Transformative Medicine最新文献

{"title":"Metformin Continuation Versus Holding Pre and Post Coronary Angiography with Normal Renal Function: A Systematic Review and Meta-Analysis","authors":"Mohammad Hamza, Yasar Sattar, Sadaf Fakhra, Neel Patel, Mubashar Karamat, Saman Razzaq, Aamir Saeed, Khaled M. Harmouch, Islam T. Elgendy, M. Mamas, Anand Prasad, Wael Al Jaroudi, Ramesh Daggubati, M. C. Alraies","doi":"10.54299/tmed/blxr6776","DOIUrl":"https://doi.org/10.54299/tmed/blxr6776","url":null,"abstract":"Background It is common practice to withhold metformin prior to cardiac catheterization due to fear of developing lactic acidosis in the setting of contrast-associated acute kidney injury (AKI). The evidence behind this recommendation is currently weak. Methods We collected 851 articles from PubMed and Embase, of which 3 met our inclusion criteria. Inclusion criteria were age > 18 years, baseline use of long-term metformin with continued or interrupted metformin use in patients during diagnostic or interventional cardiac catheterization. The outcomes studied were differences between post-catheterization and pre-catheterization serum creatinine (SCr) and glomerular filtration rate (GFR). We excluded studies dealing with patients not on long-standing metformin and those in which contrast exposure was through contrast enhanced computerized tomography. We used Hedges’s g with inverse variance method to pool standard mean difference with a random effects model using meta-cont module in CRAN-R software with 95% confidence interval (CI) for statistical significance. Higgins I-squared (I²) statistic was used to evaluate heterogeneity. Results . Post-catheterization serum creatinine (Hedges’s g = -0.12 mg/dL; CI = -0.83 to +0.6, p = 0.75, I2 = 95%), post-catheterization GFR (Hedges’s g = +0.18 mL/min; CI = -0.76 to +1.11, p = 0.71, I2 = 97%) and post-catheterization lactate levels (Hedges’s g = +0.03 mg/dL; CI = -0.66 to +0.72, p = 0.75, I2 = 95%) failed to reach statistical significance. Conclusions There is no statistically significant difference in SCr or GFR between patients who held metformin prior to cardiac catheterization and those who continued taking the medication.","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"44 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“This EKG is Concerning for Ischemia!”","authors":"Muhammad M. Zafar","doi":"10.54299/tmed/evma2305","DOIUrl":"https://doi.org/10.54299/tmed/evma2305","url":null,"abstract":"","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"51 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Dissection: The Insidious Menace","authors":"Muhammad Umer Riaz Gondal, John Lemoine, Mohammad Baig, Prem Parajuli, Zainab Kiyani, Hamza Khan, Hassam Saif","doi":"10.54299/tmed/csif6399","DOIUrl":"https://doi.org/10.54299/tmed/csif6399","url":null,"abstract":"Aortic dissection represents a critical emergency characterized by the cleavage of aortic wall layers, creating a deceptive false lumen. Associated with high mortality rates, prompt diagnosis and intervention are needed to ensure survival.","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"53 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Onset Dyspnea in a Patient with Pacemaker, What Does the ECG Tracing Show?","authors":"Jakob Nypaver, Robert Libera, A. Kundra, Ravi Choxi","doi":"10.54299/tmed/uxbt6770","DOIUrl":"https://doi.org/10.54299/tmed/uxbt6770","url":null,"abstract":"Dual chamber pacemakers are programmed to allow for AV synchrony. Whenever a patient with a dual chamber pacemaker with underlying sinus rhythm presents with AV dissociation, the lack of AV synchrony should be questioned. The authors present a case of new onset dyspnea diagnosed as pacemaker syndrome. The diagnosis was initially delayed due to underlying ventricular paced rhythm as misidentified as normal pacemaker behavior. A 69-year-old female with a past medical history of 2:1 atrioventricular block status post dual-chamber pacemaker implant presented with complaints of new onset shortness of breath and dyspnea. The ECG showed a ventricular rate of 66 beats per minute. Pacing spikes were prior to each QRS complex indicating ventricular-paced rhythm with left bundle branch morphology. There were p waves from sinus origin which were completely dissociated from the ventricular paced rhythm. Overall, there was ventricular paced rhythm with underlying AV dissociation. This was initially suspected to be normal pacemaker behavior as there was appropriate ventricular pacing and ventricular capture. Review of the tracing noted AV dissociation, which would be unusual in a patient with underlying sinus rhythm and dual chamber device. Device interrogation noted that device was at end of life and atrial lead was powered down to allow for ventricular pacing. It is important to always question the lack of AV synchrony if patients have dual chamber pacemaker as lack of AV synchrony can cause pacemaker syndrome.","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"115 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Drug Approvals 2023","authors":"Emily Wagner, Christina Swiger, Mary Hoang, Maley Zents","doi":"10.54299/tmed/bqmo9465","DOIUrl":"https://doi.org/10.54299/tmed/bqmo9465","url":null,"abstract":"his article