American Journal of Medicine最新文献

Cervical cancer remains a largely preventable malignancy, yet screening gaps persist, particularly in underserved and special populations. Recent advances have expanded screening strategies beyond traditional clinician-collected cytology to include high-risk human papillomavirus (HPV)-based testing and options for cervical and vaginal self-collection. This review summarizes current US screening guidelines, performance characteristics of primary HPV testing and co-testing, and evolving evidence supporting self-collection as a tool to improve access and adherence. Practical considerations for the primary care internist are emphasized, including a test selection algorithm, and shared decision-making. By integrating updated screening modalities with patient-centered implementation strategies, internists can play a pivotal role in advancing equitable and effective cervical cancer prevention.

Perimenopause, the transitional phase preceding menopause, is marked by hormonal fluctuations that contribute to vasomotor symptoms, mood changes, sleep disturbances, and metabolic shifts. This review explores integrative approaches to managing perimenopausal symptoms and promoting long-term health. Nutritional strategies, including plant-forward diets and phytoestrogens, may alleviate vasomotor symptoms and support cardiovascular and bone health. Movement and mind-body practices such as yoga and resistance training improve physical and psychological well-being. Selected supplements show promise for sleep, mood, and sexual function, though evidence varies. Supplements including calcium, vitamin D, magnesium, and vitamin K2 support bone health, while hormone therapy remains the most effective treatment for vasomotor and genitourinary symptoms. Individualized care that integrates lifestyle, nutritional, botanical, and conventional therapies can enhance quality of life and support healthy aging. Clinicians should engage in shared decision-making to tailor interventions to patient preferences and risks, empowering patients through the menopause transition and beyond.

Background: Osmotic demyelination syndrome (ODS), formerly known as central pontine myelinolysis, is classically associated with rapid correction of hyponatremia. However, ODS has also been reported in normo- or hypernatremic patients, often linked to other metabolic or systemic risk factors. Despite numerous single-case reports, systematic data on non-hyponatremia ODS remain scarce. This study aimed to summarize clinical characteristics, possible causes, and outcomes of ODS in patients without hyponatremia.

Methods: A systematic PubMed search was conducted for case reports on ODS or central pontine myelinolysis published between January 1990 and December 2024. Cases were included if serum sodium was ≥ 135 mmol/L. Extracted data comprised demographics, laboratory parameters, risk factors, causes of ODS, imaging findings, treatment and outcome. Statistical analyses were descriptive and performed using JASP 0.95.0.

Results: A total of 169 cases from 161 publications were identified. The mean age was 42 years, and 44% were female. MRI confirmed ODS in 96% of cases. Median sodium concentration was 140 mmol/L, with 42% showing hypernatremia. Hypokalemia was present in 24% and diabetes mellitus in 28%. Common risk factors for ODS included alcohol abuse (26%), liver disease (18%) and malnutrition (11%). Treatment approaches were heterogeneous 28 patients received glucocorticoids, but immunoglobulins or plasmapheresis were rarely used. Full recovery occurred in 47%, while mortality was 9.5%.

Conclusions: ODS can occur in the absence of hyponatremia, particularly in patients with electrolyte disturbances or systemic risk factors. The condition remains underrecognized and heterogeneously managed. Awareness of non-hyponatremia ODS and standardized treatment protocols are needed to improve patient outcomes.

Background: Familial Mediterranean fever is a lifelong autoinflammatory disorder characterized by recurrent systemic inflammation. Although chronic inflammation is a recognized driver of cardiovascular disease, the long-term cardiovascular and renal consequences of Familial Mediterranean fever remain incompletely defined at the population level.

Methods: We conducted a matched cohort study within a nationwide Israeli health maintenance organization. Patients with Familial Mediterranean fever were matched to controls by age, sex, and follow-up duration (3,403 FMF patients and 13,296 matched controls). FMF was defined by ≥2 physician-documented diagnoses and ≥2 colchicine dispensings; adherence, dose intensity, and treatment duration were not assessed. Cardiovascular and renal outcomes were evaluated over up to 20 years of follow-up. Inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)-were longitudinally assessed. Conditional logistic regression was used to estimate end-of-follow-up prevalence odds.

Results: Compared with matched controls, patients with Familial Mediterranean fever demonstrated persistently elevated inflammatory indices throughout follow-up. Familial Mediterranean fever was associated with a higher long-term prevalence of ischemic heart disease, atrial fibrillation, stroke, heart failure, and major adverse cardiovascular events. Renal manifestations, including albuminuria and chronic kidney disease, were also more prevalent among Familial Mediterranean fever patients. These associations persisted despite lower levels of traditional cardiometabolic risk factors.

Conclusions: Familial Mediterranean fever is associated with a persistent, inflammation-driven burden of cardiovascular and renal disease over decades, emphasizing the importance of proactive vascular surveillance and targeted anti-inflammatory strategies.

Background: Cardiac troponins are universal biomarkers for the diagnosis of acute coronary syndromes. Hypertroponinemia is defined as elevated troponin levels > 99th percentile of upper reference limit. An acute rise and/or fall in troponin with clinical/imaging evidence of myocardial ischemia is diagnostic of acute myocardial infarction. However, in extremely rare circumstances, spurious hypertroponinemia-falsely elevated troponin in the absence of myocardial injury/ischemia-can also occur due to pre-analytical, analytical and post-analytical factors. We provide a review of reported causes of spurious hypertroponinemia from published literature, and categorize them into pre-analytical (sample collection, handling and processing), analytical (assay- and antibody-related) and post-analytical (reporting and interpretative) factors, and propose a clinical approach to suspected spurious hypertroponinemia.

Methods: We conducted a narrative review of PubMed and Scopus publications between 1st January 2005 to 1st December 2025. 783 articles were retrieved after removing duplicates, of which 91 relevant articles pertaining spurious hypertroponinemia were selected. We performed a qualitative summary and narrative synthesis of available evidence.

Results: We identified pre-analytical (fibrin clot formation, hemolysis, lipemia), analytical (analytical platform malfunctions, macrotroponins, heterophile antibodies, rheumatoid factor, signal generating alkaline phosphatase, myopathies) and post-analytical (99th percentile interpretation) causes of spurious hypertroponinemia.

Conclusions: Spurious hypertroponinemia is a clinically important phenomenon in the era of high-sensitivity troponin testing. In our narrative review, we summarized the diverse causes of spurious hypertroponinemia and proposed a simple, pragmatic three-step approach to guide clinicians faced with discordant troponin results.

Objective: This study aimed to evaluate the conflicting effects of weight change and smoking cessation on fracture risk in male patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Methods: Using the National Health Insurance Service database, we analyzed 43,564 male patients with newly diagnosed T2DM (2009-2015) who underwent health examinations within ± 2 years of diagnosis. Participants were classified as continual smokers or quitters with no body mass index (BMI) change, BMI gain, or BMI loss. Cox proportional hazards regression was utilized to calculate adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the risk of fracture.

Results: Smoking cessation was not associated with a lower fracture risk compared with continual smoking (aHR, 0.94; 95% CI, 0.81-1.09). Quitters with stable weight had reduced risk (aHR, 0.78; 95% CI, 0.64-0.96); risks were higher with both weight gain and loss, especially loss.

Conclusion: In male patients with newly diagnosed T2DM, smoking cessation did not reduce fracture risk, but weight maintenance after cessation was protective. Weight loss after cessation significantly increased fracture risk, highlighting the need for integrated weight management.