Journal of clinical medicine research最新文献

Background: Stromal cell-derived factor-1 (SDF-1) is a chemokine that regulates atherogenesis, angiogenesis, and multiple physiological processes. Dyslipidemia can contribute to low plasma SDF-1 disturbing its vascular repair functions and elevating cardiovascular risk. Statin therapy is recommended for patients with acute coronary syndrome irrespective of low-density lipoprotein-cholesterol (LDL-C) levels. This study aimed to evaluate the potential associations of plasma SDF-1 levels with LDL-C levels, coronary occlusion-based disease severity, low left ventricular ejection fraction (LVEF) values, and statin therapy in patients with unstable angina (UA).

Methods: Patients with new UA (n = 108) were selected from Coronary Care Unit, King Abdulaziz University Hospital. The exclusion criteria included previous history of myocardial infarction, cardiac valvular problems, myocarditis, liver dysfunction, and recent acute infection. The demographic and clinical features were collected. Disease severity and LVEF values were determined. Plasma SDF-1, LDL-C, and troponin levels were measured.

Results: There were poor correlations between plasma SDF-1 level, and sociodemographic features and risk factors except with LDL-C, where it showed a significant correlation. Furthermore, plasma SDF-1 showed non-significant variations with LVEF values and troponin peak levels. In contrast, plasma SDF-1 declined significantly in statin-treated patients, regardless of LDL-C level, compared with those untreated. The receiver operating characteristic (ROC) curve for SDF-1 test showed good accuracy.

Conclusion: In patients with severe UA, plasma SDF-1 level showed significant variations with LDL-C levels and statin therapy suggesting that it can give insight into response to statin therapy regardless of LDL-C level. The ROC analysis showed favorable characteristics suggesting a potential usefulness of plasma SDF-1 assay to discriminate the statin-treated patients from those untreated. This novel approach highlights SDF-1 potential as a biomarker for monitoring statin therapy and predicting risks for adverse events in UA. Furthermore, it could pave the way for longitudinal studies with repeated measurements of plasma SDF-1 to evaluate its role as a prognostic indicator for major adverse cardiovascular events besides the other cardiovascular disease risk factors.

Background: Inflammatory bowel disease (IBD) is linked to high risks of depression and anxiety. Stigma, limited mental health awareness, and barriers to access continue to contribute to underdiagnosis in Saudi Arabia. This study aimed to determine the prevalence of depression and anxiety among IBD patients, identify related risk factors, and assess barriers to mental health treatment.

Methods: A cross-sectional study including 92 IBD patients from gastroenterology clinics at King Faisal and Al-Noor hospitals was conducted. Data were collected through face-to-face, phone interviews, and an online Arabic questionnaire assessing sociodemographic, IBD-related factors, and mental health information using Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-7 (GAD-7). Analysis employed Chi-square, Fisher's exact, and logistic regression model to determine associations.

Results: Among 92 patients, 15.2% had symptoms of anxiety, depression, or both. Screening detected 19.6% with depressive symptoms (PHQ-2) and 46.7% with anxiety symptoms (GAD-7), with 17.4% experiencing severe anxiety symptoms. Saudi nationality (OR = 40.15, P = 0.035) was significantly linked to clinical diagnoses. Shorter disease duration (< 6 months, P = 0.017; 1-3 years, P = 0.011), was associated with lower odds of anxiety symptoms, while recent exacerbations (< 3 months, P = 0.012) were associated with increased risk of anxiety symptoms. Higher risk of depression symptoms was associated with recent exacerbations (OR = 7.51, P = 0.055) and smoking (OR = 5.04, P = 0.072). Barriers included stigma (8.7%), cost (6.5%), and concerns about medication side effects (40.2%).

Conclusion: The burden of undiagnosed anxiety and depression is significant among IBD patients in Makkah. Routine screening, stigma reduction, and integrated mental health care are essential.

