Journal of clinical medicine research最新文献

This paper describes a case study of a 56-year-old male patient with a small cavernous hemangioma and concurrent peripheral vestibular symptoms, initially thought to warrant neurosurgical intervention. A structured, multidisciplinary approach involving audiology, ear, nose and throat, and physiotherapy revealed that peripheral vestibular dysfunction, rather than the central lesion, was the primary cause of symptoms. The report illustrates the diagnostic utility of video head impulse testing (vHIT), caloric testing, and vestibular evoked myogenic potentials (VEMPs) in differentiating central and peripheral vestibular dysfunction, leading to a nonsurgical treatment plan. The case underscores the importance of multidisciplinary collaboration in preventing unnecessary interventions and highlights an effective clinical decision-making framework for similar cases.

Background: Migraine is a genetic disorder characterized by recurrent episodes of headache that are throbbing in nature. The objective of this study was to directly compare the efficacy and safety of anti-calcitonin gene-related peptide (anti-CGRP) and botulinum neurotoxin (BoNT) for the preventive treatment of chronic migraine.

Methods: This quasi-experimental comparative study was conducted on 80 "chronic migraine patients" at King Fahad University Hospital, Dammam, KSA. Chronic migraineurs were divided into two groups (40 patients/group) and were treated with the standard doses of BoNT (group I) and anti-CGRP (group II). All the patients filled out the migraine pain scale, migraine disability assessment score, headache impact test (HIT-6), and adverse drug event questionnaire before the start and at the end of 9 months of treatment.

Results: Most of the patients were females (76.3% vs. 23.8%) and were suffering from migraine for more than 24 months (66%). The mean age of the participants was 39.07 ± 10.01 years. Both BoNT and anti-CGRP groups showed a statistically significant decrease in mean HIT-6 and pain scores after 9 months of intervention. A direct comparison between the two treatment groups showed that the anti-CGRP drug caused a higher decrease in HIT-6 and pain scores as compared to the botulinum drug, but the difference was not statistically significant (P = 0.075 and 0.07, respectively). The most common adverse effect was "headache", reported by 45% and 40% of patients, followed by "pain at the site of injection" reported by 27.5% and 32.5% of BoNT and anti-CGRP groups, respectively. The two groups did not differ significantly in the frequency of adverse effects such as nausea, vomiting, visual problems, etc., except "joint stiffness". A significantly higher number of anti-CGRP patients experienced joint stiffness as compared to the BoNT group (17.5% vs. 0%, P = 0.006).

Conclusion: A direct comparison between the two treatments indicated that neither of the two interventions is statistically superior to the other in terms of efficacy and both are equally effective in the management of migraine. However, BoNT can be preferred over anti-CGRP because of its cost-effectiveness.

Background: Heart failure (HF) is often accompanied by atrial fibrillation (AF), which significantly worsens the outcome of both diseases. Half of individuals with HF has AF, and HF occurs in more than one-third of individuals with AF. Thus, HF and AF are commonly encountered together and are closely interrelated with similar risk factors. The aim of this study was to investigate the impact of potential risk factors on the occurrence of paroxysmal/persistent AF in patients with heart failure with moderately reduced ejection fraction (HFmrEF).

Methods: The study included 193 patients with HFmrEF and nonvalvular paroxysmal/persistent AF after successful cardioversion. As a control group the similar 76 patients without AF were examined. All patients underwent the examination, including electrocardiography (ECG), echocardiography, ambulatory blood pressure monitoring and Holter ECG monitoring. Levels of inflammatory markers, such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and the fibrotic marker transforming growth factor-β1 (TGF-β1) were measured using the enzyme-linked immunosorbent assay (ELISA) method. The obtained results were modeled using binary logistic regression using the odds ratio (OR).

Results: It was shown that frequent episodes of hypertensive crisis (HC) and increased body mass index (BMI) were possible risk factors for paroxysmal/persistent AF. An increased OR of diastolic and systolic parameters of the left ventricle was associated with significant atrial and ventricular remodeling. Statistically, higher OR of inflammatory markers levels, such as hs-CRP, IL-6 and TNF-α were associated with an increased risk of paroxysmal/persistent AF occurrence in HFmrEF patients compared to similar patients without AF. An increase of the fibrosis marker TGF-β1 OR was statistically significant in patients with persistent AF.

