Medical Principles and Practice最新文献

{"title":"Selective Serotonin Reuptake Inhibitors and Risk of Serotonin Syndrome as Consequence of Drug-Drug Interactions: Analysis of the FDA Adverse Event Reporting System.","authors":"Chiara Elli, Alessio Novella, Chiara Elli, Luca Pasina","doi":"10.1159/000546109","DOIUrl":"10.1159/000546109","url":null,"abstract":"<p><p><p>Background: Medications exhibiting serotonergic properties, such as selective serotonin reuptake inhibitors (SSRIs) antidepressants, opioids, and other antidepressants can induce serotonin syndrome, a rare but potentially life-threatening adverse event.</p><p><strong>Aim: </strong>This study aims to investigate the risks of serotonin syndrome among different SSRIs and assess the influence of drug-drug interactions with other medications.</p><p><strong>Methods: </strong>We analyzed the suspected adverse events in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database.</p><p><strong>Results: </strong>We identified 13,312 reports of serotonin syndrome, 52% of which involved SSRIs (n = 6,921), with reporting odds ratios (RORs) of 24.19. Among the safety reports involving SSRIs, 4,851 cases reported at least one severe outcome. All active substances of the SSRI group were associated with serotonin syndrome, sertraline, and fluoxetine had the most reports, while fluvoxamine had the highest ROR and risk compared to all other SSRIs (ROR: 2.66, 95% confidence interval: 2.33-3.05). The combinations of SSRIs with other drugs with the most reported cases were SSRIs-antidepressants (n = 2,395) and SSRIs-opioids (n = 2,252). The combinations of SSRIs with serotonin-norepinephrine reuptake inhibitors (ROR 25.42) and \"other antidepressants\" (ROR 22.74) were associated with a signal for serotonin syndrome. The combination SSRIs-opioids was associated with a safety signal, particularly those with higher risk for serotonin syndrome, like tramadol and fentanyl (ROR 41.95).</p><p><strong>Conclusion: </strong>Close monitoring for symptoms of serotonin syndrome should be considered in patients with depression with a combination of antidepressants, and in those on SSRIs who also require linezolid, monoamine oxidase inhibitors or high-risk opioids, like tramadol, or fentanyl. </p>.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"456-463"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971811","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":"Differentiating Cardiac Sarcoidosis from Arrhythmogenic Right Ventricular Cardiomyopathy: A Systematic Review.","authors":"Tolga Sinan Güvenc, Hakan Hasdemir, Abdalla Abshir, Tolga Sinan Güvenç","doi":"10.1159/000546048","DOIUrl":"10.1159/000546048","url":null,"abstract":"<p><p><p>Objective: Cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are distinct disorders with different pathophysiologic pathways, but they share similar clinical presentations that could lead to misdiagnosis and inappropriate therapeutic decisions.</p><p><strong>Methods: </strong>We searched PubMed and Google Scholar databases and other relevant literature to retrieve comparative studies including CS and ARVC that were published before 2024. The National Heart, Lung and Blood Institute checklist was used for quality assessment and the review was conducted according to the PRISMA guidelines. Three reviewers determined study eligibility and made quality assessments.</p><p><strong>Results: </strong>A total of seven studies were included in the review. Patients with CS were older (five of seven studies) and had more comorbidities (two of two studies). PR interval (four of five studies) and QRS duration (four of four studies) were longer in CS. Most studies reported lower left ventricular ejection fraction in CS (five of six studies), and septal involvement on cardiac MRI was more common in CS (two of three studies). 18-Fluorodeoxyglucose uptake on positron emission tomography (PET) scan was seen in up to 90% of CS patients. 62.5%-100% of patients with CS fulfilled 1994 or 2010 International Task Force criteria for ARVC.</p><p><strong>Conclusions: </strong>Available evidence suggests that atrioventricular and intraventricular conduction defects in an older (>40 years) patient with low left ventricular ejection fraction should raise suspicion for CS, especially when other supportive findings, such as 18-fluorodeoxyglucose avidity on PET, were present. Neither 1994 nor 2010 ARVC Task Force criteria should be used to discriminate CS from ARVC. </p>.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"443-455"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025717","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":"Clinical and Medical Economic Value of Screening Colonoscopy before Laparoscopic Cholecystectomy.","authors":"Tsuyoshi Igami, Masanao Nakamura, Takuya Ishikawa, Takeshi Yamamura, Kentaro Yamao, Keiko Maeda, Yasuyuki Mizutani, Tsunaki Sawada, Yukihiro Yokoyama, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe, Masaki Sunagawa, Nobuyuki Watanabe, Taisuke Baba, Shoji Kawakatsu, Hiroki Kawashima, Tomoki Ebata","doi":"10.1159/000545322","DOIUrl":"10.1159/000545322","url":null,"abstract":"<p><strong>Objective: </strong>Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the clinical value of medical care costs for SC before LC.</p><p><strong>Subject and methods: </strong>Of the 509 patients who underwent LC, 335 underwent preoperative SC before LC. The electronic medical records were retrospectively reviewed, and the technical fees of SC and endoscopic and/or surgical resection for colorectal neoplasia (CRN) were analyzed.</p><p><strong>Results: </strong>In the 335 patients with SC before LC, the rate of CRN requiring resection, including advanced adenoma and adenocarcinoma, was 13.1%. The detected rate of CRN requiring resection in the age-groups of <45, 44-55, 55-65, 65-75, ≥75 years was 5.3%, 3.8%, 9.8%, 17.4%, and 22.9%, respectively. Of the 174 patients without SC before LC, 4 patients were diagnosed with resectable colorectal carcinomas after LC. The total technical fees of SC and/or treatment of CRNs among the 335 patients with SC before LC and surgical procedures among the 4 patients with resectable colorectal carcinoma were United States dollar (USD) 84,700 and USD 32,000 USD, respectively. Regarding the technical fee per person, the former group (USD 250) had much economic advantage compared to the latter group (USD 8,000).</p><p><strong>Conclusion: </strong>Scheduling LC is recognized as an important chance to undergo SC. For the patients aged ≥55 years, colonoscopy is no longer a screening option but a clinical necessity due to the high detected rates of CRN requiring resection.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"369-378"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657530","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}

