Obesity has plagued the entire world and is a known risk factor across the spectrum of diseases involving neurological, cardiovascular, pulmonary, gastrointestinal, and hematological and is commonly associated with poor clinical outcomes. Obesity paradox is a concept that contradicts the prevailing medical knowledge by proposing the notion that obese patients have better mortality, morbidity, and survival rates when compared to the non-obese patient population suffering with the similar medical conditions. Although observed more commonly in patients with cardiovascular diseases, more research is coming forward citing the similar effects in critically ill patients, those with chronic kidney disease, end stage renal disease, and cancer patients. Despite extensive research, the underlying mechanisms of the Obesity Paradox remain unclear, complicated by the reliance on BMI and the neglect of confounding factors like age, comorbidities, socioeconomic status, and one of the commonly proposed solutions is to make use of other anthropological indices of obesity. This calls for a more in-depth dive into this issue to find an explanation behind this paradox or even more to confirm if it actually exists.
{"title":"Exploring the obesity parADOX: A multisystem review","authors":"Kanishk Aggrawal MBBS , Vasu Gupta MBBS , Baltej Singh MD , Raunak Medatwal MBBS , Shivank Singh MBBS , Pranjal Jain MD , Rohit Jain MD","doi":"10.1016/j.amjms.2025.07.010","DOIUrl":"10.1016/j.amjms.2025.07.010","url":null,"abstract":"<div><div>Obesity has plagued the entire world and is a known risk factor across the spectrum of diseases involving neurological, cardiovascular, pulmonary, gastrointestinal, and hematological and is commonly associated with poor clinical outcomes. Obesity paradox is a concept that contradicts the prevailing medical knowledge by proposing the notion that obese patients have better mortality, morbidity, and survival rates when compared to the non-obese patient population suffering with the similar medical conditions. Although observed more commonly in patients with cardiovascular diseases, more research is coming forward citing the similar effects in critically ill patients, those with chronic kidney disease, end stage renal disease, and cancer patients. Despite extensive research, the underlying mechanisms of the Obesity Paradox remain unclear, complicated by the reliance on BMI and the neglect of confounding factors like age, comorbidities, socioeconomic status, and one of the commonly proposed solutions is to make use of other anthropological indices of obesity. This calls for a more in-depth dive into this issue to find an explanation behind this paradox or even more to confirm if it actually exists.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 315-320"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-15DOI: 10.1016/j.amjms.2025.07.007
Caihong Liu MD , Wei Wei MD , Yongxiu Huang MD , Xu Li RN , Xiaorong Huang RN , Letian Yang MD , Zhiwen Chen RN , Yingying Yang MD , Ping Fu MD , Ling Zhang MD , Yuliang Zhao MD
Background
Therapeutic plasma exchange (TPE) is acknowledged as the standard therapy for anti-glomerular basement membrane (GBM) nephritis. In recent years, double-filtration plasmapheresis (DFPP) has been proposed as an equally effective plasmapheresis modality. The present study aimed to compare the efficacy and safety of TPE and DFPP for the treatment of anti-GBM nephritis.
Methods
We conducted a retrospective cohort study of anti-GBM patients who received plasmapheresis from February 2011 to October 2023 at West China Hospital of Sichuan University. The primary outcome was a composite endpoint of in-hospital death or dialysis dependency at discharge. The secondary outcomes included length of hospitalization, long-term mortality and end-stage renal disease (ESRD). We also compared anti-GBM antibody titer reduction, plasmapheresis-related adverse events. Logistic regression and Cox hazard proportional regression analyses were performed to investigate potential risk factors of primary outcome and long-term patient/renal survival.
Results
In total, 58 anti-GBM nephritis patients were included in this study. No significant differences were observed in the incidence of primary outcome between patients receiving DFPP and TPE in fully adjusted logistic regression model (OR=0.23, 95 % CI=0.04–1.37, P = 0.106). In surviving patients, the length of hospitalization was similar (21 vs. 23 days, P = 0.165). With a follow-up of 3-years, K‒M survival analysis revealed similar risk of death or ESRD between the 2 groups (P = 0.424; P = 0.987). According to fully adjusted Cox regression analyses, anti-GBM nephritis patients receiving DFPP achieved comparable patient (HR=1.18, 95 % CI=0.23–6.04; P = 0.845) and kidney survival (HR=0.96, 95 % CI=0.13–6.86; P = 0.967) to those receiving TPE. After plasmapheresis treatment, the anti-GBM antibody concentration significantly decreased in both groups (DFPP: 136.47 vs 27.20 AU/mL, P < 0.001; TPE: 122.09 vs 27.40 AU/mL, P = 0.016), with fewer allergy episodes observed in the DFPP group (13.64 % vs 42.86 %, P = 0.049). Besides, older age and concomitant infection were independently related to 3-year patient mortality (P < 0.001, P = 0.031), whereas high-dose methylprednisolone treatment seemed to be associated with a lower risk of ESRD (P = 0.034).