Conclusions: It could be considered that frequency of HC, BMI, atrial and ventricular remodeling, as well as an increase of inflammation markers were possible risk factors for the occurrence of paroxysmal/persistent AF in HFmrEF patients. Moreover, fibrosis factor level significantly increased the likelihood of persistent AF in these patients.

Background: Per American Cancer Society, breast cancer is one of the most prevalent causes of cancer-related mortality in women in the United States. Different organizations vary in their recommendations regarding frequency of mammograms, with the United State Preventive Service Taskforce recommending biennial screening and other organizations like American College of Radiology promoting annual screening. The purpose of this study was to analyze institutional data to compare breast cancer detection rates among women undergoing annual vs. biennial mammograms.

Methods: In this retrospective chart review, we analyzed deidentified records of women aged 25 to 74 at Northeast Georgia Health System, who had undergone at least two screening mammograms and were diagnosed with primary breast cancer. We analyzed several variables including Breast Imaging Reporting and Data System (BI-RADS) categorization, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, age, race, ethnicity, nodal involvement, smoking status, insurance status, grade, tumor size, number of screening mammograms, personal history of breast cancer, family history of breast cancer, and their correlation to screening frequency (annual vs. biennial vs. less than biennial).

Results: Among the total 2,219 records that satisfied the inclusion criteria, we observed that BI-RADS categorization (P < 0.001), ER status (P = 0.003), and PR status (P = 0.001) were associated with mammogram screening frequency while the other variables were not statistically significant. Post-hoc analysis revealed that biennially screened patients exhibited less N2 node involvement than expected (P = 0.022). Additionally, Hispanic/Latino(a) patients had a greater frequency of biennial screenings than expected (P = 0.050). Lastly, post-hoc analysis revealed that current smokers had a greater incidence of less-frequent-than-biennial screenings (P = 0.023).

Conclusions: Annual mammograms were associated with a lower BI-RADS stage and lower stage of breast cancer diagnosis.

Background: Granulocyte and monocyte adsorption apheresis (GMA) is a therapeutic option for remission induction in the active ulcerative colitis (UC) patients. Effects of high processed blood volume of GMA as remission induction therapy on the long-term prognosis of UC patients have remained unclear. For this study, we investigated the relation between re-exacerbation of UC and the processed blood volume of GMA performed as induction therapy.

Methods: Data from UC patients treated using a total of 10 GMA sessions as remission induction therapy during 2012 - 2022 were retrospectively collected and analyzed. The relation between the GMA dose, processed blood volume of GMA divided by body weight, and UC re-exacerbation requiring inpatient treatment within 1 year was evaluated.

Results: This study examined data of 72 active UC patients, with median age of 44.4 years (65% male) and median GMA dose of 34.2 mL/kg/session. Kaplan-Meier analysis showed the 1-year exacerbation-free rate was significantly higher in the higher GMA dose group than in the lower GMA dose group (P = 0.008). Cox proportional hazards regression analyses revealed a higher GMA dose as inversely associated with the re-exacerbation of UC within 1 year (hazard ratio: 0.36, 95% confidence interval: 0.17 - 0.78). Extended treatment time of GMA session beyond 60 min contributed to achieving the higher GMA dose and did not increase unexpected treatment termination because of clotting.

Conclusion: Greater processed blood volume of GMA per patient body weight may be associated with a lower 1-year exacerbation rate in UC patients.

Background: An individual's simple subjective feeling of having poor sleep quality usually occurs in combination with short sleep duration. Previous studies have mainly investigated the association between simple subjective sleep quality and blood pressure in a general population without considering the complicated issue regarding poor sleep quality and short sleep duration. The aim of this study was therefore to investigate whether poor sleep quality was associated with increased blood pressure in individuals with optimal sleep duration.

