Postgraduate medicine最新文献

Introduction: Cardiovascular disease (CVD) and chronic kidney disease (CKD) are major global health concerns, with CKD significantly amplifying cardiovascular mortality. Statins, widely used to manage hyperlipidemia, are recognized for their lipid-lowering properties and additional benefits, including anti-inflammatory, antioxidant, and plaque-stabilizing effects. This review explores the multifaceted role of statins in cardiovascular and renal protection, particularly among CKD patients.

Methods: This narrative review synthesizes evidence from clinical studies assessing the cardiovascular and renal outcomes of statin use in patients with CKD. It examines the effects of statins across various clinical scenarios, demographics, and comorbidities, with a focus on their impact on cardiovascular events, renal function.

Results: Statins significantly reduce all-cause mortality and major adverse cardiovascular events in patients with mild to moderate CKD, with evidence supporting their efficacy across diverse populations. Trials such as JUPITER and the Heart Protection Study highlight their cardiovascular benefits and potential to stabilize kidney function. In surgical settings, statins show promise in mitigating acute kidney injury through inflammatory pathway modulation. However, their impact on renal outcomes, such as proteinuria, albuminuria, and glomerular filtration rate, is inconsistent. High-dose statins, especially in advanced CKD, may carry risks including hematuria or rhabdomyolysis, particularly with improper dosing or drug interactions. Safety depends on statin type, dose, and renal function. Additionally, statins reduce the risk of contrast-induced nephropathy and slow CKD progression in select populations, though variability in study designs limits generalizability.

Conclusion: Statins provide substantial cardiovascular benefits for CKD patients, but their renal effects remain uncertain. Future research should aim to optimize treatment strategies, including personalized regimens, to balance cardiovascular protection and renal safety effectively.

Objectives: Nasal irrigation is a safe and low-cost procedure. This study explores parents' knowledge, attitudes, and behaviors regarding nasal irrigation for young children.

Methods: We conducted a prospective, exploratory study at Ankara Bilkent City Hospital from August to September 2024, surveying parents of patients aged 0-24 months in the Pediatric Emergency Department. The survey collected data on demographic information, nasal cleaning practices, and related knowledge, attitudes, and behaviors. Data was compared across three age groups: 0-6 months (Group 1), 7-12 months (Group 2), and 13-24 months (Group 3).

Results: A total of 107 parents participated. Nasal irrigation was most commonly used for nasal congestion (79%) and difficulty breathing (44%), and was mainly performed once a day (30%) or 2-3 times a day (26%). The most preferred tools for nasal irrigation were syringes (58%) and normal saline solution (81%). Seventy-four participants stated they were effectively performing nasal irrigation. Twenty-one reported receiving training on nasal irrigation, and 36 expressed a desire to receive training on nasal irrigation. Only four (3.7%) participants correctly answered all the knowledge-assessment questions about nasal irrigation, while 19 (17.8%) responded accurately to six out of seven questions. The median total score was 4 [3-5], and there was no significant difference between the groups (Group 1: 5 [3-5], Group 2: 4 [3-5], Group 3: 4 [3-5], 4 [3-5], p = 0.972). No significant association was found between the employment status of the parents and the total score (p = 0.494 and p = 0.645, respectively). Parents in Group 1 demonstrated a lower frequency of correctly answering the statement regarding accurate head positioning during nasal irrigation (p = 0.025).

Conclusion: Most parents of young children presented to the pediatric emergency department have insufficient knowledge of nasal irrigation. Targeted educational initiatives and awareness campaigns are needed to enhance parents' understanding and promote the effective use of nasal irrigation.

Objectives: To determine the frequency of malnutrition, including undernutrition and overnutrition, in pediatric patients with familial Mediterranean fever (FMF), and to assess the impact of colchicine treatment on nutritional outcomes and factors associated with malnutrition.

Methods: The medical records of patients with FMF who were followed up in our pediatric rheumatology clinic between 2011 and 2024 were reviewed. Patients were divided into 3 groups according to their nutritional status: normal, undernutrition and overnutrition. Demographic and clinical characteristics and disease severity were compared before and after treatment. The international severity scoring system for FMF (ISSF) was used to assess disease severity.

Results: This retrospective study included 532 (50.6% female) pediatric patients with a median (IQR) age at diagnosis of 6.5 (6) years. Malnutrition was detected in 32.7% of patients at the time of diagnosis, after colchicine treatment this rate declined to 20.7%, significant reductions in undernutrition (from 23.5% to 12.8%) and marginal improvements in overnutrition (from 9.2% to 7.9%) (p < 0.001) groups were observed. The ISSF was significantly higher in both the undernutrition and overnutrition groups compared to patients with normal nutritional status before and after colchicine treatment (p < 0.001). A severe disease phenotype and malnutrition at the time of diagnosis were identified as significant risk factors for persistent malnutrition (p < 0.001).

