Clinical Medicine最新文献

{"title":"What is new in tuberculosis?","authors":"Ye Myat, Maddalena Cerrone, Onn Min Kon","doi":"10.1016/j.clinme.2026.100634","DOIUrl":"10.1016/j.clinme.2026.100634","url":null,"abstract":"<p><p>Tuberculosis (TB) is the deadliest leading infectious disease globally. Approximately 10.7 million people worldwide were estimated to have developed TB in 2024. TB rates have increased in the UK over the last three years. Vigilance in acute care settings and across medical subspecialties is essential to ensure early recognition and control of TB particularly given the significant proportion of extrapulmonary presentations. Advances in diagnostic tools have significantly improved detection, with rapid PCR now becoming the standard for timely case identification. Whole genome sequencing (WGS) is now routinely in place to identify drug resistance, track transmission and guide public health responses. In parallel, treatment strategies are evolving, with shorter and more effective regimens available for latent TB, active disease, and multidrug-resistant TB. This review provides an overview of the epidemiology, clinical presentation, diagnosis, and management of TB, with a focus on recent advances relevant to clinical practice in the UK.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100634"},"PeriodicalIF":3.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705862","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":"Association between dietary magnesium intake and all-cause mortality in patients with chronic kidney disease: Insights from NHANES 1999-2018.","authors":"Zi-Yan Xu, Jing Zou, Li-Jun Xie, Ying Ye, Kai-Ying He, Juan Zhu, Xiao-Lan Wang, Ruo-Li Wang, Yi-Jia Luo, Jian-Hui Zhang, Qian Chen, Dan-Dan Ruan, Yan-Feng Zhou, Mei-Zhu Gao, Li Zhang, Yun-Fei Li, Zhu-Ting Fang, Fang-Meng Huang, Bin Hu, Jie-Wei Luo, Zhi-Hai Zheng, Li Chen","doi":"10.1016/j.clinme.2026.100633","DOIUrl":"10.1016/j.clinme.2026.100633","url":null,"abstract":"<p><strong>Background: </strong>We investigated the association between food-derived dietary magnesium intake and all-cause mortality among adults with chronic kidney disease.</p><p><strong>Methods: </strong>We analysed data from adults aged ≥20 years with CKD who participated in the National Health and Nutrition Examination Survey between 1999 and 2018. Mortality status was ascertained through linkage to the National Death Index through 31 December 2019. Multivariable Cox proportional hazards models were used to evaluate the association between dietary magnesium intake and all-cause mortality. Restricted cubic spline analysis, Kaplan-Meier survival analysis, subgroup analyses, and sensitivity analyses were also performed.</p><p><strong>Results: </strong>A total of 8,104 CKD patients were included in this cohort study with a median follow-up of 85 months, during which 3,134 (38.7%) died from all causes. In the fully adjusted Cox model, each 100 mg/day increase in dietary magnesium intake was associated with a 7.5% lower risk of all-cause mortality (HR = 0.925, 95% CI 0.881-0.971; P = 0.002). Compared with the lowest quartile, adjusted hazard ratios were 0.978 (95% CI 0.883-1.083) for Q2, 0.904 (95% CI 0.804-1.016) for Q3, and 0.866 (95% CI 0.744-1.007) for Q4, with a significant trend across quartiles (P for trend = 0.036). RCS analysis demonstrated a significant overall association with no evidence of nonlinearity (P for overall association = 0.009; P for nonlinearity = 0.472). Kaplan-Meier analysis showed higher survival probabilities among participants with higher dietary magnesium intake.</p><p><strong>Conclusions: </strong>Higher dietary magnesium intake was independently associated with a lower risk of all-cause mortality among adults with CKD. These findings suggest that adequate dietary magnesium intake may represent an important nutritional factor associated with prognosis in CKD. Further prospective studies and randomised clinical trials are warranted to determine whether increasing dietary magnesium intake can improve clinical outcomes.</p><p><strong>Summary statement: </strong>Higher dietary magnesium intake was independently associated with lower all-cause mortality among patients with chronic kidney disease in NHANES 1999-2018. These findings highlight the potential protective role of adequate magnesium intake in improving long-term survival in this population.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100633"},"PeriodicalIF":3.