Clinical therapeutics最新文献

{"title":"Critical Insights Into Epidemiology and Economic Burden of Diagnosed Congenital Cytomegalovirus Infection in the First 2 Years of Life","authors":"Fathimathul Henna , Zaryab Bacha , Mahnoor Qasim , Arooba Khitab","doi":"10.1016/j.clinthera.2025.05.005","DOIUrl":"10.1016/j.clinthera.2025.05.005","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 657-658"},"PeriodicalIF":3.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293436","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":"Dexmedetomidine-Propofol Versus Propofol Alone for Sedation in Upper Gastrointestinal Endoscopic Ultrasound: A Randomized Comparative Study","authors":"Yuanming Liu MM ,&nbsp;Yi Shen MM ,&nbsp;Hai Zhong BM","doi":"10.1016/j.clinthera.2025.05.013","DOIUrl":"10.1016/j.clinthera.2025.05.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Upper gastrointestinal endoscopic ultrasonography (EUS) necessitates well-balanced sedation to ensure patient safety while optimizing procedural conditions. This study evaluates the safety and efficacy of dexmedetomidine-propofol versus propofol-only sedation in terms of respiratory safety, sedation quality, and recovery outcomes.</div></div><div><h3>Methods</h3><div>This prospective randomized controlled trial enrolled 145 patients undergoing lower esophageal or gastric EUS from January 2022 to May 2023. All participants received standardized premedication with midazolam and tetracaine gel for mucosal topicalization. Participants were randomized into two groups: dexmedetomidine-propofol (n = 72) and propofol-only (n = 73). Continuous variables were analyzed using independent t-tests, and categorical data were compared with chi-square tests, with statistical significance set at <em>P &lt;</em> 0<em>.</em>05.</div></div><div><h3>Findings</h3><div>No significant difference was observed in patient satisfaction (<em>P</em> = 0.717), but endoscopist satisfaction was significantly higher in the dexmedetomidine-propofol group (<em>P &lt;</em> 0<em>.</em>05). This group also showed significantly fewer midazolam rescue doses, fewer respiratory adverse events, and reduced intra-procedural patient movement and cough reflexes (all <em>P &lt;</em> 0<em>.</em>05). Furthermore, recovery outcomes were improved, with higher modified Aldrete scores and faster achievement of a post-anesthesia discharge score ≥9 (<em>P &lt;</em> 0<em>.</em>05). However, induction time was longer and the incidence of hypotension and bradycardia was higher in the combination group (<em>P &lt;</em> 0<em>.</em>05).</div></div><div><h3>Implications</h3><div>Dexmedetomidine-propofol sedation enhances procedural conditions and recovery metrics in EUS but is associated with greater cardiovascular side effects. These findings suggest it is a valuable alternative to propofol alone, particularly when optimizing proceduralist satisfaction and minimizing respiratory complications.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 554-558"},"PeriodicalIF":3.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293437","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":"Long-Term Outcomes of Balloon Dilation in Pediatric Distal Ureteral Stenosis Across Age Groups","authors":"Keyu Ouyang MS (Urology) ,&nbsp;Yikui Zhang MS (Urology) ,&nbsp;Sai Ma MS (Urology) ,&nbsp;Weijun Ma MS (Urology) ,&nbsp;Tong Shi MS (Urology) ,&nbsp;Xiewu Zhang MS (Urology) ,&nbsp;Jiayao Luo MS (Urology) ,&nbsp;Weihua Lao MS (Urology)","doi":"10.1016/j.clinthera.2025.05.009","DOIUrl":"10.1016/j.clinthera.2025.05.009","url":null,"abstract":"<div><h3>Purposes</h3><div>The gold standard for treating primary obstructive megaureter is ureteral reimplantation, with ongoing debate surrounding its use in patients under 1 year of age. In most primary obstructive megaureter cases requiring urinary diversion, ureterostomy is favored over pyelostomy and nephrostomy. Another described alternative would be the refluxing ureteral reimplantation. Balloon dilation, established as effective and safe in adults with ureteral strictures, may offer an alternative for pediatric patients. This study aims to evaluate pre- and postoperative parameters of balloon dilation in distal ureteral segment stenosis among pediatric patients across age groups and to identify independent parameters influencing treatment success.</div></div><div><h3>Methods</h3><div>The medical records of newborns (age, 0–28 days; n = 19), young infants (age, 28 days to 6 months; n = 29), and children (age, 6 months to 11 years; n = 29) of Han Chinese pediatric patients from the Guangdong Women and Children Hospital, Guangzhou, China, from December 8, 2020, to November 5, 2023, with distal ureteral segment stenosis who underwent balloon dilatation (size from 8 to 10.5 F) were included in the analysis.