Conclusions
Anti-GBM nephritis patients who received DFPP achieved comparable short- and long-term prognosis to those who received TPE. With less plasma consumption, DFPP was also associated with fewer allergy episodes. DFPP might be an alternative modality of plasmapheresis for anti-GBM nephritis, especially in the setting of limited blood resources.
{"title":"Double-filtration plasmapheresis versus therapeutic plasma exchange in the treatment of anti-glomerular basement membrane nephritis: A cohort study","authors":"Caihong Liu MD , Wei Wei MD , Yongxiu Huang MD , Xu Li RN , Xiaorong Huang RN , Letian Yang MD , Zhiwen Chen RN , Yingying Yang MD , Ping Fu MD , Ling Zhang MD , Yuliang Zhao MD","doi":"10.1016/j.amjms.2025.07.007","DOIUrl":"10.1016/j.amjms.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Therapeutic plasma exchange (TPE) is acknowledged as the standard therapy for anti-glomerular basement membrane (GBM) nephritis. In recent years, double-filtration plasmapheresis (DFPP) has been proposed as an equally effective plasmapheresis modality. The present study aimed to compare the efficacy and safety of TPE and DFPP for the treatment of anti-GBM nephritis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of anti-GBM patients who received plasmapheresis from February 2011 to October 2023 at West China Hospital of Sichuan University. The primary outcome was a composite endpoint of in-hospital death or dialysis dependency at discharge. The secondary outcomes included length of hospitalization, long-term mortality and end-stage renal disease (ESRD). We also compared anti-GBM antibody titer reduction, plasmapheresis-related adverse events. Logistic regression and Cox hazard proportional regression analyses were performed to investigate potential risk factors of primary outcome and long-term patient/renal survival.</div></div><div><h3>Results</h3><div>In total, 58 anti-GBM nephritis patients were included in this study. No significant differences were observed in the incidence of primary outcome between patients receiving DFPP and TPE in fully adjusted logistic regression model (OR=0.23, 95 % CI=0.04–1.37, <em>P</em> = 0.106). In surviving patients, the length of hospitalization was similar (21 vs. 23 days, <em>P</em> = 0.165). With a follow-up of 3-years, K‒M survival analysis revealed similar risk of death or ESRD between the 2 groups (<em>P</em> = 0.424; <em>P</em> = 0.987). According to fully adjusted Cox regression analyses, anti-GBM nephritis patients receiving DFPP achieved comparable patient (HR=1.18, 95 % CI=0.23–6.04; <em>P</em> = 0.845) and kidney survival (HR=0.96, 95 % CI=0.13–6.86; <em>P</em> = 0.967) to those receiving TPE. After plasmapheresis treatment, the anti-GBM antibody concentration significantly decreased in both groups (DFPP: 136.47 vs 27.20 AU/mL, <em>P</em> < 0.001; TPE: 122.09 vs 27.40 AU/mL, <em>P</em> = 0.016), with fewer allergy episodes observed in the DFPP group (13.64 % vs 42.86 %, <em>P</em> = 0.049). Besides, older age and concomitant infection were independently related to 3-year patient mortality (<em>P</em> < 0.001, <em>P</em> = 0.031), whereas high-dose methylprednisolone treatment seemed to be associated with a lower risk of ESRD (<em>P</em> = 0.034).</div></div><div><h3>Conclusions</h3><div>Anti-GBM nephritis patients who received DFPP achieved comparable short- and long-term prognosis to those who received TPE. With less plasma consumption, DFPP was also associated with fewer allergy episodes. DFPP might be an alternative modality of plasmapheresis for anti-GBM nephritis, especially in the setting of limited blood resources.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 338-346"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-15DOI: 10.1016/j.amjms.2025.07.006
Lawrence B. Afrin M.D. , Leonard B. Weinstock M.D. , Tania T. Dempsey M.D. , Katja Aschenbrenner M.D. , Svetlana Blitshteyn M.D. , Jill R. Schofield M.D.
