Medical Principles and Practice最新文献

{"title":"Effectiveness of Hormonal Therapy for Post-Menopausal Women with Hormone Receptor-Positive Advanced Breast Cancer: A Systematic Review and Meta-Analysis of Clinical Trials.","authors":"Vitalis C Okwor, Juliet C Okwor, Maryjane K Ukwuoma, Sara B Mitha, Martins C Nweke","doi":"10.1159/000545264","DOIUrl":"10.1159/000545264","url":null,"abstract":"<p><strong>Objective: </strong>Breast cancer (BC) cells exhibit mutations over time, conferring resistance to therapeutic approaches. We attempted to ascertain the efficacy of selected hormonal therapy for advanced BC.</p><p><strong>Methods: </strong>This is a systematic review and meta-analysis of clinical trials. We searched Medline, PubMed, Cochrane Library, Web of Science, and others. Studies that investigated the effectiveness of hormonal therapy for HR positive (HR+) advanced BC were included. The outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). A random-effect meta-analysis model was employed. The study protocol was registered with the International Prospective Register of Systematic Reviews: CRD42023431939.</p><p><strong>Results: </strong>Twenty-one studies were included in the meta-analysis with an overall sample size of 8,482. ORR and PFS between aromatase inhibitors (AIs) and other hormonal therapies: selective oestrogen receptor degrader, selective oestrogen modulator (SERM) and androgen inhibitors showed no significant difference (OR = 1.122 [0.917-1.374], p = 0.263; OR = 0.010 [0.000-1.292], p = 0.063), respectively. Subgroup analysis showed a statistically significant difference in ORR in favour of patients who received SERM compared to AI (OR = 1.362 [1.033-1.795], p = 0.028). For OS, no significant difference was observed among anastrozole, letrozole, and exemestane recepients (OR = 1.718 [0.021-139.128], p = 0.809).</p><p><strong>Conclusion: </strong>Given the above findings, clinical decisions could be based on factors such as the line of cancer treatment, adverse events, drug dosing, and individual drug benefits. Although newer combination therapies are being adopted, the agents explored in this review are still widely used in clinical practice for HR+ BC.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"338-359"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Implications of COVID-19.","authors":"Andreas S Triantafyllis, Danai Sfantou, Eleni Karapedi, Katerina Peteinaki, Sotirios C Kotoulas, Richard Saad, Petros N Fountoulakis, Konstantinos Tsamakis, Dimitrios Tsiptsios, Loukianos Rallidis, James N Tsoporis, Dimitrios Varvarousis, Eftychia Hamodraka, Andreas Giannakopoulos, Leonidas E Poulimenos, Ignatios Ikonomidis","doi":"10.1159/000541553","DOIUrl":"10.1159/000541553","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Patients with SARS-CoV-2 infection carry an increased risk of cardiovascular disease encompassing various implications, including acute myocardial injury or infarction, myocarditis, heart failure, and arrhythmias. A growing volume of evidence correlates SARS-CoV-2 infection with myocardial injury, exposing patients to higher mortality risk. SARS-CoV-2 attacks the coronary arterial bed with various mechanisms including thrombosis/rupture of preexisting atherosclerotic plaque, de novo coronary thrombosis, endotheliitis, microvascular dysfunction, vasculitis, vasospasm, and ectasia/aneurysm formation. The angiotensin-converting enzyme 2 receptor plays pivotal role on the cardiovascular homeostasis and the unfolding of COVID-19. The activation of immune system, mediated by proinflammatory cytokines along with the dysregulation of the coagulation system, can pose an insult on the coronary artery, which usually manifests as an acute coronary syndrome (ACS). Electrocardiogram, echocardiography, cardiac biomarkers, and coronary angiography are essential tools to set the diagnosis. Revascularization is the first-line treatment in all patients with ACS and obstructed coronary arteries, whereas in type 2 myocardial infarction treatment of hypoxia, anemia and systemic inflammation are indicated. In patients presenting with coronary vasospasm, nitrates and calcium channel blockers are preferred, while treatment of coronary ectasia/aneurysm mandates the use of antiplatelets/anticoagulants, corticosteroids, immunoglobulin, and biologic agents. It is crucial to untangle the exact mechanisms of coronary involvement in COVID-19 in order to