Clinical Medicine最新文献

{"title":"GLP-1 receptor agonist therapy and pregnancy: Evolving and emerging evidence.","authors":"Maria S Varughese, Fidelma O'Mahony, Lakshminarayanan Varadhan","doi":"10.1016/j.clinme.2025.100298","DOIUrl":"10.1016/j.clinme.2025.100298","url":null,"abstract":"<p><p>The prevalence of type 2 diabetes mellitus (T2DM) and obesity is increasing in young adults, posing significant risks around pregnancy. Obesity also impacts on fertility and the co-existence of polycystic ovarian syndrome increases the prevalence of cardiovascular metabolic risk factors. There has been a renewed interest in glucagon-like peptide-1 receptor agonists (GLP-1RA) in this context, due to their multi-dimensional impact on the reproductive axis, as well as their ability to simultaneously target weight loss and glycaemic control. There is, however, limited availability of safety data with respect to these newer non-insulin-based diabetes medications from the perspective of fetal development. As GLP-1RA are not licensed for use in pregnancy, with the increasing chances of incidental exposure from pre-conception use for obesity and T2DM, it is imperative that pre-conception counselling should be an integral part of consultation prior to the initiation of these drugs.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100298"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491007","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":"Bilateral adrenal infarction and secondary haemorrhage in pregnancy: implications of factor V Leiden heterozygosity. A review of the literature and a case report.","authors":"Wiaam Elradi, Samreen Innayat, Ahmed Hanafy, Sharifah Naseem, Abuzar Awadelkareem, Deepika Meneni","doi":"10.1016/j.clinme.2025.100288","DOIUrl":"10.1016/j.clinme.2025.100288","url":null,"abstract":"<p><p>Adrenal haemorrhage in pregnancy is rare but can lead to significant maternal and fetal morbidity if unrecognised. We present the case of a 25-year-old woman in her second pregnancy, who was admitted at 34 + 4 weeks of gestation with severe abdominal pain. Despite initial unremarkable assessments, further imaging revealed a left adrenal haemorrhage, with evidence of prior right adrenal infarction, resulting in primary adrenal insufficiency. Haematological investigations later confirmed heterozygous factor V Leiden as a likely contributing factor. This report underscores the diagnostic challenges of adrenal pathology in pregnancy, where symptoms may overlap with more common conditions. Immediate management with hydrocortisone therapy, supported by a multidisciplinary team (MDT), was employed, with a successful outcome for both mother and child following delivery by caesarean section.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100288"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045760","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":"Early and rapid initiation of quadruple therapy for heart failure with reduced ejection fraction: A real-world experience.","authors":"Shirley Sze, Chokanan Thaitirarot, Sunanthiny Krishnan, Daniel Chan, Will Nicolson, Iain Squire, Louise Clayton, Ian Loke","doi":"10.1016/j.clinme.2025.100296","DOIUrl":"10.1016/j.clinme.2025.100296","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, safety and efficacy of early and rapid initiation of quadruple therapy (four drugs in 4 weeks - '4×4 approach') for heart failure with reduced ejection fraction (HFrEF) patients in a real-world clinical setting.</p><p><strong>Design: </strong>Prospective service evaluation study.</p><p><strong>Setting: </strong>Secondary care.</p><p><strong>Participants: </strong>Consecutive patients with de novo HFrEF between March and August 2021.</p><p><strong>Intervention: </strong>'4×4 approach' - individualised initiation and up-titration of four pillars of HFrEF therapy by heart failure specialist.</p><p><strong>Main outcome: </strong>Proportion of patients initiated on four pillars of HFrEF therapy within 4 weeks.</p><p><strong>Results: </strong>Of 100 patients approached, 19 patients were not suitable for the rapid initiation and up-titration pathway due to severe frailty and significant comorbidities. 81 patients were enrolled (61% male, median age = 73 years, median N-terminal pro-brain natriuretic peptide [NT-proBNP] = 3,764 ng/L). 39 patients (48%) achieved 4×4. Of the 42 patients who did not, 26 (62%), nine (21%) and seven (17%) patients were on three drugs, two drugs and one drug, respectively. 33 patients had one or more contraindication at the outset; most commonly renal impairment (28%), bradycardia (18%) and hyperkalaemia (15%). Five patients experienced significant side effects during medication up-titration, most commonly symptomatic hypotension. During median follow-up of 554 days, 32 (40%) patients experienced the combined outcome (all-cause hospitalisation/death). Patients who did not achieve 4×4 had an increased risk of the combined outcome (HR 2.25 [1.09-4.68], p=0.029) compared to those who achieved 4×4.