Postgraduate medicine最新文献

Objectives: Most benign hepatic lesions occur in isolation. The clinical and demographic phenotype in patients with more than one lesion can overlap complicating treatment decisions. This study aimed to describe the clinical and demographic characteristics of patients with benign hepatic lesions to predict the lesion using clinical data and oral contraceptive (OCP) use and find a 'clinical phenotype' to identify these patients.

Methods: This retrospective cohort study compared demographics, laboratory values, and OCP use in patients with hepatic adenoma (HA), focal nodular hyperplasia (FNH), hemangioma (HM), and cystic lesions on imaging. Differences between groups were assessed to identify independent factors associated with the different lesions.

Results: The cohort (n = 216) contained 90 (41%) FNH, 75 (34%) cystic lesions, 47 (21%) HA, 26 (12%) HM, and 3 (1.4%) FNH+HA. Combination lesions were observed in 27 (12%) patients: HM+cyst (n = 2; 0.9%), FNH+cyst (n = 8; 3.7%), HA+cyst (n = 4; 1.9%), FNH+HM (n = 7; 3.2%), HA+HM (n = 2; 0.9%), FNH+HM+cyst (n = 1; 0.5%), and HA+FNH (n = 3; 1.4%). FNH were youngest and female. HA were young and female with highest OCP use. Patients with cystic lesions were oldest with the least OCP use. HM were male with the highest overall alkaline phosphatase (ALP) levels. Between HA and FNH, HA had significantly higher aspartate aminotransferase, alanine aminotransferase, and ALP levels with lower Hgb levels.

Conclusion: Predicting the etiology of benign hepatic lesions based on patient demographics, common laboratory values, and a brief history including OCP use alone is difficult. However, we identified the most important demographic and laboratory values to assist in building a differential.

Junctional ectopic tachycardia (JET) is an uncommon arrhythmia, but it can have devastating consequences when it occurs. Most physicians are not familiar with its diagnosis, which can seriously compromise management in emergency rooms. Many cases arise in the postoperative period following cardiovascular surgery. In this context, the arrhythmia significantly worsens the prognosis of patients. A particularly severe form of JET is congenital, which has a mortality rate of up to 35%. The diagnosis can be made from the fetal period to six months of age. JET is infrequently diagnosed in otherwise healthy adults. Some medical conditions have been associated with the occurrence of JET. In the electrocardiogram, the most prominent characteristics of the arrhythmia are atrioventricular dissociation, narrow QRS complexes, and R-R interval irregularity due to intermittent ventricular captures. A notable feature of JET is the lack of response to treatment in many patients. Management options are divided into general and specific measures. General measures include avoiding hyperthermia, pain control, and minimizing the use of exogenous catecholamines. Specific treatment involves antiarrhythmic drugs, temporary atrial pacing, and ablation.

Background: Vaccination against COVID-19 is safe for patients greater than 6 months of age and reduces virus infectivity and severity. One strategy for protecting children unable to be vaccinated is cocooning, a concept that protects at-risk individuals by vaccinating adult caregivers (ACs). This study evaluates AC characteristics of those receiving COVID-19 vaccination in pediatric healthcare clinics.

Methods: This study is a retrospective chart review that identified ACs greater than 21 years of age who received a COVID-19 vaccine at one of six UFHealth pediatric offices between March 2021-April 2022. Investigators collected demographic information of the AC and corresponding child.

Results: The AC sample was predominantly female (79.8%), parents (75.3% mothers, 19.3% fathers), White (48.2%) or Black/African American (33.7%). Those who completed both primary doses had higher rates of children less than 5 years compared to those who did not (48.2%, 37.2%; p-value: 0.0225). ACs completing both primary doses were also younger compared to their counterparts (37.0, 39.9 years; p-value: 0.0017), with double the rate of government-funded insurance (42.9%, 20.9%; p-value: <0.0001), and significantly different racial/ethnic distribution (p-value 0.0021).

Conclusions: ACs who completed both primary doses were younger females and had higher rates of children under 5 years old. We believe these results reflect the convenience of offering AC vaccines at pediatric healthcare clinics because of the high frequency of well-child checks within the first 5 years of life. This cohort also had double the rate of government-funded insurance, attributable to the free administration of COVID-19 vaccines at UF-affiliated pediatric clinics.

Objectives: To evaluate the effectiveness of semaglutide 2.4 mg for weight reduction and improvement in cardiometabolic biomarkers at 52 and 68 weeks in a real-world setting in the United States.

Methods: This noninterventional, retrospective cohort study used the Komodo Health database and included adults with obesity or overweight with ≥1 weight-related condition who initiated treatment with semaglutide 2.4 mg between June 2021 and August 2022 and remained on treatment for 1 year. A paired t-test was used to assess changes in weight, body mass index (BMI), and cardiometabolic biomarkers (systolic blood pressure [SBP], diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], HDL [high-density lipoprotein] cholesterol, LDL [low-density lipoprotein] cholesterol, and triglycerides) from baseline to 52-week and 68-week follow-up.