ensure timely diagnosis and appropriate treatment. We have reviewed the current literature and provide a detailed overview of the pathophysiology and clinical spectrum associated with coronary implications of SARS-COV-2 infection. Patients with SARS-CoV-2 infection carry an increased risk of cardiovascular disease encompassing various implications, including acute myocardial injury or infarction, myocarditis, heart failure, and arrhythmias. A growing volume of evidence correlates SARS-CoV-2 infection with myocardial injury, exposing patients to higher mortality risk. SARS-CoV-2 attacks the coronary arterial bed with various mechanisms including thrombosis/rupture of preexisting atherosclerotic plaque, de novo coronary thrombosis, endotheliitis, microvascular dysfunction, vasculitis, vasospasm, and ectasia/aneurysm formation. The angiotensin-converting enzyme 2 receptor plays pivotal role on the cardiovascular homeostasis and the unfolding of COVID-19. The activation of immune system, mediated by proinflammatory cytokines along with the dysregulation of the coagulation system, can pose an insult on the coronary artery, which usually manifests as an acute coronary syndrome (ACS). Electrocardiogram, echocardiography, cardiac biomarkers, and coronary angiography are essential tools to set the diagnosis. Revascularization is th","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking Nitrofurantoin: Understanding Molecular Mechanisms of Action and Resistance in Enterobacterales.","authors":"Balaram Khamari, Eswarappa Pradeep Bulagonda","doi":"10.1159/000542330","DOIUrl":"10.1159/000542330","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Antimicrobial resistance (AMR) is a global health crisis that has already claimed millions of lives and is projected to affect millions more unless urgent action is taken. Effective control of AMR requires the correct choice and dosage of antibiotics, as well as robust surveillance and research. Understanding the mechanisms of antibiotic action and the emergence of resistance phenotypes along with their genotypes is essential. This knowledge, combined with insights into resistance prevalence and spread, empowers clinicians to propose alternative therapies. Nitrofurantoin, a 70-year-old antibiotic, remains effective for the treatment of uncomplicated lower UTIs. Preventing emergence and spread of nitrofurantoin-resistant superbugs would preserve the efficacy of this antibiotic which is crucial for ongoing and future AMR efforts. Nitrofurantoin resistance evolves slowly, leading to low prevalence compared to other antibiotics. However, it is often linked with extensive drug resistance, complicating treatment outcomes. Even a minor percentage of nitrofurantoin-resistant bacteria can cause significant clinical challenges due to irreversible evolution. While detailed study of these mechanisms can guide the development of strategies to combat nitrofurantoin resistance, early detection of resistant infections is critical for saving lives. The current review aimed to provide a comprehensive analysis of nitrofurantoin's mechanisms of action, resistance evolution, prevalence, and resistance prediction. Our goal is to offer valuable insights for researchers and clinicians to enhance nitrofurantoin use and address the challenges posed by AMR. Antimicrobial resistance (AMR) is a global health crisis that has already claimed millions of lives and is projected to affect millions more unless urgent action is taken. Effective control of AMR requires the correct choice and dosage of antibiotics, as well as robust surveillance and research. Understanding the mechanisms of antibiotic action and the emergence of resistance phenotypes along with their genotypes is essential. This knowledge, combined with insights into resistance prevalence and spread, empowers clinicians to propose alternative therapies. Nitrofurantoin, a 70-year-old antibiotic, remains effective for the treatment of uncomplicated lower UTIs. Preventing emergence and spread of nitrofurantoin-resistant superbugs would preserve the efficacy of this antibiotic which is crucial for ongoing and future AMR efforts. Nitrofurantoin resistance evolves slowly, leading to low prevalence compared to other antibiotics. However, it is often linked with extensive drug resistance, complicating treatment outcomes. Even a minor percentage of nitrofurantoin-resistant bacteria can cause significant clinical