Postgraduate medicine最新文献

Objectives: To evaluate the effectiveness of semaglutide 2.4 mg for weight reduction and improvement in cardiometabolic biomarkers at 52 and 68 weeks in a real-world setting in the United States.

Methods: This noninterventional, retrospective cohort study used the Komodo Health database and included adults with obesity or overweight with ≥1 weight-related condition who initiated treatment with semaglutide 2.4 mg between June 2021 and August 2022 and remained on treatment for 1 year. A paired t-test was used to assess changes in weight, body mass index (BMI), and cardiometabolic biomarkers (systolic blood pressure [SBP], diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], HDL [high-density lipoprotein] cholesterol, LDL [low-density lipoprotein] cholesterol, and triglycerides) from baseline to 52-week and 68-week follow-up.

Results: Among 4,424 eligible patients, 77% were women and the mean (SD) age was 46.7 (10.0) years and BMI was 36.6 (3.6) kg/m². Dyslipidemia and hypertension were the most common obesity-related comorbidities at baseline. The mean (%) change in weight from baseline was -15.5 kg (-14.5%; p < 0.001; n = 594) at 52 weeks and -15.9 kg (-14.8%; p < 0.001; n = 391) at 68 weeks. The mean change in BMI from baseline was - 4.8 kg/m² (n = 1124) at 52 weeks and - 4.9 kg/m² (n = 700) at 68 weeks. At 52weeks, statistically significant improvements in mean values were observed for SBP (-6.3 mmHg), DBP (-3.1 mmHg), HbA1c (-0.4%), LDL cholesterol (-8.1 mg/dL), and triglycerides (-38.4 mg/dL) (all p < 0.001). Mean change at 52 weeks for HDL cholesterol was 1.0 mg/dL; p = 0.109. Results at 68 weeks were similar.

Conclusions: In this retrospective cohort study, the real-world effectiveness of semaglutide 2.4 mg was demonstrated by reductions in weight and BMI along with improvements in BP, HbA1c, and lipid panel among patients with obesity or overweight.

Background: Psoriasis vulgaris is a chronic immune-mediated inflammatory disease that significantly affects quality of life, particularly in severe cases and anatomically challenging areas. Biologic therapies targeting immune pathways have improved clinical outcomes; however, variability in effectiveness, safety, and drug survival necessitates further investigation.

Objectives: This study aimed to evaluate the effectiveness, safety, and drug survival of biologic therapies in patients with moderate-to-severe psoriasis vulgaris.

Methods: A retrospective cohort study was conducted on 400 psoriasis patients treated with IL-17, IL-12/23, and IL-23 inhibitors. Clinical outcomes were assessed using PASI, DLQI, PSSI, NAPSI, and ppPASI scores. Kaplan-Meier survival analysis and Cox regression were employed to identify predictors of drug survival.

Results: Ixekizumab demonstrated superior effectiveness in achieving PASI 100 and improving scalp psoriasis, while Guselkumab provided the most sustained improvements in palmoplantar and nail involvement. Adverse events were most frequently associated with IL-17 inhibitors, particularly upper respiratory tract infections. Guselkumab and Secukinumab demonstrated the highest drug survival rates, whereas Ixekizumab had the lowest. Early improvements in PASI and DLQI scores were strong predictors of drug survival.

Conclusion: Personalized treatment approaches are crucial, given the varied effectiveness, safety profiles, and drug survival among biologic therapies.

Background: Rheumatic mitral stenosis continues to be a significant public health issue in developing countries. Advances in echocardiography have made it possible to non-invasively assess atrial physiomechanics. In our study, we aimed to evaluate the changes in left and right atrial phasic functions in patients with have mitral stenosis and to investigate the relationship of these changes with clinical signs, symptoms, and intervention decisions.

Methods: Patients with rheumatic mitral stenosis who did not have comorbidities affecting cardiac function were included in this single-center, prospective study. The study population consisted of 122 subjects: 30 healthy controls with no chronic diseases and normal cardiac function confirmed by clinical and echocardiographic evaluations, 31 patients with moderate mitral stenosis, 31 patients with severe mitral stenosis and 30 patients with severe mitral stenosis with valvular atrial fibrillation. In addition to conventional echocardiographic parameters, biventricular deformation analyses were assessed using 2D-STE. Right and left atrial phasic functions were evaluated using both 2D and 3D-STE analysis and compared with clinical findings.