Background: Several prognostic scores and molecular patterns have been developed to predict increased in-hospital mortality in septic patients. This prospective study aimed to evaluate the prognostic value of systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA), lactate quick SOFA (LqSOFA) and cytokine production levels in emergency department sepsis patients to predict in-hospital mortality.

Methods: A total of 106 septic patients were enrolled. Baseline SOFA, SIRS, qSOFA and LqSOFA scores were calculated, and plasma levels of interleukin (IL)-6, IL-10, tumor necrosis factor-α (TNF-α) and interleukin-33 receptor (IL-33R) were measured on admission.

Results: SOFA, qSOFA, LqSOFA scores were significantly lower in sepsis survivors. IL-33R levels were significantly higher in non-survivors (P = 0.021). The best predictive score for sepsis based on the area under the receiver operating characteristic (ROC) curve was qSOFA (0.764, 95% confidence interval (CI) = 0.663 - 0.866), followed by LqSOFA (0.738, 95% CI = 0.63 - 0.845), SOFA (0.713, 95% CI = 0.604 - 0.822) and SIRS (0.603, 95% CI = 0.478 - 0.729). The addition of IL-33R levels (cut-off values > 55,393 pg/mL) to qSOFA and SOFA significantly increased the diagnostic accuracy of both scores with area under the curve (AUC) of 0.78 (95% CI = 0.695 - 0.85) and 0.740 (95% CI = 0.636 - 0.844), respectively. When evaluating early (within 72 h) in-hospital mortality, both IL-10 and IL-33R were significantly higher in non-survivors (124 pg/mL vs. 41 pg/mL in survivors, 195,610 pg/mL vs. 62,767 pg/mL in survivors, respectively). When added to qSOFA and SOFA scores (cut-off levels 74.5 pg/mL and 55,393 pg/mL for IL-10 and IL-33R, respectively), they significantly increased their diagnostic accuracy.

Conclusions: Sepsis prognostic scores were significantly lower in sepsis survivors. IL-10 levels had a significant impact in predicting early (within 72 h) in-hospital mortality and IL-33R levels in predicting both early and total in-hospital mortality, especially when combined with SOFA and qSOFA scores.

Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a heterogeneous disorder, with clinical spectrum ranging from subclinical to severe overt Cushing syndrome (CS). Armadillo repeat containing 5 (ARMC5) mutations, found in 20-55% of cases, are often associated with more severe disease, and specific genotypes may correlate with distinct phenotypes. A 60-year-old woman was admitted with a 1-year history of progressive weight gain and hypokalemia, alongside a 13-year history of refractory hypertension. She exhibited classic CS features and metabolic complications, including hypertension and diabetes. Laboratory tests revealed elevated cortisol, suppressed adrenocorticotropic hormone (ACTH), and positive low- and high-dose dexamethasone suppression tests. Contrast-enhanced computed tomography (CT) showed bilateral irregular macronodular adrenal masses. Adrenal venous sampling (AVS) demonstrated no lateralization (lateralization index < 4). Whole-exome sequencing of peripheral blood leukocytes identified a novel ARMC5 mutation (c.534_555dup, p.Ser186Profs*19). A right adrenalectomy was performed in 2023. Although symptoms improved, cortisol levels remained significantly elevated. Consequently, a left adrenalectomy was performed 15 months later in 2024, which led to marked improvement in her CS symptoms, biomarker levels, and metabolic complications. This case report describes a novel ARMC5 mutation site in a PBMAH patient who ultimately required bilateral adrenalectomy. While AVS combined with CT can help determine the dominant side for surgery, patients with ARMC5 mutations and symmetrically sized tumors often require bilateral adrenalectomy for cure.

Background: Although the tendon explant model has been gradually recognized for simulating tendon characteristics in vitro, there is still no consensus on a standardized culture protocol. Recently, tendon explants have been applied to senescence-related research but whether their own changes affected the credibility of the conclusions was not confirmed. Therefore, this study aimed to systematically evaluate the reliability of the loadless tendon explant model by characterizing its dynamic macroscopic morphological and molecular biological changes during culture.

