Journal of clinical medicine research最新文献

Background: Coronary artery bypass grafting (CABG) is a prevalent surgical procedure aimed at alleviating symptoms and improving survival in patients with coronary artery disease (CAD). Postoperative care typically necessitates an intensive care unit (ICU) stay, which is ideally less than 24 h. However, various preoperative, intraoperative, and postoperative factors can prolong ICU stays, adversely affecting hospital resources, patient outcomes, and overall healthcare costs. This study investigates the factors contributing to prolonged ICU stay (> 48 h) following CABG and CABG combined with valve surgery, and examines the associated impacts on complications and mortality.

Methods: This retrospective cohort study analyzed 1,395 patients who underwent isolated CABG or CABG combined with heart valve surgery at King Abdullah University Hospital (KAUH) between January 2004 and December 2022. Patients were categorized into two groups: those with ICU stays ≤ 48 h (group 1, n = 1,082) and those with ICU stays > 48 h (group 2, n = 313). Clinical, laboratory, and demographic data were collected and evaluated to identify risk factors for prolonged ICU stays.

Results: Patients in group 2 were older, with a mean age of 61.5 years compared to 58.7 years in group 1 (P < 0.001). Significant predictors of prolonged ICU stay included preoperative conditions such as recent myocardial infarction (odds ratio (OR) = 1.69, P = 0.015), chronic obstructive pulmonary disease or asthma (OR = 1.49, P = 0.003), and preoperative renal impairment (OR = 1.89, P = 0.002). Intraoperative factors such as emergency or urgent procedures (OR = 2.19, P < 0.001) and prolonged ventilator support (OR = 5.92, P < 0.001) were also significant. Postoperative complications, including renal impairment (OR = 6.78, P < 0.001) and pneumonia or sepsis (OR = 8.92, P < 0.001), were strongly associated with extended ICU stays.

Conclusions: Prolonged ICU stays are indicative of patients with more severe baseline conditions, greater surgical complexity, and higher rates of postoperative complications, which collectively contribute to increased risks of severe adverse outcomes and mortality. Prolonged ICU stays after CABG are strongly associated with preoperative comorbidities, intraoperative challenges, and postoperative complications, leading to increased mortality and significant healthcare resource utilization. Identifying these risk factors and implementing targeted strategies to address them can help minimize ICU stay durations, improve patient outcomes, and enhance the efficiency of cardiac surgery care. Future research should focus on refining predictive models and optimizing perioperative management to further reduce the burden of prolonged ICU stays on healthcare systems.

Pulmonary embolism (PE) and acute ischemic stroke (AIS) are serious conditions with high morbidity and mortality. In the USA, PE causes around 100,000 deaths annually, with higher incidence in males. AIS following PE occurs in 1-10% of cases and is a leading cause of death within 2 - 4 weeks post-stroke. Managing concurrent PE and AIS is complex due to the need for anticoagulation, which is contraindicated after thrombolysis for AIS. This review evaluates the impact of various PE treatments - anticoagulation, thrombolysis, and embolectomy - on mortality in patients with both conditions. Following PRISMA 2020 guidelines, a systematic review was conducted across six databases from January 2010 to December 2023. The primary outcome measured was mortality, comparing treated vs. untreated patients for PE. Secondary outcomes included marked symptom improvement, slight improvement or deterioration of symptoms, and the complications. Data were analyzed descriptively, summarizing patient demographics, clinical characteristics, and treatment outcomes. Treatment modalities, such as anticoagulation, thrombolysis, catheter-directed thrombectomy, surgical thrombectomy, and conservative management, were evaluated based on their impact on symptom improvement, survival, and mortality. Initial querying of six databases yielded 1,679 articles, with only 21 remaining after a thorough review. Thrombolysis led to 100% symptom improvement and survival, with 0% mortality. Anticoagulation resulted in symptom improvement and survival in 62.5% of cases, with a 12.5% mortality rate. Catheter-directed and surgical thrombectomy had symptom improvement and survival in 66.7% and 75% of cases, respectively, with no mortality. Conservative management, defined here as management without anticoagulation or thrombolytic therapy, was associated with symptom worsening or no improvement and 50% mortality. This systematic review, based on observational data from case reports, highlights the diverse strategies used by physicians. Proactive and aggressive treatments, especially thrombolysis, show better outcomes and lower mortality rates. However, specific recommendations cannot be made from these results alone, emphasizing the need for well-designed prospective, randomized controlled trials to design structured guidelines for healthcare providers.

