Postgraduate medicine最新文献

Objective: Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory disease affecting the bone in which, diagnostic delays are common due to lack of physician awareness. The aim of this study was to evaluate the knowledge of orthopedic surgeons and pediatricians about CNO and to investigate the effect of professional experience on this process.

Materials and methods: This study was conducted between January-February 2025 using a 13-item online questionnaire comprising multiple-choice questions with clearly defined correct and incorrect answers. The questionnaire consisted of two main categories. The first category included questions regarding the clinicians' areas of specialization, professional experience, and training needs. The second category aimed to assess clinicians' knowledge levels about CNO. For each participant, the number and rate of correct and incorrect responses were calculated.

Results: The questionnaire was sent to a total of 551 clinicians and 244 of them (44.2%) (130 orthopedic surgeons, 114 pediatricians) completed the questionnaire. Of the 61 items, orthopedic surgeons had a median of 30 correct responses (26-35), while pediatricians had a median of 32 (28-36) (p = 0.023). The rate of giving the correct answers to the questions increased with the professional experience of the clinicians (p = 0.02). 116 (47.5%) clinicians stated that they didn't think to have sufficient knowledge about CNO and 212 (86.8%) clinicians stated that they'd like to participate in a training about CNO.

Conclusion: This study demonstrates that both orthopedic surgeons and pediatricians still have significant knowledge gaps regarding CNO. Although the current level of awareness remains limited in both groups, they appear willing to acquire further knowledge. These findings highlight the need for focused educational programs to improve patient care.

Background: Although oxidative stress has been implicated in PE, findings on antioxidant and oxidative DNA damage markers remain inconsistent. This study aimed to assess the plasma levels of the antioxidant biomarkers sirtuin 1 (SIRT1) and superoxide dismutase 2 (SOD2), as well as the oxidative DNA damage marker 8-hydroxy-2'-deoxyguanosine (8-OHdG), and to evaluate their correlation with clinical parameters in cases of PE.

Methods: This case-control study included 25 women aged 20-45 years, divided into two groups: the PE group (n = 14) and the control group (n = 11). Plasma SIRT1, SOD2, and 8-OHdG concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Pearson correlation coefficients were calculated to determine the relationships between plasma concentrations of these markers and specific clinical parameters in the PE group.

Results: Plasma levels of SIRT1 and SOD2 were significantly higher in the PE group compared to that in the control group, while no significant difference was observed in 8-OHdG. A significant positive correlation was observed between SIRT1 and both systolic and diastolic blood pressures in the PE group compared to that in the control group. In addition, a borderline significant positive association was observed between SOD2 and diastolic blood pressure in the PE group compared to that in the control group.

Conclusion: Increased levels of both plasma SIRT1 and SOD2, along with their positive correlation with blood pressure, suggest a potential role for oxidative stress and antioxidant response in the pathogenesis of PE.

Objective: To evaluate the predictive value of the platelet-albumin-bilirubin (PALBI) score for hepatic failure after transarterial chemoembolization (TACE) in patients with non-small hepatocellular carcinoma (HCC) (tumor diameter > 5 cm).

Methods: A retrospective study included 577 non-small HCC patients who underwent TACE between January 2018 and December 2024. Patients were stratified by PALBI grade (Grade 1: ≤-2.53; Grade 2: > -2.53 to ≤-2.09; Grade 3: > -2.09). Hepatic failure was defined and graded (A-C) according to ISGLS criteria. The predictive efficacy of PALBI, ALBI, and Child-Pugh scores was compared using ROC curves.

Results: Hepatic failure occurred in 28.2% (163/577) of patients (Grade A: 22.0%; B: 4.6%; C: 1.5%). Hepatic failure incidence significantly increased with PALBI grade: 10.31% (Grade 1), 27.83% (Grade 2), and 78.95% (Grade 3) (p < 0.001). PALBI demonstrated superior predictive efficacy (AUC = 0.746) compared to ALBI (AUC = 0.702, p = 0.004) and Child-Pugh (AUC = 0.706, p = 0.075). Multivariate analysis identified ascites, AST, and total bilirubin as independent risk factors for hepatic failure (p < 0.05).

