Medical Principles and Practice最新文献

{"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":"<p><strong>Objective: </strong>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).</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>Out of 175 patients, the use of high-dose furosemide (>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 < 0.001). ICD shocks occurred in 67.6% of patients on high-dose furosemide without SGLT2i and 30.0% with SGLT2i (p < 0.001). Multivariate analysis identified the absence of SGLT2i as an independent predictor of ICD shocks.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FORTA Score and Negative Outcomes in Older Adults: Insights from Italian Internal Medicine Wards.","authors":"Marina Azab, Alessio Novella, Luca Pasina","doi":"10.1159/000542109","DOIUrl":"10.1159/000542109","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to assess the relationship between the Fit fOR The Aged (FORTA) score - a classification system designed to evaluate medication appropriateness in older adults - and several negative outcomes, including impaired cognitive performance, functional status, adverse clinical events, and all-cause mortality at 3, 6, and 12 months after hospital discharge.</p><p><strong>Methods: </strong>This retrospective study utilized data from the ELICADHE cohort, a cluster-randomized trial conducted across 20 Italian internal medicine and geriatric wards. The study included patients aged 75 and older with complete FORTA score assessments. Demographics, medication history, and comorbidities were collected. The FORTA classification system assessed medication appropriateness. FORTA scores were calculated and FORTA score cut-offs (3 and 5) were applied. Statistical analyses included descriptive statistics, survival analysis with Cox regression, logistic regression, and negative-binomial regression using SAS 9.4 and RStudio 12.1. Ethical approval was obtained.</p><p><strong>Results: </strong>Of the 506 patients included, 171 (33.8%) were fully assessable with complete FORTA scores. The study found no significant association between higher FORTA scores and impaired cognitive performance, functional status, or mortality. Additionally, no clear relationship was observed between FORTA scores and adverse clinical events or mortality. The analysis indicated that age was a significant factor associated with mortality and adverse clinical events.</p><p><strong>Conclusion: </strong>The study did not find a significant relationship between the FORTA score and negative outcomes in older patients discharged from internal medicine and geriatric wards. Further research is needed to define specific FORTA score cut-off values and expand the criteria to improve medication assessment in this population.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Advanced Glycation End Products in Saphenous Vein Graft Failure.","authors":"Alkame Akgümüş, Bedrettin Boyraz, Ahmet Balun","doi":"10.1159/000541879","DOIUrl":"10.1159/000541879","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the relationship between advanced glycation end product (AGE) levels in patients with saphenous vein graft (SVG) failure and in patients without SVG failure.</p><p><strong>Subjects and methods: </strong>In our study, 55 patients with a history of previous coronary artery bypass grafting (CABG) surgery, who subsequently underwent coronary angiography for any reason and were found to have either SVG occlusion or significant lesions, were included as study patients. Additionally, 55 patients who have had CABG surgery without SVG failure for at least 1 year served as the control group. AGE values of the patients were measured using the skin autofluorescence method.</p><p><strong>Results: </strong>In our study results, we observed a significant difference in AGE levels between the two groups of patients with similar demographic characteristics (SVG failure groups AGE 3.2 [2.8-3.6] vs. control groups AGE 2.4 [2.1-2.7] p < 0.001). In the receiver operating characteristic curve analysis, we determined the ability of AGE levels to detect SVG failure with an area under the curve of 0.869. We found that in patients with AGE >3, it could detect SVG failure with a sensitivity of 70.9% and a specificity of 87.3%.</p><p><strong>Conclusions: </strong>Our results demonstrate that AGE levels can predict SVG failure risk inexpensively, easily, and quickly.