发布求助
文献互助 智能选刊 最新文献

Clinical Medicine最新文献

筛选
英文 中文
Challenges in the diagnosis of systemic lupus erythematosus. 系统性红斑狼疮诊断的挑战。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-09-04 DOI: 10.1016/j.clinme.2025.100509
Jean Scopes, Md Yuzaiful Md Yusof
{"title":"Challenges in the diagnosis of systemic lupus erythematosus.","authors":"Jean Scopes, Md Yuzaiful Md Yusof","doi":"10.1016/j.clinme.2025.100509","DOIUrl":"10.1016/j.clinme.2025.100509","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is a lifelong, complex, multi-system, autoimmune condition which can occur at any age, most commonly in female adults in their reproductive years. Diagnosis is often delayed, with reported time from symptom onset to diagnosis as long as 6 years. Delayed diagnosis can result in irreversible organ damage, acute hospital admission, poor health-related outcomes and increased risk of mortality. SLE is a clinical diagnosis that requires a combination of clinical and immunological features attributable to lupus. Classification criteria have undergone several revisions and can be used to guide diagnosis. This article will review challenges in making a timely diagnosis of SLE, including heterogeneity of clinical and immunological features, disease mimickers, problems with diagnostic tests, and difficulties faced by general physicians and rheumatologists, with the aim to update knowledge among general physicians on clinical presentations and when to refer suspected patients to specialists.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100509"},"PeriodicalIF":3.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008194","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}
引用次数: 0
Therapeutics update in immune-mediated rheumatic diseases: Rheumatoid arthritis, idiopathic inflammatory myositis and ANCA-associated vasculitis. 免疫介导的风湿性疾病的最新治疗方法：类风湿关节炎、特发性炎症性肌炎和ANCA相关血管炎。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-09-02 DOI: 10.1016/j.clinme.2025.100507
Caroline Zollinger-Read, Andrew Filer
{"title":"Therapeutics update in immune-mediated rheumatic diseases: Rheumatoid arthritis, idiopathic inflammatory myositis and ANCA-associated vasculitis.","authors":"Caroline Zollinger-Read, Andrew Filer","doi":"10.1016/j.clinme.2025.100507","DOIUrl":"10.1016/j.clinme.2025.100507","url":null,"abstract":"<p><p>Immune-mediated inflammatory diseases (IMIDs) are a group of common clinically diverse conditions that are characterised by systemic inflammation. They often pose medical challenges due to their multi-organ involvement, chronicity, associated comorbidities and poor impact on quality of life for patients. The management for IMIDs has changed profoundly over the past 20 years, with the paradigm of treatment shifting away from broad immunosuppression towards pathway-specific targeted treatment. This editorial will focus on three immune mediated rheumatic diseases that physicians may encounter in their clinical practice; rheumatoid arthritis (RA), idiopathic inflammatory myositis (IIM) and anti-neutrophil cytoplasm antibodies (ANCA)-associated vasculitis (AAV). This editorial will provide a concise overview of the current targeted treatment landscape of these three conditions.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100507"},"PeriodicalIF":3.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999830","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}
引用次数: 0
POEMS syndrome: Two cases for the general physician. POEMS综合征：全科医生2例。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-25 DOI: 10.1016/j.clinme.2025.100506
Zoe Maikovsky, Peter Williams
{"title":"POEMS syndrome: Two cases for the general physician.","authors":"Zoe Maikovsky, Peter Williams","doi":"10.1016/j.clinme.2025.100506","DOIUrl":"10.1016/j.clinme.2025.100506","url":null,"abstract":"<p><p>Set in a district general hospital, this case series explores two individuals who developed a rare multisystemic syndrome:; polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin abnormalities (POEMS). Diagnostic journey, trajectory of disease and outcomes are compared. Both patients presented to healthcare numerous times and saw multiple specialists for symptoms resulting predominantly from volume overload and neuropathy, prior to being admitted with atypical ischaemic stroke. During their admission, diagnosis was made after atypical intracranial arterial stenoses, sensory neuropathy not in keeping with their stroke, plasmacytoma detection and confirmatory raised vascular endothelial growth factor (VEGF) levels. POEMS is highly treatment responsive, survival rate improving with earlier diagnosis. Both patients were transferred to specialist centres for chemotherapy. Unfortunately, patient outcomes significantly differ, one having favourable recovery, while the other experiencing treatment-resistance disease requiring local repatriation for withdrawal of care. We identify challenges faced by both patients and the medical team, and discuss the importance of the general physician within the world of specialist medicine, in order to provide holistic, comprehensive patient care.