Introduction: Mast cell (MC) activation syndrome (MCAS) is a collection of illnesses rooted in inappropriate MC activation with little to no neoplastic MC proliferation, distinguishing it from mastocytosis. Due to great heterogeneity in the underlying MC regulatory gene mutational profiles present in most cases and resulting great heterogeneity in aberrant expression of the hundreds of potent mediators known to be expressed by MCs, MCAS presents with great heterogeneity but dominantly manifests as chronic multisystem polymorbidity of generally inflammatory, allergic, and dystrophic phenotypes. MCAS’s heterogeneity at multiple levels poses challenges for identifying optimal individual treatment. Targeting commonly affected downstream effectors of the disease’s various symptoms may yield clinical benefit independent of the root/upstream mutational profile in the individual patient. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) engage with GLP-1 receptors present on many types of cells, including MCs. These drugs are already approved for management of a few chronic inflammatory diseases (e.g., diabetes mellitus type 2, obesity, obstructive sleep apnea) but are increasingly being appreciated to help in a wide range of other inflammatory diseases. Methods: We present the first case series showing utility of a variety of GLP-1RAs for managing refractory MCAS in a diverse assortment of such patients. Results: Among 47 cases (mean age 39, range 15–71, 89 % female), 89 % demonstrated clinical benefit with GLP-1RAs for a broad range of problems associated with MCAS. Conclusion: GLP-1RAs may have substantial benefit in MCAS. Randomized controlled trials are needed to assess the efficacy, and identify optimal dosing, of GLP-1RA treatment in MCAS.
{"title":"Utility of glucagon-like-peptide-1-receptor agonists in mast cell activation syndrome","authors":"Lawrence B. Afrin M.D. , Leonard B. Weinstock M.D. , Tania T. Dempsey M.D. , Katja Aschenbrenner M.D. , Svetlana Blitshteyn M.D. , Jill R. Schofield M.D.","doi":"10.1016/j.amjms.2025.07.006","DOIUrl":"10.1016/j.amjms.2025.07.006","url":null,"abstract":"<div><div>Introduction: Mast cell (MC) activation syndrome (MCAS) is a collection of illnesses rooted in inappropriate MC activation with little to no neoplastic MC proliferation, distinguishing it from mastocytosis. Due to great heterogeneity in the underlying MC regulatory gene mutational profiles present in most cases and resulting great heterogeneity in aberrant expression of the hundreds of potent mediators known to be expressed by MCs, MCAS presents with great heterogeneity but dominantly manifests as chronic multisystem polymorbidity of generally inflammatory, allergic, and dystrophic phenotypes. MCAS’s heterogeneity at multiple levels poses challenges for identifying optimal individual treatment. Targeting commonly affected downstream effectors of the disease’s various symptoms may yield clinical benefit independent of the root/upstream mutational profile in the individual patient. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) engage with GLP-1 receptors present on many types of cells, including MCs. These drugs are already approved for management of a few chronic inflammatory diseases (e.g., diabetes mellitus type 2, obesity, obstructive sleep apnea) but are increasingly being appreciated to help in a wide range of other inflammatory diseases. Methods: We present the first case series showing utility of a variety of GLP-1RAs for managing refractory MCAS in a diverse assortment of such patients. Results: Among 47 cases (mean age 39, range 15–71, 89 % female), 89 % demonstrated clinical benefit with GLP-1RAs for a broad range of problems associated with MCAS. Conclusion: GLP-1RAs may have substantial benefit in MCAS. Randomized controlled trials are needed to assess the efficacy, and identify optimal dosing, of GLP-1RA treatment in MCAS.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 377-382"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-15DOI: 10.1016/j.amjms.2025.07.009
Alan W. Hu MD , Thomas J. Beckman MD , Allison M. LeMahieu MS , Helen M. Keetley , Rosemary Adamson MBBS , Hitesh H. Patel MD, MBA, MS , Dustin C. Krutsinger MD, MSCE , Joshua L. Denson MD, MS , Sarah Dhannoon MD , David C. Chu MD , Diana J. Kelm MD
Background
Pulmonary and Critical Care Medicine (PCCM) physicians work in stressful environments and are at risk for burnout. Grit and resilience have been shown to protect against burnout in various medical specialties, but this relationship has not been explored among PCCM physicians. The purpose of this study was to determine associations between grit and resilience with burnout, academic productivity, and COVID-19-related clinical experiences in PCCM fellows and faculty.
