Postgraduate medicine最新文献

Hemophagocytic lymphohistiocytosis (HLH) is an increasingly recognized disorder of immune hyperactivity that often leads to multiorgan failure and death. In adults, HLH is usually triggered by infection, malignancy, or an autoimmune/autoinflammatory disorder that precipitates a destructive cytokine storm. Treatment aims to deescalate the hyperimmunity by treating the triggers while interfering with the immune pathways that cause the morbidity. We summarize what is known about this devastating disorder while adding insights gleaned from our review of the literature coupled with our own experiences. For example, we recognized that 1) more than one trigger may coexist in the same patient, 2) there is a predilection for HLH in lymphoma patients, particularly in the presence of Epstein-Barr virus infection, 3) aspartate transaminase elevation exceeds that of alanine transaminase, and 4) encephalopathy is underrecognized. These and other observations may assist the readers in identifying HLH, distinguishing its clinical presentation from that of its triggers, and thoroughly assessing all possible triggers rather than anchoring on the first diagnosed.

Background: Non-dilated left ventricular cardiomyopathy (NDLVC) is a distinct entity characterized by impaired left ventricular ejection fraction despite normal chamber dimensions. While it may represent an earlier or less fibrotic stage of non-ischemic cardiomyopathy compared to dilated-cardiomyopathy (DCM), its clinical and structural characterization remains incomplete.

Objectives: This study aimed to compare left atrial (LA) phasic strain parameters between patients with NDLVC and those with DCM, all with similarly reduced ejection fractions. Additionally, the relationship between LA function and exercise capacity was assessed using the 6-minute walk test (6MWT).

Methods: In this prospective, observational study, 83 patients with non-ischemic systolic dysfunction were enrolled(NDLVC:n = 51; DCM:n = 32). All underwent comprehensive transthoracic echocardiography, including LA strain analysis (reservoir, conduit, contractile phases) using speckletracking imaging. Functional capacity was evaluated via 6MWT.

Results: Patients with NDLVC exhibited significantly higher LA reservoir and conduit strain values than those with DCM. Among all echocardiographic parameters, LA conduit strain showed the strongest correlation with 6MWT distance (r = 0.42, p = 0.002) and was the only independent predictor of functional capacity in multivariable analysis.

Conclusions: LA conduit strain is a promising noninvasive parameter for identifying functional and structural differences between NDLVC and DCM. Its strong association with exercise capacity and ability to differentiate phenotypes may support its integration into clinical assessment and follow up,particularly in clarifying structural and functional differences in non-ischemic remodeling patterns. These findings suggest that preserved LA conduit function in NDLVC may reflect a less hemodynamically burdened atrial profile, which is consistent with better clinical performance and functional capacity.

Objectives: This exploratory study evaluated the feasibility of solely virtually recruiting patients with symptoms suggestive of acute rhinosinusitis (ARS) and whether a questionnaire-based study on disease history, use of over-the-counter (OTC) medications and symptom burden in ARS can provide plausible and meaningful results.

Methods: The study was advertised via Google Ads and on social media (Facebook, Instagram, and TikTok). Its questionnaire contained 20 questions regarding disease history and use of OTC medicinal products such as BNO 1016 (Sinupret® extract). Symptomatic burden and disease impact were evaluated by patient-reported outcome measures (PROMs), i.e. the major symptom score in a patient-assessed form (MSS_PAT) and bothersomeness of symptoms on a numerical rating scale (NRS). A subgroup of participants also completed the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV). Analyses on correlation of PROMs and parameters that influence outcomes of PROMs were performed after the study.

Results: During 8 weeks in winter/spring 2024, 2889 people wanted to participate in the study, 2032 (70.3%) participants over the age of 16 and with a history of ARS were finally included. There was a great willingness to participate and complete the study, as 93.7% of eligible starters also completed the study. The majority of included participants were female (83.7%) and between 25 and 54 years old (52.6%). PROMs were well accepted by participants and provided plausible results (mean MSS_PAT: 8.3 score points; NRS in 86.6% rated with at least 5; mean SNOT-20 GAV: 45.5 score points). Moreover, PROM scores correlated with each other, indicating their validity for assessing ARS disease burden and impact also in a real-world setting.

Conclusion: This feasibility study showed that it appears indeed possible to generate real-world data (RWD) in ARS in a solely virtual setting. We are planning a larger prospective virtual RWD study as the next step to gain deeper insights into the treatment course of ARS.

Objective: A new mobile application for video directly observed treatment (vDOT) was developed and implemented for tuberculosis (TB) patients in Turkey in 2023. This study evaluated its features and analyzed one-year user data.

Methods: A prospective observational study was conducted between 1 February 2023, and 31 January 2024, with 115 voluntary TB patients who met the inclusion criteria. Additionally, a satisfaction/adherence questionnaire prepared by the researchers was administered via telephone to 95 individuals who voluntarily used vDOT through the mobile application.

Findings: During the study period, a total of 12,839 videos were approved, with an average of 111.6 videos uploaded per patient. The average duration of vDOT use was 15.7 weeks. The median number of vDOT use days was 23.0, and in the last six months of the study, the number of vDOT use days was equal to or above the median. According to the satisfaction/adherence questionnaire, 72.6% of patients perceived the mobile application to be easy to use, and 94.7% stated that vDOT protected their privacy better than face-to-face monitoring. Patients with higher education levels, those living in city centers, and those owning a personal smartphone were significantly more likely to find the mobile application easy to use (p < 0.05).

