Postgraduate medicine最新文献

Objective: To describe the sociodemographic and clinical characteristics of Middle Eastern patients with atrial fibrillation (AF) and a history of prior ischemic stroke/systemic embolism (SSE) and compare the risk of adverse events between AF patients with and without prior SSE from the Middle East.

Methods: The study population was recruited from the JoFib study, a multicenter, nationwide, prospective registry of patients with AF from the Middle East. Patients were categorized into two study groups according to the history of prior SSE.

Results: The current study population consisted of 2003 AF patients divided into two groups: a prior SSE group of 318 (15.9%) patients and a no prior SSE group of 1685 (84.1%). Patients with prior SSE were older than those without prior SSE (45.3% vs. 30.4%, < 0.001). Compared to the no prior SSE group, patients with prior SSE were less symptomatic (61.3% vs. 72.8%, p < 0.001), had a higher prevalence of diabetes (49.1% vs. 42.4%, p = 0.03) and dyslipidemia (51.9% vs. 43.6%, p = 0.007), and were less commonly obese (34.0% vs. 42.2%, p = 0.009). Rhythm-control strategies were less frequently pursued in patients with prior SSE compared to the no prior SSE group (16.0% vs. 22.0%, p = 0.02). Antithrombotic medications were used more frequently by the prior SSE group, including anticoagulants (89.0% vs. 80.7%, p < 0.001) and antiplatelets (48.4% vs. 37.6%, p < 0.001). Compared to the no prior SSE group, the prior SSE group was at greater risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted sub-hazard ratio [aSHR], 95% CI: 1.50, 1.04-2.16), non-cardiovascular death (1.76, 1.00-3.08), and SSE (3.05, 1.83-5.07). History of prior SSE did not significantly alter the risk of major bleeding (0.67, 0.27-1.65) or CRNMB (AOR 0.79, 95% CI 0.47-1.33).

Conclusion: A F patients with prior SSE are at higher risk of adverse events compared to patients without prior SSE.

Objective: Frailty is becoming more widely acknowledged as a critical factor that impacts the quality of life and health outcomes of patients with chronic conditions, including those who have experienced a stroke. This study aims to analyze the determinants of frailty in a prospective cohort of chronic stroke patients undergoing rehabilitation via relevant clinical, functional, and quality-of-life measures.

Methods: In this prospective study, 124 chronic stroke patients (mean age: 63.3 years, SD = 10.5) were assessed for frailty using the Edmonton Frailty Scale (EFS). Variables included age, stroke severity indices, functional status, and quality of life. Descriptive and inferential analyses was performed.

Results: The majority (81.5%) of patients had ischemic strokes. Frail patients were older (mean age: 64.6 vs. 55.2 years, p < 0.005), had more severe strokes (modified Rankin scale (mRS) 3.87 vs. 2.53, p < 0.005; National Institutes of Health Stroke Scale (NIHSS) 6.08 vs. 3.47, p < 0.005), greater functional impairment (Barthel Index 52.9 vs. 80.6, p < 0.005), and lower quality of life (2.78 vs. 4.02, p < 0.005). Logistic regression showed that advanced age and lower self-efficacy significantly predicted frailty (age: OR = 1.1, 95% CI: 1.01-1.21; Stroke Self-Efficacy Questionnaire (SSEQ): OR = 0.72, 95% CI: 0.55-0.95). The ROC analysis demonstrated that age had an AUC of 0.742 (95% CI: 0.65-0.86, p < 0.001), whereas the AUC for SSEQ was 0.924 (95% CI: 0.86-0.96, p < 0.001).

Conclusions: In patients with chronic stroke, frailty, as measured with the EFS, is best predicted by age and by the stroke-related impaired self-efficacy. Interestingly, the latter is a stronger frailty predictor, especially in younger patients. These findings indicate that both physiological and disease-related functional declines contribute to the development of frailty. However, additional longitudinal studies are necessary to validate the causal association and to account for potential confounding factors like depression or social support.

Background: Recent studies have indicated that the pretreatment lactate dehydrogenase (LDH)-to-albumin ratio (LAR) serves as a comprehensive prognostic biomarker. However, no comprehensive meta-analysis that assesses its prognostic role in various malignancies has been conducted. This study aimed to summarize the current evidence on the prognostic value of the LAR in patients with malignancies.

Method: A systematic literature search was conducted before 1 October 2024 in six databases. Quantitative analysis with random-effect meta-analysis was employed for generating the pooled estimates of survival outcomes (overall, progression-free, disease-free, and relapse-free survivals [OS, PFS, DFS, and RFS, respectively]).

