Postgraduate medicine最新文献

Soluble barium salts including barium carbonate, nitrate, acetate, and chloride are commonly used in the manufacture of ceramics, insecticides, and rodenticides. Soluble barium salts are highly toxic to humans if ingested. Acute soluble barium poisoning is an uncommon but life-threatening problem. The fatal dose of barium chloride for man has been reported to be only 0.8 to 0.9 gram. Currently, there have been no systematic studies on acute soluble barium poisoning. Based on the retrospective analysis of 55 global cases, toxicological characteristics, clinical features and management of acute soluble barium poisoning were summarized. Barium is a competitive blocker of potassium inward rectifier channels to inhibit K⁺ efflux, resulting in profound hypokalemia. Acute soluble barium poisoning can result in gastrointestinal effects including vomiting and diarrhea, followed by hemodynamic disturbances, cardiac arrhythmias, muscle weakness, and cardiac arrest. Respiratory failure induced by muscle paralysis is the major cause of death. Management strategies mainly include prevention of barium absorption, administration of soluble sulfates, potassium supplementation, antiarrhythmic medications, hemodialysis/CVVHDF, and cardiorespiratory support. Timely administration of decontamination and correction of hypokalemia are the two important points. This narrative review will offer crucial information for treating patients with acute soluble barium poisoning.

Background and aims: Cardiometabolic multimorbidity (CMM), defined as ≥ 2 coexisting cardiometabol ic diseases, contributes significantly to global disease burden in older adults. Treatment burden and inflammation-related residual cardiovascular risk in this population remain poorly characterized. This study aimed to quantify treatment burden in community-dwelling older adults with CMM and explore its association with inflammatory indicators.

Methods: A random sample of 170 CMM patients (age ≥60 years) from a Shanghai community completed questionnaires, such as the Treatment Burden Questionnaire (TBQ), and underwent laboratory tests. The participants were stratified according to their treatment burden and then compared in terms of demographics, lifestyle, number of cardiometabolic diseases, medication usage, and cardiometabolic and inflammatory indicators (monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII)). Linear regression models and restricted cubic splines were employed to examine the associations of treatment burden with inflammatory indicators.

Results: Among participants, 37.65% (64/170) reported high treatment burden (TBQ >59). The high TBQ group exhibited poorer medication adherence (39.06% vs. 24.53%) and higher inflammatory indicators (MLR: 0.24 vs. 0.19; NLR: 1.86 vs. 1.43; SII: 352.55 vs. 276.26). No significant differences were observed in cardiometabolic indicators (except for creatinine) or medication counts. Each 10-point TBQ increase was associated with higher MLR (β = 0.01), NLR (β = 0.11), and SII (β = 18.76) in adjusted models. Non-linear associations were observed between TBQ and NLR/SII.

Conclusion: Over one-third of elderly CMM patients experience high treatment burden linked to inflammation-driven residual cardiovascular risk. Early treatment burden assessment and anti-inflammatory strategies may improve their prognosis in primary care.

Objective: To evaluate the relationship between relative fat mass (RFM) with prehypertension and hypertension in general population.

Methods: This investigation was a cross-sectional study that recruited 4,885 community-dwelling residents from Zhejiang Province in September 2023 to November 2023. The logistic regression and penalized spline method were applicated to determine the correlation between RFM with prehypertension and hypertension. The interaction effects and subgroups analyses were further conducted to estimate the stability of the aforesaid findings. Besides, the category-free analysis was performed to demonstrate whether the addition of the RFM levels to the traditional model could improve the risk classification of prehypertension and hypertension.