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697167","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":"Risk factors of clonal hematopoiesis of indeterminate potential.","authors":"Qiaoxue Liu, Fen Yang, Hans-Olov Adami, Yingsuo Zhao, Tove Wästerlid, Fang Fang, Qianwei Liu","doi":"10.1016/j.clinme.2026.100635","DOIUrl":"10.1016/j.clinme.2026.100635","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence demonstrates associations between clonal hematopoiesis of indeterminate potential (CHIP) and increased risks of haematological and non-haematological health outcomes. Although adverse health consequences of CHIP have become well-documented, large knowledge gaps exist regarding the aetiology of CHIP.</p><p><strong>Objective: </strong>To investigate risk factors for CHIP using large-scale phenotypic data and Mendelian randomisation analysis.</p><p><strong>Methods: </strong>We utilised rich phenotypic and genomic data from the UK Biobank (UKB) to perform a cross-sectional study to systematically investigate risk factors of CHIP, including around 460,000 participants recruited from 2006 to 2010. We used Logistic regression to estimate odds ratios (ORs) of CHIP in relation to risk factors (sociodemographic factors, lifestyle factors, history of diseases, blood cell count, blood biochemistry parameters, proteomics biomarkers and metabolomics biomarkers). In addition, we conducted Mendelian Randomisation (MR) analyses to assess causality between the studied risk factors and CHIP, using publicly available summary statistics of genome-wide association studies (GWAS).</p><p><strong>Results: </strong>We found that advanced age, smoking, history of several diseases (including breast cancer and leiomyoma of uterus), as well as several serum biomarkers (monocyte count, proteins LY75, SIGLEC6, SIRPB1 and CYB5R2) were associated with CHIP.</p><p><strong>Conclusion: </strong>Our findings expanded existing knowledge base by demonstrating novel risk factors of CHIP, especially history of several diseases and serum biomarkers. These findings advance understanding of the aetiology of CHIP.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100635"},"PeriodicalIF":3.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697258","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":"Finerenone exposure and ischaemic stroke in patients with type 2 diabetes and chronic kidney disease: A propensity score-matched cohort study.","authors":"Wu-Lung Chuang, Ruey-Hwang Chou, Yuan-Hung Wang, I-Ju Tsai, Cheng-Li Lin, Der-Yang Cho, Kuang-Hsi Chang","doi":"10.1016/j.clinme.2026.100617","DOIUrl":"10.1016/j.clinme.2026.100617","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) commonly coexist and are associated with an increased risk of ischaemic stroke. Finerenone has demonstrated benefits on composite renal and cardiovascular outcomes in randomised trials; however, ischaemic stroke has generally been evaluated as part of composite endpoints, and real-world evidence focusing on this outcome remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Global Research Network to evaluate the association between finerenone use and incident ischaemic stroke among adults with newly diagnosed T2DM who subsequently developed CKD. Finerenone users were compared with non-users. Propensity score matching was applied to balance demographic characteristics and baseline comorbidities. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 125,086 eligible patients were identified before matching, including 1,990 finerenone users. After 1:1 propensity score matching, 1,990 finerenone users were matched with 1,990 non-users with adequate covariate balance. Finerenone use was associated with a lower observed hazard of ischaemic stroke both before matching (adjusted HR, 0.30; 95% CI, 0.24-0.36) and after matching (adjusted HR, 0.33; 95% CI, 0.26-0.42).</p><p><strong>Conclusions: </strong>In this real-world cohort of patients with T2DM and CKD, finerenone use was associated with a lower observed hazard of ischaemic stroke.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100617"},"PeriodicalIF":3.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381815","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":"Structured, person-centred glycaemic optimisation before surgery: The Manchester IP3D experience.","authors":"Mohammed S O Ahmed, Mariyah Ahmed, Adhithya Sankar, Jacqueline Toombs, Hood Thabit","doi":"10.1016/j.clinme.2026.100619","DOIUrl":"10.1016/j.clinme.2026.100619","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the impact of a diabetes specialist nurse (DSN)-led perioperative optimisation service on glycaemic control in adults undergoing elective surgery.