Conclusion: Malnutrition, including undernutrition and overnutrition, is a common condition in pediatric FMF patients that can be improved with colchicine. The presence of malnutrition at diagnosis and a more severe disease phenotype seemed to be the most important determinants of persistent malnutrition.

Background: Persistent shoulder pain is often driven by inflammatory conditions, including tendinopathy, bursitis, and frozen shoulder. Treatment remains uncertain, but targeting underlying mechanisms like inflammation, metabolic factors, and nervous system disturbances may be more effective.

Objective: This perspective review summarizes these underlying mechanisms' roles in patients with inflammatory-driven shoulder pain and potential effective treatments for these mechanisms.

Results: Literature links inflammatory-driven shoulder pain to low-grade inflammation, obesity, hypertension, diabetes mellitus, and/or autonomic and central nervous system disturbances, which are interconnected. Both acute and chronic inflammation are evident in tissue around the shoulder joint, potentially compromising treatment outcomes and predisposing tissue to hyperresponsiveness. Persistent inflammation can disrupt endocrine and nervous system functions, leading to additional health issues. Metabolic factors, characterized by low-grade inflammation, increase the risk for developing inflammatory-driven shoulder pain. Patients with inflammatory-driven shoulder pain often exhibit autonomic and somatosensory dysregulation. The autonomic nervous system's involvement in the inflammatory pathway can be influenced by or influence inflammation when dysregulation precedes shoulder pain development. Its pathways overlap with pain processing, potentially affecting each other. Prolonged stress (mental or biological) can lead to a maladaptive state and trigger somatosensory dysregulation. Interventions targeting these mechanisms go beyond the joint and include pain neuroscience education, exercise therapy, graded motor imagery, stress management, lifestyle interventions, and combinations of these. However, evidence specific to shoulder pain is limited.

Conclusion: Future research should prioritize understanding these underlying mechanisms in patients with inflammatory-driven musculoskeletal shoulder pain and evaluating targeted interventions' effects on shoulder disabilities.

Objective: The relationship between lipid profile components and health-related quality of life (HRQoL) has gained attention in general populations along with disease conditions; however, scant data is clarifying these connections in cirrhosis. We sought to identify which lipid profile component was associated with HRQoL in hospitalized cirrhotics and delineate the relationship by performing multiple linear regression and generalized additive model (GAM) analyses.

Methods: This cross-sectional study recruited 344 patients with lipid profile data, which comprised total cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol (HDL-C). HRQoL was defined by the EuroQol Group 5 Dimension (EQ-5D) utility index.

Results: The levels of HDL-C were positively correlated with the utility index (r: 0.159, p = 0.003). Multiple linear regression analysis showed an increase in HDL-C was independently associated with better EQ-5D-defined HRQoL (β: 0.088 [0.015, 0.161], p = 0.018). Moreover, sex disparities concerning the dose-response relationship between male versus female patients existed via GAM analysis. In males, GAM indicated a non-linear correlation between HDL-C and EQ-5D utility index, whilst a linear correlation was observed in females.

Conclusions: We disentangled the association between increased HDL-C levels and better EQ-5D-defined HRQoL in hospitalized cirrhotics. Furthermore, the dose-response relationship between HDL-C and EQ-5D utility index differed between males and females, suggesting sex-dimorphic mechanisms linking HDL-C to HRQoL. If validated in interventional studies, sex-specific HDL-C pathway modulation might inform future adjunctive approaches.

Introduction and aim: Factors determining the prognosis of ischemic stroke include clinical, laboratory, and demographic variables, such as initial neurological status, brain imaging findings, blood glucose levels, inflammatory markers, and early treatment response. This study aimed to assess the prognostic value of the frontal QRS-T angle in predicting prognosis in patients with acute ischemic stroke.

Materials and methods: This prospective, single-center, observational prognostic value study was conducted at the Emergency Department of the University of Health Sciences Ümraniye Training and Research Hospital. Adult patients presenting to the emergency department with stroke symptoms between 1 September 2022, and 1 September 2023, were included. The study population consisted of patients with ischemic stroke confirmed by radiological and clinical evaluations. Demographic data, comorbidities, electrocardiography parameters, laboratory results, affected arteries and hemispheres, and in-hospital mortality were recorded.