Results: Among 4,424 eligible patients, 77% were women and the mean (SD) age was 46.7 (10.0) years and BMI was 36.6 (3.6) kg/m². Dyslipidemia and hypertension were the most common obesity-related comorbidities at baseline. The mean (%) change in weight from baseline was -15.5 kg (-14.5%; p < 0.001; n = 594) at 52 weeks and -15.9 kg (-14.8%; p < 0.001; n = 391) at 68 weeks. The mean change in BMI from baseline was - 4.8 kg/m² (n = 1124) at 52 weeks and - 4.9 kg/m² (n = 700) at 68 weeks. At 52weeks, statistically significant improvements in mean values were observed for SBP (-6.3 mmHg), DBP (-3.1 mmHg), HbA1c (-0.4%), LDL cholesterol (-8.1 mg/dL), and triglycerides (-38.4 mg/dL) (all p < 0.001). Mean change at 52 weeks for HDL cholesterol was 1.0 mg/dL; p = 0.109. Results at 68 weeks were similar.

Conclusions: In this retrospective cohort study, the real-world effectiveness of semaglutide 2.4 mg was demonstrated by reductions in weight and BMI along with improvements in BP, HbA1c, and lipid panel among patients with obesity or overweight.

The high morbidity of obesity and depression pose significant public health concerns, with the prevalence of obesity doubling in the US between 1990 and 2022 and patients frequently presenting with both. Untreated obesity and depression can greatly impact patient health and well-being, as both obesity and depression are associated with a number of comorbidities including sleep apnea, type 2 diabetes mellitus, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease. This narrative review aims to provide a comprehensive and current overview of the overlapping etiologies between obesity and depression as well as the available treatment options that may be recommended by primary care professionals to treat these patients with concomitant obesity and depression. With the considerable overlap in the population of patients with obesity and depression, as well as the overlap in the neurobiological, hormonal, and inflammatory pathways underlying both diseases, primary care professionals should consider screening patients presenting with obesity for depression. Holistic treatment options, including lifestyle and behavioral modifications, and pharmacotherapy for both depression and obesity and bariatric surgery for obesity are critical to manage both conditions simultaneously. Therefore, due to the overlapping neurobiological pathways and mechanisms responsible for the incidence and progression of both obesity and depression, a holistic treatment plan including strategies with efficacy for both conditions and any additional comorbidities may improve the clinical approach for patients with concomitant obesity and depression.

Background: Rheumatic mitral stenosis continues to be a significant public health issue in developing countries. Advances in echocardiography have made it possible to non-invasively assess atrial physiomechanics. In our study, we aimed to evaluate the changes in left and right atrial phasic functions in patients with have mitral stenosis and to investigate the relationship of these changes with clinical signs, symptoms, and intervention decisions.

Methods: Patients with rheumatic mitral stenosis who did not have comorbidities affecting cardiac function were included in this single-center, prospective study. The study population consisted of 122 subjects: 30 healthy controls with no chronic diseases and normal cardiac function confirmed by clinical and echocardiographic evaluations, 31 patients with moderate mitral stenosis, 31 patients with severe mitral stenosis and 30 patients with severe mitral stenosis with valvular atrial fibrillation. In addition to conventional echocardiographic parameters, biventricular deformation analyses were assessed using 2D-STE. Right and left atrial phasic functions were evaluated using both 2D and 3D-STE analysis and compared with clinical findings.

Results: In the patient group with severe mitral stenosis in sinus rhythm, the contractile left atrial strain values were significantly higher. The left atrial peak longitudinal (reservoir) strain values were found to be significantly lowest in the group with severe mitral stenosis accompanied by atrial fibrillation. Similarly, in the group with severe mitral stenosis accompanied by atrial fibrillation, the right atrial phasic strain values were significantly lower in both 2D and 3D measurements.

Conclusion: Mitral stenosis, the increased left atrial afterload in patients with sinus rhythm is compensated by an increase in contractile function. However, this compensatory increase is insufficient to preserve left atrial reservoir function. Patients with mitral stenosis who develop atrial fibrillation lack the compensatory contractile function, and this deficiency underlies the increased clinical deterioration associated with the development of atrial fibrillation.

Bacteremia due to Moraxella Catarrhalis is rare. An 85-year-old Japanese woman had productive cough, dyspnea, and fever. She had type 2 diabetes mellitus and chronic heart failure. Infiltration shown on chest radiography could be explained by heart failure or pneumonia. Initial blood culture yielded Gram-negative cocci, identified as M. catarrhalis. We therefore diagnosed cardiogenic pulmonary edema and M. catarrhalis pneumonia. M. catarrhalis has a high prevalence of β-lactamase production, so treatment comprised ampicillin/sulbactam. The clinical outcomes were favorable. Our case shows the importance of consideration of M. catarrhalis when patients with heart failure have pneumonia and the importance of blood culture for such patients.

Venous thromboembolism (VTE), consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an extremely common condition both in the United States and worldwide. Not only is the diagnosis associated with significant morbidity and mortality for patients but it also imposes a deleterious financial burden on the US healthcare system. Diagnosis may be challenging due to variability in clinical presentation and requires a sequential workup including assessment of clinical pretest probability for VTE, D-dimer testing, and imaging. Following diagnosis, proper risk stratification is necessary to determine the appropriate treatment as well as the need for inpatient care. Elucidation of underlying major or minor risk factors at the time of diagnosis is essential as the presence of which may influence the duration of therapy. First-line treatment for most patients is anticoagulation with a direct oral anticoagulant (DOAC) for a minimum of 3-6 months. In multiple clinical trials, DOACs have proven to be non-inferior to vitamin K antagonists for the treatment of VTE with a lower risk of bleeding. Special consideration should be taken in the choice of agent and duration of treatment for patients who have underlying thrombophilias or malignancy and who are pregnant.