</div></div><div><h3>Findings</h3><div>The prevalence of distal ureteral segment stenosis is higher in males than females (58 vs 19) and that was higher on the left lateral side in both boys and girls than right or both lateral sides (<em>P</em> = 0.0375). The therapeutic effect of balloon dilation in distal ureteral segment stenosis is effective across all age groups (<em>P</em> &lt; 0.05 for all) and especially reported to be more effective in newborns, followed by young infants and children regarding anterior and posterior pelvic diameter, renal parenchymal thickness (thinnest point), ureter diameter (widest point), and urine white blood cells (<em>P</em> &lt; 0.05 for all). The treatment effect of balloon dilation correlated with age (<em>P</em> = 0.0412), hydronephrosis (<em>P</em> = 0.0481), renal cortical thickness (<em>P</em> = 0.0419), and ureteral dilation (<em>P</em> = 0.0491).</div></div><div><h3>Implications</h3><div>These findings suggest that balloon dilation may offer a manageable alternative for younger patients, especially newborns for distal ureteral segment stenosis, with age and specific anatomical factors influencing outcomes. Age, hydronephrosis, renal cortical thickness, and ureteral dilation were independent parameters for the treatment effect of balloon dilation in very young patients.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 610-623"},"PeriodicalIF":3.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274312","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":"The Role, Potential Benefits and Cost-effectiveness of Digital Tools for Diabetes Management","authors":"Anders L. Carlson MD ,&nbsp;Sameer Badlani MD ,&nbsp;Viral N. Shah MD","doi":"10.1016/j.clinthera.2025.05.002","DOIUrl":"10.1016/j.clinthera.2025.05.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Health and financial burdens associated with poorly managed diabetes are considerable both for individuals and for healthcare systems. The last decade has seen a significant increase in the use of automated insulin delivery systems, continuous glucose monitoring and insulin pumps. With this, digital healthcare tools — such as smart or connected insulin pens and wearable continuous glucose monitoring (CGM) sensors utilizing current digital smartphone and wireless technology have emerged — helping people with diabetes and their healthcare providers maximize treatment adherence and achieve optimal glycemic control. This article reviews the available literature to assess current unmet needs within diabetes care management, summarizes the efficacy and safety of the latest US Food and Drug Administration (FDA)-approved insulin delivery systems and digital diabetes healthcare tools, and investigate the economic and healthcare benefits of such FDA-approved digital healthcare tools for people with diabetes in the US.</div></div><div><h3>Methods</h3><div>Literature searches were conducted using PubMed for articles published between 2014 and 2023. Type of articles included were narrative reviews, systematic reviews, randomized controlled trials and cost-effectiveness analyses.</div></div><div><h3>Findings</h3><div>There are many insulin delivery systems and associated digital devices, CGMs and software applications that utilize wireless and smartphone technology available within the US that have published efficacy, safety and cost-benefit outcomes. The safety and efficacy of CGM and continuous subcutaneous insulin infusion (CSII) therapy are well established. In contrast, the evidence available for the most recent digital diabetes healthcare tools (e.g., smart or connected insulin pens) is relatively limited.</div></div><div><h3>Implications</h3><div>Despite the acknowledged cost-effectiveness of digital healthcare tools within diabetes care and potential associated cost savings for healthcare markets, there are limited numbers of clinical studies investigating the efficacy and safety of newer devices such as smart or connected insulin pens. Further research is needed to pave the way for integrating these devices more fully into diabetes management.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 638-648"},"PeriodicalIF":3.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265446","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":"Prenatal Opioid Exposure: Have We Lost an Opportunity to Improve the Outcomes of Mothers and Their Infants?","authors":"Jonathan M. Davis MD ,&nbsp;Lauren M. Jansson MD ,&nbsp;Hendree E. Jones PhD","doi":"10.1016/j.clinthera.2025.05.012","DOIUrl":"10.1016/j.clinthera.2025.05.012","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 536-537"},"PeriodicalIF":3.