Methods
A cross-sectional, multi-institutional survey was conducted during the 2022–2023 academic year among PCCM fellows and faculty from six academic institutions. Measures included the Short Grit Scale, Connor-Davidson Resilience scale, single-item measures of emotional exhaustion and depersonalization, ICU-level COVID-19 experience, and academic productivity metrics. Mixed-effects proportional odds regression models assessed relationships between grit, resilience, burnout, and academic performance, considering clustering within institutions.
Results
One hundred and thirty-one participants were surveyed with a response rate of 40.3 %. Median scores for grit, burnout, and resiliency were 3.8 (0–5), 4 (0–12), and 31 (0–40), respectively. Higher grit correlated with less burnout (OR=0.34, p < 0.001), fewer PubMed publications (OR = 0.57, p = 0.048), and more national or international presentations (OR = 1.99, p = 0.027). Higher resilience was associated with less burnout (OR = 0.90, p = 0.001).
Conclusions
This is the first study to examine grit and resilience in the field of PCCM. Higher grit and resilience were associated with less burnout in PCCM physicians. Additionally, physicians with higher grit and resilience scores experienced more COVID-19 related deaths. Given the intense and emotionally taxing nature of PCCM, further research on interventions to optimize grit and resilience in PCCM physicians is needed.
肺和危重病医学（PCCM）的医生在压力大的环境中工作，有职业倦怠的风险。坚韧和恢复力在各种医学专业中都被证明可以防止倦怠，但这种关系尚未在PCCM医生中得到探讨。本研究的目的是确定毅力和韧性与PCCM研究员和教师的职业倦怠、学术生产力以及与covid -19相关的临床经验之间的关系。在2022-2023学年期间，对来自六个学术机构的PCCM研究员和教师进行了一项横断面，多机构调查。测量方法包括短勇气量表、康纳-戴维森恢复力量表、情绪衰竭和去人格化的单项测量方法、重症监护病房级别的COVID-19经验和学术生产力指标。考虑到机构内的聚类，混合效应比例优势回归模型评估了毅力、恢复力、倦怠和学业成绩之间的关系。131名参与者接受了调查，回复率为40.3%。坚毅、倦怠和弹性的中位数得分分别为3.8（0-5）、4（0-12）和31（0-40）。更高的毅力与更少的倦怠相关(OR=0.34, p
{"title":"Grit and resilience among pulmonary and critical care physicians: A multi-institutional study","authors":"Alan W. Hu MD , Thomas J. Beckman MD , Allison M. LeMahieu MS , Helen M. Keetley , Rosemary Adamson MBBS , Hitesh H. Patel MD, MBA, MS , Dustin C. Krutsinger MD, MSCE , Joshua L. Denson MD, MS , Sarah Dhannoon MD , David C. Chu MD , Diana J. Kelm MD","doi":"10.1016/j.amjms.2025.07.009","DOIUrl":"10.1016/j.amjms.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary and Critical Care Medicine (PCCM) physicians work in stressful environments and are at risk for burnout. Grit and resilience have been shown to protect against burnout in various medical specialties, but this relationship has not been explored among PCCM physicians. The purpose of this study was to determine associations between grit and resilience with burnout, academic productivity, and COVID-19-related clinical experiences in PCCM fellows and faculty.</div></div><div><h3>Methods</h3><div>A cross-sectional, multi-institutional survey was conducted during the 2022–2023 academic year among PCCM fellows and faculty from six academic institutions. Measures included the Short Grit Scale, Connor-Davidson Resilience scale, single-item measures of emotional exhaustion and depersonalization, ICU-level COVID-19 experience, and academic productivity metrics. Mixed-effects proportional odds regression models assessed relationships between grit, resilience, burnout, and academic performance, considering clustering within institutions.</div></div><div><h3>Results</h3><div>One hundred and thirty-one participants were surveyed with a response rate of 40.3 %. Median scores for grit, burnout, and resiliency were 3.8 (0–5), 4 (0–12), and 31 (0–40), respectively. Higher grit correlated with less burnout (OR=0.34, <em>p</em> < 0.001), fewer PubMed publications (OR = 0.57, <em>p</em> = 0.048), and more national or international presentations (OR = 1.99, <em>p</em> = 0.027). Higher resilience was associated with less burnout (OR = 0.90, <em>p</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>This is the first study to examine grit and resilience in the field of PCCM. Higher grit and resilience were associated with less burnout in PCCM physicians. Additionally, physicians with higher grit and resilience scores experienced more COVID-19 related deaths. Given the intense and emotionally taxing nature of PCCM, further research on interventions to optimize grit and resilience in PCCM physicians is needed.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 5","pages":"Pages 466-471"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mitral annular calcification (MAC) is common in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (TEER). However, the safety and effectiveness of TEER systems in patients with MAC is poorly understood.
