American Journal of Medicine最新文献

Background: GLP-1 RA and SGLT2i have demonstrated cardio-renal protective effects in randomized clinical trials. However, their comparative cardio-renal benefits in diabetes patients with stage 4-5 chronic kidney disease remain underexplored.

Methods: This is a retrospective study with target trial emulation design using TriNetX platform. Adults type 2 diabetes mellitus, stage 4-5 chronic kidney disease patients who were new initiation of GLP-1 RA compared to SGLT2i were enrolled.

Outcomes: major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), and all-cause mortality. Hazard ratios (HRs) were calculated for outcomes in 1:1 propensity score-matched patients.

Results: A total of 7,458 participants were included in each group, with a mean eGFR of 23-24 mL/min/1.73 m². New users of GLP-1 RAs had a higher HR for MAKE (HR 1.05, 95% CI 1.0-1.1) & dialysis (HR 1.09, 95% CI 1.03-1.15), but similar HRs for all-cause mortality (HR 0.98, 95% CI 0.91-1.05) and MACE (HR 0.97, 95% CI 0.93-1.01) compared with SGLT2i users, despite a lower HR for heart failure (HR 0.94, 95% CI 0.90-0.99). Among new GLP-1 RA users, higher HRs for MAKE occurred in subgroup of males and patients without heart failure.

Conclusions: In patients with type 2 diabetes and stage 4-5 chronic kidney disease, initiating an SGLT2i, relative to a GLP-1 RA, was associated with a lower risk of adverse kidney events and comparable cardiovascular and mortality risks. Further studies are warranted to confirm these findings.

Background: Although varenicline is efficacious and safe for smoking cessation, its role in vaping cessation remains uncertain.

Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing varenicline with placebo for vaping cessation. The primary outcome was the most rigorous criterion of biochemically validated vaping abstinence at maximum follow-up. Secondary outcomes were 7-day point prevalence and continuous abstinence at end of treatment and maximum follow-up. Safety outcomes included any adverse events and serious adverse events. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models.

Results: Three RCTs were included, comprising 178 participants randomized to varenicline and 177 to placebo. The mean participant age ranged from 21-54 years, and the proportion of males ranged from 46-51%. Treatment duration was 8-12 weeks, and maximum follow-up was 12-24 weeks. The pooled RR for varenicline versus placebo for vaping abstinence at maximum follow-up was 2.20 (95% CI 0.58-8.36). Varenicline was associated with doubling of 7-day point prevalence abstinence at end of treatment (RR: 2.29; 95% CI 1.21-4.33) and maximum follow-up (RR: 2.22; 95% CI 1.03-4.81). In the two trials reporting continuous abstinence, rates were greater with varenicline than placebo at end of treatment (51% vs 14% and 40% vs 20%) and maximum follow-up (28% vs 7% and 34% vs 17%). Most adverse events were mild and transient; serious adverse events were rare (range: 0-3%).

Conclusion: Varenicline appears safe and promising for vaping cessation. However, larger RCTs are needed to confirm its long-term efficacy and safety.

Integrative health programs are gaining recognition for their whole-person approach to patient care, combining conventional medicine with evidence-based traditional and complementary therapies. However, few medical systems have dedicated integrative health programs. The development and implementation of such programs require passionate and influential leaders, strategic planning and innovation, interdisciplinary collaboration, and structured evaluation. The objective of this paper is to describe the creation, evolution, and sustainability of two long-standing integrative health programs at Hennepin Healthcare Systems (HHS), a safety-net hospital system in Minneapolis, MN, and at the University of New Mexico (UNM) academic medical center in Albuquerque, NM. The two programs developed and evolved through multi-phase processes, involving literature review, needs assessment, professional development, collaboration, innovation, and pilot implementation. Key components evolved and endured based on clinical evidence, patient needs, and feasibility within the healthcare setting. The program in New Mexico is primarily centralized, while the program in Minnesota is dispersed throughout the institution. Improved patient-reported outcomes and high demand for integrative health services, demonstrated community impact, and robust philanthropic and grant-supported programming are reflected in both programs. Challenges included sustainable funding and institutional support. Lessons learned highlight the importance of interprofessional collaboration, innovation, and program evaluation. These integrative health programs serve as institutional models for whole-person integration of conventional and complementary approaches to patient care.

Decompression sickness (DCS), traditionally associated with SCUBA diving, increasingly occurs in breath-hold diving, particularly during repetitive shallow or deep dive profiles. This comprehensive review synthesizes 85 records documenting 244+ cases across 75 years, including historical Taravana syndrome in Polynesian pearl divers and cases among Japanese Ama, Korean Haenyeo, recreational freedivers, instructors, and spear fishers. Unlike SCUBA-related DCS, breath-hold DCS predominantly manifests as cerebral symptoms that can mimic stroke or transient ischemic attack, often presenting in young, healthy individuals. Key risk factors include inadequate surface intervals during repetitive shallow dives, deep dives exceeding 40 m, rapid ascent rates, and individual physiological factors including patent foramen ovale. Despite growing freediving popularity with an estimated one million participants globally, DCS remains underrecognized and underreported. Early recognition is critical, requiring high clinical suspicion in divers presenting with neurological symptoms. Immediate high-flow oxygen and urgent hyperbaric oxygen therapy remain essential treatments. This review emphasizes the need for enhanced education among both divers and medical professionals to improve prevention, recognition, and management of this potentially devastating condition.