Pub Date : 2025-05-09DOI: 10.1016/j.ajmo.2025.100101
Ana Julia de Magalhães Pina MS , Luís Fernando de Oliveira Mr , Letícia de Oliveira Nascimento MS , Deborah Maciel Cavalcanti Rosa MS , Jefferson Barela Mr , Bruno Martinelli PhD , Carlos Antonio Negrato PhD
Purpose
To evaluate the impact of stress hyperglycemia (SH) in a cohort of Brazilian patients with COVID-19 admitted to a tertiary care level hospital.
Methods
This retrospective cohort study enrolled 754 patients with COVID-19 hospitalized at Hospital Estadual de Bauru, São Paulo, in 2020. Data were collected from the E-pront system and covered sociodemographic, clinical, and laboratory aspects, including mechanical ventilation, comorbidities, and outcomes. Included patients were those >18 years old, with confirmed COVID-19 diagnosis, who required hospitalization, with or without preexisting type 2 diabetes (T2DM), or who developed SH. Patients younger than 18 years, with other types of diabetes, or incomplete data were excluded.
Results
Patients with SH had longer hospital and intensive care unit (ICU) stay (P < .001) as well as longer mechanical ventilation duration (P < .001). Additionally, this group needed a higher number of orotracheal intubations (P < .001) and presented higher mortality rates (P < .001) and fewer discharges 284 (P < .001) compared to patients with T2DM and normoglycemia.
Conclusions
Patients who developed SH presented poorer clinical outcomes; needed more frequently orotracheal intubation, mechanical ventilation, and longer hospitalization and ICU stay; and had higher mortality rates and fewer discharges compared to patients with T2DM and normoglycemia.
{"title":"Impact of Stress Hyperglycemia in a Cohort of Brazilian Patients With COVID-19","authors":"Ana Julia de Magalhães Pina MS , Luís Fernando de Oliveira Mr , Letícia de Oliveira Nascimento MS , Deborah Maciel Cavalcanti Rosa MS , Jefferson Barela Mr , Bruno Martinelli PhD , Carlos Antonio Negrato PhD","doi":"10.1016/j.ajmo.2025.100101","DOIUrl":"10.1016/j.ajmo.2025.100101","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of stress hyperglycemia (SH) in a cohort of Brazilian patients with COVID-19 admitted to a tertiary care level hospital.</div></div><div><h3>Methods</h3><div>This retrospective cohort study enrolled 754 patients with COVID-19 hospitalized at Hospital Estadual de Bauru, São Paulo, in 2020. Data were collected from the E-pront system and covered sociodemographic, clinical, and laboratory aspects, including mechanical ventilation, comorbidities, and outcomes. Included patients were those >18 years old, with confirmed COVID-19 diagnosis, who required hospitalization, with or without preexisting type 2 diabetes (T2DM), or who developed SH. Patients younger than 18 years, with other types of diabetes, or incomplete data were excluded.</div></div><div><h3>Results</h3><div>Patients with SH had longer hospital and intensive care unit (ICU) stay (<em>P</em> < .001) as well as longer mechanical ventilation duration (<em>P</em> < .001). Additionally, this group needed a higher number of orotracheal intubations (<em>P</em> < .001) and presented higher mortality rates (<em>P</em> < .001) and fewer discharges 284 (<em>P</em> < .001) compared to patients with T2DM and normoglycemia.</div></div><div><h3>Conclusions</h3><div>Patients who developed SH presented poorer clinical outcomes; needed more frequently orotracheal intubation, mechanical ventilation, and longer hospitalization and ICU stay; and had higher mortality rates and fewer discharges compared to patients with T2DM and normoglycemia.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-04DOI: 10.1016/j.ajmo.2025.100100
Kateri J. Spinelli , Allison H. Oakes , Shih-Ting Chiu , Mary T. Imboden , Austin Miller , Sanjula Jain , Ty J. Gluckman
Background
Off-label prescribing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may exacerbate health disparities.
Methods
We performed a retrospective analysis of data from the Trilliant Health national all-payer claims database, US Census Bureau data (race, ethnicity, median household income), and Centers for Disease Control and Prevention social vulnerability index (SVI). Patients with prescriptions for GLP-1 RAs approved for type 2 diabetes mellitus (T2DM) between January 1, 2022, and December 31, 2022 were included. Those without an ICD-10 code for T2DM in their medical claims were considered off-label. Correlations between county-level off-label rates and health disparity variables were examined using visual mapping, geographically weighted regression models, and hierarchical clustering on principle components (HCPC).