challenges due to irreversible evolution. While detailed study of these mechanisms can guide the development of strategies to combat nitrofurantoin resistance, early detection of resistant infections is critical","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"121-137"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-Genome Sequencing of Brucella melitensis Isolates from Kuwait for the Identification of Biovars, Variants, and Relationship within a Biovar.","authors":"Abu Salim Mustafa, Mohd Wasif Khan, Nazima Habibi, Wadha Alfouzan","doi":"10.1159/000542867","DOIUrl":"10.1159/000542867","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The identification of Brucella genotypes is essential for epidemiological studies. The whole-genome sequencing is emerging as a novel tool for genetic characterization of infectious microbes. The aim of this study was to genotype Brucella melitensis isolates from Kuwait using whole-genome sequencing and variant analysis of the sequence data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;DNA was purified from 15 heat-inactivated B. melitensis isolates and used to prepare sequencing libraries employing Nextera XT DNA Sample Preparation Kit (Illumina San Diego, CA, USA) and sequenced on a MiSeq (Illumina). The sequence files were aligned to three biovars of B. melitensis, i.e., biovar 1 str. 16M, biovar 2 str. 63/9, and biovar 3 str. Ether. The alignment and variant calling were performed using \"bwa-mem\" and SAMtools/VCFtools, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The genome size of all the isolates was around 3.3 mega base pairs and resembled B. melitensis biovar 2. Single-nucleotide polymorphisms (SNPs), insertions, and deletions (indels) were spread all over the genome; but 138 SNPs were common among the 14 isolates, supporting the same ancestral origin. A neighbor-joining tree analysis identified isolate 2 as an outlier. In addition, SNPs (2-478) specific to each isolate were also identified, which divided the B. melitensis biovar 2 into two major groups/genotypes. A further analysis showed that the Kuwaiti isolates of the present study shared phylogeny mainly with strains from the Middle Eastern countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among the 15 studied isolates from Kuwait, biovar 2 is the most prevalent biovar of B. melitensis. Furthermore, isolate-specific genetic variations were identified, which may be useful in epidemiological investigations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The identification of Brucella genotypes is essential for epidemiological studies. The whole-genome sequencing is emerging as a novel tool for genetic characterization of infectious microbes. The aim of this study was to genotype Brucella melitensis isolates from Kuwait using whole-genome sequencing and variant analysis of the sequence data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;DNA was purified from 15 heat-inactivated B. melitensis isolates and used to prepare sequencing libraries employing Nextera XT DNA Sample Preparation Kit (Illumina San Diego, CA, USA) and sequenced on a MiSeq (Illumina). The sequence files were aligned to three biovars of B. melitensis, i.e., biovar 1 str. 16M, biovar 2 str. 63/9, and biovar 3 str. Ether. The alignment and variant calling were performed using \"bwa-mem\" and SAMtools/VCFtools, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The genome size of all the isolates was around 3.3 mega base pairs and resembled B. melitensis biovar 2. Single-nucleotide polymorphisms (SNPs), insertions, and deletions (indels) were spread all over the genome; but 138 SNPs were common among the 14 isolates, supporting the same an","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"152-161"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Statin Use and Pulp Chamber Calcification: A Pilot Retrospective Case-Control Study Using Cone-Beam Computed Tomography.","authors":"Selen Nihal Sisli, Birgul Ozasir, Tufan Ozasir, Derin Bugu Yuzer, Kamran Gulsahi","doi":"10.1159/000542398","DOIUrl":"10.1159/000542398","url":null,"abstract":"<p><strong>Objectives: </strong>This pilot retrospective case-control study questioned whether systemic statin use causes pulp calcification using cone-beam computed tomography (CBCT) images from the patients prescribed oral statins and comparing those of healthy individuals.