Results: The prevalence of prehypertension and hypertension were, respectively, 64.8%. Multivariable logistic regression indicated that the risk of prehypertension (hazard ratio, 1.99; 95% confidence interval, 1.63-2.44) and hypertension (3.41; 2.81-4.14), respectively, increased by 99% and 241% per standard deviation increase in RFM after adjusting for established risk factors. Taking the participants in the lowest RFM quartile as the reference, and those with the highest quartile had a significantly increased risk of prehypertension (5.26; 3.03-9.12) and hypertension (20.42; 11.84-35.22). The restricted cubic splines demonstrated aforesaid associations were linear, and interaction and subgroup analysis observed the stability of these findings. The category-free analysis suggested that the addition of RFM to the traditional model eventuated an improvement in predictive ability of prehypertension and hypertension.

Conclusions: Our results corroborated the positive association between RFM with prehypertension and hypertension. Clinically, the calculation of RFM should be emphasized in the risk assessment of hypertension and prehypertension.

Objectives: This research aimed to investigate the factors contributing to mortality in patients with type 2 diabetes (T2D) to identify the primary determinants that exacerbate mortality risks in this population.

Methods: In this cohort study, 297 T2D patients from an urban Spanish population were monitored over 49 months to assess survival. The study collected sociodemographic and clinical data, including cardiovascular risk factors and initial treatments, to examine their impact on patient survival.

Results: Of the initial 291 T2D patients, 60.1% were over 65y, with a male majority (53.3%) and average T2D duration of 8.8 years. In the 4-year follow-up, 15.4% of the patients died, predominantly due to cardiovascular disease (33.3%) and cancer (31.1%). In multivariate analysis, age (Hazard Ratio [HR] 1.169, p = 0.002) and body mass index (BMI; HR 0.807, p = 0.039) were identified as potential modulators of such relationships.

Conclusion: The present study reveals that cardiovascular disease, closely followed by cancer, are the leading causes of mortality in a Spanish T2D patients' cohort over a 4-year follow-up. In addition to age - which, as expected, was clearly associated with higher mortality - BMI was inversely associated with mortality, supporting the existence of an obesity paradox in T2D.

Objective: Accurate tumor localization is necessary for the application of minimally invasive surgery, which is preferred in the treatment of primary hyperparathyroidism. Parathormone-washout (PTH-WO) is parathyroid fine-needle aspiration followed by PTH measurement in the needle washout fluid. This study aimed to determine appropriate cutoff values for the PTH-WO method.

Methods: A total of 402 PTH-WO assays from 339 patients were included in the study. The diagnostic accuracy of the test was assessed by accepting as a positive result a PTH-WO result higher than the serum PTH level [PTH-WO/serum PTH(PTH ratio)>1]. In addition, a cutoff value for the test was established by evaluating the PTH washout results obtained in comparison with postoperative histopathology. Undiluted test results were not included to obtain a clear numerical value in this evaluation. The results of parathyroid scintigraphy and fine needle aspiration biopsy (FNAB) were compared with postoperative histopathology.

Results: While 309 (76.86%) of the PTH-WO procedures were considered positive, 93 (23.13%) were considered negative if the PTH ratio was > 1. When these results were compared with the postoperative histopathology, the test's sensitivity was 92.51%, and the specificity was 100.00%. In the analysis of the remaining 292 PTH-WO samples after excluding the undiluted ones, the sensitivity and specificity of the method were 92.3% and 94.1%, respectively, with a PTH ratio > 0.99. With a cutoff value of 99.5 ng/l for PTH-WO value, 93.1% sensitivity and 94.3% specificity were obtained. The sensitivities of parathyroid scintigraphy and FNAB were 53.4% and 15.3%, respectively.

Conclusions: The PTH-WO method is safe and cheap, with high sensitivity and specificity in localizing parathyroid tumor. In cases where radiological methods cannot achieve localization with specified cutoff values, it has high diagnostic accuracy.

Background: The impact of diabetes mellitus (DM) on outcomes of Takotsubo cardiomyopathy (TC) remains unclear, with conflicting evidence suggesting either protective or harmful effects. This study evaluates the association between DM and in-hospital outcomes in TC patients.