Results
A total of 3,688,430 GLP-1 RA prescriptions from 2783 (89%) US counties were included. The median off-label prescribing rate was 37.7% [30.0%-46.3%]. Higher household income was modestly correlated with a higher off-label prescribing rate. HCPC modeling produced seven clusters with distinct geographic locations. The highest off-label prescribing rate (51.6%) occurred in a cluster of counties in Hawaii with high median income ($92,124). The lowest off-label prescribing rate (31.2%) occurred in a cluster of counties that included American Indian Tribal reservation lands, with low median income ($52,437) and high SVI (0.88). Other clusters showed unique patterns of racial and ethnic diversity, income, SVI, and off-label prescribing rates.
Conclusions
We identified distinct populations with varying GLP-1 RA off-label prescribing and known health disparities. These results could inform clinical and market strategies to increase access to GLP-1 RAs in underserved populations.
{"title":"Health Disparity Clusters of Off Label Prescriptions for Glucagon-Like Peptide 1 Receptor Agonists","authors":"Kateri J. Spinelli , Allison H. Oakes , Shih-Ting Chiu , Mary T. Imboden , Austin Miller , Sanjula Jain , Ty J. Gluckman","doi":"10.1016/j.ajmo.2025.100100","DOIUrl":"10.1016/j.ajmo.2025.100100","url":null,"abstract":"<div><h3>Background</h3><div>Off-label prescribing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may exacerbate health disparities.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of data from the Trilliant Health national all-payer claims database, US Census Bureau data (race, ethnicity, median household income), and Centers for Disease Control and Prevention social vulnerability index (SVI). Patients with prescriptions for GLP-1 RAs approved for type 2 diabetes mellitus (T2DM) between January 1, 2022, and December 31, 2022 were included. Those without an ICD-10 code for T2DM in their medical claims were considered off-label. Correlations between county-level off-label rates and health disparity variables were examined using visual mapping, geographically weighted regression models, and hierarchical clustering on principle components (HCPC).</div></div><div><h3>Results</h3><div>A total of 3,688,430 GLP-1 RA prescriptions from 2783 (89%) US counties were included. The median off-label prescribing rate was 37.7% [30.0%-46.3%]. Higher household income was modestly correlated with a higher off-label prescribing rate. HCPC modeling produced seven clusters with distinct geographic locations. The highest off-label prescribing rate (51.6%) occurred in a cluster of counties in Hawaii with high median income ($92,124). The lowest off-label prescribing rate (31.2%) occurred in a cluster of counties that included American Indian Tribal reservation lands, with low median income ($52,437) and high SVI (0.88). Other clusters showed unique patterns of racial and ethnic diversity, income, SVI, and off-label prescribing rates.</div></div><div><h3>Conclusions</h3><div>We identified distinct populations with varying GLP-1 RA off-label prescribing and known health disparities. These results could inform clinical and market strategies to increase access to GLP-1 RAs in underserved populations.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1016/j.ajmo.2025.100098
Ioanna Dimitriadou , Christi Deaton , Evangelos C. Fradelos , John Skoularigis , Ioannis Vogiatzis , Evangelos Sdogkos , Aikaterini Toska , Eleni Tsiara , Anastasios Christakis , Dimitra Anagnostopoulou , Maria Saridi
Background
The Greek HeartQoL questionnaire is designed to assess health-related quality of life (HRQoL) in patients with ischemic heart disease.
Objectives
This study aims to validate its psychometric properties in Greek patients diagnosed with angina pectoris, myocardial infarction, and ischemic heart failure.
Methods
A cross-sectional study was conducted with 158 patients from five clinical sites in Greece. Participants completed the Greek HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale. Psychometric evaluations included Mokken scale analysis, reliability testing with Cronbach's alpha, and validity assessments through Spearman correlation coefficients, and analysis of covariance.
Results
The Greek HeartQoL exhibited excellent internal consistency, with Cronbach's alpha values exceeding 0.90. Factor analysis confirmed the questionnaire's two-factor structure, effectively capturing physical and emotional dimensions of HRQoL. Convergent validity was demonstrated by strong correlations with Short Form-36 Health Survey (r > 0.70), and discriminative validity was confirmed by significant differences in HRQoL scores between patients with angina pectoris, myocardial infarction, and ischemic heart failure (P < .001).
Conclusions
The findings suggest that the Greek HeartQoL demonstrates strong reliability and validity in assessing HRQoL in Greek ischemic heart disease patients. However, further studies with larger and more diverse samples are needed to confirm its psychometric properties across different clinical populations.