</p><p><strong>Subjects and methods: </strong>CBCT scans of 54 patients, including 27 age- and sex-matched patients for the study and control groups, were analysed using Mimics Innovation Suite software. The study included patients using statins regularly for at least 1 year. Only intact teeth with opposing teeth were selected for the study group and matched with the control group. Dental crown and pulp chamber volumes were calculated and proportioned. The data were analysed with chi-square and Shapiro-Wilk tests to assess normal distribution, followed by Mann-Whitney U test if necessary.</p><p><strong>Results: </strong>Statistical analysis showed no difference between the study and control groups (p = 0.505). Statin use duration did not cause statistically significant difference in terms of the reduction of pulp chamber volume (p = 0.141).</p><p><strong>Conclusion: </strong>Within the limitations of the study, systemic statin use did not cause dental pulp calcification. The results suggest, oral administration of the statin drugs is not an unfavourable condition for dental practice. Further studies with larger numbers of patients are needed to support this conclusion.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"291-300"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biopsychosocial Factors and Pain Hypervigilance Should Be Considered in the Interpretation of Disease Activity in Systemic Sclerosis.","authors":"Özlem Kılıç, Mehmet Nur Kaya, Muhammed Canbaş, Muhammet Çınar, Sedat Yılmaz","doi":"10.1159/000545343","DOIUrl":"10.1159/000545343","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify a pain phenotype associated with hypervigilance in systemic sclerosis (SSc) and evaluate possible variables that influence pain hypervigilance symptoms.</p><p><strong>Methods: </strong>This cross-sectional, observational study included healthy controls (HCs) and SSc patients diagnosed with a score of 9 or higher according to the 2013 American College of Rheumatology-European League against Rheumatism classification criteria. The pain hypervigilance symptoms were evaluated using the central sensitization inventory (CSI), while disease activity was assessed using the European Scleroderma Research Group Activity Index (EScSG-AI). Patients were classified by CSI scores. Comparatives were done.</p><p><strong>Results: </strong>A total of 51 SSc patients (92.2% female, mean age [50.54 years]) and 45 HCs (88.9% female, mean age [52.62]) were included. Education and monthly income were lower for SSc than HCs (p < 0.05). The CSI score ≥40 proportion was 56.9% in SSc and 15.6% in HCs (p < 0.001). Depression-Anxiety-Stress Scale (DASS-21), Epworth Sleepiness Scale (ESS), Global Pittsburgh Sleep Quality Index (PSQI), and EuroQol Five-Dimensional Three-Level Questionnaire (EQ-5D-3L) scores were higher in SSc than HCs (p < 0.05). By using multiple linear regression analysis to determine predictors of CSI score ≥40, the effective variable was EScSG-AI. In multivariate logistic regression analysis, educational level and global PSQI scores were factors associated with CSI score ≥40 in SSc.</p><p><strong>Conclusions: </strong>CSI score was positively associated with depression, disease activity, stress, anxiety, and poor sleep quality, while it was negatively associated with education and economic status. Pain hypervigilance may affect organ involvement and functioning in SSc. Clinicians should examine its biopsychosocial components.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"379-390"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Dose Escalation of Ustekinumab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Mohammad Ebad Ur Rehman, Ammara Tahir, Amna Hussain, Aizaz Ali, Abu Huraira Bin Gulzar, Abdul Qadeer Khan, Maha Sajjad, Fatima Shahid, Shahroon Zahid, Ummara Aslam, Talha Bin Yasin, Aqsa Bilal, Tehreem Fatima, Muhammad Sheraz Hameed, Tehseen Haider, Sajeel Saeed, Abdulqadir J Nashwan","doi":"10.1159/000543831","DOIUrl":"10.1159/000543831","url":null,"abstract":"<p><strong>Background: </strong>Ustekinumab is an effective drug in the treatment of inflammatory bowel disease (IBD), but inadequate response or loss of response is reported in several patients. Dose escalation by intravenous reinduction or interval shortening may be a suitable option to recapture response. We undertook a systematic review and meta-analysis to assess the efficacy of dose escalation in IBD patients receiving ustekinumab.