Methods: A cross-sectional study was conducted on 169 residents aged ≥ 18 years who lived in a remote island of Okinawa, Japan. The participants had a sleep duration of 6 - 7.9 h/day on weekdays and were not taking either sleep medication or antihypertensive medication. Analysis of covariance was used to compare systolic and diastolic blood pressures in the participants grouped according to simple subjective sleep quality.

Results: Of the 169 participants, 51 (30.2%) reported that their sleep quality was poor. After adjustment for age, sex, and other potential confounders including sleep duration within optimal levels, the participants aged ≤ 49 years had mean (95% confidence interval) systolic and diastolic blood pressures (mm Hg) of 121.0 (114.7 - 127.3) and 68.7 (63.8 - 73.6) in the good sleep quality group, and 127.8 (120.7 - 134.9) and 71.8 (66.2 - 77.3) in the poor sleep quality group (P = 0.01 and P = 0.14, respectively). However, in those aged ≥ 50 years, the corresponding means were 130.6 (121.3 - 139.8) and 79.1 (73.5 - 84.7) in the good-quality group and 126.9 (114.6 - 139.2) and 78.0 (70.5 - 85.4) in the poor-quality group (P = 0.43 and P = 0.68, respectively). There was a statistically significant interaction between simple subjective sleep quality and age for systolic blood pressure (P value for interaction = 0.04).

Conclusions: This study showed that an individual's simple subjective feeling of poor sleep quality was associated with increased systolic blood pressure in participants aged ≤ 49 years with optimal sleep duration. These findings highlight the importance of easily assessing simple subjective sleep quality in clinical settings even in individuals with optimal sleep duration, in order to prevent and manage hypertension.

Background: Our hospital is a designated emergency hospital and accepts many patients with out-of-hospital cardiac arrest (OHCA). Previously, after receiving a direct call from emergency services to request acceptance of an OHCA patient, the emergency room (ER) chief nurse notified medical staff. However, this method delayed ER preparations, so a Code Blue system (CB) was introduced in which the pending arrival of an OHCA patient was broadcast throughout the hospital.

Methods: In this study, we retrospectively analyzed the impact of introducing CB at our hospital on OHCA patient prognosis to examine whether the introduction of CB is clinically meaningful. We compared consecutive cases treated before introduction of the CB (March 3, 2022, to March 22, 2023) with those treated afterwards (March 23, 2023, to July 23, 2024).

Results: A total of 30 cases per group were included. The mean number of medical staff present at admissions increased significantly from 5.4 ± 0.6 to 15.0 ± 3.0 (P < 0.001). Although not statistically significant, the introduction of the CB increased the return of spontaneous circulation (ROSC) rate from 20% to 30%, survival to discharge rate from 3% to 10%, and social reintegration rate from 0% to 3%. ROSC occurred in 15 patients. Among OHCA patients with cardiac disease, the ROSC rate tended to increase from 0% to 43% (P = 0.055). In addition, in OHCA patients with cardiac disease whose electrocardiogram initially showed ventricular fibrillation or pulseless electrical activity, the ROSC rate increased from 0% to 100%. ROSC tended to be influenced by the total number of staff and physicians present and the number of staff such as medical clerks, clinical engineers, and radiology technicians (P = 0.095, 0.076, 0.088, respectively).

Conclusions: Introduction of a CB may increase the ROSC rate and the number of patients surviving to discharge. It also appears to improve the quality of medical care by quickly gathering all necessary medical staff so that they can perform their predefined roles.