{"title":"Measuring Patient-Reported Outcomes in Ischemic Heart Disease: Validation of the Greek HeartQoL Questionnaire","authors":"Ioanna Dimitriadou , Christi Deaton , Evangelos C. Fradelos , John Skoularigis , Ioannis Vogiatzis , Evangelos Sdogkos , Aikaterini Toska , Eleni Tsiara , Anastasios Christakis , Dimitra Anagnostopoulou , Maria Saridi","doi":"10.1016/j.ajmo.2025.100098","DOIUrl":"10.1016/j.ajmo.2025.100098","url":null,"abstract":"<div><h3>Background</h3><div>The Greek HeartQoL questionnaire is designed to assess health-related quality of life (HRQoL) in patients with ischemic heart disease.</div></div><div><h3>Objectives</h3><div>This study aims to validate its psychometric properties in Greek patients diagnosed with angina pectoris, myocardial infarction, and ischemic heart failure.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 158 patients from five clinical sites in Greece. Participants completed the Greek HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale. Psychometric evaluations included Mokken scale analysis, reliability testing with Cronbach's alpha, and validity assessments through Spearman correlation coefficients, and analysis of covariance.</div></div><div><h3>Results</h3><div>The Greek HeartQoL exhibited excellent internal consistency, with Cronbach's alpha values exceeding 0.90. Factor analysis confirmed the questionnaire's two-factor structure, effectively capturing physical and emotional dimensions of HRQoL. Convergent validity was demonstrated by strong correlations with Short Form-36 Health Survey (<em>r</em> > 0.70), and discriminative validity was confirmed by significant differences in HRQoL scores between patients with angina pectoris, myocardial infarction, and ischemic heart failure (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>The findings suggest that the Greek HeartQoL demonstrates strong reliability and validity in assessing HRQoL in Greek ischemic heart disease patients. However, further studies with larger and more diverse samples are needed to confirm its psychometric properties across different clinical populations.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.ajmo.2025.100099
Manoj Ambalavanan , James S. Love , Nan Lv , Colin Goodman , Conner M. Olsen , Adam E. Mikolajczyk
Background
The transition from a postgraduate year (PGY)-1 resident to a PGY-2 resident is often stressful for trainees. Despite various preparatory efforts, the lack of hands-on experiences remains a challenge. In response, we developed the "Step-Up" curriculum, allowing PGY-1 residents to assume the senior resident role in a supervised environment.
Methods
During the final blocks of the 2021-2023 academic years, categorical PGY-1 residents divided into eligible and ineligible groups for the "Step-Up" curriculum. Preliminary, off-service and transition-year residents were excluded from the study. Eligible participants were those who rotated on inpatient or specialty wards and received a rubric outlining senior residents' best practices to encourage self-reflection and feedback from supervising attendings and senior residents. The ineligible group were residents that rotated on critical care or outpatient rotations and served as the control group. Pre- and postcurriculum surveys, with 19 Likert-scale questions (rated 1 [strongly disagree] to 5 [strongly agree]), were administered. Two-sample Wilcoxon rank-sum tests compared ordinal measures between the intervention and control groups.
Results
Of 76 residents, 49 (64.5%) were in the intervention group and 27 (35.5%) were in the control group. No significant differences in survey responses were noted before the curriculum. Following it, participants displayed increased confidence in various competencies compared to nonparticipants. "Step-Up" participants also felt significantly more confident transitioning to the senior resident role. Of the 42 completing the curriculum, 39 (93%) agreed that the curriculum facilitated their transition.
Conclusions
Our study highlights the effectiveness of a hands-on curriculum where PGY-1 residents assume the senior resident role, offering a satisfying experience and enhancing comfort with the role and specific competencies. This novel approach addresses challenges in the PGY-1 to PGY-2 transition, providing valuable insights for medical education programs.
{"title":"“Step-Up” to Internal Medicine: An Experiential Curriculum to Assist with the Transition of Becoming a Senior Resident","authors":"Manoj Ambalavanan , James S. Love , Nan Lv , Colin Goodman , Conner M. Olsen , Adam E. Mikolajczyk","doi":"10.1016/j.ajmo.2025.100099","DOIUrl":"10.1016/j.ajmo.2025.100099","url":null,"abstract":"<div><h3>Background</h3><div>The transition from a postgraduate year (PGY)-1 resident to a PGY-2 resident is often stressful for trainees. Despite various preparatory efforts, the lack of hands-on experiences remains a challenge. In response, we developed the \"Step-Up\" curriculum, allowing PGY-1 residents to assume the senior resident role in a supervised environment.</div></div><div><h3>Methods</h3><div>During the final blocks of the 2021-2023 academic years, categorical PGY-1 residents divided into eligible and ineligible groups for the \"Step-Up\" curriculum. Preliminary, off-service and transition-year residents were excluded from the study. Eligible participants were those who rotated on inpatient or specialty wards and received a rubric outlining senior residents' best practices to encourage self-reflection and feedback from supervising attendings and senior residents. The ineligible group were residents that rotated on critical care or outpatient rotations and served as the control group. Pre- and postcurriculum surveys, with 19 Likert-scale questions (rated 1 [strongly disagree] to 5 [strongly agree]), were administered. Two-sample Wilcoxon rank-sum tests compared ordinal measures between the intervention and control groups.