Conclusion: This study revealed high usage rates for the mobile application, which was developed for vDOT and implemented as a telemedicine solution for the first time in Turkey. Additionally, the results on ease of use and satisfaction/adherence suggest that the mobile application can be used positively by the majority of patients.

Objective: This research investigates the prevalence of thyroid nodules and their association with anxiety and depression disorders in Eastern China. It also investigates the potential factors influencing this relationship, focusing on demographics and thyroid function.

Methods: As part of the SPECT-China project, a cross-sectional survey was conducted with 5497 participants from both urban and rural regions in Shanghai, Zhejiang, and Jiangxi provinces. Participants received thyroid ultrasonography and laboratory tests for thyroid function, while their mental health was evaluated using the Zung Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Data analysis employed descriptive statistics, Student's T-test, Chi-square test, and logistic regression.

Results: The study found a high prevalence of TNs (57.5%) among participants, with a higher incidence in females, older individuals, and those with lower education levels. Anxiety and depression disorders were diagnosed in 4.8% and 5.2% of participants, respectively, with higher rates in females and older individuals. Logistic regression analysis, controlling for age and gender, showed no significant link between TNs and anxiety or depression disorders in the general population. However, a significant association was observed in females. No significant correlation was identified between thyroid function (as measured by TSH levels) and the presence of TNs or mental disorders.

Conclusion: Thyroid nodules are prevalent in Eastern China, particularly among females, older individuals, and those with lower education. TNs show a significant correlation with anxiety and depression disorders in females, although not in the general population. This study emphasizes the significance of examining gender differences in the link between thyroid nodules and mental health, and calls for additional research in this domain.

Objective: Arteriovenous graft (AVG) infection is a severe and potentially life-threatening complication that frequently leads to graft dysfunction in patients undergoing maintenance hemodialysis (MHD). However, antimicrobial resistance are becoming increasingly common.This study investigated the efficacy of linezolid in treating graft infections and to compare the effectiveness and safety of linezolid against teicoplanin among MHD patients.

Method: This retrospective cohort study was conducted at a single center. A total of 53 cases of AVG infections occurring between June 2016 and June 2023 were included in this study. The AVG infections were divided into two groups: the control group (teicoplanin 200 mg/day iv) and the linezolid group (600 mg/day iv). The antimicrobial treatment period for AVG infection depended on whether the symptoms completely disappeared.Clinical data, operative records, duration of hospital stays, and costs were collected from the Hospital Information System (HIS) and analyzed between the two groups.

Results: Out of the 53 patients, 30 (56.6%) were women, and their median age was 64 years. The most common clinical presentations of graft infection were purulent drainage, abscesses, pain, and swelling. Among the 53 patients, 9 (17.0%) had positive blood or wound cultures. Gram-positive cocci were the most common organisms identified. The proportion of salvaged grafts in the linezolid group was significantly higher (24 out of 28) compared to the control group (15 out of 25) (p = 0.034). The duration of hospital stays was shorter for patients in the linezolid group compared to the control group (9.6 ± 1.0 versus 16.1 ± 1.9, p = 0.012). Additionally, the average cost in the linezolid group was significantly lower than that in the control group (CNY 15,050 ± 1,611 versus 23,920 ± 4,097, p = 0.039).

Conclusions: Linezolid was found to effectively control most cases of AVG infections, resulting in shorter hospital stays and significantly reducing the clinical burden on MHD patients especially when the blood or wound cultures were negative.

Objective: Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease for which colchicine is regularly used every day. Health literacy (HL) is the ability of individuals to acquire, understand and use health information. The aim of this study was to evaluate medication adherence and HL levels in adolescents with FMF and to investigate the impact of HL on colchicine adherence.

Methods: A cross-sectional, prospective study was conducted with FMF patients aged 12-18 years at the Pediatric Rheumatology Department. Medication adherence was measured using the Medication Adherence Scale in FMF Patients, with scores ≥60 indicating adherence. HL was assessed using the Health Literacy Scale for School-Age Children, categorizing scores as low (10-25), moderate (26-35), or high (36-40).

Results: Among 87 FMF patients, 53 (60.9%) were female. The mean age of the patients was 14.89 ± 1.69 years. HL levels were moderate in 64 (73.6%), high in 17 (19.5%) and low in 6 (6.9%) patients. Patients were divided into 2 groups according to medication adherence. Nineteen (21.8%) patients were colchicine adherent and 68 (78.2%) were colchicine non-adherent. A significant difference was observed between the groups in terms of HL levels (p < 0.05). None of the patients with low HL were adherent to colchicine treatment. Higher HL levels were associated with increased medication adherence (p < 0.05). There was no statistically significant difference between adherent and non-adherent patients in terms of gender, age, educational status, reminder methods, school absenteeism, frequency attacks at the last year, colchicine dose, number of colchicine tablets per day (p > 0.05).

Conclusion: Adolescents with FMF were generally found to have moderate levels of HL. Colchicine adherence was found to be higher as HL levels increased.

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.