</p><p><strong>Methods: </strong>A systematic literature search was conducted on PubMed, Embase, Clinicaltrails.gov, and Cochrane from inception to June 1, 2024. We conducted a proportional meta-analysis on MetaXL. Our primary outcomes were clinical response and clinical remission.</p><p><strong>Results: </strong>Twenty-eight articles were included (n = 2,129 patients). Eighteen studies (692 patients out of 1,218) reported clinical response, with pooled prevalence of 55% (95% CI: 46-65%). Out of 1,041 patients, 524 showed clinical remission with pooled prevalence of 51% (95% CI: 42-59%).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis showcased promising results, in terms of clinical response and remission, in IBD patients receiving dose escalation of ustekinumab.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"226-237"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Relationship between CD44 Expression and Gleason Grade among Prostate Adenocarcinoma and Benign Prostatic Hyperplasia: A Cross-Sectional Study.","authors":"Joben Kianparsa, Masood Soltanipur, Mohammadreza Jalali Nadoushan","doi":"10.1159/000544021","DOIUrl":"10.1159/000544021","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the expression of cluster of differentiation 44 (CD44) in prostate adenocarcinoma (PAC) compared to benign prostatic hyperplasia (BPH) to address the need for biomarkers that can aid in grading classification and prognosis.</p><p><strong>Methods: </strong>In this cross-sectional study, the CD44 expression in the tissue samples of the PAC and BPH was examined with hematoxylin and eosin and immunohistochemistry methods. The Gleason scores and grades and percentage of CD44 expression for specimens were determined. Data were analyzed using IBM SPSS version 23.0 software.</p><p><strong>Results: </strong>This study included 80 PAC and 83 BPH samples. The mean expression of CD44 in PAC samples was significantly lower than in BPH samples (28.59 ± 14.84 vs. 47.82 ± 14.65, p < 0.001). A moderate to strong significant negative correlation was found between CD44 expression and total Gleason scores and Gleason grade groups (r: -0.743, p < 0.001; r: -0.732, p < 0.001, respectively). Ordinal logistic regression showed that lower CD44 expression was associated with higher odds of advanced disease (OR = 0.884, p < 0.001).</p><p><strong>Conclusion: </strong>This study highlights CD44 expression not only as a potential biomarker for PAC diagnosis but also potential guide to therapeutic decision-making. Patients exhibiting lower CD44 levels may require closer monitoring and more aggressive treatment strategies, while those with higher expression may be candidates for less intensive management. Overall, our findings advocate for further investigation into CD44 as a biomarker for prostate cancer aggressiveness, which could ultimately enhance personalized treatment approaches and improve the patient outcomes.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"271-280"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Implantable Cardioverter Defibrillator Shocks in Heart Failure Patients Undergoing Diuretic Therapy.","authors":"Ilke Erbay, Naile Eris Gudul, Ugur Kokturk, Pelin Aladag, Meltem Kandazoglu, Ahmet Avci","doi":"10.1159/000542172","DOIUrl":"10.1159/000542172","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Implantable cardioverter defibrillators (ICDs) are the standard treatment for patients with reduced left ventricular ejection fraction (LVEF ≤35%) to reduce the risk of sudden cardiac death. Loop diuretics can cause electrolyte imbalances, leading to an increased incidence of ICD shocks. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have shown cardiovascular benefits in patients with heart failure (HF), but their effects on ventricular arrhythmias and ICD shocks, particularly in patients receiving different doses of loop diuretics, are not fully understood. This study evaluated the effects of furosemide dose and SGLT2i use on ICD shocks in HF patients with reduced left ventricular ejection fraction (HFrEF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;HFrEF patients using oral furosemide and undergoing ICD implantation in our clinic were followed for 12 months to monitor ICD shocks for ventricular arrhythmias. They were grouped according to daily oral furosemide dose and SGLT2i use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 175 patients, the use of high-dose