</div></div><div><h3>Results</h3><div>Of 76 residents, 49 (64.5%) were in the intervention group and 27 (35.5%) were in the control group. No significant differences in survey responses were noted before the curriculum. Following it, participants displayed increased confidence in various competencies compared to nonparticipants. \"Step-Up\" participants also felt significantly more confident transitioning to the senior resident role. Of the 42 completing the curriculum, 39 (93%) agreed that the curriculum facilitated their transition.</div></div><div><h3>Conclusions</h3><div>Our study highlights the effectiveness of a hands-on curriculum where PGY-1 residents assume the senior resident role, offering a satisfying experience and enhancing comfort with the role and specific competencies. This novel approach addresses challenges in the PGY-1 to PGY-2 transition, providing valuable insights for medical education programs.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-17DOI: 10.1016/j.ajmo.2025.100097
Muhammad Hamayal MBBS, Muhammad Arham Abbas MBBS, Momina Hafeez MBBS, Saira Mahmud MBBS, Warda Shahid MBBS, Saman Naeem MBBS, Hasan Shaukat Abbasi MBBS, Muhammad Danyal Tahir MBBS, Aleea Abbas MBBS, Iqra Iftikhar MBBS, Naaemah Saleem MBBS
Cardiac resynchronization therapy (CRT) has emerged instrumental in managing heart failure. Notably, there is a lack of evidence of CRT efficacy among both sexes. Thus, this meta-analysis focuses on the long-term benefits of CRT in both sexes. PubMed, The Cochrane Library and clinicaltrials.gov were searched for articles from 2010 to 2024. ROB2 was used to assess risk of bias of RCTs. Newcastle Ottawa Scale was used for quality appraisal of cohorts. Meta-analysis was conducted on Revman 5.4. Out of 2722 articles, only 9 RCTs and 18 cohorts were included. Our results demonstrated that females had a significantly lower risk of composite outcomes compared to males in both RCTs (RR 0.80; 95% CI [0.68, 0.94], P = .006) and cohorts (RR 0.76; 95% CI [0.63, 0.92], P = .004). Results were similar for all-cause mortality. For heart failure hospitalization, only cohorts showed a significant lesser risk in females (RR 0.78; 95% CI [0.65, 0.93], P = .006). Left ventricular ejection fraction improved significantly in females but no differences were observed for NYHA class improvement. Males showed a 31% lower survival rate. However future trials are needed to highlight this variation.
心脏再同步化治疗（CRT）已成为治疗心力衰竭的工具。值得注意的是，缺乏证据表明CRT对两性都有效。因此，本荟萃分析侧重于CRT对两性的长期益处。PubMed、Cochrane图书馆和clinicaltrials.gov检索了2010年至2024年的文章。ROB2用于评估随机对照试验的偏倚风险。采用纽卡斯尔渥太华量表对队列进行质量评价。采用Revman 5.4进行meta分析。在2722篇文章中，只有9篇rct和18个队列被纳入。我们的结果显示，在两项随机对照试验中，女性的综合结局风险显著低于男性(RR 0.80；95% CI [0.68, 0.94], P = 0.006)和队列(RR 0.76；95% ci [0.63, 0.92], p = 0.004)。全因死亡率的结果相似。对于心力衰竭住院治疗，只有女性队列的风险显着降低(RR 0.78；95% ci [0.65, 0.93], p = 0.006)。女性左室射血分数显著改善，但NYHA分级改善无差异。雄性的存活率低了31%。然而，需要未来的试验来突出这种差异。
{"title":"Sex Specific Outcomes With Cardiac Resynchronization Therapy in Patients With Symptomatic Heart Failure Having Reduced Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis","authors":"Muhammad Hamayal MBBS, Muhammad Arham Abbas MBBS, Momina Hafeez MBBS, Saira Mahmud MBBS, Warda Shahid MBBS, Saman Naeem MBBS, Hasan Shaukat Abbasi MBBS, Muhammad Danyal Tahir MBBS, Aleea Abbas MBBS, Iqra Iftikhar MBBS, Naaemah Saleem MBBS","doi":"10.1016/j.ajmo.2025.100097","DOIUrl":"10.1016/j.ajmo.2025.100097","url":null,"abstract":"<div><div>Cardiac resynchronization therapy (CRT) has emerged instrumental in managing heart failure. Notably, there is a lack of evidence of CRT efficacy among both sexes. Thus, this meta-analysis focuses on the long-term benefits of CRT in both sexes. PubMed, The Cochrane Library and clinicaltrials.gov were searched for articles from 2010 to 2024. ROB2 was used to assess risk of bias of RCTs. Newcastle Ottawa Scale was used for quality appraisal of cohorts. Meta-analysis was conducted on Revman 5.4. Out of 2722 articles, only 9 RCTs and 18 cohorts were included. Our results demonstrated that females had a significantly lower risk of composite outcomes compared to males in both RCTs (RR 0.80; 95% CI [0.68, 0.94], P = .006) and cohorts (RR 0.76; 95% CI [0.63, 0.92], P = .004). Results were similar for all-cause mortality. For heart failure hospitalization, only cohorts showed a significant lesser risk in females (RR 0.78; 95% CI [0.65, 0.93], P = .006). Left ventricular ejection fraction improved significantly in females but no differences were observed for NYHA class improvement. Males showed a 31% lower survival rate. However future trials are needed to highlight this variation.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-15DOI: 10.1016/j.ajmo.2025.100096
Maria Emilia Romero Noboa MD , Shilpa Arora MD , Preeti Kansal MD , Augustine M. Manadan MD
Introduction
Takayasu's arteritis (TAK) is a rare chronic granulomatous vasculitis that primarily affects the aorta and its major branches but is also known to affect the coronary arteries. This involvement can result in acute coronary syndrome (ACS). This study aims to analyze TAK as an ACS risk factor in a US adult inpatient population.