Methods
We systematically reviewed multiple online databases to identify studies that reported outcomes in patients undergoing TEER with underlying moderate/severe MAC versus those with no/mild MAC. Random-effect model meta-analysis at a 95 % confidence interval was done via Cochrane Review Manager 5.4.
Results
A total of 6 studies with a pooled 2808 patients (no/mild MAC: 84.5 % vs moderate/severe MAC: 15.5 %) were included. Compared to those with no/mild MAC, patients undergoing TEER with moderate/severe MAC have an insignificant trend towards a lower immediate procedural success (OR: 0.62, 95 % CI: 0.37 – 1.04, p = 0.07). After one year of TEER, the two groups had similar rates of repeat mitral valve intervention or surgery (OR: 1.67, 95 %CI: 0.92 – 3.05, p = 0.09), sustained clinical improvement (NYHA ≤ 2) (OR: 0.86, 95 %CI: 0.64 - 1.15, p = 0.30), and heart failure re-admission (OR: 0.84, 95 %CI: 0.52 - 1.36, p = 0.48). All-cause mortality was, however, higher in the moderate/severe MAC patients (OR: 1.82, 95 %CI: 1.15 – 2.86, p = 0.01).
Conclusions
TEER appears safe and effective in carefully selected patients with significant MAC. A standardized selection algorithm is needed to identify MAC patients that would benefit most from TEER.
{"title":"Transcatheter edge-to-edge repair in patients with mitral annular calcification: A systematic review and meta-analysis","authors":"Abiodun Idowu MD , Olayinka Adebolu MD , Bakhtawer Siraj MD , Phuuwadith Wattanachayakul MD , Omotola Balogun MD , Kevin Bryan Lo MD , Christian Witzke MD , Emmanuel Akintoye MD , Behnam Bozorgnia MD , Gregg Pressman MD","doi":"10.1016/j.amjms.2025.07.008","DOIUrl":"10.1016/j.amjms.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Mitral annular calcification (MAC) is common in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (TEER). However, the safety and effectiveness of TEER systems in patients with MAC is poorly understood.</div></div><div><h3>Methods</h3><div>We systematically reviewed multiple online databases to identify studies that reported outcomes in patients undergoing TEER with underlying moderate/severe MAC versus those with no/mild MAC. Random-effect model meta-analysis at a 95 % confidence interval was done via Cochrane Review Manager 5.4.</div></div><div><h3>Results</h3><div>A total of 6 studies with a pooled 2808 patients (no/mild MAC: 84.5 % vs moderate/severe MAC: 15.5 %) were included. Compared to those with no/mild MAC, patients undergoing TEER with moderate/severe MAC have an insignificant trend towards a lower immediate procedural success (OR: 0.62, 95 % CI: 0.37 – 1.04, <em>p</em> = 0.07). After one year of TEER, the two groups had similar rates of repeat mitral valve intervention or surgery (OR: 1.67, 95 %CI: 0.92 – 3.05, <em>p</em> = 0.09), sustained clinical improvement (NYHA ≤ 2) (OR: 0.86, 95 %CI: 0.64 - 1.15, <em>p</em> = 0.30), and heart failure re-admission (OR: 0.84, 95 %CI: 0.52 - 1.36, <em>p</em> = 0.48). All-cause mortality was, however, higher in the moderate/severe MAC patients (OR: 1.82, 95 %CI: 1.15 – 2.86, <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>TEER appears safe and effective in carefully selected patients with significant MAC. A standardized selection algorithm is needed to identify MAC patients that would benefit most from TEER.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 5","pages":"Pages 452-457"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The finding that COPD can also develop in non-smokers has led to further investigations of etiologic causes other than smoking. This study evaluated the relationship between tobacco smoking and/or biomass-burning smoke exposure (BBS) and the demographic, clinical, and prognostic characteristics of individuals with COPD.
Methods
A total of 1129 stable COPD patients from the COPET study were retrospectively analyzed. The patients were divided into three groups: the COPD-B group (n = 52), which included patients who were solely BBS; the COPD-C group (n = 634), which included patients who exclusively tobacco smoking; and the COPD-BC group (n = 443), which included patients with both BBS and tobacco smoking.