Methods: This study collected surgical samples from patients as loadless tendon explants for culture and conducted molecular biology and cytology tests once every 3 days within 15 days. Both their macroscopic and microscopic changes were recorded and analyzed, with each compared to the corresponding parameters at day 0.

Results: Loadless tendon explants spontaneously underwent progressive disintegration, leading to the collapse of the original dense structure. Consistently, the collagen fibers also gradually became loose and fractured, contributing to a significant decrease of collage density from day 9. In addition, the senescence and apoptosis markers P21 and Caspase 3 increased over time, and there were statistically significant differences starting from day 6, respectively. The main intrinsic component, Collagen I, and the main catabolic enzyme, metalloproteinase 13 (MMP 13), could hardly be detected since day 3. During the daily evaluations from day 0 to day 4, Collagen I gradually decreased and was barely detectable by day 3, whereas MMP 13 increased on day 1 followed by a rapid decline since day 2.

Conclusions: These results indicate that loadless tendon explants rapidly degrade and lose matrix integrity, with their spontaneous changes compromising the reliability of research conclusions related to senescence and apoptosis. Therefore, further optimization is still required before a well-established protocol is applied.

Background: Previous studies developed the SeizCT primer and optimized models, both demonstrating similar values for the area under the receiver operating characteristic curve (AuROC). The optimized model incorporates Glasgow Coma Scale (GCS) change from baseline instead of categorized GCS at emergency department (ED) presentation. This study aimed to validate these two models for predicting positive computed tomography (CT) findings in patients with non-traumatic seizures.

Methods: A retrospective cross-sectional study was conducted among adult patients (≥ 18 years) with non-traumatic seizures who underwent CT brain imaging in the ED at Lampang Hospital. Data were collected between December 2023 and July 2024 based on parameters from the SeizCT primer and optimized models. External validation compared model performance using AuROC, calibration, decision curve analysis (DCA), and confusion matrices.

Results: The validation cohort included 312 patients (210 (67.3%) male; mean age 53 years). Positive CT findings were found in 58 patients (18.6%). The SeizCT primer model had an AuROC of 0.7218 (95% confidence interval (CI): 0.6476, 0.7961), while the SeizCT optimized model achieved 0.7394 (95% CI: 0.6663, 0.8124). An equivalence test showed statistically equivalent discrimination between the two models (P < 0.015), with the optimized model demonstrating better calibration (slope: 0.582 vs. 0.701; P = 0.002; observed-to-expected ratio: 0.934 vs. 0.971; P = 0.030).

Conclusions: Both models demonstrated fair to acceptable discrimination after external validation. The SeizCT optimized model is recommended, as it showed superior calibration and its incorporation of GCS change from baseline offers greater clinical applicability.

Background: Preterm birth (PB) continues to be a leading cause of neonatal morbidity and mortality, with isthmic-cervical insufficiency (ICI) being among the most serious contributory factors. ICI is often a precursor for PB, and monitoring and diagnosis of this event can largely be achieved through cervicometry and elastography, especially with the use of the E-Cervix index. The aim of this study was to assess the effectiveness of integrating elastography and cervicometry, specifically the E-Cervix index, in predicting PB risk in pregnant women with ICI during the second trimester.

Methods: A prospective cohort study was performed on 250 pregnant women during their second trimester, including 150 women with ICI alongside 100 control women. Cervical elastography was done to assess the stiffness of the cervix coupled with transvaginal ultrasound cervicometry to obtain the length of the cervix. The E-Cervix index was also computed to enhance the discrimination accuracy of lower predictive values. Analysis was done on Statistical Package for the Social Sciences version 27.0 and Statistical Software for Data Analysis version 17.0.