Methods
We performed a retrospective study of ACS in 2016-2020 National Inpatient Sample (NIS) database. TAK and traditional cardiovascular (CV) risk factors were included in a multivariable logistic regression analysis for an outcome of ACS. The results were reported as adjusted odds ratios (ORadj) with P values <.05 considered significant.
Results
There were 148,767,786 adult hospitalizations in the 2016-2020 NIS database. Of the 3,282,749 hospitalizations with ACS, 180 (0.005%) had TAK. Multivariable analysis showed that age (ORadj 1.02), lowest income quartile (ORadj 1.03), diabetes (ORadj 1.19), hypertension (ORadj 1.06), hyperlipidemia (ORadj 2.94), nicotine dependence/tobacco use (ORadj 1.96), obesity (ORadj 1.21), and TAK (ORadj 1.78) were associated with a higher odds of ACS.
Conclusions
Despite rare occurrence of concurrent ACS and TAK, we found TAK was independently associated with ACS similar to traditional CV risk factors. These results should alert physicians to the high risk of ACS in TAK inpatients.
{"title":"Analysis of Takayasu's Arteritis as a Risk Factor for Acute Coronary Syndrome","authors":"Maria Emilia Romero Noboa MD , Shilpa Arora MD , Preeti Kansal MD , Augustine M. Manadan MD","doi":"10.1016/j.ajmo.2025.100096","DOIUrl":"10.1016/j.ajmo.2025.100096","url":null,"abstract":"<div><h3>Introduction</h3><div>Takayasu's arteritis (TAK) is a rare chronic granulomatous vasculitis that primarily affects the aorta and its major branches but is also known to affect the coronary arteries. This involvement can result in acute coronary syndrome (ACS). This study aims to analyze TAK as an ACS risk factor in a US adult inpatient population.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of ACS in 2016-2020 National Inpatient Sample (NIS) database. TAK and traditional cardiovascular (CV) risk factors were included in a multivariable logistic regression analysis for an outcome of ACS. The results were reported as adjusted odds ratios (OR<sub>adj</sub>) with <em>P</em> values <.05 considered significant.</div></div><div><h3>Results</h3><div>There were 148,767,786 adult hospitalizations in the 2016-2020 NIS database. Of the 3,282,749 hospitalizations with ACS, 180 (0.005%) had TAK. Multivariable analysis showed that age (OR<sub>adj</sub> 1.02), lowest income quartile (OR<sub>adj</sub> 1.03), diabetes (OR<sub>adj</sub> 1.19), hypertension (OR<sub>adj</sub> 1.06), hyperlipidemia (OR<sub>adj</sub> 2.94), nicotine dependence/tobacco use (OR<sub>adj</sub> 1.96), obesity (OR<sub>adj</sub> 1.21), and TAK (OR<sub>adj</sub> 1.78) were associated with a higher odds of ACS.</div></div><div><h3>Conclusions</h3><div>Despite rare occurrence of concurrent ACS and TAK, we found TAK was independently associated with ACS similar to traditional CV risk factors. These results should alert physicians to the high risk of ACS in TAK inpatients.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.ajmo.2025.100095
John Musachia, Jon Radosta, Dirin Ukwade, Shahrukh Rizvi, Romani Wahba
Background
Although there has been a steady decrease in morbidity and mortality from the SARS-CoV-2 virus since the 2020-2021 period, thousands of Americans are still infected with the virus daily. Some proportion of these infected individuals will go on to develop postacute sequelae from SARS-CoV-2 (PASC, or Long COVID), manifesting symptoms 4 weeks or more after recovery from COVID-19. PASC and its underlying pathophysiology are still poorly described and understood. Although hundreds of peer-reviewed, published investigations on Long COVID exist, few have focused on underserved urban patient populations. Most of the published research has involved reviews of diagnostic codes from electronic health records, or responses to questionnaires.