Results: In the patient group with severe mitral stenosis in sinus rhythm, the contractile left atrial strain values were significantly higher. The left atrial peak longitudinal (reservoir) strain values were found to be significantly lowest in the group with severe mitral stenosis accompanied by atrial fibrillation. Similarly, in the group with severe mitral stenosis accompanied by atrial fibrillation, the right atrial phasic strain values were significantly lower in both 2D and 3D measurements.

Conclusion: Mitral stenosis, the increased left atrial afterload in patients with sinus rhythm is compensated by an increase in contractile function. However, this compensatory increase is insufficient to preserve left atrial reservoir function. Patients with mitral stenosis who develop atrial fibrillation lack the compensatory contractile function, and this deficiency underlies the increased clinical deterioration associated with the development of atrial fibrillation.

Background: The potential improvement in uric acid (UA) levels following laparoscopic sleeve gastrectomy (LSG) in patients with obesity and type II diabetes mellitus (T2DM) has not been systematically studied. Our aim was to investigate the influencing factors of UA level improvement following LSG and its correlation with glucose metabolism and lipid metabolism.

Methods: A total of 392 patients with obesity and T2DM were prospectively recruited from 1 November 2022 to 31 December 2023. All patients underwent LSG surgery and were followed at 1, 2, 3, 6, 12 months after surgery. The presurgical and postsurgical levels of body-mass index(BMI), UA and indicators of glucose metabolism and lipid metabolism were recorded.

Results: Distinct UA improvement was observed between males and females and among different BMI groups following LSG. Female patients exhibited more sustained and greater recovery of UA level up to 12 months than male patients in all BMI groups, although male patients showed a sharper UA level decrease in the first two months. Furthermore, patients with BMI ≥ 37.5 appeared to have significantly greater UA level decrease than other patients up to 12 months. UA level improvement showed significant correlation with BMI improvement in all three BMI groups in females while only in BMI 28-32.5 group in males. For glucose metabolism, a significant linear correlation between UA level changes and fasting blood glucose (FBG), fasting blood insulin (FBI), glycosylated hemoglobin A1c (HbA1c) and C-peptide (CP) was found in patients with presurgical elevated UA level group, and in female patients for FBI and CP. For lipid metabolism, a significant linear correlation was only observed between UA level changes and HDL in female and those with high presurgical UA levels.

Conclusions: Sex and presurgical BMI appeared to influence the UA improvement following LSG. Females and those with presurgical elevated UA levels exhibited the most significant UA level alleviation. UA level changes also correlated with glucose metabolism and lipid metabolism.

Type 2 diabetes and obesity rates continue to rise. Type 2 diabetes affects 1-2 million new individuals annually. Despite a wide range of treatment options for type 2 diabetes, many people still fail to achieve therapeutic goals. Treating type 2 diabetes more proactively with a pathophysiologic approach can ensure higher rates of success and reduce complications. This article summarizes the progressive understanding of the pathophysiology of diabetes, draws a connection between illness and beta-cell health, and introduces the pathophysiologic approach to type 2 diabetes and its focus on beta-cell preservation. This article compiled clinical data, evidence-based medicine, and experimental results to create a comprehensive narrative review.

Objectives: To investigate the association of four liver fibrosis scores - Fibrosis-4 (FIB-4), AST/ALT ratio, AST-to-platelet ratio index (APRI) and Gamma-glutamyl transferase-to-platelet ratio index (GPRI) - and clinical outcomes in ambulatory patients with heart failure (HF).

Methods: We conducted a retrospective study involving 2379 patients with HF referred to a specialized clinic from January 2010 to June 2022. We used multivariable Cox´s regression models to study the association between liver fibrosis scores and long-term clinical outcomes (all-cause death and the combined endpoints all-cause death or HF hospitalization and cardiovascular death or heart transplantation). Areas under receiver-operator curves were used to evaluate the discriminative capacity of each score for predicting 1-year clinical outcomes, as well as to analyze their incremental predictive value in addition to the broadly validated MAGGIC risk score.