{"title":"The Anti-Elixir Triad: Non-Synced Circadian Rhythm, Gut Dysbiosis, and Telomeric Damage.","authors":"Anup Kumar Mani, Venkatachalam Deepa Parvathi, Sumitha Ravindran","doi":"10.1159/000542557","DOIUrl":"10.1159/000542557","url":null,"abstract":"<p><p>Aging is an inevitable life process which is accelerated by lifestyle and environmental factors. It is an irreversible accretion of molecular and cellular damage associated with changes in the body composition and deterioration in physiological functions. Each cell (other than stem cells) reaches the limit of its ability to replicate, known as cellular or replicative senescence, and consequently, the organs lose their physiological functions, resulting in overall impairment. Other factors that promote aging include smoking, alcohol, UV rays, sleep habits, food, stress, sedentary lifestyle, and genetic abnormalities. These stress factors can alter our endogenous clock (the circadian rhythm) and the microbial commensals. As a result of the effect of these stressors, the microorganisms that generally support human physiological processes become baleful. The disturbance of natural physiology instigates many age-related pathologies, such as cardiovascular diseases, chronic obstructive pulmonary disorder, cerebrovascular diseases, opportunistic infections, high blood pressure, cancer, diabetes, kidney diseases, dementia, and Alzheimer's disease. The present review covers the three most essential processes of the circadian clock; the circadian gene mechanism and regulation, the mitotic clock (which plays a vital role in the telomere's attrition) and the gut microbiota and their metabolome that drive aging and lead to age-related pathologies. In conclusion, maintaining a synchronized circadian rhythm, a healthy gut microbiome, and telomere integrity is essential for mitigating the effects of aging and promoting longevity. The interplay among these factors underscores the importance of lifestyle choices in enhancing overall health and lifespan.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"212-225"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623803","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":"Racial Discrimination and Multiple Health Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses.","authors":"Jun Hyuk Lee, Hyeri Lee, Yejun Son, Hyeon Jin Kim, Jaeyu Park, Hayeon Lee, Guillaume Fond, Laurent Boyer, Lee Smith, Masoud Rahmati, Damiano Pizzol, Jiseung Kang, Dong Keon Yon, Hans Oh","doi":"10.1159/000542988","DOIUrl":"10.1159/000542988","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to systematically investigate the associations between racial discrimination and various health outcomes and to evaluate the certainty of evidence from existing meta-analyses of observational studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We systemically searched the associations between racial discrimination and health outcomes for PubMed/MEDLINE, Embase, WoS, and Google Scholar up until January 31, 2024. Notably, the included studies were predominantly conducted in the USA and Europe, limiting the generalizability of our findings to a global context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight meta-analyses of observational studies involving over 1 million individuals were included, describing 15 potential health outcomes related to racial discrimination. The quality assessment revealed that most included meta-analyses were of low quality. For oncological health outcomes, significant associations were found with the mortality of hepatocellular carcinoma (HCC); black patients had a higher risk, while Asian patients had a lower risk when compared to white patients. In addition, black patients with disparities on the cancer care continuum are a protective factor for early-stage HCC diagnosis. For gastroenterological health outcomes, Hispanic patients with nonalcoholic fatty liver disease and black patients with socioeconomic status/differential access to health care, compared to white patients (reference), showed significant associations. For mental health outcomes, racial discriminations were significantly associated with increased odds of psychotic experiences, suicidal ideation, and suicidal attempts. Numerous significant associations were from weak to suggestive evidence levels, indicating variability in the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Despite the complexity of measuring its impact, racial discrimination shows a profound influence across clinical areas, including an unexpected protective association in early-stage HCC diagnosis among black patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to systematically investigate the associations between racial discrimination and various health outcomes and to evaluate the certainty of evidence from existing meta-analyses of observational studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We systemically searched the associations between racial discrimination and health outcomes for PubMed/MEDLINE, Embase, WoS, and Google Scholar up until January 31, 2024. Notably, the included studies were predominantly conducted in the USA and Europe, limiting the generalizability of our findings to a global context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight meta-analyses of observational studies involving over 1 million individuals were included, describing 15 potential health outcomes related to racial discrimination. The quality assessment revealed that most included meta-analyses were of low quality. For oncological health outcomes, significant associations were found with the mortali","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"138-151"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785459","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}