Clinical Medicine最新文献

{"title":"Pituitary Disorders in Pregnancy.","authors":"Darran Mc Donald, Maria Tomkins, Michael W O'Reilly, Mark Sherlock","doi":"10.1016/j.clinme.2025.100488","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100488","url":null,"abstract":"<p><p>The management of pituitary disorders in pregnancy presents a unique challenge for maternal medicine specialists and endocrinologists. Advances in assisted reproductive technologies (ART) mean that women with hypopituitarism are increasingly able to conceive. The pituitary undergoes significant physiological changes during pregnancy. Pituitary hormone replacement regimens must therefore be adjusted throughout pregnancy in an attempt to mimic these pregnancy-related changes. Close clinical and biochemical follow up and collaboration across specialities is essential to ensure optimal maternal and foetal outcomes. Although many women with hypopituitarism will have a normal pregnancy, rates of miscarriage, labour induction and caesarean sections are higher than the general population. Most women with hypopituitarism are diagnosed prior to pregnancy, however, some pituitary disorders including lymphocytic hypophysitis, Sheehan's Syndrome and pituitary apoplexy have a predilection to arise during pregnancy or the post-partum period. Prompt recognition of these disorders is essential to prevent potentially fatal complications and optimise maternal and foetal wellbeing.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100488"},"PeriodicalIF":3.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Health Burden of Chronic Diseases in the United States Attributable to Air Particulate Matter.","authors":"Manan Raina, Jieji Hu, Raghav Shah, Max Gilliland, Sanjay Rajagopalan","doi":"10.1016/j.clinme.2025.100493","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100493","url":null,"abstract":"<p><strong>Background: </strong>There is an established link between air pollution and chronic disease. In this study, we measure the impact and health burden of fine particulate matter (PM_2.5) in chronic disease in the United States (US), specifically type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), and stroke.</p><p><strong>Methods: </strong>Data on the global burden of chronic disease attributable to air pollution were obtained from Global Burden of Diseases (GBD) 2021. The number of deaths and disability-adjusted life-years (DALYs) attributable to air pollution from 1990 to 2021 were extracted and analysed by different US locations and years.</p><p><strong>Results: </strong>The death rates due to chronic diseases attributable to PM2.5 in the US have decreased significantly. In 2021, death rates were lowest for T2DM (1.307), followed by stroke (2.004), COPD (2.119), and IHD (5.865). Between 1990 and 2021, death rates declined by 36% for T2DM, 30% for COPD, 70% for IHD, and 61% for stroke. DALY rates in 2021 were lowest for stroke (52.389), followed by COPD (54.147), T2DM (73.32), and IHD (119.471), with reductions of 16.4%, 39.6%, 70.3%, and 58.9%, respectively, since 1990. High- sociodemographic index (SDI; a measure of social and economic development) states saw greater improvements, with average annual percent change (AAPCs) of -5.2% for IHD and -2.68% for COPD, compared to -4.4% and -1.35% in low-SDI states. Higher-income states also showed faster declines, such as an AAPC of COPD death rates of -2.51% versus -1.21% in low-income states.</p><p><strong>Discussion: </strong>The results highlight a decreasing trend in death rates and DALYs and identify varying locations that remain at high risk of health burden from PM_2.5 associated chronic disease. There is a continued need for addressing air pollution control and policy revisions targeted to patient subpopulations in the US where the burden of PM_2.5 can still be detrimental.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100493"},"PeriodicalIF":3.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The changing landscape of palliative care: A universal imperative.","authors":"Dr Amy Taylor, Prof Andrew Davies, Prof P Saravanan","doi":"10.1016/j.clinme.2025.100492","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100492","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100492"},"PeriodicalIF":3.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3-Year Assessment of Cognitive and Olfactory Disturbances Among COVID-19 Convalescent Patients Grouped by Olfactory Hallucination Status in Armenia: A Qualitative and Quantitative Study.","authors":"Karine Melkumyan, Syuzanna Simonyan, Darshan Shingala, Hrag Torossian, Karen Mkrtumyan, Milena Tulbenjyan, Yekaterina Hovhannisyan, Konstantin Yenkoyan","doi":"10.1016/j.clinme.2025.100489","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100489","url":null,"abstract":"<p><strong>Background: </strong>Smell disturbances, memory, and mood changes are frequently reported as long-COVID symptoms that can be debilitating and long-lasting, having a detrimental impact on a patient's quality of life and possibly contributing to depression and a decline in cognitive abilities.