Journal of clinical medicine research最新文献

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.

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.