Results: The study involved the evaluation of 149 patients presenting to the emergency department with stroke symptoms, of whom 40.3% were women, with a median age of 73 years. The in-hospital mortality rate was 8.7%. The most common comorbidity was hypertension (64%). The median frontal QRS-T angle was 50.5 (interquartile range [IQR]: 19.0-122.5) in the survival group and 90 (IQR: 58-133) in the mortality group (p = 0.069, Mann-Whitney U test). Multivariate logistic regression analysis revealed that age ( >68, odds ratio [OR]: 8.92), heart rate ( >110, OR: 19.8), RR interval ( <525 ms, OR: 38.7), P interval ( <94 ms, OR: 9.36), QTcB interval ( >467 ms, OR: 7.27), and atrial fibrillation (OR: 8.31) significantly increased the risk of mortality.

Conclusion: According to the findings of this study, no significant difference was observed in the frontal QRS-T angle between survivors and non-survivors among patients with acute ischemic stroke.

Purpose: This study investigates the relationships between melanocortin-4 receptor (MC4R) rs17782313 gene polymorphisms, low-fat diet, aerobic exercise, and the reduction in blood lipid levels in individuals with obesity.

Methods: A total of 240 adults living with obesity were enrolled to take part in a 12-week program that combined exercises with dietary interventions. Measurements taken included body weight, body mass index (BMI), plasma lipids, fasting insulin (FIN), and insulin resistance (Homeostasis Model Assessment, HOMA-IR). All participants underwent exercise intervention and genotyping.

Results: Our findings revealed significant interactions between genotype, sex, and diet in modulating lipid metabolism. Specifically, after the exercise intervention, the mean reduction in BMI in was: CC+CT with low-fat diet: -2.56 ± 1.98 kg/m²; CC+CT with regular diet: -1.00 ± 0.99 kg/m²; TT with low-fat diet: -1.89 ± 1.31 kg/m²; TT with regular diet: -0.85 ± 0.68 kg/m². Males with CC+CT genotypes exhibited significant improvements in low-density lipoprotein (LDL-C) (P<0.05) and insulin resistance (P<0.05) on a low-fat diet, while changes in high-density lipoprotein (HDL-C) were not significant (p > 0.05). Triglyceride (TG) reduction was most pronounced in males with CC+CT genotypes on a low-fat diet and regular diet(effect sizes:-0.75, p = 0.018), though genotype-diet interactions for TG reached statistical significance (p = 0.02). These males also showed a significant decrease in LDL-C between a low-fat diet with CC+CT genotypes and regular diet with TT genotypes (effect sizes -0.46, p = 0.008), though genotype-diet interactions for LDL-C on those two groups reached statistical significance (p = 0.01). However, this decrease was not significantly different from that in females with the CC+CT genotypes. Trends in FIN changes were similar to those in LDL-C between low-fat diet with CC+CT genotypes and regular diet with TT genotypes groups (effect sizes -12.88, P<0.001). Additionally, HOMA-IR scores reduction was most pronounced in males with CC+CT genotypes on a low-fat diet and regular diet (effect sizes-2.90, P<0.001).

Conclusion: The CC+CT genotype group, particularly males on a low-fat diet, showed robust improvements in TG, LDL-C, and insulin resistance markers. However, HDL-C responses were inconsistent across subgroups. Notably, males with the CC+CT allele exhibited the most pronounced benefits in LDL-C reduction and HOMA-IR improvement with a low-fat diet.

Background: Growth hormone (GH) reduces visceral adiposity, increases lean body mass, and improves the lipid profile in obese adults. However, high-dose GH regimens have been associated with frequent adverse effects. The efficacy and safety of low-dose GH treatment in obese individuals without GH deficiency remain unclear. This study aims to evaluate the effects of recombinant human growth hormone (rhGH) on body composition, lipid profile, glucose metabolism, and adverse events in this population.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA statement. PubMed, Cochrane Library, and EMBASE databases were systematically searched up to December 2024. Eligible studies included randomized controlled trials (RCTs) involving obese individuals without GH deficiency, with at least one endpoint related to body composition, lipid profile, or glucose metabolism. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42023464234).

Results: A total of 10 RCTs involving 420 participants were included. The mean age of participants ranged from 18 to 65 years, and treatment durations varied from 4 to 72 weeks. Low-dose rhGH therapy resulted in a significant reduction in visceral adipose tissue (SMD: -0.34, 95%CI: -0.57 to -0.12, p = 0.003) and a significant increase in thigh muscle area (MD: 6.33 cm², 95%CI: 1.72 to 10.95, p = 0.007) compared to placebo. Additionally, fasting glucose levels were modestly elevated (MD: 4.18 mg/dL, 95%CI: 0.68 to 7.67, p = 0.02). No serious adverse events were reported in association with low-dose rhGH treatment across the included studies.

Conclusions: Low-dose rhGH therapy significantly reduces visceral fat and enhances thigh muscle mass in obese individuals without GH deficiency. These findings suggest that low-dose rhGH may offer therapeutic potential for sarcopenic obesity, warranting further investigation in larger, longer-term studies.