Methods
We sought to review Long COVID in an underserved population in Chicago, and to go beyond electronic health record reviews of diagnostic codes, utilizing in-depth chart reviews, gleaned via manual extraction, focusing on notations of care providers. We investigated which specific preexisting conditions, if any, might be associated with specific Long COVID symptomatology's, and if any preexisting conditions predicted Long COVID. Study participants included 204 Long COVID patients, 98 COVID-19–positive patients, and 104 healthy (no history of COVID-19 infection) patients from an inner-city health system caring for underserved communities, whose records were reviewed via manual data extraction from electronic health records, focusing on provider notes in patient charts.
Results
Our Long COVID symptom frequencies were distinct compared to frequencies from other reviews that did not focus on underserved populations and done with medical records when only diagnostic codes are utilized. Preexisting medical conditions did not predict similar Long COVID symptomologies, save for the significant association between preexisting cough/dyspnea/pulmonary conditions and preexisting migraine/headache and their analogous Long COVID symptoms.
Conclusions
The odds of having Long COVID increased comparatively in subjects hospitalized with COVID-19, subjects with BMI >30, and female subjects.
{"title":"Postacute Sequelae From SARS-CoV-2 at the University of Illinois Hospital and Clinics: An Examination of the Effects of Long COVID in an Underserved Population Utilizing Manual Extraction of Electronic Health Records","authors":"John Musachia, Jon Radosta, Dirin Ukwade, Shahrukh Rizvi, Romani Wahba","doi":"10.1016/j.ajmo.2025.100095","DOIUrl":"10.1016/j.ajmo.2025.100095","url":null,"abstract":"<div><h3>Background</h3><div>Although there has been a steady decrease in morbidity and mortality from the SARS-CoV-2 virus since the 2020-2021 period, thousands of Americans are still infected with the virus daily. Some proportion of these infected individuals will go on to develop postacute sequelae from SARS-CoV-2 (PASC, or Long COVID), manifesting symptoms 4 weeks or more after recovery from COVID-19. PASC and its underlying pathophysiology are still poorly described and understood. Although hundreds of peer-reviewed, published investigations on Long COVID exist, few have focused on underserved urban patient populations. Most of the published research has involved reviews of diagnostic codes from electronic health records, or responses to questionnaires.</div></div><div><h3>Methods</h3><div>We sought to review Long COVID in an underserved population in Chicago, and to go beyond electronic health record reviews of diagnostic codes, utilizing in-depth chart reviews, gleaned via manual extraction, focusing on notations of care providers. We investigated which specific preexisting conditions, if any, might be associated with specific Long COVID symptomatology's, and if any preexisting conditions predicted Long COVID. Study participants included 204 Long COVID patients, 98 COVID-19–positive patients, and 104 healthy (no history of COVID-19 infection) patients from an inner-city health system caring for underserved communities, whose records were reviewed via manual data extraction from electronic health records, focusing on provider notes in patient charts.</div></div><div><h3>Results</h3><div>Our Long COVID symptom frequencies were distinct compared to frequencies from other reviews that did not focus on underserved populations and done with medical records when only diagnostic codes are utilized. Preexisting medical conditions did not predict similar Long COVID symptomologies, save for the significant association between preexisting cough/dyspnea/pulmonary conditions and preexisting migraine/headache and their analogous Long COVID symptoms.</div></div><div><h3>Conclusions</h3><div>The odds of having Long COVID increased comparatively in subjects hospitalized with COVID-19, subjects with BMI >30, and female subjects.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-15DOI: 10.1016/j.ajmo.2025.100092
Neha Pagidipati , Brooke Heidenfelder , Lydia Coulter Kwee , Fatima Rodriguez , Ranee Chatterjee , Kishan S. Parikh , Michel G. Khouri , Jennifer Stiller , Julie Eckstrand , P. Kelly Marcom , Priyatham S. Mettu , Glenn J. Jaffe , Sumana Shashidhar , Susan Swope , Susan Spielman , Elizabeth Fraulo , L. Kristin Newby , Pamela Douglas , Charlene Wong , Robert Green , Svati H. Shah
Background
Returning results to research participants is increasingly recognized as an ethical mandate, yet little is known about best practices to optimally communicate urgent or emergent results.
Methods
We describe the development of and experience with a process to return results to participants in the Project Baseline Health Study (PBHS), which was a prospective observational cohort study of 2502 participants enrolled from 2017 to 2019 and followed through 2023. Urgent or emergent results were returned during or after the baseline visit from vital signs; clinical laboratory testing; and ocular, cardiovascular, and pulmonary imaging.
Results
Among 2002 participants in this analysis, 39.7% had at least one urgent or emergent finding returned, representing a total of 1159 results returned over 3 years. The most commonly returned results were eye findings (n = 246), pulmonary nodules (n = 159), abnormal stress echocardiograms (n = 123), abnormal rest electrocardiograms (bradycardia) (n = 74), and lung parenchyma findings (n = 55). Participants with urgent or emergent incidental findings were older (mean [SD] 58.0 [16.2] years vs 48.0 [16.6] years) with a greater burden of cardiovascular, metabolic, or cancer comorbidities than those without urgent or emergent incidental findings.