Left ventricular non-compaction (LVNC) is a rare primary cardiomyopathy with genetic etiology, resulting from an abnormality of myocardial development during embryogenesis. It carries an elevated risk of left ventricular dysfunction, thromboembolic events and malignant arrhythmias. We report the case of LVNC associated with paroxysmal atrial fibrillation and ankyrin 2 (ANK2) mutation at the genetic test. An 18-year-old competitive athlete visited our medical center to undergo the diagnostic investigations protocol preparatory to the release of the suitability for competitive practice. The echocardiographic examination shows LVNC without ventricular remodeling (left ventricular ejection fraction (LVEF) 53%, global longitudinal strain (GLS) -18.3%). The echocardiographic diagnosis was confirmed by cardiac magnetic resonance imaging (cMRI), which revealed dense hypertrabeculation in the left ventricular apex and lateral wall. The cardiogenetic investigation showed a c.9145C>T variant (p.Arg3049Trp) identified in the ANK2 gene. This mutation is associated in the literature with rare cases of LVNC. The patient underwent an extended Holter monitoring which excluded ventricular arrhythmic events but showed two brief episodes of paroxysmal atrial fibrillation. Despite the absence of significant ventricular remodeling, considering the presence of paroxysmal atrial fibrillation and the presence of a mutation in the ANK2 gene, which has several variants related to high-risk phenotypes, it has been decided to suspend the competitive practice, and is defined an adequate clinical-diagnostic follow-up.

Background: Upper gastrointestinal bleeding (UGIB) is a common and potentially fatal medical emergency. This study aimed to investigate the frequency, causes, outcomes, and efficacy of endoscopy in the treatment of UGIB at King Fahad Central Hospital in Jazan, Saudi Arabia.

Methods: Between January 2017 and December 2023, a retrospective study was performed including all hospitalized patients with UGIB. This research investigated sociodemographic characteristics, clinical history, endoscopic findings, treatment options, and results using statistical analysis, which included both descriptive and inferential approaches.

Results: The study included 483 patients (of which 74.1% men), with a mean age of 53.9 ± 19.5 years. Hematemesis was observed in 67.5% of the patients, whereas melena occurred in 49.7% of the cases. Two-hundred sixty-two (54.2%) patients underwent endoscopy within the first 24 h from presentation. The most frequent endoscopic findings were esophageal varices (52.2%) and duodenal ulcers (21.7%). Bandings accounted for 48.0% of all endoscopic procedures, whereas 36.9% of the patients received epinephrine injections along with endoclips. Medical therapy mostly consisted of a mix of proton pump inhibitors (PPIs) and octreotide. A significant minority (43.5%) of the patients stayed in the hospital for 1 - 3 days, while 59.6% did not need blood transfusions. During the first 3 days, 7% of patients experienced rebleeding, with a 6% mortality rate. Using multivariate regression analysis, rebleeding was strongly associated with initial presentation with shock (P < 0.001), renal disease (P = 0.01), and increased transfusion requirement (P = 0.001). Mortality was strongly associated with steroid usage (P = 0.007), increasing transfusion requirements (P < 0.0001), and rebleeding (P = 0.002).

Conclusions: Timely endoscopy and proper treatment dramatically improved UGIB results. Identifying those who are at high risk and acting swiftly is a critical step in reducing the likelihood of recurrent bleeding and fatality.

Background: Systemic lupus erythematosus (SLE) can affect a plethora of organ systems and cause organ damage due to the disease process and medication toxicity, notably corticosteroids. Patients with SLE often suffer irreversible organ damage. Older age, glucocorticoid use, longer disease duration, and disease activity all represent risk factors for organ damage. This study aims to assess the incidence and predictors of organ damage among Saudi Arabian SLE patients.

Methods: This study is a single-center, retrospective cohort observational study conducted at the adult Rheumatology Outpatient Clinic in King Fahad Medical City, Riyadh, Saudi Arabia. It included all patients aged 16 years and older who met at least four of the American College of Rheumatology Classification criteria for SLE or had a renal biopsy consistent with lupus nephritis and had regular follow-ups at our hospital, with the last visit occurring within 2 years.

Results: The study included 196 patients with SLE, predominantly female (92.9%) with a mean age of 36.2 years and an average disease duration of 8.88 years. Among the patients, 38.8% had a positive Systemic Damage Index (SDI) score. Hydroxychloroquine was used by 93.4% of the patients, and 46.9% had a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 3 or higher. The neuropsychiatric system was most affected, with 16.8% of patients having positive SDI scores in this domain, followed by the renal system at 9.2%. Patients with positive SDI scores were significantly older, had longer disease duration, and had higher prevalence of diabetes mellitus and hypertension.

