Southern Medical Journal最新文献

{"title":"Financial Literacy of Medical Trainees: A Major and Worrisome Educational Void to Fill.","authors":"Adam B Fleming, Shivum Desai, James Sikes, Michael S Lebhar, Megha Patel, Venkata Seerapu, Eldrin Bhanat, Marc E Walker","doi":"10.14423/SMJ.0000000000001866","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001866","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to evaluate the financial literacy of medical trainees and assess knowledge gaps in loan repayment, credit management, investment strategies, and financial planning.</p><p><strong>Methods: </strong>A cross-sectional survey study was conducted at a single institution between July 25, 2023 and January 10, 2024. A 52-question financial literacy survey was distributed to 97 residents and 101 first- and second-year medical students. The survey assessed knowledge across financial domains, including student loans, credit cards, mortgages, investing, and business ownership. Statistical analysis included independent samples t tests and analysis of variance to compare financial literacy scores across trainee levels.</p><p><strong>Results: </strong>Residents demonstrated significantly higher financial literacy scores than medical students (mean 18.80 vs 9.40 out of 35; <i>P</i> < 0.05). Despite this, substantial knowledge gaps persisted across multiple financial concepts. Of all respondents, 84.5% reported student loan debt exceeding $50,000, yet 64.6% were not enrolled in income-driven repayment plans, and 57.3% could not differentiate between Pay As You Earn and Revised Pay As You Earn. In addition, although 74.2% contributed to retirement accounts, 60.8% lacked knowledge about investment strategies. Despite limited financial literacy, 82.5% expressed interest in receiving structured financial education.</p><p><strong>Conclusions: </strong>Medical trainees, including both medical students and residents, exhibit significant financial literacy deficits despite their progression through medical education. These findings underscore the need for structured financial education early in training to improve financial decision making, debt management, and long-term financial stability among future healthcare professionals.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"634-638"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201377","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":"Dissemination and Impact of a Multimodal Pain Regimen on Analgesia Prescribing at an Academic Hospital.","authors":"Kyle J Kalkwarf, Krista J Stephenson, William Griffin, Allison Wells, Allison K Jenkins, Rebecca R Smith, Richard D Betzold, Avi Bhavaraju","doi":"10.14423/SMJ.0000000000001875","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001875","url":null,"abstract":"<p><strong>Objectives: </strong>An opioid-sparing, multimodal pain (MMP) protocol was initiated at our institution in August 2016 in the Division of Trauma and Acute Care Surgery (TACS). During the next year, the practice was codified into a protocol. This study aims to evaluate the dissemination and impact of MMP.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of all patients admitted to a surgical service from May 2015 to July 2020 to evaluate opioid and nonopioid prescribing for analgesia. The analysis consisted of three populations: patients admitted to the TACS service, the General Surgery subspecialty (GSS) services (excluding TACS), and other surgical department (OSD) services.</p><p><strong>Results: </strong>Of the 12,010 patients who met the inclusion criteria, 1979 (16.5%) were admitted to the TACS service, 1106 (9.2%) to GSS services, and 8925 (74.3%) to OSD services. Opioid morphine milligram equivalents averaged 38.6 ± 33.3 daily but decreased in all groups over time. Nonopioid adjunctive medications were used in 5932 (49.4%) and increased in all groups after implementation of the protocol (all <i>P</i> < 0.001). After MMP introduction, nonopioid analgesic use increased most rapidly in TACS and the slowest in OSD. Conversely, the average daily morphine milligram equivalents decreased most quickly in TACS (24.4%, <i>P</i> < 0.001), while GSS and OSD services saw a subsequent decrease in opioid use (<i>P</i> = 0.004 and <i>P</i> < 0.001, respectively) as MMP increased.</p><p><strong>Conclusions: </strong>Implementation of an MMP protocol by a single division can facilitate the spread of nonopioid adjunctive pain medication use and decrease opioid utilization throughout surgical specialties in a hospital.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"579-584"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201403","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":"Evaluating Internal Medicine Intern Report Efficacy: Findings from a Cross-Sectional Survey.","authors":"Justin Qiyun Wang, Wilson Xingsheng Wang, Dennis Roarke, Jared Honigman, Ava-Dawn Gabbidon","doi":"10.14423/SMJ.0000000000001870","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001870","url":null,"abstract":"<p><strong>Objective: </strong>The case-based morning report (MR) is a widespread tradition in Internal Medicine training. Because MR content was originally geared toward second- and third-year residents, however, there are limited data regarding any specific learning considerations when having an intern-only MR. We aimed to elicit attitudes surrounding the intern report (IR) as an educational exercise from interns, residents, and facilitators.