furosemide (&gt;80 mg/day) was significantly higher in the ICD shock group compared to the non-shock group (38.8% vs. 16.7%, p = 0.001), while the use of SGLT2i was lower (19.4% vs. 45.4%, p &lt; 0.001). ICD shocks occurred in 67.6% of patients on high-dose furosemide without SGLT2i and 30.0% with SGLT2i (p &lt; 0.001). Multivariate analysis identified the absence of SGLT2i as an independent predictor of ICD shocks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;SGLT2i was associated with reduced ventricular arrhythmias and ICD shocks in HF patients, even when high doses of furosemide were used. The absence of SGLT2i in HF treatment was an independent predictor of ICD shocks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Implantable cardioverter defibrillators (ICDs) are the standard treatment for patients with reduced left ventricular ejection fraction (LVEF ≤35%) to reduce the risk of sudden cardiac death. Loop diuretics can cause electrolyte imbalances, leading to an increased incidence of ICD shocks. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have shown cardiovascular benefits in patients with heart failure (HF), but their effects on ventricular arrhythmias and ICD shocks, particularly in patients receiving different doses of loop diuretics, are not fully understood. This study evaluated the effects of furosemide dose and SGLT2i use on ICD shocks in HF patients with reduced left ventricular ejection fraction (HFrEF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;HFrEF patients using oral furosemide and undergoing ICD implantation in our clinic were followed for 12 months to monitor ICD shocks for ventricular arrhythmias. They were grouped according to daily oral furosemide dose and SGLT2i use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 175 patients, the use of high-dose furosemide (&gt;80 mg/day) was significantly higher in the ICD shock group compared to the non-shock group (38.8% v","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"179-190"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance of Corrected QT Interval-Prolonging Medications upon Admission throughout Hospitalization in a Tertiary Care Geriatric Ward.","authors":"Ivana Baralić Knežević, Milena Kovačević, Katarina Stefanović, Predrag Erceg, Gordana Mihajlović, Jovana Aćimović, Katarina M Vučićević","doi":"10.1159/000544820","DOIUrl":"10.1159/000544820","url":null,"abstract":"<p><strong>Objective: </strong>Long QT syndrome (LQTS) poses a significant risk of torsade de pointes, particularly in older patients due to age-related changes in cardiac repolarization and increased susceptibility to medication-induced QTc interval prolongation. Despite the increased risk, data on medication-related LQTS remain limited, leading to this study on its prevalence, characteristics, and risk factors, along with QT-prolonging drug use in older patients. The study aimed to identify clinical and medication-related predictors of LQTS and evaluate the burden of co-prescribed QT-prolonging medications in this population.</p><p><strong>Subjects and methods: </strong>This prospective study at a tertiary care hospital included initial and follow-up ECGs, with medication details were collected. Statistical analyses compared variables, including QTc intervals and medication use, between patients with and without LQTS.</p><p><strong>Results: </strong>The study included 128 adults aged 65 or older, with 27.3% presenting LQTS on admission, increasing to 42.2% after 7 days of hospitalization. Patients with LQTS had a higher prevalence of QTc interval-prolonging medications, list 1 medications, and atrial fibrillation. Laboratory changes and medication use were observed, with significant increases in QTc interval and list 1 medication administration. Male sex and amiodarone use were identified as predictors of LQTS during hospitalization.</p><p><strong>Conclusion: </strong>The study reports a high prevalence of prolonged QTc interval and LQTS in older inpatients. Proton pump inhibitors were frequently prescribed despite their QTc-prolonging potential. This underscores the need of close monitoring and awareness of QTc prolongation risks in older patients, advocating for routine ECG assessments and vigilant management of modifiable risk factors, especially the electrolytes.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"281-290"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}