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Sodium and Laboratory Parameters in Determining Complicated Appendicitis in Children.","authors":"Ramazan Amanvermez, Hızır Ufuk Akdemir","doi":"10.1159/000541748","DOIUrl":"10.1159/000541748","url":null,"abstract":"","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global and Regional Burden of Vaccine-Associated Erythema Multiforme and Their Related Vaccines, 1967-2023: An In-Depth Analysis of the World Health Organization Pharmacovigilance Database.","authors":"Seoyeon Kyung, Masoud Rahmati, Jiseung Kang, Kyeogmin Lee, Hayeon Lee, Dong Keon Yon","doi":"10.1159/000541797","DOIUrl":"10.1159/000541797","url":null,"abstract":"<p><strong>Objective: </strong>Vaccine-associated erythema multiforme (EM) remains under-researched, impacting global vaccine safety evaluations. This study examines the global and regional burden of EM and its association with specific vaccines to optimize vaccination strategies.</p><p><strong>Subject and methods: </strong>We analyzed data from the WHO pharmacovigilance database on vaccine-associated EM from 1967 to 2023 (n = 131,255,418 reports). Reporting frequencies, reported odds ratios (RORs), and information components (IC) were calculated for 16 vaccines across 170 countries.</p><p><strong>Results: </strong>We identified 6,355 cases (males, n = 3,182 [50.07%]) of vaccine-associated EM from a total of 46,378 reports of all-cause EM. While vaccine-associated EM has been consistently reported, there has been a notable increase in reported incidence particularly in 2010 and 2020. Measles, mumps, and rubella vaccines had the highest association with vaccine-associated EM reports (ROR: 8.75 [95% confidence interval, 8.11-9.44]; IC, 3.10 [IC0.25, 2.97]), followed by hepatitis B (8.54 [7.66-9.51]; 3.06 [2.88]), hepatitis A (8.11 [7.01-9.39]; 2.98 [2.74]), typhoid (6.50 [4.75-8.90]; 2.60 [2.07]), encephalitis (5.86 [4.35-7.91]; 2.47 [1.96]), diphtheria, tetanus toxoids, pertussis, polio, and Hemophilus influenza type b (5.70 [5.42-5.99]; 2.46 [2.38]), pneumococcal (5.56 [5.11-6.06]; 2.45 [2.31]), rotavirus (4.96 [4.21-5.84]; 2.29 [2.01]), varicella-zoster (4.44 [3.99-4.95]; 2.13 [1.95]). Vaccine-associated EM reports were more strongly correlated with younger age groups and males. The overall fatality rate of vaccine-associated EM was 0.04%.</p><p><strong>Conclusions: </strong>The rise in vaccine-associated EM across multiple vaccines, especially in younger populations, highlights the need for closer monitoring and more informed vaccination practices to mitigate adverse reactions.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-14"},"PeriodicalIF":2.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter on \"Plasma Sodium and Laboratory Parameters in Determining Complicated Appendicitis in Children\".","authors":"Zlatan Zvizdic, Asmir Jonuzi, Una Glamoclija, Semir Vranic","doi":"10.1159/000541749","DOIUrl":"10.1159/000541749","url":null,"abstract":"","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","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":"<p><p>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.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Baricitinib Effective and Safe for Patients with Difficult-to-Treat Rheumatoid Arthritis? Comparative Data with the RA Group of Rheumatoid Arthritis not Difficult to Treat.","authors":"Ali Ekin,Salim Misirci,Ahmet Görünen,Belkis Nihan Coskun,Burcu Yagiz,Ediz Dalkilic,Yavuz Pehlivan","doi":"10.1159/000541488","DOIUrl":"https://doi.org/10.1159/000541488","url":null,"abstract":"OBJECTIVEThis study investigates the efficacy and safety of baricitinib, an oral targeted synthetic Disease Modifying Anti-Rheumatic Drugs (DMARD), in patients with difficult-to-treat rheumatoid arthritis (D2T RA) compared to those without, aiming to determine its potential as an alternative treatment for D2T RA.SUBJECT AND METHODSA total of 78 patients participated in this retrospective cohort study, with 33 meeting the D2T RA criteria and 45 were in the non-D2T RA group. Various clinical and laboratory parameters, adverse events, and disease activity indices were assessed, alongside drug efficacy and survival rates.RESULTSPatients with D2T RA exhibited higher seronegativity, prior use of bDMARDs and cDMARDs, and longer disease duration. Both groups experienced reductions in VAS and DAS28 scores, as well as SDAI, CDAI, HAQ, CRP, and ESR levels at baseline and 3, 6, and 12 months post-baricitinib initiation, with sustained efficacy observed over 12 months. The most prevalent adverse event was infection (28.21%). Although initial drug survival rates were similar between groups, the non-D2T RA group demonstrated higher rates at 24 months (46.70% vs. 59.40%). Subgroup analyses showed comparable survival rates between D2T RA and non-D2T RA groups, whether treated with baricitinib alone or in combination with methotrexate or leflunomide.CONCLUSIONDespite potential treatment resistance, patients meeting the D2T RA criteria shared similar safety and efficacy profiles with those non-D2T RA. Baricitinib emerges as a promising treatment option for D2T RA patients, offering effectiveness and safety comparable to the non-D2T RA group.","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":"75 1","pages":"1-19"},"PeriodicalIF":3.