Clinical Medicine最新文献

{"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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982972/pdf/","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":"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":"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":"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":3.9,"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":"Body fat changes and risk of new onset of hypertension and hyperlipidaemia among Korean adults: A longitudinal study.","authors":"Jinyoung Shin, Sang-Hyun Park, Jae Hoon Cho, Tae-Eun Kim","doi":"10.1016/j.clinme.2025.100293","DOIUrl":"10.1016/j.clinme.2025.100293","url":null,"abstract":"<p><strong>Background: </strong>This study examined the association between changes in body fat, body mass index (BMI), and the risk of newly developed hypertension and hyperlipidaemia in the general population.</p><p><strong>Methods: </strong>This longitudinal study included 17,598 individuals without prior hypertension and hyperlipidaemia who underwent at least three health examinations between January 2015 and December 2022. Body fat was classified as decreased (≥ 5%), stable (within 5%), and increased (≥ 5%) using bioelectrical impedance analysis. BMIs were categorised as healthy weight/underweight (BMI < 23), overweight (23 ≤ BMI < 25), and obesity (BMI ≥ 25). Hypertension and hyperlipidaemia were identified through self-reported medication use or clinical measurements.</p><p><strong>Results: </strong>Increases in BMI or body fat were associated with higher incidence rates of hypertension and hyperlipidaemia. Decreased body fat was associated with a lower risk of hypertension in the overweight (odds ratio: 0.638, 95% confidence interval: 0.464-0.876) and obese groups (0.724, 0.577-0.909). Individuals with healthy weight/underweight with increased body fat had a higher incidence of hyperlipidaemia than individuals with overweight with decreased body fat (87.2 vs 66.4 per 1,000 people). Compared to the stable body fat group, increased body fat raised the risk of hyperlipidaemia (healthy weight/underweight: 1.522, 1.248-1.855; overweight: 1.278, 1.032-1.583; and obesity: 1.214, 1.028-1.433). Individuals living with overweight with decreased body fat demonstrated a lower risk of hyperlipidaemia (0.546, 0.400-0.747).</p><p><strong>Conclusions: </strong>Increased body fat was associated with a higher risk of hyperlipidaemia, even within the same BMI category. Decreasing body fat, particularly in individuals living with overweight, is associated with a lower risk of hypertension and hyperlipidaemia.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100293"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413624","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":"Perinatal care in primary care for cardiovascular risk reduction.","authors":"Clare Macdonald, Elizabeth Dapre","doi":"10.1016/j.clinme.2025.100297","DOIUrl":"10.1016/j.clinme.2025.100297","url":null,"abstract":"<p><p>General practitioners (GPs) and multidisciplinary members of the primary care team in the UK have, since the earliest days of the NHS, played a key role in the care of women throughout their perinatal journey, particularly postnatally. With cardiometabolic complications of pregnancy becoming increasingly common, and bringing an associated increased lifetime risk of adverse maternal and neonatal outcomes, GPs and the wider primary care team play a crucial role in risk reduction and management. Managing healthcare effectively to reduce adverse maternal and neonatal outcomes and health inequalities requires a system-wide change in approach where women's pre-conception to postnatal health is optimised. GPs' role in postnatal care, and other opportunistic moments in primary care for health promotion and risk management, is a key part of the solution.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100297"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491013","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}