</p><p><strong>Study: </strong></p><p><strong>Objective: </strong>This study aims to investigate long-term post-COVID cognitive and olfactory disturbances among the COVID-19 convalescent adult Armenian population aged between 18 and 65 years. The assessment extends to the differentiation of various olfactory distortions and association between various olfactory and cognitive variables grouped by participants' olfactory hallucination status.</p><p><strong>Study: </strong></p><p><strong>Design: </strong>Explanatory sequential mixed-methods design was employed. Through three follow-up visits, the quantitative phase evaluated olfactory and cognitive abnormalities following COVID-19, comparing those with and without olfactory hallucinations. Through in-depth interviews, the qualitative phase investigated how participants perceived these symptoms and their impact on their quality of life.</p><p><strong>Study: </strong></p><p><strong>Participants: </strong>The quantitative study participants were those who self-reported subjective disturbances in the olfactory perception 14 days following a COVID-19 diagnosis, as confirmed by a positive PCR test at the time of diagnosis. The qualitative study participants were those who self-reported persistent olfactory disturbances post-visit 3.</p><p><strong>Results: </strong>The study found that olfactory hallucinations lead to more pronounced depression as compared to non-hallucinogenic types of olfactory disturbances. It was determined that a significant predictor of parosmia is persistent anosmia up to four months following COVID-19 infection.</p><p><strong>Conclusion: </strong>The long-term olfactory disturbances post-COVID-19 infection have a better prognosis among participants without olfactory hallucination as compared to participants with olfactory hallucination.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100489"},"PeriodicalIF":3.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative care or supportive care?","authors":"Amy Taylor, Andrew Davies","doi":"10.1016/j.clinme.2025.100487","DOIUrl":"10.1016/j.clinme.2025.100487","url":null,"abstract":"<p><p>Palliative care is the active holistic (physical, psychological, social and spiritual) care of people who experience health-related suffering due to severe illness and those close to them, aiming to improve their quality of life. There are three levels of palliative care: palliative care approach, generalist palliative care, and specialist palliative care. Traditionally associated with end-of-life care, this article highlights the evolution of specialist palliative care, now deemed to be applicable throughout the course of an illness. Terminologies surrounding 'palliative care' are also considered, especially the notable nomenclature debate between 'palliative care' and 'supportive care'. Specialist palliative care has evolved somewhat over time, and will need to continue to evolve to maintain its relevance.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100487"},"PeriodicalIF":3.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From research to reality: A review of three clinical problems in the last days of life.","authors":"Tasneem Wadee, Simon Noble","doi":"10.1016/j.clinme.2025.100486","DOIUrl":"10.1016/j.clinme.2025.100486","url":null,"abstract":"<p><p>All of us will one day die. For most of us, death will be anticipated, usually following a period of ill health. The opportunity to anticipate and manage clinical conditions associated with the agonal process is an essential part of advance care planning. Guidelines exist for the palliation of most symptomatic events at the end of life, although many recommendations are based on low-quality evidence or consensus. Furthermore, when potentially practice-changing data emerge, there is an inevitable lag time before clinical practice changes. In this paper, we shall discuss the management of three challenging scenarios faced by teams looking after patients at the end of life: delirium, terminal haemorrhage and noisy upper airway secretions. We aim to critically evaluate the utility of current evidence, pharmacological and non-pharmacological, and how it translates into clinical practice.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100486"},"PeriodicalIF":3.