Results
The average age of the patients was 65.8 ± 9.1 years, and 87.4 % of them were men. In the COPD-B group, the following factors were significantly greater compared to the COPD-C and COPD-BC groups: age (p = 0.001), BMI (p = 0.001), percentage of female patients (p < 0.001), FEV1/FVC ratio (p = 0.014), eosinophil count (p < 0.001), ADO score (p < 0.001), and the proportion of patients with frequent exacerbations (p = 0.013). Thorax CT scans showed that the COPD-BC group had a greater incidence of bronchiectasis and emphysema than the COPD-B and COPD-C groups (p < 0.001).
Conclusions
This study highlights significant clinical and radiological differences among COPD patients based on tobacco smoking and BBS, which may substantially impact COPD outcomes, including exacerbations and prognosis.
{"title":"COPET study findings regarding the clinical relevance of biomass exposure as an etiotype in COPD","authors":"Esra Ertan Yazar MD, PhD , Nilgün Demirci MD, PhD , Burcu Arpınar Yiğitbaş MD, PhD , Mukadder Çalıkoğlu MD, PhD , Gazi Gülbaş MD, PhD , Muzaffer Onur Turan MD, PhD , Hülya Şahin MD, PhD , Nurhan Sarıoğlu MD, PhD , Nevin Taci Hoca MD, PhD , Fulsen Bozkuş MD, PhD , Seda Tural MD, PhD , Nihal Arzu Mirici MD, PhD , Nalan Ogan MD, PhD , Burcu Yormaz MD, PhD , Ayperi Öztürk MD, PhD , Filiz Koşar MD, PhD , Evrim Eylem Akpınar MD, PhD , Gülşah Günlüoğlu MD, PhD , Burak Mete MD, PhD , Can Öztürk MD, PhD , Mecit Süerdem MD, PhD","doi":"10.1016/j.amjms.2025.07.001","DOIUrl":"10.1016/j.amjms.2025.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>The finding that COPD can also develop in non-smokers has led to further investigations of etiologic causes other than smoking. This study evaluated the relationship between tobacco smoking and/or biomass-burning smoke exposure (BBS) and the demographic, clinical, and prognostic characteristics of individuals with COPD.</div></div><div><h3>Methods</h3><div>A total of 1129 stable COPD patients from the COPET study were retrospectively analyzed. The patients were divided into three groups: the COPD-B group (<em>n</em> = 52), which included patients who were solely BBS; the COPD-C group (<em>n</em> = 634), which included patients who exclusively tobacco smoking; and the COPD-BC group (<em>n</em> = 443), which included patients with both BBS and tobacco smoking.</div></div><div><h3>Results</h3><div>The average age of the patients was 65.8 ± 9.1 years, and 87.4 % of them were men. In the COPD-B group, the following factors were significantly greater compared to the COPD-C and COPD-BC groups: age (<em>p</em> = 0.001), BMI (<em>p</em> = 0.001), percentage of female patients (<em>p</em> < 0.001), FEV<sub>1</sub>/FVC ratio (<em>p</em> = 0.014), eosinophil count (<em>p</em> < 0.001), ADO score (<em>p</em> < 0.001), and the proportion of patients with frequent exacerbations (<em>p</em> = 0.013). Thorax CT scans showed that the COPD-BC group had a greater incidence of bronchiectasis and emphysema than the COPD-B and COPD-C groups (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>This study highlights significant clinical and radiological differences among COPD patients based on tobacco smoking and BBS, which may substantially impact COPD outcomes, including exacerbations and prognosis.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 365-370"},"PeriodicalIF":1.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-08DOI: 10.1016/j.amjms.2025.07.002
Eeshal Fatima MBBS , Anoushey Fatima MBBS
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Pub Date : 2025-07-05DOI: 10.1016/j.amjms.2025.06.011
Zein Kattih MD , Simon Meredith DO , Vincent Dong DO , Victoria Roselli MS , Daniel Mina , Dimitre Stefanov PhD , Shankar Thampi MD , Arber Kodra MD , Chad Kliger MD , Bushra Mina MD , The Lenox Hill Hospital Pulmonary Embolism Response Team (PERT)
Introduction
Pulmonary embolism is the third most common cause of cardiovascular death in the US with a high financial burden. Data on cost-analysis is limited in comparing advanced treatment modalities.
Methods
A cohort of patients were selected from a PERT registry database from cases at a tertiary center in a metropolitan area between 2016 and 2023. Patients were treated with either anticoagulation alone, CDT, or MT. The primary outcome was revenue-per-case.