</p><p><strong>Conclusion: </strong>Early and rapid initiation of four pillars HFrEF therapy is clinically feasible and safe when implemented in selected patients and is associated with improved clinical outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100296"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476358","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":"Reduction in body fat improves metabolic risk: BMI-based measures alone are not adequate.","authors":"Ponnusamy Saravanan","doi":"10.1016/j.clinme.2025.100301","DOIUrl":"10.1016/j.clinme.2025.100301","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100301"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673450","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":"Training, experience and perceptions of point-of-care ultrasound among internal medicine trainees: Implications for training, curriculum development and service delivery.","authors":"Ben Joseph Probyn, Cyrus Daneshvar","doi":"10.1016/j.clinme.2025.100283","DOIUrl":"10.1016/j.clinme.2025.100283","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) has revolutionised modern-day medicine and has widespread utilisation throughout healthcare settings. Despite the availability of ultrasounds, there are no requirements for internal medicine trainees (IMTs) to undergo any form of POCUS training. This study aimed to explore the perceptions and experience of IMTs of POCUS. A multicentre survey was distributed via mass email to all internal medicine trainees (IMT1-ST8) across two deaneries in south-west England. A total of 42% (213/509) IMTs completed the survey. Of these, 97% (207/213) contributed to the acute medical or general medical rota and 95% (202/213) of trainees reported performing invasive procedures on call. Training in ultrasound site selection was reported by 30% (63/213) of IMTs, and 11% (23/213) worked in a trust with accessible POCUS training. Formal POCUS accreditation was reported by 16% (34/213) of trainees. Identifying sonographic findings of common medical conditions was considered useful by 86.9% of trainees. Identifying pleural effusions being the most useful (99%, 211/213), while identifying a deep vein thrombosis was the least (87%,185/213). Higher confidence scores were reported for ultrasound-assisted as opposed to ultrasound-guided ascitic or pleural procedures, although this was not significant. On a 10-point Likert scale, most trainees highly rated POCUS training (median = 10, interquartile range 8-10). Free text responses supported POCUS training in the IMT curriculum. We found that IMTs perceive POCUS training as highly valuable. However, few IMTs are obtaining sufficient experience or training of POCUS. Opportunities for enhanced POCUS training should be embedded in training programmes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100283"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028146","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":"A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain-Barré syndrome.","authors":"De Yee Gan, Chin Meng Lee, Shakirin Pairan, Raja Ahmad Reza Raja Lope Ahmad, Hamdi Najman Achok","doi":"10.1016/j.clinme.2025.100294","DOIUrl":"10.1016/j.clinme.2025.100294","url":null,"abstract":"<p><p>Thiamine (vitamin B1) deficiency may present with diverse symptoms and is often triggered by chronic alcoholism, severe malnutrition or hyperemesis gravidarum. While typically diagnosed clinically, atypical presentations may delay recognition and treatment. We report a 26-year-old pregnant woman in her second trimester with prolonged nausea and vomiting since early pregnancy. She developed ascending lower limb paralysis, dysarthria, horizontal nystagmus, and lagophthalmos. Initially managed as hypokalaemia periodic paralysis with thyrotoxicosis and later Guillain-Barré syndrome (GBS), her symptoms worsened despite treatment. Subsequent MRI brain imaging revealed findings indicative of Wernicke encephalopathy, prompting high-dose thiamine therapy. This resulted in significant neurological improvement. This case underscores the importance of considering thiamine deficiency in atypical neurological presentations, particularly in pregnancy. Early recognition and prompt treatment can mitigate irreversible neurological damage, emphasising the necessity of maintaining a high index of suspicion in clinical practice.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100294"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424848","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":"Developing an electronic surprise question to predict end-of-life prognosis in a prospective cohort study of acute hospital admissions.","authors":"Baldev Singh, Nisha Kumari-Dewat, Adam Ryder, Vijay Klaire, Hannah Jennens, Kamran Ahmed, Mona Sidhu, Ananth Viswanath, Emma Parry","doi":"10.1016/j.clinme.2025.100292","DOIUrl":"10.1016/j.clinme.2025.100292","url":null,"abstract":"<p><strong>Objective: </strong>Determining the accuracy of a method calculating the Gold Standards Framework Surprise Question (GSFSQ) equivalent end-of-life prognosis amongst hospital inpatients.</p><p><strong>Design: </strong>A prospective cohort study with regression calculated 1-year mortality probability. Probability cut points triaged unknown prognosis into the GSFSQ equivalent 'Yes' or 'No' survival categories (> or < 1-year respectively), with subsidiary classification of 'No'. Prediction was tested against prospective mortality.</p><p><strong>Setting: </strong>An acute NHS hospital.</p><p><strong>Participants: </strong>18,838 acute medical admissions.