Postgraduate Medical Journal最新文献

{"title":"Risk factors for post-stroke epilepsy and seizures among stroke survivors: a qualitative aggregate analysis of more than 82 000 cases.","authors":"Heping Cai, Zaibang Feng, Rui Guo, Kangkang Mei, Huiying Chen, Yanhui Liu, Wenyi Ruan, Jing Chen, Zubing Mei","doi":"10.1093/postmj/qgaf054","DOIUrl":"https://doi.org/10.1093/postmj/qgaf054","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke seizures and epilepsy can affect patients' quality of life, increase mortality in stroke patients, affect patient outcomes, and are associated with higher medical expenditures. However, little is known about the risk factors that influence the onset post-stroke seizures and epilepsy.</p><p><strong>Aim: </strong>We aimed to summarize and assess the credibility of evidence of potential risk factors for seizures and epilepsy after stroke.</p><p><strong>Design: </strong>Qualitative synthesis in random-effects model and evidence appraisal using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.</p><p><strong>Methods: </strong>Pubmed, Embase, and the Cochrane Library were searched from inception to March 31, 2023. Random-effects models were used to estimate the pooled crude or adjusted relative risks (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>We screened 51 991 citations, selecting 15 publications with 82 829 stroke survivors encompassing 6970 seizures and epilepsy events. Risk factors assessed included patient demographic factors, stroke characteristics, medical pre-existing history, and other clinical factors. Independent risk factors identified from pooled analyses included imaging indicators of cortical location (RR, 1.62; 95% CI, 1.23-2.12), cortical involvement (RR, 3.34; 95% CI, 1.67-6.66), early seizure (RR, 4.84; 95% CI, 2.16-10.85), and stroke severity (Scandinavian Stroke Scale [SSS]-score: <30 vs. >30. RR, 5.45; 95% CI, 2.42-12.24). Based on the quality of the evidence or GRADE criteria, there was high (Class I) to very low (Class IV) confidence in the pooled effect estimates.</p><p><strong>Conclusion: </strong>This meta-analysis identifies several risk factors for post-stroke seizures and epilepsy among stroke survivors. The findings enhance clinical awareness for early identification of high-risk individuals and may guide interventions to improve outcomes.</p><p><strong>Registration: </strong>PROSPERO (CRD42023434348). Key Messages What is already known on this topic  Post-stroke seizures and epilepsy are common neurological complications of stroke, significantly affecting survivors' quality of life and clinical outcomes. Although several studies have suggested potential risk factors, including stroke severity, cortical involvement, and early seizures, no comprehensive systematic review or meta-analysis has previously been conducted to summarize and appraise the strength of evidence for these factors. What this study adds  This study provides the first comprehensive synthesis of evidence, identifying significant risk factors for post-stroke epilepsy and seizures among stroke survivors. Key findings include that cortical involvement, imaging indicators of cortical location, early seizures, and stroke severity are associated with increased risk. The study also evaluates the strength of evidence for each factor using GRADE criteria","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045219","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":"Publication for sale: the rise of academies catering to medical students.","authors":"Hamrish Kumar Rajakumar, Umashri Sundararaju","doi":"10.1093/postmj/qgaf059","DOIUrl":"https://doi.org/10.1093/postmj/qgaf059","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976040","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":"Dopaminergic medications as a preventive for myopia: insights derived from pediatric patients diagnosed with attention deficit hyperactivity disorder.","authors":"Yu-Te Huang, Jhih-Yi Lu, Peng-Tai Tien, Yih-Dih Cheng, Heng-Jun Lin, Yow-Wen Hsieh, Fuu-Jen Tsai, Lei Wan, Hui-Ju Lin","doi":"10.1093/postmj/qgaf051","DOIUrl":"https://doi.org/10.1093/postmj/qgaf051","url":null,"abstract":"<p><strong>Background/objectives: </strong>This study investigated the impact of dopaminergic medications on myopia progression by comparing myopia susceptibility in ADHD patients treated with dopaminergic agents to those untreated. A non-ADHD cohort was also established to assess myopia risk compared to individuals with ADHD.</p><p><strong>Subjects/methods: </strong>This population-based cohort study used Taiwan National Health Insurance data (2009-2020), stratifying participants by ADHD status. Myopia was identified using ICD-10 diagnostic codes, while ADHD-related drug usage (methylphenidate, atomoxetine, clonidine) was analyzed. Cox regression models compared hazard ratios (HRs) for myopia, with cumulative incidence curves generated via the Kaplan-Meier method.</p><p><strong>Results: </strong>Adjusting for sex, age, comorbidities, and follow-up time, the untreated ADHD cohort had a 1.22-fold higher myopia risk (95% CI: 1.21-1.24) compared to the non-ADHD cohort. In contrast, ADHD patients receiving treatment showed a 39% reduced myopia risk (adjusted HR (aHR): 0.61; 95% CI: 0.59-0.62). An increased number of ADHD-related medications correlated with a notable myopia risk reduction: one drug (aHR: 0.50; 95% CI: 0.49-0.51) and two drugs (aHR: 0.28; 95% CI: 0.26-0.31).