Conclusions
This report from the PBHS study is one of the first to describe a process to systematically return urgent or emergent results to research participants. This process led to the successful return of clinically important results to participants but also required significant time and effort from study clinicians and staff.
{"title":"Returning Individual-Level Urgent or Emergent Research Results to Participants: The Project Baseline Health Study Experience","authors":"Neha Pagidipati , Brooke Heidenfelder , Lydia Coulter Kwee , Fatima Rodriguez , Ranee Chatterjee , Kishan S. Parikh , Michel G. Khouri , Jennifer Stiller , Julie Eckstrand , P. Kelly Marcom , Priyatham S. Mettu , Glenn J. Jaffe , Sumana Shashidhar , Susan Swope , Susan Spielman , Elizabeth Fraulo , L. Kristin Newby , Pamela Douglas , Charlene Wong , Robert Green , Svati H. Shah","doi":"10.1016/j.ajmo.2025.100092","DOIUrl":"10.1016/j.ajmo.2025.100092","url":null,"abstract":"<div><h3>Background</h3><div>Returning results to research participants is increasingly recognized as an ethical mandate, yet little is known about best practices to optimally communicate urgent or emergent results.</div></div><div><h3>Methods</h3><div>We describe the development of and experience with a process to return results to participants in the Project Baseline Health Study (PBHS), which was a prospective observational cohort study of 2502 participants enrolled from 2017 to 2019 and followed through 2023. Urgent or emergent results were returned during or after the baseline visit from vital signs; clinical laboratory testing; and ocular, cardiovascular, and pulmonary imaging.</div></div><div><h3>Results</h3><div>Among 2002 participants in this analysis, 39.7% had at least one urgent or emergent finding returned, representing a total of 1159 results returned over 3 years. The most commonly returned results were eye findings (<em>n</em> = 246), pulmonary nodules (<em>n</em> = 159), abnormal stress echocardiograms (<em>n</em> = 123), abnormal rest electrocardiograms (bradycardia) (<em>n</em> = 74), and lung parenchyma findings (<em>n</em> = 55). Participants with urgent or emergent incidental findings were older (mean [SD] 58.0 [16.2] years vs 48.0 [16.6] years) with a greater burden of cardiovascular, metabolic, or cancer comorbidities than those without urgent or emergent incidental findings.</div></div><div><h3>Conclusions</h3><div>This report from the PBHS study is one of the first to describe a process to systematically return urgent or emergent results to research participants. This process led to the successful return of clinically important results to participants but also required significant time and effort from study clinicians and staff.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1016/j.ajmo.2025.100093
Anders Holt , Jarl Emanuel Strange , Morten Lock Hansen , Morten Lamberts , Peter Vibe Rasmussen
Aims
Studies have reported excess risk of mortality associated with digoxin in atrial fibrillation (AF).
This study sought to investigate if these findings could be replicated and whether a potential association could be explained by bias.
Methods
Using Danish Nationwide registers, a nested-case control study from 2012 to 2022 was conducted in a cohort of patients with AF. Cases were defined as death of any cause and the exposure was treatment with digoxin compared with beta blockers/verapamil. To investigate bias, additional analyses with negative control outcomes as case definitions—in which we would not expect a plausible association (eg, nursing home admission)—were employed. Associations were reported as hazard ratios (HRs) with 95% confidence intervals (95% CI).
Results
A total of 59,748 cases were identified and matched 1:10 with controls (53% men, median age: 84 [IQR: 77-89]). Digoxin was associated with increased rates of mortality in the entire cohort (HR 1.85, 95% CI 1.78-1.92) as well as subgroups such as patients with heart failure (HR 1.84, 95% CI 1.65-2.06), diabetes (HR 1.85, 95% CI 1.6-2.14), and kidney disease (HR 1.37, 95% CI 1.04-1.8). Significant associations with all negative control outcomes were also found, most notably nursing home admissions (HR 1.79, 95% CI 1.67-1.93).
Conclusion
Digoxin use was associated with increased mortality in AF. However, negative control outcomes were also associated with digoxin use indicating that the described association between digoxin and mortality is likely not causal and being prescribed digoxin is merely a marker of more advanced disease and frailty.