Methods: A retrospective analysis of the National Inpatient Sample database (2016-2019) was conducted to compare in-hospital outcomes in TC patients with and without DM. The primary outcome was in-hospital mortality, while secondary outcomes included cardiac arrest, cardiogenic shock, and acute kidney injury (AKI). Propensity-score matching (PSM) was applied to balance covariates, and multivariable logistic regression was used to evaluate DM as an independent predictor of mortality, with results reported as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Of 63,155 TC hospitalizations 13,380 (21.2%) involved patients with DM, who were older and had higher rates of comorbidities. PSM analysis revealed a higher risk of AKI in DM patients (20.13% vs. 15.91%; OR, 1.33; 95% CI, 1.16-1.54; p < 0.001), with no significant differences in mortality, cardiogenic shock, or cardiac arrest. Patients with diabetic neuropathy showed a non-significant trend toward increased AKI risk (27.04% vs. 20.44%; OR, 1.44; 95% CI, 1.00-2.09; p = 0.053). Multivariable analysis identified comorbidities like CKD, liver disease, and coagulopathy as mortality predictors, but not DM.

Conclusion: DM was associated with a higher risk of AKI but did not affect in-hospital mortality or major cardiac events in TC patients. These findings suggest that DM has a neutral impact on TC outcomes, highlighting the need for further investigation.

Acute decompensated heart failure (ADHF) is a leading cause of hospital admissions and is associated with significant increases in morbidity and mortality, as well as marked impacts on quality of life. This review aims to guide hospital medicine providers in the management of ADHF from hospital admission to safe discharge. Hospitalists commonly care for HF patients in the acute phase, and a clear understanding of HF classification and etiologies is vital for guiding the evaluation and treatment of HF decompensation. Medical management of HF is centered around guideline-directed medical therapy (GDMT), agents which have been shown in large-scale studies to improve morbidity and mortality, while diuretics are used in adjunct to alleviate symptoms and improve volume status. As patients approach discharge, a multidisciplinary approach centering on patient education, counseling, and coordination of transitional care services can help to improve outcomes and reduce readmission risk.

Objectives: The purpose of this study was to evaluate the effect of using peanut balls during labor-on-labor memory, labor satisfaction, labor length, and neonatal APGAR scores.

Methods: This randomized, controlled, single-blind trial was conducted in 140 primiparous pregnant women (peanut ball group n = 70, control group n = 70) who delivered between January 2023 and March 2024. The study was conducted in the Obstetrics Clinic of a Medical Faculty Hospital in the Central Anatolian region of Turkey. Pregnant women in the peanut ball group were instructed to perform movements with the peanut ball after cervical dilation reached 5 cm. The control group received only standard intrapartum midwifery care. Data were collected by personal information form, labor and postpartum follow-up form (APGAR score, etc.), Birth Memory and Recall Scale, and Birth Satisfaction Scales.

Results: It was determined that the birth memory and recall memories of the pregnant women in the peanut ball group were more positive and their birth satisfaction was higher than the pregnant women in the control group (p < 0.001). The 1st minute APGAR scores (8.3 ± 0.6) and 5th minute APGAR scores (9.2 ± 0.7) of the newborns of the peanut ball group were higher than the 1st minute APGAR scores (7.8 ± 0.7) and 5th minute APGAR scores (8.5 ± 0.7) of the newborns of the control group (p < 0.001). The duration of the first stage (209.3 ± 38.6) and second stage (27.4 ± 13.7) of labor in the peanut ball group was shorter than the duration of the first stage (250.3 ± 54.6) and second stage (32.3 ± 11.3) of labor in the control group (p < 0.001, p = 0.021, respectively).

Conclusion: This study found that peanut ball application positively affected women's labor memory and recall, and increased labor satisfaction. In addition, we found that peanut ball application increased neonatal APGAR scores and shortened the duration of the first and second stages of labor.

Clinical trial registration: www.clinicaltrials.gov (NCT06387680).