</p><p><strong>Methods: </strong>We constructed a cross-sectional online anonymous survey using a de novo item-specific 5-point Likert scales and free-text responses. We analyzed nonparametric data via Mann-Whitney <i>U</i> tests and content analysis for free responses.</p><p><strong>Results: </strong>A total of 44/133 (33%) trainees and 12/14 (86%) facilitators completed the survey. Nearly all responses were concordant between trainees and facilitators. During IR, interns were often distracted and interrupted. Valued cases were interesting or applicable to clinical practice or included faculty-specific techniques such as take-home points. All groups were neutral regarding IR as an educational exercise and called for more structural and learner-specific changes.</p><p><strong>Conclusions: </strong>One static IR format may not be sufficient to support an intern's changing clinical and diagnostic stages of development. Nuanced approaches are needed to optimize faculty training, foster engagement, align with learner progression, and ensure intern fulfillment.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"639-643"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201418","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":"Minimally Invasive Burch Colposuspension to Reduce De Novo Stress Incontinence: The MICRO Randomized Trial.","authors":"Tsung Mou, Akira Gillingham, Julia Geynisman-Tan, Oluwateniola Brown, Christina Lewicky-Gaupp, Margaret G Mueller, Kimberly Kenton, Sarah Collins","doi":"10.14423/SMJ.0000000000001872","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001872","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to determine whether the addition of prophylactic retropubic colposuspension is superior to no anti-incontinence procedure during minimally invasive surgical sacrocolpopexy for stress-continent patients in decreasing rates of postoperative de novo stress urinary incontinence (SUI).</p><p><strong>Methods: </strong>In this randomized superiority trial, we recruited stress-continent prolapse patients undergoing either conventional or robotic-assisted laparoscopic sacrocolpopexy with negative preoperative supine cough stress tests. Patients were randomized to receive either prophylactic retropubic colposuspension or no retropubic colposuspension (control). The primary outcome was the composite measure of postoperative de novo SUI at 3 months, which included either (1) \"Yes\" to Question #17 on the Pelvic Floor Distress Inventory-20 endorsing symptoms of urinary leakage with coughing, sneezing, laughing, (2) positive retrofill cough stress test, or (3) any SUI treatment after sacrocolpopexy. Using data from the Colpopexy and Urinary Reduction Efforts trial, a sample size of 42 participants would demonstrate the addition of prophylactic retropubic colposuspension to be superior to control with a superiority margin of 15%.</p><p><strong>Results: </strong>Fifty patients underwent randomization, with 26 assigned to prophylactic retropubic colposuspension and 24 as controls. Three months after surgery, 50.0% of the patients in the retropubic colposuspension group and 41.7% of controls met one or more criteria for de novo SUI (<i>P =</i> 0.555). There was no difference between the retropubic colposuspension and control groups in symptoms of urinary frequency, urgency incontinence, or urinary retention at 3 months.</p><p><strong>Conclusions: </strong>Among stress-continent patients undergoing minimally invasive surgical sacrocolpopexy in this single-center study, the addition of prophylactic retropubic colposuspension was not superior to no retropubic colposuspension in preventing postoperative de novo SUI at 3 months after surgery.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"622-627"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201412","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":"Analysis of Biopsy Modalities and Timeline for the Workup of Undiagnosed Lesions: Mayo Clinic Experience.","authors":"Joan M Irizarry-Alvarado, Nancy L Dawson, John P Fasolino, Karthik Ghosh, Elizabeth A Gilman, Ivana T Croghan, Steven W Ressler","doi":"10.14423/SMJ.0000000000001868","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001868","url":null,"abstract":"<p><strong>Objective: </strong>Incidental lesions identified clinically or on imaging are diagnostically challenging. The workup for these lesions is not well established. We investigated diagnostic modalities used at our institutions for undiagnosed lesions and the timeline from intake to biopsy and resultant diagnoses.</p><p><strong>Methods: </strong>We retrospectively analyzed data from all 3 Mayo Clinic sites (Arizona, Florida, and Minnesota) between November 1, 2018 and July 31, 2022. We evaluated the frequency of the biopsy technique used (if any) and how often the resultant diagnosis was malignant, benign, or inconclusive. The turnaround time from intake to biopsy and final diagnosis also was evaluated.