Clinical Medicine最新文献

{"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}

{"title":"Hyperglycaemia in pregnancy: Outcomes and diagnostic accuracy of combined modalities.","authors":"Jaishil Manga, Natalie Odell, Lungile Khambule, Sayuri Harishun, Farzahna Mohamed","doi":"10.1016/j.clinme.2025.100495","DOIUrl":"10.1016/j.clinme.2025.100495","url":null,"abstract":"<p><p>The prevalence of diabetes mellitus (DM) during pregnancy is rising globally, yet data on gestational diabetes mellitus (GDM) in South Africa remain limited. This study retrospectively analysed glycaemic characteristics and outcomes in 298 women with pre-gestational DM and hyperglycaemia first detected in pregnancy (HFDP) between August 2019 and January 2021. Hyperglycaemic disorders were attributed to GDM (39.6%, n = 118), followed by type 2 diabetes (T2DM) (29.2%, n = 87), overt DM (22.1%, n = 66) and type 1 diabetes (T1DM) (9.1%, n=27). Significant risk factors for GDM included family history, obesity, poor obstetric history, and a previous history of macrosomia in pregnancy. Glycated haemoglobin (HbA1c) levels at booking were highest in women with pre-gestational DM (8.8% in T1DM and 7.8% in T2DM). A combination of HbA1c ≥ 5.75% and fasting plasma glucose (FPG) of 5.1-6.9 mmol/L was the most accurate method for diagnosing GDM, with an area under the curve (AUC) of 0.93. Postpartum follow-up using an oral glucose tolerance test (OGTT) revealed that 21% of women with GDM developed DM, while 53% had an impaired glucose tolerance (IGT). However, only 48% of those with GDM were followed up postpartum, highlighting the significant challenge of loss to follow-up. These findings emphasise the growing prevalence of HFDP and the elevated risk of postpartum DM, highlighting the need for improved follow-up care to mitigate long-term complications. Additionally, the combination of FPG and HbA1c ≥ 5.75% shows promise for enhancing GDM diagnosis and screening protocols, particularly in developing countries. Further research is needed to validate these findings and assess their broader applicability.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100495"},"PeriodicalIF":3.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798370","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":"Pituitary disorders in pregnancy.","authors":"Darran Mc Donald, Maria Tomkins, Michael W O'Reilly, Mark Sherlock","doi":"10.1016/j.clinme.2025.100488","DOIUrl":"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 changes. Close clinical and biochemical follow-up and collaboration across specialties is essential to ensure optimal maternal and fetal 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 postpartum period. Prompt recognition of these disorders is essential to prevent potentially fatal complications and optimise maternal and fetal 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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398249/pdf/","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":"OA","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":"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 (USA), specifically type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), ischaemic 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 study. 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 PM_2.5 in the USA 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 percentage 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 USA 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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446674/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-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":"10.1016/j.clinme.2025.100489","url":null,"abstract":"<p><strong>Background: </strong>Smell disturbances, memory and mood changes are frequently reported as symptoms of long COVID 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 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 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 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 compared with non-hallucinogenic types of olfactory disturbances. It was determined that a significant predictor of parosmia is persistent anosmia up to 4 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 compared to participants with olfactory hallucination.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100489"},"PeriodicalIF":3.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395519/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically assisted nutrition and hydration at the end of life.","authors":"Andrew Davies","doi":"10.1016/j.clinme.2025.100323","DOIUrl":"10.1016/j.clinme.2025.100323","url":null,"abstract":"<p><p>The initiation, continuance or discontinuance of clinically assisted hydration and nutrition are some of the most challenging decisions in patients near the end of life. This article reviews the limited evidence to support or otherwise these medical treatments, and provides an overview of relevant clinical practice guidance. Essentially, decisions need to be individualised, and importantly regularly reviewed to ensure that the objectives of treatment are being achieved.