研究报告地高辛与房颤（AF）相关的死亡风险过高。这项研究试图调查这些发现是否可以被复制，以及是否可以用偏见来解释潜在的关联。方法使用丹麦全国登记系统，在2012年至2022年期间对房颤患者进行巢式病例对照研究。病例定义为任何原因死亡，暴露于地高辛治疗与β受体阻滞剂/维拉帕米治疗比较。为了调查偏倚，我们采用了额外的分析，将阴性对照结果作为病例定义——在这种情况下，我们不会期望有合理的关联（例如，疗养院入院）。以95%置信区间（95% CI）的风险比（hr）报告相关性。结果共发现59,748例，与对照组（男性53%，中位年龄84岁[IQR: 77-89]）的匹配比例为1:10。地高辛与整个队列（HR 1.85, 95% CI 1.78-1.92）以及诸如心力衰竭（HR 1.84, 95% CI 1.65-2.06）、糖尿病（HR 1.85, 95% CI 1.6-2.14）和肾脏疾病（HR 1.37, 95% CI 1.04-1.8）等亚组的死亡率升高相关。与所有阴性对照结果也发现显著相关，最显著的是疗养院入院（HR 1.79, 95% CI 1.67-1.93）。结论地高辛的使用与房颤死亡率增加有关。然而，阴性对照结果也与地高辛的使用有关，这表明地高辛与死亡率之间的关联可能不是因果关系，处方地高辛仅仅是疾病更晚期和虚弱的标志。
{"title":"The Bad Reputation of Digoxin in Atrial Fibrillation—Causality or Bias? Nationwide Nested Case-Control Study","authors":"Anders Holt , Jarl Emanuel Strange , Morten Lock Hansen , Morten Lamberts , Peter Vibe Rasmussen","doi":"10.1016/j.ajmo.2025.100093","DOIUrl":"10.1016/j.ajmo.2025.100093","url":null,"abstract":"<div><h3>Aims</h3><div>Studies have reported excess risk of mortality associated with digoxin in atrial fibrillation (AF).</div><div>This study sought to investigate if these findings could be replicated and whether a potential association could be explained by bias.</div></div><div><h3>Methods</h3><div>Using Danish Nationwide registers, a nested-case control study from 2012 to 2022 was conducted in a cohort of patients with AF. Cases were defined as death of any cause and the exposure was treatment with digoxin compared with beta blockers/verapamil. To investigate bias, additional analyses with negative control outcomes as case definitions—in which we would not expect a plausible association (eg, nursing home admission)—were employed. Associations were reported as hazard ratios (HRs) with 95% confidence intervals (95% CI).</div></div><div><h3>Results</h3><div>A total of 59,748 cases were identified and matched 1:10 with controls (53% men, median age: 84 [IQR: 77-89]). Digoxin was associated with increased rates of mortality in the entire cohort (HR 1.85, 95% CI 1.78-1.92) as well as subgroups such as patients with heart failure (HR 1.84, 95% CI 1.65-2.06), diabetes (HR 1.85, 95% CI 1.6-2.14), and kidney disease (HR 1.37, 95% CI 1.04-1.8). Significant associations with all negative control outcomes were also found, most notably nursing home admissions (HR 1.79, 95% CI 1.67-1.93).</div></div><div><h3>Conclusion</h3><div>Digoxin use was associated with increased mortality in AF. However, negative control outcomes were also associated with digoxin use indicating that the described association between digoxin and mortality is likely not causal and being prescribed digoxin is merely a marker of more advanced disease and frailty.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1016/j.ajmo.2025.100094
Blayne E. Fenner , Kevin M. Burningham , Jamael L. Thomas , Brent C. Kelly , Auris O. Huen , Stephen K. Tyring
Once subdued after the advent of penicillin, syphilis has re-emerged in recent years, with incidence rates rising in many countries, including the United States. Its reputation as “the great imitator” is well earned due to its widely variable presentation, particularly in its second stage. This contributes to a high rate of delayed diagnosis and misdiagnosis, adding significant burden to patients and the health care system generally. Herein, we present 2 cases in which syphilis was misdiagnosed, leading to unnecessary therapies and delay of symptom clearance until treponemal tests were performed. In the context of recent epidemiologic trends and its notorious difficulty to clinically define, syphilis should always be considered in the differential diagnosis of diffuse cutaneous eruptions.
{"title":"The Great Mimicker: Forgotten but not Gone","authors":"Blayne E. Fenner , Kevin M. Burningham , Jamael L. Thomas , Brent C. Kelly , Auris O. Huen , Stephen K. Tyring","doi":"10.1016/j.ajmo.2025.100094","DOIUrl":"10.1016/j.ajmo.2025.100094","url":null,"abstract":"<div><div>Once subdued after the advent of penicillin, syphilis has re-emerged in recent years, with incidence rates rising in many countries, including the United States. Its reputation as “the great imitator” is well earned due to its widely variable presentation, particularly in its second stage. This contributes to a high rate of delayed diagnosis and misdiagnosis, adding significant burden to patients and the health care system generally. Herein, we present 2 cases in which syphilis was misdiagnosed, leading to unnecessary therapies and delay of symptom clearance until treponemal tests were performed. In the context of recent epidemiologic trends and its notorious difficulty to clinically define, syphilis should always be considered in the differential diagnosis of diffuse cutaneous eruptions.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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