Results
MT had the highest revenue-per-case, with a median (IQR) of $59,058 ($42,827-$86,950) (p < 0.0001). CDT had a median (IQR) revenue-per-case of $19,007 ($14,062-$34,651). Anticoagulation alone had a median (IQR) revenue-per-case of $16,171 ($12,666-$31,473). Margin-per-case closely paralleled the primary outcome. While hospital length of stay, survival at discharge, and 90-day readmission were not different among the groups, ICU utilization was 20 % in anticoagulation patients, 100 % in CDT patients, and 24 % in MT patients (p < 0.0001). CTEPH was identified in 12 % of the anticoagulation group, 12 % of the CDT patients, and none of the MT patients (p = 0.04).
Discussion
MT has a significantly higher revenue-per-case compared with anticoagulation alone and CDT. ICU utilization of mechanical thrombectomy was lower than catheter-directed thrombolysis and near the ICU utilization with anticoagulation alone. Institution policies and device choice may impact these outcomes, which may vary by center.
Conclusions
Advanced therapies that can prevent the downstream sequalae of PE have higher cost but may be more advantageous, and further research is required to evaluate long term benefits.
{"title":"Cost analysis of mechanical thrombectomy vs catheter-directed thrombolysis vs anticoagulation alone for pulmonary embolism","authors":"Zein Kattih MD , Simon Meredith DO , Vincent Dong DO , Victoria Roselli MS , Daniel Mina , Dimitre Stefanov PhD , Shankar Thampi MD , Arber Kodra MD , Chad Kliger MD , Bushra Mina MD , The Lenox Hill Hospital Pulmonary Embolism Response Team (PERT)","doi":"10.1016/j.amjms.2025.06.011","DOIUrl":"10.1016/j.amjms.2025.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Pulmonary embolism is the third most common cause of cardiovascular death in the US with a high financial burden. Data on cost-analysis is limited in comparing advanced treatment modalities.</div></div><div><h3>Methods</h3><div>A cohort of patients were selected from a PERT registry database from cases at a tertiary center in a metropolitan area between 2016 and 2023. Patients were treated with either anticoagulation alone, CDT, or MT. The primary outcome was revenue-per-case.</div></div><div><h3>Results</h3><div>MT had the highest revenue-per-case, with a median (IQR) of $59,058 ($42,827-$86,950) (<em>p</em> < 0.0001). CDT had a median (IQR) revenue-per-case of $19,007 ($14,062-$34,651). Anticoagulation alone had a median (IQR) revenue-per-case of $16,171 ($12,666-$31,473). Margin-per-case closely paralleled the primary outcome. While hospital length of stay, survival at discharge, and 90-day readmission were not different among the groups, ICU utilization was 20 % in anticoagulation patients, 100 % in CDT patients, and 24 % in MT patients (<em>p</em> < 0.0001). CTEPH was identified in 12 % of the anticoagulation group, 12 % of the CDT patients, and none of the MT patients (<em>p</em> = 0.04).</div></div><div><h3>Discussion</h3><div>MT has a significantly higher revenue-per-case compared with anticoagulation alone and CDT. ICU utilization of mechanical thrombectomy was lower than catheter-directed thrombolysis and near the ICU utilization with anticoagulation alone. Institution policies and device choice may impact these outcomes, which may vary by center.</div></div><div><h3>Conclusions</h3><div>Advanced therapies that can prevent the downstream sequalae of PE have higher cost but may be more advantageous, and further research is required to evaluate long term benefits.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 328-332"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We sought to identify studies that examined myocarditis and pericarditis after both COVID-19 vaccination and SARS-CoV-2 infection. A literature search was conducted, and retrospective cohort studies examining incidence rates for myocarditis and pericarditis after both COVID-19 vaccination and SARS-CoV-2 infection were included. The methodologies and conclusions of each study was assessed, and a risk of bias was determined. We found 6 articles that utilized cohorts of both vaccinated and infected populations. Of the included articles, all of them had risk of bias concerns, with 50 % having a poor-quality rating and 50 % having a fair quality rating. Methodological biases, including reliance on electronic health record data, inadequate observational periods, and failure to account for baseline characteristics between the two cohorts, were observed across studies. Ultimately, these methodological limitations lead to hyperinflated myocarditis rates in the infection cohorts and a lack of meaningful comparisons between the infection and vaccination cohorts.