</p><p><strong>Results: </strong>Of 93 patients with an undiagnosed lesion, 54 (58%) underwent biopsy; most patients underwent a single biopsy (n = 42, 77%), and 12 (23%) had two or more biopsies. Unbiopsied patients were diagnosed as having benign lesions according to imaging or had follow-up imaging. Of the 54 patients biopsied, 38 (70%) biopsies were obtained via fine-needle aspiration. Biopsy results were malignant for 34 patients (63%), benign for 14 (26%), and inconclusive for six (11%). Most patients were seen within 9 days of their initial contact (69/93, 74%), underwent biopsy within 20 days of seeing the physician (40/54, 74%), and had a final diagnosis within 30 days of the initial visit (72/93, 77%).</p><p><strong>Conclusions: </strong>Our findings can help clinicians dispel the misconception that most undiagnosed lesions are malignant. Our findings also may help clinicians determine the appropriate workup for undiagnosed lesions. Further research is recommended to guide clinicians on the best sampling methodologies to obtain the highest yield of tissue for analysis. Dedicated patient workflows can help expedite diagnosis.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"596-601"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201415","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":"Psychiatric Condition Management in Primary Care for Adults with Intellectual and Developmental Disabilities.","authors":"Hugh Nguyen, Daisy Valle, Ethan Jetter, Sheldon Joseph, Adia Gomes, Amica Lertkitcharoenpo, Michelle Liu, Jeanine Escandor, Rafik Jacob","doi":"10.14423/SMJ.0000000000001869","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001869","url":null,"abstract":"<p><p>Psychiatric conditions are prevalent among adults with intellectual and developmental disabilities (IDDs), with studies estimating that 33% of this population experiences psychiatric disorders such as mood, anxiety, and behavioral issues. These rates are significantly higher than the general population, underscoring the need for proper management within primary care settings. Although the integration of mental health services into primary care is increasing, general practitioners often report a lack of training and time to treat psychiatric conditions in adults with IDDs. Collaborative care models, involving partnerships between primary care providers and mental health specialists, have emerged as a promising solution, offering tailored, patient-centered treatment. Barriers like diagnostic overshadowing, communication challenges, and stigmatization hinder access to appropriate care, however. In recent years, the inclusion of genetic testing in psychiatric care has gained traction, especially in managing IDDs associated with specific genetic conditions like fragile X syndrome and DiGeorge syndrome. Genetic testing can help identify the underlying causes of psychiatric symptoms, offering valuable insights into appropriate treatment pathways. Pharmacogenetic insights provided by genetic testing can guide more personalized medication management, reducing adverse effects and improving outcomes. Effective management of psychiatric conditions in adults with IDDs requires further research, particularly randomized controlled trials, to establish evidence-based treatment approaches. Expanding research on interventions, including psychotherapy, pharmacotherapy, and genetic testing, is essential to improve patient outcomes in this underserved population.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"649-654"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200632","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":"Regional Differences in Hospitalizations among Patients Admitted with Chronic Obstructive Pulmonary Disease.","authors":"Alhareth Alsagban, Scott Mitchell Wright, Che' Matthew Harris","doi":"10.14423/SMJ.0000000000001873","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001873","url":null,"abstract":"<p><strong>Objective: </strong>Extreme temperatures negatively impact pulmonary function. This study explored whether the variability in ambient temperatures across disparate geographic regions in the United States was associated with differences in hospital outcomes for patients admitted with chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>Using the 2016-2019 National Inpatient Sample database, we compared adults hospitalized with COPD in the US Northeast with those in the US South. We conducted multivariable regression analyses to study outcomes, including mortality, resource utilization, and posthospital discharge disposition.</p><p><strong>Results: </strong>From 2016 to 2019, 463,830 (30.1%) patients were admitted with COPD in the Northeast and 1,078,930 (69.9%) in the South. The lowest hospitalization rates for COPD were observed in both regions during the hottest months (July and August). Those in the Northeast had higher adjusted odds of in-hospital mortality (adjusted odds ratio: 1.1 [95% confidence interval {CI} 1.0-1.2]; <i>P</i> = 0.03) and a lower likelihood of being discharged to home after the hospitalizations (adjusted odds ratio: 0.63 [95% CI 0.61-0.65]; <i>P</i> < 0.01]) compared with patients hospitalized in the South. Patients in the Northeast had longer hospital stays (adjusted mean difference: +0.19 days; 95% CI 0.13-0.25; <i>P</i> < 0.01) and incurred greater hospital charges compared with patients in the South (adjusted mean difference: $3728; 95% CI 1840-5616; <i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Patients hospitalized with COPD in the Northeast had worse clinical outcomes and greater resource utilization than in the South. These findings, coupled with the higher admission rates during colder months, raise questions about the influence of colder ambient temperatures on COPD exacerbations.