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246861","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":"Characteristics and Treatment Patterns of People Without Type 2 Diabetes Diagnoses Who Use Tirzepatide in the United States","authors":"Theresa Hunter Gibble ,&nbsp;Emily R. Hankosky ,&nbsp;Alexandra Meeks ,&nbsp;Birong Liao ,&nbsp;Jennifer Ward ,&nbsp;Ahong Huang ,&nbsp;Chanadda Chinthammit","doi":"10.1016/j.clinthera.2025.05.003","DOIUrl":"10.1016/j.clinthera.2025.05.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to understand real-world use of Tirzepatide among people without type 2 diabetes (T2D) diagnoses in the United States in the Merative^TM MarketScan® Commercial (MarketScan) and Optum Clinformatics Claims (CDM) databases.</div></div><div><h3>Methods</h3><div>This retrospective, observational, descriptive study used data from the MarketScan and Optum CDM databases (index date: first-observed Tirzepatide claim) from May 2021 to September 2023. Key eligibility criteria included age ≥18 years, ≥1 Tirzepatide claim, no baseline T2D diagnosis codes or antihyperglycemic medication use (except metformin), and continuous medical and pharmacy enrollment for ≥12 months pre-index. Demographic characteristics were assessed at the index date, while clinical characteristics and treatment-related data were identified during the 12-month pre-index period. Tirzepatide persistence and utilization (6 months post index) were assessed for individuals with ≥6 months of follow-up after initiation of Tirzepatide treatment (index date). Data were analyzed separately for each database.</div></div><div><h3>Findings</h3><div>Overall, 15,534 eligible adults were identified in the MarketScan database and 6800 in the Optum CDM database; mean age was 46.2 years and 55.9 years, respectively, and in both databases, &gt;70% were female. A total of 70.6% (MarketScan) and 81.0% (Optum CDM) of individuals had at least one obesity-related complication, with the most prevalent being hypertension, dyslipidemia, and pre-diabetes. There were 8709 individuals in the MarketScan database and 3384 in the Optum CDM database with ≥6 months of follow-up. In both databases, approximately two-thirds of people were started on 2.5 mg and, by the sixth prescription fill, the most common doses of Tirzepatide were 5 mg and 7.5 mg. Tirzepatide persistence ranged from 60.6% to 75.7% across both databases, with an allowed gap between prescriptions of 45 days or 60 days. Of individuals who discontinued tirzepatide, 10.2–19.5% restarted Tirzepatide during the 6-month follow-up.</div></div><div><h3>Implications</h3><div>In both databases, most people initiating Tirzepatide without T2D diagnoses had ≥1 obesity-related complication, indicating that Tirzepatide is being used in people with multimorbidity. A high proportion of people who initiated Tirzepatide were persistent on treatment at 6 months, which is higher than that previously reported for glucagon-like peptide-1 receptor agonists.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 572-580"},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246858","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":"Efficacy and Safety of Nintedanib in Japanese Patients With Early-Stage Idiopathic Pulmonary Fibrosis: A One-Year Interim Analysis from a Multicenter Observational Study in Kyushu and Okinawa, Japan","authors":"Noriho Sakamoto ,&nbsp;Masaki Okamoto ,&nbsp;Kazunori Tobino ,&nbsp;Hidenori Ichiyasu ,&nbsp;Kazuya Ichikado ,&nbsp;Hiroshi Ishii ,&nbsp;Naoki Hamada ,&nbsp;Kazuhiro Yatera ,&nbsp;Taiga Miyazaki ,&nbsp;Hiroshi Ishimoto ,&nbsp;Takashi Kido ,&nbsp;Takuto Miyramura ,&nbsp;Shimpei Morimoto ,&nbsp;Naoki Hosogaya ,&nbsp;Hiroshi Mukae","doi":"10.1016/j.clinthera.2025.05.007","DOIUrl":"10.1016/j.clinthera.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease with a poor prognosis. Nintedanib, an antifibrotic agent, has been shown in clinical trials to slow the decline in forced vital capacity (FVC) and reduce acute exacerbations (AE-IPF). Long-term studies confirm its continued effectiveness, though side effects like diarrhea may affect adherence. Despite real-world data supporting nintedanib’s benefits, no prospective study has assessed its efficacy in early-stage IPF. This study evaluated the efficacy, safety, and tolerability of nintedanib in patients with early-stage IPF to assess its effectiveness outside randomized control trials.</div></div><div><h3>Methods</h3><div>A 1-year interim analysis of a prospective, multicenter observational study was conducted in Kyushu and Okinawa, Japan. This study included 215 patients with early-stage IPF (stage I/II per the Japanese IPF severity system) who were followed up for 52 weeks. Changes in FVC and diffusion capacity of carbon monoxide (DLco); incidence of adverse events, acute exacerbations, and death; and factors associated with FVC decline and nintedanib discontinuation were evaluated.