><div><h3>Methods</h3><div>Relevant literature was identified through searches on PubMed, Web of Science, and Science Direct in English, up to April 2023.</div></div><div><h3>Results</h3><div><span>COVID-19 can lead to distressing symptoms and pose a significant challenge for individuals living with diabetes. Older individuals and those with pre-existing conditions such as diabetes, coronary illness, and asthma are more susceptible to COVID-19 infection. Managing COVID-19 in individuals with diabetes presents challenges, as it not only complicates the fight against the infection but also potentially prolongs the recovery time. Moreover, the virus may thrive in individuals with high blood glucose levels. Various therapeutic approaches, including </span>antidiabetic drugs, are available to help prevent COVID-19 in diabetic patients.</div></div><div><h3>Conclusions</h3><div>Diabetes increases the morbidity and mortality risk for patients with COVID-19. Efforts are globally underway to explore therapeutic interventions aimed at reducing the impact of diabetes on COVID-19.</div></div>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"138 2","pages":"Pages 308-329"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pleural Effusion in a Patient on Peritoneal Dialysis 腹膜透析患者的胸腔积液。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.043

H. Tahsin Özpolat MD, Sangeetha Murugapandian MD

引用次数: 0

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