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: Scurvy masquerading as acquired haemophilia.","authors":"Jess Griffin, Will Thomas, Elaine Christina Jolly","doi":"10.1016/j.clinme.2025.100342","DOIUrl":"10.1016/j.clinme.2025.100342","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100342"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer pain - all change please?","authors":"Olav Erich Yri, Barry J A Laird","doi":"10.1016/j.clinme.2025.100341","DOIUrl":"10.1016/j.clinme.2025.100341","url":null,"abstract":"<p><p>Managing cancer-related pain remains a major clinical challenge, particularly in the context of increasing concerns around opioid use. The World Health Organization (WHO)'s analgesic ladder, a widely used framework for cancer pain management, is being re-evaluated - especially the second step involving weak opioids such as codeine and tramadol. Evidence suggests that these offer limited benefit and more side effects compared to initiating treatment with strong opioids. As cancer care advances, more patients live longer with chronic pain, requiring a tailored, multimodal approach. Meanwhile, the global opioid crisis has led to heightened regulatory scrutiny, making prescribers more cautious and potentially contributing to the under-treatment of pain. Long-term opioid use is also associated with risks including cognitive impairment, opioid-induced hyperalgesia and endocrine dysfunction. This review examines the ongoing relevance and limitations of the WHO ladder, highlights the challenges of opioid toxicity, and advocates for a personalised, multidisciplinary strategy to deliver safe, effective and compassionate cancer pain relief.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100341"},"PeriodicalIF":3.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of hepatic steatosis index in early pregnancy with perinatal outcomes: A prospective birth cohort study.","authors":"Shaofei Su, Enjie Zhang, Shen Gao, Yue Zhang, Jianhui Liu, Shuanghua Xie, Jinghan Yu, Qiutong Zhao, Wentao Yue, Ruixia Liu, Chenghong Yin","doi":"10.1016/j.clinme.2025.100343","DOIUrl":"10.1016/j.clinme.2025.100343","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the association between maternal hepatic steatosis index (HSI) in the first trimester and adverse perinatal outcomes.</p><p><strong>Methods: </strong>A prospective birth cohort study was conducted from 19 February 2018 to 31 December 2022 in China. Logistic regression models and restricted cubic splines were used to estimate the associations of maternal HSI in early pregnancy and the risk of perinatal outcomes. Subgroup analyses stratified by maternal age and gravidity were carried out.</p><p><strong>Results: </strong>A total of 42,589 participants were included in this study. The overall prevalence of caesarean delivery, preterm birth, large-for-gestational age (LGA), shoulder dystocia and low Apgar scores were 39.17%, 5.18%, 9.45%, 0.92% and 0.77%, respectively. With the increase of HSI quartiles, the incidence of caesarean delivery, preterm birth, large-for-gestational age (LGA) and shoulder dystocia significantly increased (P < 0.0001). The highest quartile of HSI was associated with the highest risk of caesarean delivery (odds ratio (OR) 1.777, 95% CI 1.674-1.886), preterm birth (OR 1.323, 95% CI 1.160-1.510), LGA (OR 2.743, 95% CI 2.468-3.049) and shoulder dystocia (OR 1.487, 95% CI 1.094-2.021). The associations between HSI and adverse perinatal outcomes showed non-linear relationships except for shoulder dystocia (P < 0.0001 for all, P = 0.4792 for non-linearity). Subgroup analyses revealed that the associations between HSI and the risks of LGA and caesarean delivery were significantly stronger in younger and first-time pregnant women.</p><p><strong>Conclusion: </strong>Elevated maternal HSI in early pregnancy was positively associated with the risk of adverse perinatal outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100343"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance care planning.","authors":"Lucy Robinson, Paul Paes","doi":"10.1016/j.clinme.2025.100339","DOIUrl":"10.1016/j.clinme.2025.100339","url":null,"abstract":"<p><p>Advance care planning (ACP) is done in anticipation of something adverse happening and the likelihood of losing the capacity to be involved in future decision making. ACP encourages people to think about what might happen in serious illness scenarios and to consider their needs or wishes. As long-term conditions, multimorbidity, frailty and end-of-life care become more dominant health challenges, planning for future problems and giving patients and their carers the tools to self-manage becomes more imperative. ACP is part of this philosophy of care, anticipating and planning for future health and care needs. Increasingly, the utility of ACP seems to lie more in promoting conversations and particularly shining a light on the values that give people their identity. Patient relationships with family caregivers and health professionals, and a collective shared understanding, improve through the ACP process. Enabling people to be cared for in a way that preserves their identities and values for as long as possible seems to be more effective than focusing on documentary outputs.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100339"},"PeriodicalIF":3.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}