</div></div><div><h3>Results</h3><div>The percentage of predicted FVC (%FVC) remained stable, from 83.2% at baseline to 83.7% at 52 weeks, while %DLco decreased from 70.8% to 64.2%. Incidences of acute exacerbation and death were both 4.7%. Nintedanib was discontinued due to adverse events in 21.9% of the patients. Risk factors for FVC decline (&gt;5%) included female sex, GAP stage II/III, low oxygen saturation (SpO₂) in the 6-minute walk test (6 MWT), and elevated biomarkers (KL-6). Significant factors for nintedanib discontinuation were advanced age, modified Medical Research Council (mMRC) grade I or higher, GAP stage II/III, low %FVC, low SpO₂ in the 6 MWT, short 6 MWT distance, and low albumin levels.</div></div><div><h3>Conclusion</h3><div>The findings of this interim analysis indicate that nintedanib has good efficacy, safety, and tolerability for early-stage IPF in real-world settings, outside randomized control trials.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 587-594"},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246859","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":"New Approach Combination-Dosed Therapy for Nonalcoholic Steatohepatitis Versus Vitamin E: A Randomized Controlled Trial","authors":"Amr Y. Zakaria Pharm D, MSc ,&nbsp;Rehab Badawi MD ,&nbsp;Hasnaa Osama PhD ,&nbsp;Mona A. Abdelrahman PhD ,&nbsp;Asmaa M. El-Kalaawy MD","doi":"10.1016/j.clinthera.2025.05.006","DOIUrl":"10.1016/j.clinthera.2025.05.006","url":null,"abstract":"<div><h3>Purpose</h3><div>There is currently no US Food and Drug Administration–approved remedy for nonalcoholic steatohepatitis (NASH). The present study evaluated the efficacy of N-acetyl cysteine (NAC) and rosuvastatin (RSV) compared with conventional vitamin E in patients with NASH.</div></div><div><h3>Methods</h3><div>This study was designed as a parallel, double-blinded, randomized controlled trial. Ninety patients who met the eligibility criteria were enrolled in this study. Subsequently, 45 patients were allocated to each group as follows: group 1 reported consistent administration of vitamin E 400 IU^Ⓡ (PHARCO-Pharmaceuticals) twice daily over a duration of 6 months. Group 2 included patients with NASH who received NAC, Gemacysteine 300 mg^Ⓡ (GEMA-Pharma) at 1200 mg twice daily, along with RSV, Crestor 20 mg^Ⓡ (AstraZeneca). To achieve the study’s objective, FibroScan^Ⓡ examination of liver tissue and fibrosis scores, as well as tests for liver aminotransferases, lipid profile, glycemic parameters, and hepatic and renal functions, besides health-related quality of life using the Short-Form 36 were evaluated before and after 6 months of treatment.</div></div><div><h3>Findings</h3><div>In group 1, a statistically significant decrease in the mean value of steatosis was observed after 6 months by 6.05% (<em>P</em> = 0.017), whereas treated group 2 exhibited a reduction of 16.49% (<em>P</em> = 0.001). Group 2 reported a statistically significant decrease in the mean fibrosis value of approximately 19.5% (<em>P</em> = 0.001). Fibrosis-4 Index score’s significance stated a reduction in the mean values within treatment group 2, with decreases of 51.70%. MACK-3 score which is a combination of homeostatic model assessment, aspartate aminotransferase, and cytokeratin-18, exhibited a notable reduction in mean values within treatment group 2 by 25.06% (<em>P</em> = 0.001). Concerning biological markers, malondialdehyde, both groups reported significant reductions in mean values of 11.90% (<em>P</em> = 0.006) and 27.43% (<em>P</em> = 0.001), respectively. Group 2 exhibited substantial reductions in mean levels of all biological markers: NOD-like receptor-associated protein 3 inflammasome decreased by 24.40%, tumor necrosis factor-α by 9.64%, tissue inhibitor of metalloproteinases 1 by 10.28%, N-terminal propeptide of procollagen type III by 14.58%, cytokeratin-18 by 23.44%, and fibroblast growth factor-21 by 15.08% (<em>P</em> &lt; 0.05), whereas group 1 did not demonstrate significant differences. Group 2 has substantial improvement in various metabolic parameters and health-related quality of life with accepted safety profile parameters.</div></div><div><h3>Implications</h3><div>Patients in group 2 treated with the combination of NAC/RSV exhibited tolerability and efficacy in improving liver steatosis and fibrosis, besides metabolic parameters, indicating a new combination approach to the management of NASH. C","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages e19-e30"},"PeriodicalIF":3.