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100506"},"PeriodicalIF":3.9,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945445","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}
引用次数: 0
Are we comfortable managing oral anticoagulation at the end of life? A national survey of secondary care clinicians in the UK. 在生命的最后阶段，口服抗凝治疗是否合适？在英国二级护理临床医生的全国调查。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-23 DOI: 10.1016/j.clinme.2025.100505
Thomas Shevlin, Michelle Kidd, Hannah Cronin, Alastair Gilmore, Catherine Hayle, Elizabeth Jones, Rachel Parry, Rose Penfold, Olga Tsiamita
{"title":"Are we comfortable managing oral anticoagulation at the end of life? A national survey of secondary care clinicians in the UK.","authors":"Thomas Shevlin, Michelle Kidd, Hannah Cronin, Alastair Gilmore, Catherine Hayle, Elizabeth Jones, Rachel Parry, Rose Penfold, Olga Tsiamita","doi":"10.1016/j.clinme.2025.100505","DOIUrl":"10.1016/j.clinme.2025.100505","url":null,"abstract":"<p><strong>Aims/background: </strong>Prior research has demonstrated variation of opinion among physicians regarding management of oral anticoagulation (OAC) at the end of life (EOL). To investigate current practice and attitudes towards OAC at the EOL among secondary care clinicians in the UK, with particular emphasis on how comfortable clinicians feel in making these decisions.</p><p><strong>Methods: </strong>A digital, self-report survey was designed, validated by experts in relevant fields and then distributed via email to secondary care clinicians in the UK involved in EOL care, utilising the existing mailing lists of national societies and research groups.</p><p><strong>Results: </strong>186 responses were received across 10 specialties and 47 NHS trusts. 56% of clinicians routinely seek advice from colleagues regarding these decisions. 53% of respondents reported having worried about the medico-legal implications of discontinuing OAC, 52% of whom reported that these worries influence their decision making. Patient characteristics are more commonly considered than anticipated life expectancy in deciding whether to suspend or continue OAC at the EOL (56.5% versus 43.5%), 83% of respondents would feel more confident in broaching this subject if national guidance existed.</p><p><strong>Conclusions: </strong>Our findings demonstrate a significant variation in practice, a widely reported discomfort and a strong desire for professional guidance regarding the management of OAC at the EOL, among UK-based secondary care clinicians.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100505"},"PeriodicalIF":3.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944904","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}
引用次数: 0
From gut to heart: Salmonella gastroenteritis complicated by myocarditis: a case report. 从肠道到心脏：沙门氏菌肠胃炎并发心肌炎1例报告。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-20 DOI: 10.1016/j.clinme.2025.100503
Orestis Paschalis, Paul Njoku, Amit K J Mandal, Constantinos G Missouris
{"title":"From gut to heart: Salmonella gastroenteritis complicated by myocarditis: a case report.","authors":"Orestis Paschalis, Paul Njoku, Amit K J Mandal, Constantinos G Missouris","doi":"10.1016/j.clinme.2025.100503","DOIUrl":"10.1016/j.clinme.2025.100503","url":null,"abstract":"<p><p>Acute myocarditis is an inflammatory condition of the heart muscle, most commonly caused by viral infections. Bacterial myocarditis, particularly due to non-typhoidal Salmonella (NTS), is exceptionally uncommon in immunocompetent individuals. We report a rare case of acute myocarditis secondary to Salmonella gastroenteritis in a woman in her early 20s, characterised by elevated cardiac biomarkers, positive stool cultures for Salmonella enterica, electrocardiographic changes and confirmatory cardiac magnetic resonance imaging. Management was conservative with anti-inflammatory monotherapy without antibiotic treatment, resulting in full clinical recovery with resolution of symptoms and normalisation of cardiac biomarkers. This case highlights a rare presentation of NTS-associated myocarditis and suggests that conservative management may be sufficient in selected cases. It underscores the importance of considering bacterial pathogens, including NTS, in the differential diagnosis of acute myocarditis, even in immunocompetent patients, and highlights the utility of multimodal imaging and individualised management strategies in achieving favourable outcomes in bacterial myocarditis.