Postgraduate medicine最新文献

Objective: This pooled analysis of data from four randomized placebo-controlled trials summarizes the efficacy and safety of rimegepant for acute treatment of migraine.

Methods: In all studies, participants were aged ≥18 years and had a ≥ 1-year history of migraine, two to eight migraine attacks of moderate or severe pain intensity per month, and attacks lasting 4-72 hours if untreated. Participants were provided with a single dose of rimegepant 75 mg or placebo to treat a single migraine attack of moderate or severe pain intensity within the next 45 days. Co-primary endpoints at 2 hours post-dose were pain freedom and freedom from the most bothersome symptom (MBS). Treatment comparisons utilized Mantel-Haenszel risk estimation with stratification by study and prophylactic migraine medication use randomization stratum; p values are nominal. On-treatment adverse events (AEs) were also assessed.

Results: Overall, 4,895 participants received rimegepant (n = 2,439) or placebo (n = 2,456). For the co-primary endpoints, the proportion of participants with pain freedom 2 hours post-dose (20.0% vs. 11.8%; p < 0.0001) and MBS freedom 2 hours post-dose (40.2% vs. 29.2%; p < 0.0001) was higher in the rimegepant vs. the placebo group. Rimegepant also demonstrated improvements over placebo in nearly all secondary and exploratory efficacy endpoints. AEs were reported in 11.1% and 9.6% of participants in the rimegepant and placebo groups, respectively. The only AE reported in > 1% of participants was nausea (rimegepant = 1.4%, placebo = 1.3%). Severe AEs occurred in 0.3% and 0.1% of participants in the rimegepant and placebo groups, respectively. Serious AEs occurred in 0.1% of participants in both groups; none were deemed related to study treatment.

Conclusion: In this pooled analysis of four randomized placebo-controlled trials, a single dose of rimegepant 75 mg demonstrated efficacy and a favorable safety profile for the acute treatment of a migraine attack with moderate or severe pain.

Background: Cow's milk protein allergy (CMPA) is early life's most common food allergy. There is limited data on the development of respiratory allergies in childhood for infants with CMPA.

Objective: This study aimed to evaluate the development of respiratory allergic diseases in childhood according to the mechanism of CMPA in patients with CMPA in the first two years of life.

Methods: Patients who were diagnosed with CMPA in the first two years of life and were over five years old during the study period were included in the study. The sociodemographic, clinical, and laboratory data of patients were recorded, and the status of respiratory allergic disease development in patients was assessed using the ISAAC questionnaire.

Results: A total of 301 patients were included in the study; 182 (60.5%) were male. Most of the patients had mixed-type (87;28.9%) and had non-IgE-mediated (n:87;28.9%) CMPA. Of CMPA cases, 27.9% developed doctor-diagnosed asthma and 31.2% developed doctor-diagnosed allergic rhinitis. Doctor-diagnosed asthma was observed mostly with IgE-mediated CMPA (n:30;37%), and doctor-diagnosed allergic rhinitis was observed mostly with non-IgE-mediated CMPA (n:32;36.8%), and these differences were not statistically significant (p = 0.094, p = 0.385). Also, maternal asthma increased the risk of doctor-diagnosed asthma, while parental consanguinity, allergic rhinitis in mother/sibling, and paternal eczema were risk factors for doctor-diagnosed allergic rhinitis.

Conclusion: In this study, 27.9% of patients with CMPA in the first two years of life developed doctor-diagnosed asthma, and 31.2% developed allergic rhinitis. There was no difference in the frequency of occurrence based on the mechanism of CMPA development.

Objectives: This study aimed to assess the impact of a WHO-aligned intrapartum care model on labor aspects, including pain, fear, comfort, labor duration, oxytocin use, and perceptions of supportive care.

Methods: This is a randomized controlled study. The study was conducted with 124 primiparous pregnant women (intervention group n = 62, control group n = 62) who were admitted to the maternity unit of a hospital in Central Anatolia, Türkiye. The intervention group was subjected to the intrapartum care model, once cervical dilatation reached 5 cm. The control group received only standard intrapartum care in the hospital.

Results: The Visual Analog Scale (VAS) scores for the pregnant women in the intervention group who received intrapartum care in accordance with WHO recommendations were significantly lower than those for the control group (p < 0.001). The pregnant women in the intervention group exhibited lower fear of labor scores and higher comfort of labor scores during the active phase than those in the control group (p < 0.001). Furthermore, the duration of the first, second, and third stages of labor was observed to be significantly shorter in the intervention group compared to the control group (p < 0.001). Additionally, the use of oxytocin was found to be less prevalent in the intervention group compared to the control group (p < 0.001). Furthermore, the mean scores of the scale measuring women's perception of supportive care during labor were found to be significantly higher in the intervention group compared to the control group (p < 0.001).

Conclusion: In alignment with these findings, it is recommended that midwives and obstetricians implement the intrapartum care model in accordance with the World Health Organization's (WHO) recommendations. The implementation of this model aims to reduce labor pain, fear, and oxytocin use, enhance women's perception of birth comfort and care, and transform the birth experience into a more positive one.

Clinical trial registration: www.clinicaltrials.gov identifier NCT06681675.

Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It is characterized by chronic inflammation and granuloma formation. We designed this study to assess the compliance and remission status of patients with IGM on methotrexate treatment.

Methods: The study included 114 patients who were treated with methotrexate for at least 1 year after a biopsy-proven diagnosis of IGM at a tertiary rheumatology center between January 2017 and February 2024. Demographic characteristics, clinical findings, laboratory parameters, treatment options and patient compliance with treatment were obtained from patient files.

Results: The mean age of patients diagnosed with IGM was 32.3 ± 6.3 years. Patients were treated with a combination of methotrexate, and complete remission was achieved in 97 patients (85.1%) after an average of one year. When Kaplan-Meier analysis was performed for the average annual methotrexate use, the average duration of drug use in patients with IGM was found to be 11.24 (10.88-11.49) months.

Conclusion: The use of methotrexate treatment in IGM patients has been shown to be both successful and well tolerated when evaluated according to the duration of drug administration.

Background: Upper airway surgery for obstructive sleep apnea (OSA) offers an alternative to CPAP, but its impact on weight changes is poorly studied.

Purpose: To systematically review published literature on the relationship between surgical intervention for OSA and changes in body mass index (BMI).

Methods: A literature search was conducted from 2013-2024 in five databases. Full-text English articles which examined BMI changes in adults with OSA pre- and post-surgery were included. The quality of each study was assessed independently by two researchers using the Newcastle-Ottawa Scale. This study was reported according to the PRISMA-ScR.

Results: Eleven studies, involving 406 patients from six countries were included. Most patients were males (88.4%) with a mean age of 40 years old. The pre-operative BMI were higher [27.8 kg/m² (SD = 2.6)] compared to a BMI of 27.7 kg/m² (SD = 1.3) at 21.0 months post-operation. The pre-operative Epworth Sleepiness Score was 13.28 (SD = 6.36), while the apnea-hypopnea index was 41.2 (SD = 16.88), indicating that most patients were diagnosed with severe OSA. The average oxygen desaturation index was 35.63 (SD = 11.17). The meta-analysis showed no significant BMI changes after surgery (mean difference:-0.29; 95% CI:-0.80 to 0.21; I² = 30%). Findings were consistent with no publication bias found.

Conclusions: Upper airway surgery for OSA does not significantly affect BMI. The authors propose closer monitoring of weight changes following upper airway surgery, as weight fluctuations can impact the outcomes of surgery. Unchanged weight post-surgery may be attributed to suboptimal OSA treatment.

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.