Conclusion: The PALBI score is an effective tool for predicting hepatic failure after TACE in non-small HCC patients. PALBI Grade 3 indicates high risk (78.95%), suggesting preoperative liver protection therapy before TACE. PALBI outperforms ALBI and Child-Pugh scores in risk stratification.

Objective: Severe pneumonia is typically characterized by severe pulmonary inflammatory responses. This study evaluated the predictive value of D-dimer (DD) and neutrophil-to-lymphocyte ratio (NLR) for disease severity in children with severe pneumonia.

Methods: Children with severe pneumonia (280 cases) were enrolled and divided into the critical and non-critical groups based on the pediatric critical illness score (PCIS). Clinical data were collected at patients' initial admission. Correlations of DD and NLR with the PCIS, their predictive value and the independent predictors for disease severity in children with severe pneumonia were assessed by Spearman test, receiver operating characteristic curve and multivariate logistic regression. Outcomes were determined as per the 28-day disease progression.

Results: The critical group showed higher DD and NLR than the non-critical group. DD and NLR negatively correlated with the PCIS. Children in the higher DD quartile group showed higher systolic blood pressure (SBP), NLR and procalcitonin, and lower platelet and PCIS. Children in the higher NLR quartile group had higher SBP, DD and procalcitonin, and platelet and lower PCIS. Areas under the curve to predict severe pneumonia severity were 0.805, 0.883 and 0.918 for DD, NLR and their combination, suggesting superior diagnostic value of their combination for disease severity. The critical group (59.05%) had higher 28-day poor outcomes of pneumonia than the non-critical group (18.29%). DD and NLR were independent risk factors for the disease severity in severe pneumonia children.

Conclusion: Elevated DD and NLR have certain predictive value for disease severity and poor prognosis in severe pneumonia children.

Objectives: Serotonin syndrome (SS) is a life-threatening emergency that develops as a result of increased serotonin amount or activity in the synaptic cleft. The present study aimed to determine the clinical findings in serotonergic drug intoxications in children that may alert clinicians about the development of SS.

Methods: The patients aged between 1 to 18 years, who were admitted to the pediatric emergency department (PED) because of drug intoxications between September 2022 and August 2024, were analyzed retrospectively. Patients with a history of taking one or more serotonergic drugs were included in the study. Patients were divided into two groups: SS and without SS. The sensitivity, specificity, negative and positive predictive value (PPV) of the Hunter's criteria and SS-related symptoms were evaluated.

Results: A total of 162 patients were included in the study. SS developed in 25 (15.4%) of the patients. SS developed in 23 (21.1%) of 109 patients receiving SSRI group drugs, while SS developed in two (4.8%) of 42 patients receiving non-SSRI group drugs (p = 0.015). Nineteen (76%) of the patients diagnosed with serotonin syndrome were also diagnosed with SS according to Hunter's criteria, and the sensitivity and specificity of Hunter's criteria in the diagnosis of SS in pediatric patients were 76% and 100%, respectively. The specificity and PPV were 100% for spontaneous clonus, inducible clonus, ocular clonus, hyperreflexia, and hyperthermia in the diagnosis of serotonin syndrome. The symptoms with the highest sensitivity were mydriasis (76%) and tremor (64%). All patients with serotonin syndrome were treated with cyproheptadine, and clinical findings improved.

Conclusion: SS developed in 15.4% of patients with serotonergic drug intoxication, and the sensitivity of Hunter's criteria for the diagnosis of SS was 76%. The combined use of Hunter's criteria and clinician decision in the diagnosis of childhood SS may be more useful.

Objectives: For many decades, guaifenesin and dextromethorphan have been two of the most well-established and commonly used nonprescription medications to manage cough and cold symptoms. A single source that summarizes the clinical data supporting the use of guaifenesin and dextromethorphan as self-care treatment options in cough and cold could assist healthcare professionals (HCPs) in making informed recommendations to patients. The objective of this narrative review is to discuss the benefits of guaifenesin and dextromethorphan for the management of cough and mucus-related cold symptoms in adults by examining published data on the effectiveness and safety of the products containing these ingredients.