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100503"},"PeriodicalIF":3.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945394","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}
引用次数: 0
Navigating complications of disease-modifying anti-rheumatic drugs at the 'front door'. 在“前门”导航改善疾病的抗风湿药的并发症。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-20 DOI: 10.1016/j.clinme.2025.100504
Ruchir Singh, Adam P Croft
{"title":"Navigating complications of disease-modifying anti-rheumatic drugs at the 'front door'.","authors":"Ruchir Singh, Adam P Croft","doi":"10.1016/j.clinme.2025.100504","DOIUrl":"10.1016/j.clinme.2025.100504","url":null,"abstract":"<p><p>Disease-modifying anti-rheumatic drugs (DMARDs) have revolutionised the treatment landscape in rheumatology, reducing both disease severity and the risk of systemic comorbidities. These immunomodulatory drugs have been repurposed for use in other chronic inflammatory diseases, conferring further advantages. However, DMARDs can be associated with adverse events that have implications for the management of common symptoms and conditions that present to medical services at the 'front door'.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100504"},"PeriodicalIF":3.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945425","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}
引用次数: 0
Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors - a cross-site multi-cycle audit. 基于钠-葡萄糖转运-2抑制剂的2型糖尿病患者血糖型糖尿病酮症酸中毒围手术期预防——一项跨部位多周期审计
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-12 DOI: 10.1016/j.clinme.2025.100502
Karl A Romain, Jody Cheng, Seung Ho Luka Kim, Kenneth Watters, Aikaterini Theodoraki
{"title":"Perioperative prevention of euglycaemic diabetic ketoacidosis in people living with type 2 diabetes established on sodium-glucose transport-2 inhibitors - a cross-site multi-cycle audit.","authors":"Karl A Romain, Jody Cheng, Seung Ho Luka Kim, Kenneth Watters, Aikaterini Theodoraki","doi":"10.1016/j.clinme.2025.100502","DOIUrl":"10.1016/j.clinme.2025.100502","url":null,"abstract":"<p><p>Sodium-glucose transport-2 (SGLT2) inhibitors are commonly prescribed for the management of type 2 diabetes mellitus, chronic kidney disease and heart failure. However, their continuation in the perioperative setting in people with diabetes can precipitate euglycaemic diabetic ketoacidosis (EDKA), a potentially life-threatening complication. This multi-cycle audit evaluated adherence to perioperative guidelines regarding preoperative cessation and postoperative re-initiation of SGLT2 inhibitors. Electronic health records of consecutive surgical patients with type 2 diabetes were reviewed over a 6-month period. Two cases of EDKA were identified. Targeted interventions - including staff education and dissemination of guidance - were implemented, followed by re-audit over a 4-month period. Documentation and perioperative SGLT2 inhibitor cessation improved significantly post-intervention; however, postoperative ketone monitoring remained suboptimal, and one further case of EDKA was identified. Since then, capillary blood ketone monitoring has been introduced in clinical areas. These findings add to the body of evidence on the perioperative use of SGLT2 inhibitors.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100502"},"PeriodicalIF":3.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854797","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}
引用次数: 0
Infection in people with heart failure: an overlooked cause of adverse outcomes. 心力衰竭患者的感染：不良后果的一个被忽视的原因。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-10 DOI: 10.1016/j.clinme.2025.100497
Victoria Palin, Oliver Brown, Fergus Hamilton, Patrick Lillie, Mark Kearney, Richard Cubbon, Michael Drozd