Long-term survival has improved in kidney transplant recipients (KTRs) due to effective surgical techniques and anti-rejection therapies. Chronic immunosuppression associated with it has led to several types of skin cancers leading to substantial morbidity and mortality. Structured patient education including sun protective behaviors, regular dermatological surveillance, nicotinamide, long-chain omega-3 polyunsaturated fatty acids (PUFAs), early switch to mammalian target of rapamycin inhibitors (mTORis), combining them with low-dose calcineurin inhibitors (CNIs), can decrease the cancer risk. Checkpoint inhibitors (CPIs) are the major backbone of the treatment of advanced skin cancers. Unfortunately, these agents can increase the risk of graft rejection. Prospective studies done so far looking at combining steroids with CPI in treatment of skin cancer in KTRs have shown mixed results. Adoption of the weight-based approach of CPI has shown to decrease the amount of drug exposure with acceptable outcomes in the general population, which is something that can be studied in KTRs with skin cancer. Also, it is reasonable to consider surveillance allograft biopsies in KTRs receiving CPIs to detect early subclinical rejection. More studies are needed to develop guidelines to safely treat this population with minimal graft rejection. We conducted a comprehensive literature review from PubMed on skin cancer in kidney transplant patients, focusing on incidence, risk factors, protective behaviors, financial and treatment implications, especially with regards to CPIs therapy. We also discussed potential newer treatment options that will decrease skin cancer risk, as well as graft rejection.

Background: Abdominal aortic calcification (AAC) is a critical indicator of cardiovascular risk, particularly in patients with chronic kidney disease (CKD). Traditional classification systems may underestimate the risk in those with moderate CKD. This study aimed to evaluate the association between CKD risk categories - defined by both estimated glomerular filtration rate (eGFR) and albuminuria - and the prevalence of severe AAC.

Methods: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. We included adults aged ≥ 40 years who underwent imaging for AAC assessment, excluding pregnant individuals and those without AAC scores. Survey-weighted and multivariate logistic regression was employed to assess the relationship between CKD risk categories and severe AAC, adjusting for age, hypertension, and smoking history. Subgroup analyses were conducted to explore variability across demographic and clinical subgroups.

Results: We analyzed data from 3,140 participants in the NHANES, 423 (13.4%) of whom had severe AAC. The cohort was categorized into CKD risk categories 1 through 4, with the majority (76%) in stage 1. Severe AAC was more prevalent among older individuals and those with traditional cardiovascular risk factors. Initial unadjusted analyses revealed that CKD category 2 was associated with a nearly fourfold increase in severe AAC (odds ratio (OR): 3.93), while categories 3 and 4 showed 3.75-fold and over 10-fold increases, respectively (all P < 0.01). However, after adjusting for confounders, categories 2 and 4 showed higher risks of severe AAC compared to category 1, but these associations did not reach statistical significance (OR: 1.72, 95% confidence interval (CI): 0.90 - 1.86, P = 0.06 and OR: 5.70, 95% CI: 0.85 - 38.00, P = 0.07, respectively).

Conclusion: Our study offers insights that may complement the current reliance on eGFR and albuminuria in risk stratification, highlighting that CKD category 2, defined by mildly reduced eGFR and albuminuria, may be a potential marker for severe AAC. Although statistical significance was narrowly missed after full adjustment, the clinical implications remain significant, advocating for more aggressive cardiovascular risk management in this population. This understanding may contribute to evolving approaches in CKD-related cardiovascular risk assessment and inform potential intervention strategies.

Background: Salivary α-amylase plays a crucial role in the glucose metabolism. However, postprandial salivary α-amylase activity (SAA) and its relationship with blood glucose (BG) are poorly understood. Therefore, we investigated SAA and BG after starch loading in healthy young women.

Methods: In 60 healthy non-obese young women, we investigated SAA, BG, and blood 3-hydroxybutyrate (3HB) after the consumption of 150 g rice (starch 48.8 g). Participants were classified into two groups based on the changes (Δ) in SAA from baseline at 60 min: small- and large-increase in ΔSAA groups (SI-ΔSAA and LI-ΔSAA).

Results: BG levels were significantly higher at 60, 90, and 120 min in participants with SI-ΔSAA (n = 31) than LI-ΔSAA (n = 29). Baseline 3HB concentration was also higher in participants with SI-ΔSAA. ΔSAA at 60 min was most closely and inversely correlated with BG and ΔBG at 90 min (r = -0.53 and -0.50, both P < 0.0001). Generalized linear model analysis also indicated that ΔSAA at 60 min was the most predictive of ΔBG at 90 min.

Conclusions: Higher levels of BG and ΔBG were observed after starch loading in healthy young women with smaller increase in salivary amylase, suggesting another crucial role of postprandial salivary amylase for the postprandial glucose metabolism.