Methods: Literature searches were performed on PubMed, Embase, and MEDLINE to identify randomized, controlled studies comparing guaifenesin or dextromethorphan treatment with placebo control in adults with cough and cold (mucus) symptoms. Of 36 guaifenesin and 53 dextromethorphan clinical studies initially identified by the literature search, 13 guaifenesin and 19 dextromethorphan publications met the predefined inclusion criteria. Additional studies were identified during manuscript development by reviewing the citations of included articles, for a total of 17 guaifenesin and 21 dextromethorphan publications.

Results: Data from studies of guaifenesin and dextromethorphan either used alone or combined with other active ingredients showed statistically significant improvements compared with placebo control in sputum looseness/adhesiveness and reductions in cough frequency/severity, respectively. A small number of studies did not show significant improvements with study drug compared with placebo control. Conflicting data may originate from differences in study design, patient enrollment, and a relatively high placebo control effect across studies.

Conclusion: The data reviewed in this article support the importance of guaifenesin and dextromethorphan in the armamentarium of effective nonprescription treatment options for cough and mucus-related cold symptoms.

Objectives: To review the efficacy of lemborexant (LEM), a dual orexin-receptor antagonist approved in multiple countries for treatment of insomnia in adults, by assessing the consistency of the available LEM objective and subjective evidence.

Methods: Data from 2 pivotal phase 3, randomized, double-blind, parallel-group, placebo (PBO)-controlled studies are reviewed. Study 304 (1-month) and Study 303 (12-months; only first 6 months included here) evaluated the efficacy/safety of LEM 5 mg (LEM5) and LEM 10 mg (LEM10) in adults with insomnia disorder. Objective sleep onset (latency to persistent sleep [LPS]) and sleep maintenance (wake after sleep onset [WASO] and total sleep time [TST]) were assessed with polysomnography in Study 304. Subjective sleep onset latency (sSOL) and sleep maintenance (sWASO and sTST) were assessed with sleep diaries in both studies. Other patient-reported efficacy measures included Insomnia Severity Index-total score (ISI-TS), ISI-daytime functioning (ISI-DF), Fatigue Severity Scale (FSS), and Patient Global Impression-Insomnia (PGI-I).

Results: Compared with PBO, significantly larger decreases (improvements) from baseline in LPS, sSOL, WASO, and sWASO and significantly larger increases (improvements) from baseline in TST and sTST were observed within the first week of LEM treatment (as early as within the first 1-2 nights) and were sustained throughout the treatment period (1-6 months) (all p < 0.05, except for sWASO at Month 1). These improvements aligned with significantly larger decreases (improvements) from baseline in ISI-TS, ISI-DF, and PGI-I (all p < 0.05). Significantly larger decreases (improvement) from baseline in FSS scores were observed at 3 and 6 months (both p < 0.05).

Conclusion: LEM showed concordance in its ability to improve objective and subjective measures of nighttime sleep, as well as daytime functioning and patient perception of nighttime sleep. These findings demonstrate that LEM is effective both objectively and from the patient's perspective, supporting LEM as a valuable treatment option for adults with insomnia.

Objectives: Tinea capitis is one of the most common fungal infections in children around the world. However, the relationship between nutrition and the risk of infection, as well as treatment outcomes, has not been thoroughly studied. This study aimed to explore the relationship between certain micronutrient deficiencies and the occurrence, severity, and treatment response of tinea capitis in children.

Methods: This prospective cohort study included 280 children aged 2-12 years, with 140 confirmed cases of tinea capitis and 140 matched controls from three clinical locations. Detailed nutritional assessments included growth measurements and lab tests for zinc, iron, vitamin D, and protein-energy levels. The cases received standard antifungal treatment and were monitored for 6 months to evaluate treatment results. We employed multivariate analyses to identify relationships between nutritional factors and the occurrence, severity, and treatment outcomes of the disease.