Conclusion: To address organ damage in SLE patients, integrating adjunctive therapies like antihypertensives and antidiabetic agents into management plans is essential. Future research should adopt prospective cohort designs to evaluate the dynamic interactions between comorbidities and organ damage over time. Additionally, studies should assess the effectiveness of combined treatment strategies and develop targeted approaches for high-risk groups to enhance outcomes and quality of life.

Background: Transcranial static magnetic stimulation (tSMS) as a new noninvasive brain stimulation (NIBS) technique is gradually gaining widespread attention. This study aims to investigate the effects of tSMS on the excitability of the somatosensory cortex in healthy adults.

Methods: Forty healthy volunteers were recruited and randomly assigned to either the intervention group (tSMS) or the control group (sham), with 20 participants in each. The intervention group received 30 min of 180 mT neodymium magnet stimulation at the C3 site, while the control group underwent sham stimulation with a non-magnetic cylinder. Electrodes were placed at the C3 and Fz sites according to the 10-20 system. Somatosensory evoked potentials (SEPs) N20 component amplitudes were measured at baseline, immediately after stimulation (0 - 2 min), 5 - 7 min, and 10 - 12 min post-stimulation to evaluate the effects on cortical excitability.

Results: Following 30 min of static magnetic stimulation, the SEP N20 component amplitude at the C3 site in the tSMS group decreased by an average of 13.2%, with a significant reduction of 13.7% within 0 - 2 min post-stimulation (P < 0.001). This decrease persisted at 5 - 7 min, with a reduction of 16.6% (P < 0.001), and diminished to 9.3% at 10 - 12 min (P = 0.034). Significant differences were observed between time points and groups (P = 0.003). In the control group, no significant changes were observed in SEP N20 component amplitude throughout the experiment (P = 0.382), and there was no significant difference between the two groups (P = 0.195).

Conclusions: These results confirm that a single session of tSMS effectively inhibits cortical excitability in the somatosensory cortex of young adults. This finding underscores the potential of tSMS as a promising, noninvasive brain stimulation technique with broad future applications.

Background: Association of serum vitamin D (vitD) with leptin (Lep) and tumor necrosis factor-alpha (TNF-α) is not precisely known in overweight hypertensive (OW-HT) postmenopausal (PMP) women. Hence, the present study was carried out to investigate the body mass index (BMI)-based correlation of serum vitD with Lep and TNF-α in OW-HT PMP women.

Methods: Women subjects in their early PMP (n = 346, age: 51 - 60 years) categorized into three groups had main inclusion criteria of specified range of age, BMI and blood pressure (BP). Enzyme-linked immunosorbent assay (ELISA) and other kit methods were employed to investigate the role of various variables in three subject groups (normal weight normotensive (NW-NT, n = 116, BMI (kg/m²): 22 - 24.9), normal weight hypertensive (NW-HT, n = 115, BMI: 22 - 24.9) and OW-HT (n = 115, BMI: 25 - 29.9) PMP women).

Results: A significant negative linear correlation of vitD with serum Lep and TNF-α, and a significant positive linear correlation of BMI with Lep and TNF-α in OW-HT PMP women were obtained. Significantly higher levels of serum Lep, TNF-α and interleukin-6 (IL-6) were found in OW-HT PMP women, as compared to NW-HT PMP women.

Conclusions: The present study suggests that decreased serum vitD levels correlate with the Lep and TNF-α in OW-HT PMP women. However, further studies may help understand the impact of vitD in cardiovascular events and the influencing factors in OW-HT PMP women.

Background: This study is designed to investigate the differential microRNA (miRNA) expression profiles in individuals with and without type 2 diabetes mellitus (T2DM). The focus is on miRNAs that play a crucial role in the onset and progression of T2DM, particularly in glucose metabolism, inflammation, platelet reactivity, and endothelial dysfunction.

Methods: Twenty samples were categorized into groups of T2DM and non-T2DM, and miRNA profiling was conducted using microarray analysis. The expression levels of the candidate miR-25-3p, as well as its target genes platelet-activating factor receptor (PTAFR) and insulin-like growth factor 2 mRNA binding protein 3 (IGF2BP3), were validated using quantitative polymerase chain reaction (qPCR).

Results: The present study revealed a significant reduction in the level of miR-25-3p in the T2DM group compared to the non-T2DM group. This suggests higher levels of PTAFR and IGF2BP3 in individuals with T2DM, indicating a potential biomarker for the condition.