Results: Median follow up was 1568 days. GPRI was identified as an independent predictor of all-cause death or HF hospitalization (HR 1.12, 95% CI 1.07-1.18), all-cause death (HR 1.14, 95% CI 1.08-1.20) and cardiovascular death or heart transplantation (HR 1.10, 95% CI 1.03-1.17). FIB-4 and AST/ALT ratios were also independently associated with all-cause mortality. According to receiver-operator curve analyses, GPRI showed the best discriminative capacity among the four liver fibrosis scores evaluated in the study to predict 1-year clinical outcomes. The predictive value of GPRI was incremental to the one of the MAGGIC risk score.

Conclusions: Liver fibrosis scores are associated with long-term clinical outcomes in ambulatory patients with HF. In our study, the predictive capacity of GPRI outperformed the one of FIB-4, APRI and AST/ALT and was incremental to the one of the MAGGIC risk score.

Objectives: Anemia is a significant public health concern, particularly among migrants. The aim of this study was to evaluate the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among adult migrants in Nigde.

Methods: This retrospective study included a total of 2378 adult migrants who were admitted to Nigde Omer Halisdemir University Training and Research Hospital. The complete blood count, serum iron, unsaturated iron-binding capacity, transferrin saturation, and serum ferritin levels of all migrants were analyzed. The status and severity of anemia and ID were determined according to the definitions of the World Health Organization.

Results: Out of the migrants, 77.2% were female. The migrants originated from 40 different countries, with the majority of them coming from Syria (41.4%), followed by Afghanistan (27.3%), Iraq (9.1%), Iran (9.1%), and other countries (13.1%). The prevalence of anemia, ID, and IDA among adult migrants was 20.8%, 23.8%, and 14%, respectively. In females, the prevalence of anemia, ID, and IDA in 25.5%, 29.9%, and 17.7%, respectively. In males, the prevalence of anemia, ID, and IDA was 4.8%, 3.1%, and 1.6%, respectively. 57.5% of the anemia cases were mild anemia and 57.9% were microcytic anemia. IDA accounted for 67.6% of total cases of anemia, 69.4% of females with anemia, and 34.6% of males with anemia. Serum iron, ferritin, and mean corpuscular volume (MCV) levels in Syrians were significantly lower than those in all other countries.

Conclusion: Anemia among adult migrants was a moderate public health concern. IDA is the most common cause of anemia in females, but not in males. The prevalence of anemia, ID and IDA varied significantly by geography and gender. Public awareness, screening and prevention programs on iron supplementation and food fortification should be implemented to reduce the prevalence of anemia in at-risk populations.

Objectives: Most benign hepatic lesions occur in isolation. The clinical and demographic phenotype in patients with more than one lesion can overlap complicating treatment decisions. This study aimed to describe the clinical and demographic characteristics of patients with benign hepatic lesions to predict the lesion using clinical data and oral contraceptive (OCP) use and find a 'clinical phenotype' to identify these patients.

Methods: This retrospective cohort study compared demographics, laboratory values, and OCP use in patients with hepatic adenoma (HA), focal nodular hyperplasia (FNH), hemangioma (HM), and cystic lesions on imaging. Differences between groups were assessed to identify independent factors associated with the different lesions.

Results: The cohort (n = 216) contained 90 (41%) FNH, 75 (34%) cystic lesions, 47 (21%) HA, 26 (12%) HM, and 3 (1.4%) FNH+HA. Combination lesions were observed in 27 (12%) patients: HM+cyst (n = 2; 0.9%), FNH+cyst (n = 8; 3.7%), HA+cyst (n = 4; 1.9%), FNH+HM (n = 7; 3.2%), HA+HM (n = 2; 0.9%), FNH+HM+cyst (n = 1; 0.5%), and HA+FNH (n = 3; 1.4%). FNH were youngest and female. HA were young and female with highest OCP use. Patients with cystic lesions were oldest with the least OCP use. HM were male with the highest overall alkaline phosphatase (ALP) levels. Between HA and FNH, HA had significantly higher aspartate aminotransferase, alanine aminotransferase, and ALP levels with lower Hgb levels.

Conclusion: Predicting the etiology of benign hepatic lesions based on patient demographics, common laboratory values, and a brief history including OCP use alone is difficult. However, we identified the most important demographic and laboratory values to assist in building a differential.