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246860","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":"Sex differences in time to testing for pulmonary embolism in the emergency department: a survival analysis","authors":"Brandon C. Maughan MD, MHS, MSHP ,&nbsp;Alexa Redmond MD, MPH ,&nbsp;Yoona Shim BS ,&nbsp;Nick Patrick MD ,&nbsp;Mike J. Hildebrand ,&nbsp;Bory Kea MD ,&nbsp;Esther K. Choo MD, MPH ,&nbsp;Angela F. Jarman MD, MPH","doi":"10.1016/j.clinthera.2025.04.014","DOIUrl":"10.1016/j.clinthera.2025.04.014","url":null,"abstract":"<div><h3>Study Objective</h3><div>Female patients experience delays in diagnostic testing for major cardiovascular diseases such as myocardial infarction and stroke. The objective of this study was to assess sex differences in the time to initial diagnostic testing among emergency department (ED) patients evaluated for pulmonary embolism (PE).</div></div><div><h3>Methods</h3><div>The sample included 15,038 adult patients evaluated for PE in 3 EDs from 2017 to 2023. The primary outcome was the time from ED arrival to the first order of a diagnostic test. Secondary outcomes included time to CT scan completion and time to admission for patients diagnosed with PE. Data on patient demographics, medical history, diagnostic test orders, and ED-operational factors were extracted from the electronic medical record. We performed survival analysis with a Cox proportional hazards model using an elastic net regression strategy for variable selection. Poisson regression with robust standard errors was used to measure the average marginal association of female sex with time to first PE test order.</div></div><div><h3>Results</h3><div>Female sex was associated with a slower time to first PE test (hazard ratio (HR) 0.92 [95% confidence interval (CI) 0.88, 0.95], p&lt;0.001) with an average delay of 7.2 minutes [95% CI 4.6, 9.8] compared to male patients. Secondary outcomes noted similar delays to CT scan completion (HR 0.85 [95% CI 0.8, 0.89], average 14.1 minutes [95% CI 9.3, 18.8]) and hospital admission (HR 0.83 [95% CI 0.71, 0.98], average 18.7 minutes [95% CI 1, 36.4]) for female patients compared to males.</div></div><div><h3>Conclusions</h3><div>Female patients experience slower times to diagnostic testing for PE in the emergency department. Future research should examine sex-associated delays to anticoagulation and other treatments.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 581-586"},"PeriodicalIF":3.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224626","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":"Comparative Efficacy and Safety of Antibiotic Regimens in Sepsis-Induced Acute Kidney Injury: A Retrospective Cohort Study","authors":"Yiheng Zhou MM ,&nbsp;Yan Sun MM","doi":"10.1016/j.clinthera.2025.05.001","DOIUrl":"10.1016/j.clinthera.2025.05.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute kidney injury (AKI) is a prevalent and serious complication in septic patients, potentially exacerbated by certain medications, which significantly affects morbidity and mortality rates. This study aims to evaluate the comparative efficacy and safety of different antibiotic regimens for treating sepsis-induced AKI.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed adult patients with AKI resulting from sepsis between 2022 and 2024. Patients were divided into three groups: Group 1 received beta-lactam monotherapy (e.g., piperacillin-tazobactam); Group 2 was treated with non-beta-lactam antibiotics (e.g., fluoroquinolones, macrolides); and Group 3 received combination therapy (e.g., betalactam plus vancomycin for MRSA). Data on demographics, clinical parameters, and outcomes—including in-hospital mortality, length of stay, and renal function—were collected.</div></div><div><h3>Findings</h3><div>A total of 552 patients were included, with no significant differences in baseline characteristics among the groups. The combination therapy group experienced a shorter duration of fever (1.33 ± 0.57 days, <em>P</em> = 0.001), lower 30-day mortality, and shorter ICU stays (4.36 = 0.81 days, <em>P</em> = 0.001). Serum creatinine levels rose significantly across all groups (<em>P</em> = 0.005), with the highest levels observed in the combination therapy group. AKI incidence was 25.3% in fluoroquinolone patients, 15.7% in beta-lactam patients, and 18.9% in the combination therapy group. Renal replacement therapy was required for 11.2% of betalactam and 16.5% of fluoroquinolone patients.</div></div><div><h3>Implications</h3><div>This study underscores significant differences in renal outcomes associated with various antibiotic regimens in septic patients with AKI. While combination therapy may improve infection control, it also poses risks to renal function. Clinicians should consider these findings when selecting antibiotic regimens for septic patients, particularly those with preexisting renal impairment.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 8","pages":"Pages 546-553"},"PeriodicalIF":3.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224625","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}