provides an overview of the novel drugs approved for 2023. The Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research (CDER) provides standards to drug developers. The CDER sets standards for required data needed in the drug development and application process. Every year a variety of new drugs and biological products are approved. Some are new molecular compounds while others are structurally similar to those already on the market. Therefore, products may not have been used in medical practice previously while others have already been used in practice. This article highlights medications that are new in medical practice over the last year and bring attention to the numerous advancements in medicine. From January 1, 2023, to December 6, 2023, the FDA has approved fifty-three novel drugs highlighted in Table 1. Hematology and Oncology accounted for the majority of drug approvals. Four medications are discussed in detail based on their use in the outpatient setting.","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"15 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Improvement In Healthcare: A Practical Guide For Providers (Part 3)","authors":"Jeremy Ellis","doi":"10.54299/tmed/wvey4703","DOIUrl":"https://doi.org/10.54299/tmed/wvey4703","url":null,"abstract":"","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"18 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune hemolytic anemia: A rare presentation of mantle cell lymphoma","authors":"I. Garrahy, Shoja Rahimian","doi":"10.54299/tmed/hcqw1127","DOIUrl":"https://doi.org/10.54299/tmed/hcqw1127","url":null,"abstract":"Autoimmune hemolytic anemia (AIHA) is a well-recognized phenomenon of non-Hodgkin lymphoma, albeit with only few cases described with mantle cell lymphoma (MCL). The characteristics of such cases can improve understanding and management of AIHA in this type of lymphoma. To that end, we describe herein two cases of patients with MCL who presented with AIHA, with comparison to nine previously described cases in literature.","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"76 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“What Pattern Does This ECG Show?”","authors":"Ravi Choxi, Arun Kundra","doi":"10.54299/tmed/ygsw8908","DOIUrl":"https://doi.org/10.54299/tmed/ygsw8908","url":null,"abstract":"","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Welcome to the Fall 2023 Issue of Transformative Medicine","authors":"Adam Sigal","doi":"10.54299/tmed/jmdp2279","DOIUrl":"https://doi.org/10.54299/tmed/jmdp2279","url":null,"abstract":"","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135584304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Criteria of Takotsubo Cardiomyopathy in the Clinical Setting: A Case Report","authors":"Annu Suresh, Yi-Ju Chen, Richa Neupane, Jessica Cunningham","doi":"10.54299/tmed/nfzq8029","DOIUrl":"https://doi.org/10.54299/tmed/nfzq8029","url":null,"abstract":"Introduction Takotsubo cardiomyopathy (TTS) is a rare condition related to stress featuring apical hypokinesis. Current guidelines suggest that the exclusion of other causal factors like myocarditis is required to diagnose TTS. However, we propose that the existing diagnostic criteria for TTS, particularly, required exclusion of myocarditis, adds to the challenge of making this diagnosis in the clinical setting. Hereby, we present a case with basal hypokinesis that could have been attributed to a conjunction of reverse Takotsubo syndrome (rTTS) with viral or toxic myocarditis. Case Presentation: A 29-year-old female complained of acute persistent chest pain, palpitations, and vomiting after smoking marijuana. She was tachycardic without hemodynamic instability or hypoxia. Electrocardiogram showed sinus tachycardia. Troponin peaked at 16.1 ng/ml. Urine drug screen was positive for amphetamines. Echocardiogram and catheterization showed left ventricular reduced ejection fraction (25-30%) with basal hypokinesia and apical hyperkinesis, suggestive of reversed Takotsubo cardiomyopathy. Cardiac magnetic resonance (CMR) also showed delayed contrast enhancement suggestive of myocarditis. Viral panel noted positive Coxsackie B titer on day 7 of hospitalization. She was treated with goal-directed medical therapy and repeat echocardiogram 6 days after showed normalized left ventricular systolic function. Discussion: Guidelines recommend the use of clinical history, inflammatory markers, and CMR to exclude infectious myocarditis before diagnosing rTTS. The clinical scenario in this case presented evidence of a catecholamine-related substance exposure known to trigger takotsubo cardiomyopathy and of an elevated Coxsackie B titer. The CMR showed features explainable by myocarditis and partially by rTTS. This case highlights the complexity of diagnosing TTS or rTTS with infective myocarditis as exclusion criteria. While imaging, history, and labs play a vital role, a lack of complete understanding about the pathophysiology of this disease as well as existing diagnostic criteria complicate the ability to make this diagnosis in the clinical setting.","PeriodicalId":478282,"journal":{"name":"Transformative Medicine","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135579649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}