</p><p><strong>Design: </strong>Retrospective service evaluation.</p><p><strong>Setting: </strong>Manchester Royal Infirmary (Manchester University NHS Foundation Trust), a large UK teaching hospital and regional specialist centre.</p><p><strong>Participants: </strong>398 adults with diabetes (mean age 62.2 years; 76.3% type 2 diabetes) referred to the preoperative pathway between 2020 and 2024.</p><p><strong>Interventions: </strong>A structured pathway involving DSN-led outpatient consultations, blood result monitoring, and targeted education to support self-management and guideline adherence.</p><p><strong>Main outcome measure(s): </strong>Change in HbA1c from referral to the perioperative period (within 12 weeks of surgery) and predictors of glycaemic improvement.</p><p><strong>Results: </strong>Participants had a median baseline HbA1c of 75 mmol/mol. Over a median 16-week interval with two DSN contacts, HbA1c decreased by a median of 18 mmol/mol. Multivariable analysis identified higher baseline HbA1c (p < 0.001) and frequency of DSN contacts (p < 0.001) as independent predictors of improvement. Notably, medication intensification and diabetes technology use were not significantly associated with HbA1c reduction.</p><p><strong>Conclusions: </strong>A structured DSN-led pathway achieves clinically meaningful HbA1c reductions in high-risk surgical patients. These gains were associated with specialist engagement rather than complex medication adjustments, suggesting that focused education is a safe, effective strategy for perioperative optimisation that minimises pharmacological burden in the secondary care setting.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100619"},"PeriodicalIF":3.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403798","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":"Clinical research is not an optional extra.","authors":"Tom Solomon","doi":"10.1016/j.clinme.2026.100631","DOIUrl":"10.1016/j.clinme.2026.100631","url":null,"abstract":"<p><p>Clinical research underpins almost everything we do in the NHS, from diagnostics and therapeutics to service design and workforce development, while also driving economic growth through the life sciences sector. Yet the UK clinical research workforce is in decline, at a time of rising patient need. Financial pressures on universities, increasing clinical demand, fragile funding routes and inflexible training pathways, are making academic careers harder to enter and sustain. Valuable research delivered by resident doctors, consultants, SAS and locally employed doctors is also unrecognised and unsupported. Research should not be seen as an optional extra. It is mandated in policy, embedded in professional standards, and essential to improving outcomes. A whole workforce approach is needed. At the Royal College of Physicians, we are supporting doctors making the case for research in job planning and training, strengthening recognition and funding opportunities for early clinical research, and addressing structural barriers to academic careers through national policy engagement.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100631"},"PeriodicalIF":3.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577397","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":"HIV update for the non-HIV specialist and general physician.","authors":"Miriam Ringshall, Jaime H Vera","doi":"10.1016/j.clinme.2026.100628","DOIUrl":"10.1016/j.clinme.2026.100628","url":null,"abstract":"<p><p>HIV has become a manageable chronic condition, one of the major successes of modern medicine. People living with HIV can now expect near-normal life expectancy with effective treatment, yet important challenges remain. Comorbidities, prevention of new infections, and the persistence of stigma continue to affect outcomes. Addressing these issues requires coordinated care, with general practice, hospital services and specialist HIV teams working closely together. This article aims to support healthcare professionals by summarising current best practice in treatment, outlining advances in prevention and early diagnosis, and exploring how stigma can be reduced both within healthcare and in the wider community. These efforts are essential if the UK is to meet its goal of ending new HIV transmissions by 2030.