</p><p><strong>Conclusions: </strong>Untreated ADHD in children is linked to a higher myopia risk than both non-ADHD individuals and treated ADHD patients. Dopaminergic treatments may provide a therapeutic avenue for mitigating myopia progression by enhancing dopamine signaling pathways. Key messages What is already known on this topic  Dopamine release in the retina inhibits myopia progression, and ADHD is linked to dopaminergic dysfunction. ADHD treatments like methylphenidate enhance dopamine signaling, but their effect on myopia risk has not been thoroughly studied. What this study adds  This study shows that untreated ADHD children have a higher risk of myopia, while dopaminergic treatments significantly reduce this risk. The use of multiple ADHD medications further strengthens the protective effect. How this study might affect research, practice or policy  These findings suggest that ADHD treatments may serve as a new approach for myopia prevention, encouraging cross-field research and consideration of systemic therapies for managing comorbid conditions.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027760","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":"Opportunities and challenges for young physicians in the era of artificial intelligence: current status and future perspectives.","authors":"Bo Gao","doi":"10.1093/postmj/qgaf052","DOIUrl":"https://doi.org/10.1093/postmj/qgaf052","url":null,"abstract":"<p><p>Artificial Intelligence (AI) has witnessed rapid evolution in recent years and is gradually integrated into healthcare systems worldwide. For young physicians, navigating this landscape requires a delicate balance. They must weigh the potential benefits offered by AI-driven innovations against the intricate demands of patient care, ethical imperatives, and the evolving nature of their professional roles. This concise review aims to spotlight the key opportunities and challenges that young physicians encounter in this digital age. Additionally, practical recommendations are provided to guide young physicians in integrating AI knowledge seamlessly into their clinical practice. Finally, this review concludes with forward-looking suggestions,including incorporating AI training into medical education curricula and formulating policy initiatives. The overarching goal is to optimize the role of young physicians within the dynamic and evolving digital healthcare environment, ensuring they are well-equipped to leverage AI for the betterment of patient care.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029645","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":"Citation rat race-an academic malignancy.","authors":"Kaushik Bhattacharya","doi":"10.1093/postmj/qgaf053","DOIUrl":"https://doi.org/10.1093/postmj/qgaf053","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035368","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 improvement of functional dyspepsia symptoms after Helicobacter pylori eradication: caused by an unrecognized change in duodenal microbiota?","authors":"Rujun Ai, Guozhong Ji, Bota Cui","doi":"10.1093/postmj/qgaf050","DOIUrl":"https://doi.org/10.1093/postmj/qgaf050","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020860","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":"Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis.","authors":"Rasha Kaddoura, Dina Abushanab, Nidal Asaad","doi":"10.1093/postmj/qgaf049","DOIUrl":"10.1093/postmj/qgaf049","url":null,"abstract":"<p><p>This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804097","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":"Insulin resistance: a paradoxical protector against low-grade prostate cancer? Findings from the REDUCE trial.","authors":"Rupak Desai, Akhil Jain","doi":"10.1093/postmj/qgaf047","DOIUrl":"https://doi.org/10.1093/postmj/qgaf047","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780698","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":"Volrustomig/Rilvegostomig related \"triple M\"-myasthenia gravis and overlap syndrome.","authors":"Tim Cooksley, Ryan Y S Keh, Jamie M J Weaver","doi":"10.1093/postmj/qgaf048","DOIUrl":"https://doi.org/10.1093/postmj/qgaf048","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780699","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 oral anticoagulants in patients with atrial fibrillation and acute myocardial infarction: a systematic review and meta-analysis.","authors":"Yi Zheng, Xinyu Zheng, George Bazoukis, Gary Tse, Tong Liu","doi":"10.1093/postmj/qgaf046","DOIUrl":"https://doi.org/10.1093/postmj/qgaf046","url":null,"abstract":"<p><strong>Background: </strong>The optimal antithrombotic therapy strategies for patients with atrial fibrillation (AF) and acute myocardial infarction (AMI) remain uncertain. We aimed to evaluate the efficacy and safety of oral anticoagulants (OAC) among patients with AF and AMI.</p><p><strong>Methods: </strong>PubMed, Embase, and Web of Science were searched from inception till 5 February 2025. The primary outcome was any stroke.</p><p><strong>Results: </strong>Eleven studies with 83 549 patients were included. OAC therapy was associated with lower risks of any stroke (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.60-0.77; P < .001), ischemic stroke (OR: 0.64; 95% CI: 0.57-0.73; P < .001), and all-cause mortality (OR: 0.81; 95% CI: 0.74-0.89; P < .001). Additionally, OAC therapy was associated with a higher risk of any bleeding (OR: 1.24; 95% CI: 1.06-1.46; P = .009), but not for major bleeding (OR: 1.28; 95% CI: 0.87-1.90; P = .21).</p><p><strong>Conclusions: </strong>OAC therapy is effective for patients with AF and AMI, but should be administered cautiously in those at high bleeding risk.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773098","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}