{"title":"Infection in people with heart failure: an overlooked cause of adverse outcomes.","authors":"Victoria Palin, Oliver Brown, Fergus Hamilton, Patrick Lillie, Mark Kearney, Richard Cubbon, Michael Drozd","doi":"10.1016/j.clinme.2025.100497","DOIUrl":"10.1016/j.clinme.2025.100497","url":null,"abstract":"<p><p>Infections are a major cause of morbidity and mortality in people with heart failure, accounting for approximately 25% of hospitalisations and deaths. Infection hospitalisations in people with heart failure last twice as long as other hospitalisations, with mortality rates after discharge being comparable to those seen after acute decompensated heart failure. Addressing this major challenge is essential to further improving the survival and quality of life of this population. However, very few studies have sought to understand why people with heart failure are predisposed to adverse infection outcomes and there are currently very few interventions that target this problem. In this review, we explore the underlying factors that may predispose individuals with heart failure to infection, highlight the impact of infections on outcomes, explore the potential strategies that may reduce adverse infection outcomes, and highlight future research priorities.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100497"},"PeriodicalIF":3.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834381","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}
引用次数: 0
Musculoskeletal Manifestations of Diabetes Mellitus - an update. 糖尿病的肌肉骨骼表现-最新进展。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-10 DOI: 10.1016/j.clinme.2025.100498
Harry Ward, Ali S Jawad
{"title":"Musculoskeletal Manifestations of Diabetes Mellitus - an update.","authors":"Harry Ward, Ali S Jawad","doi":"10.1016/j.clinme.2025.100498","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100498","url":null,"abstract":"<p><p>Diabetes mellitus is an increasingly prevalent condition with an estimated 1.3 billion people projected to be affected by 2050 and can reduce life expectancy by up to 20 years. Musculoskeletal complications are present in more than half of patients with diabetes and lead to significant morbidity and disability. Diabetes increases chronic inflammation, reduces anabolism and compromises blood supply to bones, muscles and joints. This can cause fibrosis of tendons and joints, impaired quality of bone and muscle production and in some instances local joint destruction. The risk is further increased in patients with overlapping with metabolic syndrome. Musculoskeletal complications promote a sedentary lifestyle and worsen the trajectory of diabetes management. Here, we provide an update on the musculoskeletal manifestations of diabetes and their treatments since our review in 2015.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100498"},"PeriodicalIF":3.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834382","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}
引用次数: 0
Immune checkpoint inhibitor-induced inflammatory arthritis. 免疫检查点抑制剂诱导炎性关节炎。
IF 3.9 4区 医学
Clinical Medicine Pub Date : 2025-08-06 DOI: 10.1016/j.clinme.2025.100496
Benjamin A Fisher, Andrew Allard, Shirish Dubey, Kulveer Mankia, Arthur G Pratt, Lalit Pallan
{"title":"Immune checkpoint inhibitor-induced inflammatory arthritis.","authors":"Benjamin A Fisher, Andrew Allard, Shirish Dubey, Kulveer Mankia, Arthur G Pratt, Lalit Pallan","doi":"10.1016/j.clinme.2025.100496","DOIUrl":"10.1016/j.clinme.2025.100496","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICI) used for the treatment of malignancy are associated with immune-related adverse events, which include inflammatory arthritis. ICI-induced inflammatory arthritis (ICI-IA) is a new clinical entity that may lead to functional impairment and may be persistent even after ICI cessation. We discuss the clinical features, investigation and differential diagnosis. Management needs to consider the safety of immunosuppression in the context of the underlying cancer, and current practice will be further informed by ongoing clinical trials.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100496"},"PeriodicalIF":3.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798371","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}
引用次数: 0
首页 上一页 下一页 尾页
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整，为了账户安全，请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
请完成安全验证×
相关产品
×
本文献相关产品
联系我们：info@booksci.cn Book学术提供免费学术资源搜索服务，方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号：604180095
Book学术官方微信