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"614-617"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200837","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":"Outcomes and Complications of Thoracentesis in Hospitalized Patients.","authors":"Kristin N Sheehan, Bethany R Hines, HarLeigh D Haynie, Katelyn R Garcia, Caroline C Rushing, Arjun B Chatterjee, Karl W Thomas","doi":"10.14423/SMJ.0000000000001878","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001878","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the common performance of thoracentesis, predicting risk for adverse outcomes and abnormal postprocedural findings remains difficult. Although guidelines and experts have suggested that routine postprocedure imaging has low yield, compliance with these guidelines has not been well studied. In addition, previous studies have shown that pleural effusions are associated with high short-term mortality rates, longer hospitalizations, and higher readmission rates, increasing the importance of systematic study of procedural results. We aimed to determine the rate of imaging abnormalities, the utility of routine postprocedure imaging, and health outcomes for hospitalized patients requiring thoracentesis.</p><p><strong>Methods: </strong>An epidemiologic description including adult inpatients at one academic medical center who underwent thoracentesis outside of radiology-specialty procedural areas during a 2-year period. Charts were individually reviewed for data extraction.</p><p><strong>Results: </strong>In total, 425 thoracentesis procedures in 329 patients were included. A chest x-ray was obtained after 80.9% of procedures. Postprocedure imaging abnormalities included pneumothorax (8.0%), hemothorax (1.6%), reexpansion pulmonary edema (7.8%), and pneumothorax ex vacuo (4.7%). The average hospital length of stay was 13 days, and 15% required mechanical ventilation during their hospitalization. Fifty-five percent of participants were discharged home, 22.8% to a medical facility, 14.4% transitioned to hospice care, and 8.1% died during hospitalization.</p><p><strong>Conclusions: </strong>Overall, approximately 20% of patients required clinical reassessment or intervention following thoracentesis. The findings confirm a high rate of secondary morbidity, in-hospital mortality, and long length of stay for hospitalized patients undergoing thoracentesis. The requirement for inpatient thoracentesis represents an opportunity to address end-of-life issues and to identify approaches to optimize resource utilization.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"589-595"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201400","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":"Comparing ACL Reconstruction Postoperative Outcomes in Medicaid versus Private Insurance Patients: Is There a Difference?","authors":"Fahad Nadeem, Dev Dayal, Thomas Evely, Eugene Brabston, Amit Momaya, Aaron Casp","doi":"10.14423/SMJ.0000000000001867","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001867","url":null,"abstract":"<p><strong>Objectives: </strong>There has been growing evidence that insurance status is a major indicator of postoperative outcomes, which has been extensively reported in orthopedic procedures such as shoulder and knee arthroplasty. Patients with Medicaid public insurance had increased complications, longer lengths of stay, and increased costs compared with patients who had private insurance when controlling for demographic characteristics. Our study compared the outcomes of patients with Medicaid insurance with those patients with private commercial insurance who have undergone anterior cruciate ligament (ACL) reconstruction. We hypothesized that patients with Medicaid insurance coverage would have worse patient-reported outcomes and complication rates in comparison with a matched cohort of patients with private insurance.</p><p><strong>Methods: </strong>Our departmental registry was queried for all patients who underwent primary arthroscopically assisted ACL reconstruction by 10 surgeons in the practice between January 2018 and June 2022 and were at least 2 years out from their surgery. Eligible patients in the matched cohort model were contacted via telephone for consent to participate in this study and questioned about their pain level, return to sport, physical therapy compliance, and any incidence of retear rates or additional procedures in their ipsilateral or contralateral knee. Patients were then compared across insurance types based on Lysholm knee score, as well as the other patient-reported outcomes.