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100323"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955737","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 descriptive cohort study of pregnancy and parenthood in women with cystic fibrosis.","authors":"Aleksandra Duffy, Susan Parker, Simon Williams, Kenneth Hodson, Simon Doe, Carlos Echevarria, Stephen J Bourke","doi":"10.1016/j.clinme.2025.100340","DOIUrl":"10.1016/j.clinme.2025.100340","url":null,"abstract":"<p><p>Women with cystic fibrosis (wwCF) are increasingly undertaking pregnancy. This study assessed the current state of relationships, fertility, pregnancy and parenthood in a total cohort of 217 wwCF. Overall, 64% of wwCF were in long-term heterosexual relationships, 32% were single and 4% were in same-sex relationships; 64 wwCF had 111 children; 97 (87.4%) were conceived naturally and 10 (9%) by assisted reproduction. One woman had two children by surrogacy, one couple adopted a child and six wwCF had a role as a step-parent. Of the 217 wwCF, 31 (14%) died at a mean age of 41.4 years; they had 18 children, and eight of these children (44%) were younger than 18 years old when their mother died. There was a marked increase in pregnancies associated with the introduction of CF modulator medications, from three in 2020 to 16 in 2023. There were 50 pregnancies between 2020 and 2024; 17 (34%) were not planned (five were terminated); and 15 (30%) partners did not have CF genetic tests pre-conception. There were eight miscarriages. Exacerbations of lung disease occurred in 11 (31%) completed pregnancies, gestational diabetes in 12 (34%), one gastrointestinal bleeding, and one pre-eclampsia. Delivery was by caesarean section in 14 pregnancies (40%), and four (11%) births were premature (<37 weeks gestation). Although outcomes are generally good, pre-conception planning is suboptimal, pregnancy is associated with increased complications and parenthood raises complex issues regarding prognosis. CF teams should have close links with maternal medicine services to meet the specific needs of wwCF.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100340"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293419","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":"Comparisons of efficacy and safety of immunotherapies for Alzheimer's disease treatment: A network meta-analysis of randomised controlled trials.","authors":"Ching-Hui Su, Ying-Tzu Chang, Huan-Shu Tseng, Chan-Yen Kuo, Jin-Hua Chen, Po-Yu Chien, Yao-Jen Chang, Chin-Chuan Hung","doi":"10.1016/j.clinme.2025.100336","DOIUrl":"10.1016/j.clinme.2025.100336","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) remains a major challenge due to limited effective therapies. Moreover, direct comparisons between newly developed and symptomatic drugs are lacking. This network meta-analysis aimed to compare the efficacy and safety of immunotherapies for AD.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, the Cochrane Library and ClinicalTrials.gov was conducted for randomised controlled trials (RCTs) up to 29 June 2024. Eligible studies included adults with AD receiving immunotherapy versus placebo or symptomatic treatment.</p><p><strong>Results: </strong>Fifty-nine RCTs were included. Donanemab and lecanemab ranked among the most effective treatments for improving cognitive function (Clinical Dementia Rating Scale - Sum of Boxes P-scores: 0.88 and 0.77) and daily activities (Alzheimer's Disease Cooperative Study - Activities of Daily Living P-scores: 0.85 and 0.90), based on network meta-analysis findings.</p><p><strong>Conclusions: </strong>Anti-Aβ monoclonal antibodies, particularly donanemab and lecanemab, demonstrated superior efficacy over other immunotherapies in slowing cognitive deterioration, supporting their role in AD management.</p><p><strong>Prospero registration number: </strong>CRD42023461680.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100336"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233398","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":"Impact of chronic liver disease (CLD) on mortality, complications and early readmission in patients with spontaneous intracranial haemorrhage (ICH): A national readmission database analysis 2016-2020.","authors":"Ping-Jui Tsai, Yu-Jen Kuo","doi":"10.1016/j.clinme.2025.100332","DOIUrl":"10.1016/j.clinme.2025.100332","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver disease (CLD) is associated with worse outcomes in many medical conditions, but its impact on patients with spontaneous intracranial haemorrhage (ICH) has not been fully explored. This study aims to evaluate the influence of CLD on in-hospital outcomes of patients with a spontaneous ICH.</p><p><strong>Methods: </strong>Data from the Nationwide Readmissions Database (NRD) between 2016 and 2020 were retrospectively reviewed. Patients ≥18 years old admitted for the first time with a spontaneous ICH were included. Study outcomes included in-hospital mortality, length of stay (LOS), major complications and 90-day readmission rate. Patients with and without CLD were matched using 1:4 propensity score matching (PSM). Univariate and multivariable logistic and linear regression analyses were performed to determine the associations between CLD and outcomes of interest.</p><p><strong>Results: </strong>After applying PSM, 21,345 patients were included in the analysis, of whom 4,269 had CLD. After adjustment, compared to patients without CLD, those with CLD had significantly higher in-hospital mortality (adjusted odds ratio (aOR) = 1.23, 95% confidence interval (CI): 1.13-1.34, p < 0.001), a longer LOS (aOR = 1.26, 95% CI: 1.12-1.39, p < 0.001), higher rates of major complications (aOR = 1.76, 95% CI: 1.62-1.91, p < 0.001) and increased 90-day readmission rates (aOR = 1.20, 95% CI: 1.09-1.31, p < 0.001)​.</p><p><strong>Conclusions: </strong>CLD is independently associated with higher mortality, more complications, longer LOS and higher readmission rates in patients admitted for spontaneous ICH. These findings underscore the need for specialised care strategies for patients with an ICH and underlying CLD.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100332"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173202","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":"The changing landscape of palliative care: a universal imperative.","authors":"Amy Taylor, Andrew Davies, Ponnusamy Saravanan","doi":"10.1016/j.clinme.2025.100492","DOIUrl":"10.1016/j.clinme.2025.100492","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100492"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365498/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}