{"title":"An analysis of studies comparing myocarditis and pericarditis in COVID-19 vaccinated and SARS-CoV-2 infected individuals","authors":"Whitney Bowyer BS , Alyson Haslam PhD , Vinay Prasad MD, MPH","doi":"10.1016/j.amjms.2025.06.012","DOIUrl":"10.1016/j.amjms.2025.06.012","url":null,"abstract":"<div><div><span>We sought to identify studies that examined myocarditis<span> and pericarditis after both COVID-19 </span></span>vaccination<span> and SARS-CoV-2 infection. A literature search was conducted, and retrospective cohort studies<span><span> examining incidence rates for myocarditis and </span>pericarditis<span> after both COVID-19 vaccination and SARS-CoV-2 infection were included. The methodologies and conclusions of each study was assessed, and a risk of bias was determined. We found 6 articles that utilized cohorts of both vaccinated and infected populations. Of the included articles, all of them had risk of bias concerns, with 50 % having a poor-quality rating and 50 % having a fair quality rating. Methodological biases, including reliance on electronic health record data, inadequate observational periods, and failure to account for baseline characteristics between the two cohorts, were observed across studies. Ultimately, these methodological limitations lead to hyperinflated myocarditis rates in the infection cohorts and a lack of meaningful comparisons between the infection and vaccination cohorts.</span></span></span></div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 392-399"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-16DOI: 10.1016/j.amjms.2025.06.007
Yun-Hu Chen MS , Fang Yan MB
Background
Associations among migraines, spontaneous coronary artery dissection (SCAD), and fibromuscular dysplasia (FMD) have been reported; however, their causality is inconclusive.
Methods
We inferred a causal relation between exposure (migraines) and outcomes (SCAD and FMD) using two-sample MR analysis. Mediation analysis was performed using reverse and multivariate MR analysis methods. Finally, using two-sample MR analysis, we explored whether the currently perceived potential risk factors for SCAD and FMD mediate the aforementioned causal association.
Results
Inverse Variance Weighted (IVW) analysis showed that migraines increased the risk of developing SCAD and FMD. SCAD increases the risk of developing FMD. Reverse causality or pleiotropy was not observed. Multivariate random IVW analysis showed that the effect of migraine on FMD was no longer significant in the multivariate model, whereas the effect of SCAD remained significant. SCAD mediated the causal association between migraine and FMD, with a mediating effect of 0.119 and a proportion of 18.30 %. IVW analyses did not find direct evidence that these associations were consistently related to other potential pathogenic factors of SCAD or FMD.
Conclusions
Migraines are a risk factor for both SCAD and FMD, whereas SCAD is an incomplete mediator of the causal relation between migraine and FMD. However, mechanistic studies are warranted to investigate this link.
{"title":"Effect of genetic liability to migraines on spontaneous coronary artery dissection and fibromuscular dysplasia","authors":"Yun-Hu Chen MS , Fang Yan MB","doi":"10.1016/j.amjms.2025.06.007","DOIUrl":"10.1016/j.amjms.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Associations among migraines, spontaneous coronary artery dissection<span> (SCAD), and fibromuscular dysplasia (FMD) have been reported; however, their causality is inconclusive.</span></div></div><div><h3>Methods</h3><div>We inferred a causal relation between exposure (migraines) and outcomes (SCAD and FMD) using two-sample MR<span> analysis. Mediation analysis was performed using reverse and multivariate MR analysis methods. Finally, using two-sample MR analysis, we explored whether the currently perceived potential risk factors for SCAD and FMD mediate the aforementioned causal association.</span></div></div><div><h3>Results</h3><div>Inverse Variance Weighted (IVW) analysis showed that migraines increased the risk of developing SCAD and FMD. SCAD increases the risk of developing FMD. Reverse causality or pleiotropy was not observed. Multivariate random IVW analysis showed that the effect of migraine on FMD was no longer significant in the multivariate model, whereas the effect of SCAD remained significant. SCAD mediated the causal association between migraine and FMD, with a mediating effect of 0.119 and a proportion of 18.30 %. IVW analyses did not find direct evidence that these associations were consistently related to other potential pathogenic factors of SCAD or FMD.</div></div><div><h3>Conclusions</h3><div>Migraines are a risk factor for both SCAD and FMD, whereas SCAD is an incomplete mediator of the causal relation between migraine and FMD. However, mechanistic studies are warranted to investigate this link.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 4","pages":"Pages 383-391"},"PeriodicalIF":1.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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