Results: Even after controlling for other variables, zinc deficiency (OR = 2.87, 95% CI [1.71, 4.84], p < 0.001) and vitamin D deficiency (OR = 2.11, 95% CI [1.25, 3.58], p = 0.005) were found to increase the risk of tinea capitis independently. The symptoms and outcomes of treatment were worse in children with multiple nutritional deficiencies. At 8 weeks, children with nutritional deficiencies had a significantly lower rate of clinical cure (44.2%) than those without (71.4%, p < 0.001). The relationship between treatment response and socioeconomic status was significantly influenced by nutritional status.

Conclusions: Low levels of certain micronutrients, especially zinc and vitamin D, are key risk factors for children developing tinea capitis and not responding well to treatment. These findings suggest the potential benefits of integrated nutritional assessment and focused supplementation strategies, which should be evaluated in future interventional trials for pediatric tinea capitis, especially in resource-limited settings.

Introduction: The effects of estrogen on arrhythmias are controversial. While animal studies suggest complex effects, the hypothesis that higher estrogen levels increase women's arrhythmia susceptibility has not yet been fully validated in human studies.

Case report: This case report describes a 30-year-old female patient who frequently experienced palpitations and was initially diagnosed with idiopathic ventricular arrhythmia. However, her symptoms were strongly correlated with her menstrual cycle. She experienced premature ventricular contractions (PVCs) 6 days before menstruation and 5 days before ovulation, which coincided with elevated estrogen levels. After other potential causes were ruled out, a diagnosis of hormone-induced PVCs was established. The patient was treated with a combination of estrogen and progestogen that not only alleviated her palpitations but also relieved her dysmenorrhea and menstrual irregularities. During a 5-month follow-up period, the patient reported no further palpitations.

Conclusion: This case provides clinical support of the hypothesis that elevated estrogen levels can increase vulnerability to ventricular arrhythmias in women. The influence of estrogen on arrhythmias may occur via a biphasic effect that potentially provides antiarrhythmic benefits during phases of low estrogen and increases the risk of arrhythmia during peak estrogen phases. Clinicians should consider hormone-related arrhythmias when young female patients present with palpitations that follow a cyclical pattern that is clearly linked to the menstrual cycle. Such cases warrant thorough history-taking and assessments of sex hormone levels. Hormonal regulation therapy could be an effective treatment strategy; however, its effectiveness and safety require careful evaluation.

Introduction: Hyperkalemia is a critical electrolyte imbalance in neonatal intensive care unit (NICU), linked to increased mortality. This study aimed to determine the prevalence, etiological factors, and clinical outcomes of hyperkalemia in neonates admitted to the NICU over a 10-year period, with a specific focus on differentiating actual hyperkalemia from pseudohyperkalemia according to gestational age - based thresholds.

Materials and methods: Data from NICU admissions over 10 years were analyzed. Hyperkalemia was defined as potassium levels ≥6 mmol/L in term neonates and >6.5 mmol/L in preterm. Cases of pseudohyperkalemia, primary etiology, and mortality were assessed.

Results: Among 5997 admissions, hyperkalemia was observed in 4.9% of cases, while true hyperkalemia was confirmed in 1.6%. Pseudohyperkalemia was the most common type. Actual hyperkalemia was more frequent in term neonates (p = 0.016). Acute kidney injury (AKI) was identified in 43.6% of cases. In term neonates, the most common causes were asphyxia, AKI, and congenital adrenal hyperplasia, whereas in preterms, they were AKI, hypoxia, and hemorrhage. A negative correlation was found between Apgar scores and potassium levels (p < 0.001). Mortality rates were 7.2% in neonates without actual hyperkalemia and 37.2% in those with it.

Conclusion: Hyperkalemia is a common and serious condition in NICUs, requiring prompt differentiation of pseudohyperkalemia from actual hyperkalemia. Given its high mortality risk, rapid etiology-specific treatment and potassium-lowering therapies are essential for managing actual hyperkalemia.