</p><p><strong>Results: </strong>A total of 189 ACL reconstructions were screened during the study period. Fifteen private insurance and 15 Medicaid patients responded to the telephone call and consented to the study. Comparison of the clinical outcomes within the insurance cohorts revealed that there were no significant differences in Lysholm knee scores, pain scores, revision rate, and return to sport. The only significant difference observed was that Medicaid patients had a greater physical therapy compliance rate. Multivariate linear regression analysis revealed that males had the highest odds ratio associated with higher Lysholm scores, but there was no significance observed with any factor.</p><p><strong>Conclusions: </strong>Although Medicaid patients did have greater physical therapy attendance, this did not improve their postoperative outcomes, which may suggest that Medicaid status may affect physical therapy effectiveness and can be a confounding variable related to other health disparities. Because the multivariate linear regression analysis did not show any associated factors with poorer postoperative outcomes, this may imply that some demographic factors or insurance status may not be contraindications to ACL reconstruction. Despite the lack of significance, males had a greater likelihood of achieving acceptable Lysholm knee scores based on the multivariate analysis.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"585-588"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201448","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":"Risk of Nephrolithiasis in Cirrhosis: A Comparison between MASLD Cirrhosis and Cirrhosis Due to Other Etiologies.","authors":"Sarpong Boateng, Mayssaa Hoteit, Prince Ameyaw, Simran Joshi, Alexa Plato, Rofina Johnkennedy, Donghyun Ko, Abhiraj Patel, Frances Mejia, Cheng-Hung Tai, Basile Njei, Gregory Buller","doi":"10.14423/SMJ.0000000000001876","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001876","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Nephrolithiasis is a systemic condition influenced by metabolic disorders, with rising prevalence worldwide. Although several studies have investigated the relationship between metabolic-associated steatotic liver disease (MASLD) and nephrolithiasis, few have focused on cirrhosis-specific etiologies. As the epidemiology of cirrhosis shifts from viral and alcohol-related causes to metabolic dysfunction-related etiologies, understanding how these different causes influence the risk of nephrolithiasis is crucial. This study aims to evaluate the association between MASLD cirrhosis and nephrolithiasis, compared with other cirrhosis etiologies, using a nationally representative cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study using the US National Inpatient Sample from 2016 to 2020. Patients aged 18 years and older with a diagnosis of cirrhosis were included. Cirrhosis etiologies were categorized as MASLD cirrhosis and non-MASLD cirrhosis (including alcohol, chronic viral hepatitis, and other causes). The primary outcome was attaining a diagnosis of nephrolithiasis. Propensity score matching was performed to balance covariates between groups. Multivariate logistic regression models were used to estimate adjusted odds ratios (aORs) for nephrolithiasis risk, accounting for demographics, comorbidities and hospital characteristics. Sensitivity analysis using the E-value was conducted to assess robustness of the findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 112,312 patients with cirrhosis were included after matching; 56,156 patients were classified with MASLD cirrhosis and 56,156 with non-MASLD cirrhosis. The mean age of patients in the matched cohort was 64.2 ± 11.48 years, with 39.5% being male. Patients with MASLD cirrhosis were less likely to have Medicaid (12.0% vs 17.5%) (&lt;i&gt;P&lt;/i&gt; &lt; 0.0001) or to be from lower-income households (31.8% vs 35.3%) compared with those with cirrhosis of other etiologies (&lt;i&gt;P &lt;&lt;/i&gt; 0.0001). In multivariate analysis, MASLD cirrhosis was associated with a significantly higher risk of nephrolithiasis compared with non-MASLD cirrhosis (aOR 1.229, 95% confidence interval [CI] 1.093-1.383, &lt;i&gt;P&lt;/i&gt; &lt; 0.0001). Subgroup analysis revealed that the risk of nephrolithiasis was significantly higher in MASLD cirrhosis compared with alcohol-related cirrhosis (aOR 1.328, 95% CI 1.053-1.692, &lt;i&gt;P&lt;/i&gt; = 0.020), and to other cirrhosis types (aOR 1.147, 95% CI 1.010-1.305, &lt;i&gt;P&lt;/i&gt; = 0.035), but not significantly different from viral hepatitis-related cirrhosis (aOR 1.124, 95% CI 0.894-1.429, &lt;i&gt;P&lt;/i&gt; = 0.33). Sensitivity analysis using the E-value indicated that an unmeasured confounder would need to have an odds ratio of at least 1.76 to explain for the observed association.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;MASLD cirrhosis is associated with a higher risk of nephrolithiasis than cirrhosis of other etiologies. Our findings underscore the need for tailored nephrolithi","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 9","pages":"606-613"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201000","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}