</p><p><strong>Interventions: </strong>Allocation of mortality probability by binary logistic regression model (X²=6,650.2, p<0.001, r² = 0.43) and stepwise algorithmic risk-stratification.</p><p><strong>Main outcome measure: </strong>Prospective mortality at 1-year.</p><p><strong>Results: </strong>End-of-life prognosis was unknown in 67.9%. The algorithm's prognosis allocation (100% vs baseline 32.1%) yielded cohorts of GSFSQ-Yes 15,264 (81%), GSFSQ-No Green 1,771 (9.4%) and GSFSQ-No Amber or Red 1,803 (9.6%). There were 5,043 (26.8%) deaths at 1-year. In Cox's survival, model allocated cohorts were discrete for mortality (GSFSQ-Yes 16.4% v GSFSQ-No 71.0% (p<0.001). For the GSFSQ-No classification, the mortality odds ratio was 12.4 (11.4-13.5) (p<0.001) vs GSFSQ-Yes (c-statistic 0.72 (0.70-0.73), p<0.001; accuracy, positive and negative predictive values 81.2%, 83.6%, 83.6%, respectively). Had the tool been utilised at the time of admission, the potential to reduce possibly avoidable subsequent hospital admissions, death-in-hospital and bed days was significant (p<0.001).</p><p><strong>Conclusion: </strong>This study is unique in methodology with prospectively evidenced outcomes. The model algorithm allocated GSFSQ equivalent EOL prognosis universally to a cohort of acutely admitted patients with statistical accuracy validated against prospective mortality outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100292"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373999","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":"Letter to the editor: \"Implementation of ultrasound-guided cannulation training for foundation doctors\".","authors":"Kushal Krishna Banerjee, Rabia Batool Hussain","doi":"10.1016/j.clinme.2025.100284","DOIUrl":"10.1016/j.clinme.2025.100284","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100284"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001450","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":"Respiratory effects of electronic cigarette use in individuals who never smoked: A systematic review.","authors":"Grazia Caci, Arielle Selya, Giusy Rita Maria La Rosa, Lucia Spicuzza, Jaymin B Morjaria, Giulio Geraci, Riccardo Polosa","doi":"10.1016/j.clinme.2025.100295","DOIUrl":"10.1016/j.clinme.2025.100295","url":null,"abstract":"<p><p>Current evidence on whether electronic cigarettes (ECs) pose respiratory risks is unclear, due to confounding by cigarette smoking; evidence among never-smoking individuals is needed. Following a narrative review and critical appraisal, a systematic review assessed possible respiratory outcomes prospectively associated with EC use among individuals who never smoked. Bias risk was evaluated using a Joanna Briggs Institute tool. Ten eligible studies examined outcomes of self-reported respiratory diagnosis, symptoms and lung function. Eight examined adults and three examined youth (with overlap). Overall, seven studies showed no significant association between respiratory outcomes and EC use among never-smoking individuals (P>0.05). Evidence for coughing and wheezing symptoms varied by model specification. Overall, EC use by never-smoking individuals is not associated with risk of severe respiratory outcomes, but may be associated with mild coughing/wheezing. Further research is needed using larger samples, long-term follow-ups (>5 years), and information on detailed patterns of EC use.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100295"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491015","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":"A mixed-methods evaluation of a novel targeted health messaging intervention to promote COVID-19 protective behaviours and vaccination among Black and South Asian communities living in the UK (the COBHAM study).","authors":"Katie Sutton, Jo Armes, Lindsay Forbes, Amran Mohamed, Shuja Shafi, Reham Mustafa, Sunayana Shah, Andrew Hayward, Tasneem Pirani, Tushna Vandrevala, Jane Hendy, Osman Dar, Miqdad Asaria, Alimuddin Zumla, Aftab Ala","doi":"10.1016/j.clinme.2025.100285","DOIUrl":"10.1016/j.clinme.2025.100285","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate an intervention (a film and electronic leaflet) disseminated via text message by general practices to promote COVID-19 preventative behaviours in Black and South Asian communities.</p><p><strong>Methods: </strong>We carried out a before-and-after questionnaire study of attitudes to and implementation of COVID-19 preventative behaviours, and qualitative interviews about the intervention, with people registered with 26 general practices in England who identified as Black or South Asian.</p><p><strong>Results: </strong>In the 108 people who completed both questionnaires, we found no significant change in attitudes to and implementation of COVID-19 preventative behaviours, although power was too low to detect significant effects. A key qualitative finding was that participants felt they did not 'belong' to the group targeted by the intervention.</p><p><strong>Conclusion: </strong>Interventions targeting ethnic minorities in the UK need to acknowledge the heterogeneity of experience and circumstances of the target group so that people feel that the intervention is relevant to them.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100285"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037387","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}