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100628"},"PeriodicalIF":3.9,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519937","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: 'Heart failure with preserved ejection fraction (HFpEF): Diagnosis and management for the general physician'.","authors":"Maria Giulia Bellicini","doi":"10.1016/j.clinme.2026.100627","DOIUrl":"10.1016/j.clinme.2026.100627","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100627"},"PeriodicalIF":3.9,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519998","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":"Update in asthma management: A narrative review of recent advances, challenges, and future directions.","authors":"Ziad Alhaj, Ruth H Green","doi":"10.1016/j.clinme.2026.100623","DOIUrl":"10.1016/j.clinme.2026.100623","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a heterogeneous chronic respiratory disease with persistent morbidity and mortality despite effective therapies. The UK continues to report high asthma-related deaths, underscoring the need for improved care.</p><p><strong>Objective: </strong>To review recent advances in asthma management, identify ongoing challenges, and outline future directions for clinical practice.</p><p><strong>Methods: </strong>This narrative review integrates recent guideline updates (BTS/SIGN 2024, GINA 2024), audit data (NACAP), and emerging evidence on diagnostics, phenotype-driven therapy, and novel treatments.</p><p><strong>Findings: </strong>Innovations include biomarker-guided phenotyping, anti-inflammatory reliever (AIR) therapy, biologics targeting type 2 inflammation, and structured frameworks like A2BCD. Foundational care-such as adherence, inhaler technique, and self-management-remains essential. Systemic improvements, including virtual wards and the BTS Asthma4 bundle, enhance continuity of care. The NHS Green Agenda supports sustainable asthma practices.</p><p><strong>Conclusions: </strong>Asthma care is evolving toward personalised, integrated, and environmentally conscious approaches. Clinicians should combine precision therapies with system-level strategies to optimise outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100623"},"PeriodicalIF":3.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469355","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":"Prevalence and cardiovascular associations of elevated lipoprotein(a) in people living with HIV: A cross-sectional study.","authors":"Marta Lago, Marta Salas, Ana Torres, Cristina Diez, Chiara Fanciulli, Leire Perez, Francisco Tejerina, Elena Bello, Jose Maria Bellon, Patricia Muñoz, Luis Antonio Álvarez-Sala, Irene González-Martinez, Teresa Aldámiz-Echevarria","doi":"10.1016/j.clinme.2026.100625","DOIUrl":"10.1016/j.clinme.2026.100625","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] has emerged as an important cardiovascular risk factor. However, the prevalence and determinants of elevated Lp(a) in people living with HIV (PLHIV) remain insufficiently characterised. Since PLHIV have an increased cardiovascular risk even under effective virological control, our aim was to explore the prevalence of elevated Lp(a) and its association with cardiovascular risk in this population.</p><p><strong>Methods: </strong>We conducted a single-centre observational study in adult PLHIV with sustained virological suppression and without active oncological or infectious comorbidities. According to most international consensus statements, elevated Lp(a) was defined as levels >50 mg/dL.</p><p><strong>Results: </strong>A total of 186 PLHIV were included. Of these, 21% had Lp(a) levels >50 mg/dL. Individuals with elevated Lp(a) had significantly higher total cholesterol, Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B levels, as well as a higher odds of a cardiovascular event [odds ratio (OR) 5.3, p = 0.018]. Although the proportion of patients receiving lipid-lowering therapy was significantly higher among those with elevated Lp(a), the percentage achieving LDL-C targets according to cardiovascular risk was significantly lower compared with patients with Lp(a) <50 mg/dL. No association was observed between elevated Lp(a) and antiretroviral therapy regimens, CD4 count, CD4/CD8 ratio or duration of HIV infection.</p><p><strong>Conclusions: </strong>In our study, elevated Lp(a) was present among 21% of virologically suppressed PLHIV and was associated with an adverse lipid profile and cardiovascular events, whereas no association was observed with HIV-related factors. Lp(a) may represent a marker of residual cardiovascular risk in this population and could help refine cardiovascular risk stratification beyond traditional lipid parameters.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100625"},"PeriodicalIF":3.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469365","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}