Results: A meta-analysis of 19 retrospective studies encompassing 11,088 patients with cancer demonstrated the significant association between a high LAR and poorer OS (hazard ratio [HR] = 1.67 [1.37-2.05], I² = 84%). Patients with solid tumors exhibited a significantly higher risk of poorer OS and PFS (HR = 1.73 [1.44-2.06], I² = 84%; HR = 1.43 [1.11-1.84], I² = 75%). Subgroup analysis revealed that digestive system tumors were associated with an increased risk of poor OS (HR = 2.15), including oral cancer (HR = 5.14), esophageal carcinoma (HR = 1.85), hepatocellular carcinoma (HR = 1.90), and colorectal cancer (HR = 2.12). Furthermore, nasopharyngeal carcinoma was associated with poorer OS and PFS (HR = 1.62 [1.36-1.92]; HR = 1.60 [1.20-2.14], I² < 50%).

Conclusion: This study demonstrated the significant association between an elevated pretreatment LAR and poorer survival outcomes in malignancies, particularly in solid and digestive system tumors. These findings support the LAR as a potential prognostic biomarker, warranting further validation in diverse populations with standardized cutoff values.

Introduction: Childhood and adolescence are critical stages during which mental health disorders may develop and profoundly impact individuals and families in the future. Understanding the prevalence and distribution of these disorders is crucial for public health policies and interventions. This analysis aims to summarize current evidence of the prevalence and geographic distribution of mental health disorders among children and adolescents to inform the development of effective psychopharmacological treatments.

Methods: The data were systematically gathered from the most commonly used databases worldwide, including PubMed, PsycINFO, EMBASE, PSYNDEX, MEDLINE, and the Global Burden of Disease (GBD), as well as from current literature to ensure comprehensive coverage. The studies using standardized assessment procedures and recognized diagnostic standards (i.e. DSM, DC, SDQ) were included in the final analysis.

Findings: Our findings indicated that the prevalence of mental health disorders in children and adolescents is higher than previously reported and varies widely across the regions. The analysis underlines the imperative for extensive, culturally attuned research and fortifies the call for global cooperation to surmount the challenges posed by these mental health disorders. It accentuates the need to appreciate the intricate interplay of cultural, socioeconomic, and healthcare factors to improve mental healthcare infrastructure and endorse equitable care access worldwide.

Conclusion: The pursuit of evidence-based public health policies and pharmacotherapy is deemed crucial for improving the prevention and management of mental illnesses in children and adolescents.

Background: Isolated sphenoid sinus fungal balls are a rare but clinically significant entity, often presenting with nonspecific symptoms. This case highlights the importance of multidisciplinary collaboration among different specialties to achieve optimal patient outcomes.

Case presentation: We report a case of a 29-year-old female presenting with recurrent pregnancy loss, referred by obstetrics for neurosurgical evaluation. Imaging revealed a giant sphenoid sinus fungal ball causing secondary hypopituitarism and infertility, a very rare complication. Subsequently, she was referred to ENT specialists, who did more imaging tests and removed the mass, leading to the restoration of pituitary function and pregnancy.

Conclusions: This case highlights the importance of considering sphenoid sinus pathology in patients with unexplained endocrine dysfunctions and the critical role of multidisciplinary collaboration in diagnosis and management. It also underscores the necessity of imaging the sphenoid sinus in patients with unexplained hyperprolactinemia and infertility, even in the absence of classic sinonasal symptoms. Early recognition and surgical intervention can lead to the resolution of symptoms and restoration of normal physiological functi[on, as demonstrated by the successful outcome in this patient.

Background: Agitation in Alzheimer's dementia has a substantial impact on patients, caregivers/family, and healthcare systems. As new evidence surrounding the treatment of agitation emerges, a roundtable of multispecialty experts convened to review published literature (from a PubMed database search on 1 October 2024) and provide evidence-based clinical practice consensus recommendations for the diagnosis and management of agitation in Alzheimer's dementia for US-based primary care providers.

Aim: The main objective of this article is to summarize key recommendations from the roundtable on identification, differential diagnosis, current clinical practice, nonpharmacologic interventions, pharmacologic interventions, and treatment and communication considerations for residential care facilities/home care settings and caregivers.

Results: Active communication between healthcare providers, patients, and caregivers/family is critical for early recognition, accurate diagnosis, and appropriate management and prevention of agitation. The foundation of treatment always begins with individualized psychoeducation and nonpharmacologic interventions based on the patient's personality, interests, and level of functioning. Pharmacologic interventions are strongly considered when agitated behaviors become highly intense, disturbing, and disruptive or if major safety concerns cannot be otherwise addressed, and only when the healthcare provider is confident that the agitation can be sufficiently managed or mitigated with a pharmacologic intervention possessing a favorable individual risk-benefit profile. While several pharmacologic agents have been studied in high-quality clinical trials for the treatment of agitation in Alzheimer's dementia, brexpiprazole is the only US Food and Drug Administration - approved treatment and it can be prescribed if warranted. Interventions should be continuously evaluated to optimize treatment and monitor and minimize potential side effects. A patient-centered approach that includes a strong partnership with caregivers/family as a vital part of the patient's larger care team is encouraged.

Conclusion: Following these recommendations for timely detection, accurate diagnosis, and appropriate management of agitation in patients with Alzheimer's dementia is likely to improve outcomes for most patients and caregivers.