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Silver Dressings on Wound Healing Rate in Patients with Lower Extremity Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Qingling Yi,Zhongkui Huang,Bangli Tang","doi":"10.1159/000541331","DOIUrl":"https://doi.org/10.1159/000541331","url":null,"abstract":"OBJECTIVEThe ulcers of lower extremities, both venous and diabetic, impose a massive burden on sufferers globally. This meta-analysis evaluates the efficacy of silver dressings in improving healing rate of these ulcers.METHODSWe carried out comprehensive searches in PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Internet (CNKI) up to March 2024. Two reviewers independently screened the study and extracted data. While the primary outcome was wound healing rate, secondary outcomes included wound healing area and recurrence rate. Data were analyzed using Stata 16.0. software.RESULTSA total of 18 studies involving 1825 participants were included. Silver dressings demonstrated statistically significant effects in improving healing rates for diabetic foot ulcers (DFU) (OR 2.14, 95% CI: 1.52, 3.00, p = 0.00), whereas the effects were not statistically significant for venous leg ulcers (VLU) (OR 1.32, 95% CI: 0.97, 1.78, p = 0.07). Silver dressings also reduced ulcer area by 27.44 cm2 (95% CI 6.96 to 47.92) and recurrence rate of 45% (95% CI 0.11 to 1.79). Subgroup analysis revealed that the Asia-Pacific region and treatments of six weeks or less exhibited higher healing rates than their respective counterparts, although there was no statistical significance.CONCLUSIONSThis study indicated a statistically significant benefit of the treatment for DFU. However, the effect on VLU, though positive, did not reach statistical significance. This distinction should be considered in clinical application and further research.","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":"1 1","pages":"1-17"},"PeriodicalIF":3.2,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Thyroid Uptake Values Measured from 131I Scintigraphy and Uptake Probe in Hyperthyroid Patients.","authors":"Nami Yeyin, Sinem Akyol, Lebriz Uslu-Beşli, Mustafa Demir","doi":"10.1159/000541147","DOIUrl":"10.1159/000541147","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid uptake test plays an important role in diagnosis, treatment planning and radioiodine dose determination in patients with hyperthyroidism. The aim of this study was to compare the % uptake values calculated with gamma camera and uptake probe after diagnostic 131I application in hyperthyroid patients.</p><p><strong>Materials and methods: </strong>In this study, % uptake values were measured using a thyroid uptake probe and gamma camera in 32 patients who underwent thyroid radioiodine uptake measurement in our Nuclear Medicine center. Thyroid uptake measurements were prepared in the neck phantom with 0.74-0.925 MBq activity of 131I radionuclide. After counting the phantom with 131I separately in the uptake probe and gamma camera, 131I sample was orally administered to the patient. % uptake values were calculated by the uptake probe measurements and drawing regions of interest (ROI) from scintigraphic images at 2 and 24 h.</p><p><strong>Results: </strong>The 2-h mean % uptake values in the probe and gamma camera were calculated as 30.5 ± 20.4 and 27.1 ± 18.6, respectively. The 24-h mean % uptake values in the thyroid probe and gamma camera were calculated as 57.6 ± 21.9 and 55.3 ± 21.5, respectively. Linear regression analyses for the 2- and 24-h % uptake values calculated with the probe and gamma camera were found as R2 = 0.8412 and R2 = 0.7313, respectively.</p><p><strong>Conclusion: </strong>The 2- and 24-h % uptake values with the probe and gamma camera were found to be consistent with each other, indicating that they can be safely used interchangeably in patients with hyperthyroidism.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}