Conclusions: The downregulation of miR-25-3p, which is associated with increased PTAFR levels, may contribute to heightened platelet reactivity and inflammation, worsening endothelial dysfunction, and potentially influencing vascular complications in diabetes. Additionally, the upregulation of IGF2BP3 is correlated with insulin resistance and β-cell dysfunction, which may contribute to elevated hyperglycemia and hyperinsulinemia, further aggravating the progression of diabetes. These findings highlight the potential of miR-25-3p and IGF2BP3 as biomarkers for T2DM and suggest their possible relevance for improving diagnosis and treatment strategies.

Background: Hearing loss prevalence increases with age, affecting over 25% of the global population aged 60 years or older. The aim of the study was to investigate the association between the development of sensorineural hearing loss (SNHL) and the blood levels of nicotinamide adenine dinucleotide (NAD⁺).

Methods: A single-center, observational study was conducted at Kawagoe Otology Institute in Japan. A total of 80 patients were included and allocated to four groups of 20 patients each: patients aged 50 - 79 years with or without unilateral sudden sensorineural hearing loss (SSNHL), and patients aged ≥ 80 years with or without bilateral age-related hearing loss (ARHL). The distribution of whole-blood NAD⁺ levels was investigated. We also measured oxidative stress markers (diacron-reactive oxygen metabolites (dROMs) and biological antioxidant potential (BAP)) and examined the relationship between the development of SNHL and whole-blood NAD⁺ levels, dROMs, and BAP.

Results: Comparison of NAD⁺ levels with and without hearing loss in the same age group by analysis of covariance showed a significantly lower NAD⁺ level in those with hearing loss than those without in the ≥ 80 age group (P = 0.047), whereas there was no difference between the two groups in the 50 - 79 age group (P = 0.232). All 80 patients, without consideration of age or type of hearing loss, were subjected to multivariate analysis to explore factors contributing to the development of hearing loss. With each 1 µM increase in the NAD⁺ level, the probability of developing SNHL decreased to 0.9-fold (P = 0.047), and each 1 U.CARR increase in dROMs was associated with a 1.01-fold increase in the risk of developing SNHL (P = 0.014). Whole-blood NAD⁺ levels in ARHL patients were significantly lower than those in non-ARHL patients. There was no association between whole-blood NAD⁺ and dROMs or BAP levels. This study has some limitations, including a sample size that was not large enough to detect a significant difference and an imbalance in the male-to-female ratio.

Conclusions: Decreased amount of NAD⁺ in the body and increased dROMs levels were associated with increased risk of developing SNHL, and the development of ARHL was especially highly associated with a decreased amount of NAD⁺ in the body.

Background: While femoral head replacement is widely used with remarkable efficacy, the complexity and diversity of postoperative complications pose a serious prognostic challenge. There is an urgent need to develop a clinical prediction model that can integrate multiple factors and accurately predict the risk of postoperative complications to guide clinical practice and optimize patient management strategies. This study is dedicated to constructing a postoperative complication prediction model based on statistics and machine learning techniques, in order to provide patients with a safer and more effective treatment experience.

Methods: A total of 186 patients who underwent femoral head replacement in the Orthopedic Department of our hospital were collected in this study. Forty-two of the patients had at least one postoperative complication, and 144 had no complications. The preoperative and postoperative data of patients were collected separately and medical history was collected to study the correlation factors affecting the occurrence of postoperative complications in patients and to establish a prediction model.

Results: Possibly relevant factors were included in a one-way logistic regression, which included the patient's gender, age, body mass index, preoperative diagnosis of the mode of injury, osteoporosis or lack thereof, as well as medical history, surgical-related information, and laboratory indices. After analyzing the results, it was concluded that operation time, alanine transaminase (ALT), aspartate aminotransferase (AST), white blood cell count, serum albumin, and osteoporosis, were the risk factors affecting the development of complications after femoral head replacement in patients (P < 0.2). The data obtained were further included in a multifactorial regression, and the results showed that operation time, AST, white blood cell count, serum albumin, and osteoporosis were independent risk factors for complications after the patients underwent femoral head replacement (P < 0.05).

Conclusion: Based on the results of this study, five factors, including duration of surgery, AST, white blood cell count, serum albumin, and osteoporosis, were identified as independent risk factors for complications after patients underwent femoral head replacement. In addition, the prediction model developed in this study has a high scientific and clinical application value, providing clinicians and patients with an important tool for assessing the risk of complications after affected femoral head replacement.