Results: This study investigated the effectiveness of combining cervical elastography and cervicometry, utilizing the E-Cervix index, to assess the risk of PB in pregnant women diagnosed with ICI. The main group (n = 150) had a significantly younger mean age (30.24 ± 5.68 years) compared to the control group (32.17 ± 6.00 years, P = 0.011). Women with ICI showed shorter cervical lengths (2.6 ± 0.5 cm vs. 3.5 ± 0.4 cm, P < 0.001) and higher elasticity contrast index (6.5 ± 1.2 vs. 4.2 ± 0.9, P < 0.001). A significantly higher rate of PB (16% vs. 8%, P = 0.047) was observed in the main group. However, early diagnosis through combined elastography and cervicometry, followed by timely interventions, effectively contributed to a reduction in early PB rates, emphasizing the clinical value of integrated diagnostic approach.

Conclusion: The combined use of elastography and cervicometry, particularly through the E-Cervix index, provides accurate risk assessment for preterm delivery in women with ICI. This approach demonstrates strong diagnostic performance and supports timely clinical decision-making, enhancing early intervention and improving outcomes in high-risk pregnancies.

Background: Alcohol withdrawal syndrome (AWS) carries a high risk of morbidity and mortality that often requires critical care admission and monitoring. Dexmedetomidine is a known sedative that can help with patient symptoms and potentially reduce Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) scores. This study looks at two groups - the use of dexmedetomidine versus non-dexmedetomidine - in the management of AWS patients to assess the length of intensive care unit (ICU) stay, length of stay (LOS) in hospital, mortality and readmission rate.

Methods: This retrospective cohort study was conducted at Geisinger Health System, a tertiary care, academic health care system, between January 2016 and December 2022. This study did not require ethics approval according to the Institutional Review Board (IRB). The patients assessed included those aged 18 years or older with a documented CIWA-Ar score requiring admission to the ICU or ICU step-down unit. Exclusion criteria included ICU admission for alternative indications, a prior history of seizure disorder, or patients who left against medical advice.

Results: A total of 994 patients were identified to have met the inclusion criteria; 371 patients were in the non-dexmedetomidine group and 623 in the dexmedetomidine group. Primary outcomes assessed were hospital LOS (5.0 (3.0 - 9.0) vs. 10 (6.0 - 16.0), P < 0.0001) and days in the ICU (1.9 (1.0 - 3.4) vs. 4.9 (2.9 - 9.0), P < 0.0001), respectively. Secondary outcomes assessed were lorazepam equivalent usage, and readmission within 30, 60 and 90 days, which were not statistically significant when accounting for ICU LOS.

Conclusions: Among patients treated for AWS, dexmedetomidine use appeared to be associated with longer hospital and ICU stays, while benzodiazepine requirements remained unchanged. These associations may reflect differences in illness severity, emphasizing the need for future prospective evaluation.

Background: There are limited investigations on the general pathogen features, clinical characteristics, and predicted clinical markers of secondary lower respiratory tract infection of chronic respiratory disorders.

Methods: A total of 154 adult inpatients with chronic respiratory diseases between 2019 and 2022 were enrolled. Clinical data were retrospectively collected and analyzed. Multivariate logistic regression analysis was used to analyze the susceptibility factors of infection secondary to chronic respiratory diseases.

Results: Among the patients with chronic respiratory diseases, the most prevalent condition was chronic obstructive pulmonary disease (44.2%, 68/154). Cough, expectoration, chest tightness, and wheezing were the predominant symptoms irrespective of infection. Pseudomonas aeruginosa accounted for 37% (20/54) in pathogen infection. Aspergillus fumigatus was the primary cause of filamentous fungal infection. The combination of low body mass index, increased tricuspid regurgitation pressure, and decreased lymphocyte count could accurately predict infection secondary to chronic respiratory diseases (area under curve (AUC): 0.788, 95% confidence interval (CI): 0.689 - 0.887, P = 0.000).

Conclusions: This study focused and explored the common features between secondary infections of various chronic respiratory diseases. The prediction model is expected to enable timely detection and treatment of secondary infections in clinical practice.