European Medical Journal最新文献

{"title":"Can COVID-19 Help Us Deliver Whole-System Holistic Healthcare?","authors":"Ada Enesco","doi":"10.33590//emj/10304838","DOIUrl":"https://doi.org/10.33590//emj/10304838","url":null,"abstract":"The 7ᵗʰ Joint Symposium between the European Association for the Study of Diabetes (EASD) and the Asian Association for the Study of Diabetes (AASD) took place on the 2ⁿᵈ–6ᵗʰ October in Hamburg, Germany. In an engaging session examining the impact of COVID-19 on new healthcare models, experts provided insights into whole-system approaches for diabetes, and opportunities for improvement in patient outcomes via telemedicine.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139179496","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":"Exploring Methotrexate Route of Administration Decisions for Adults with Rheumatoid Arthritis","authors":"Hannah Moir","doi":"10.33590/emj/10308161","DOIUrl":"https://doi.org/10.33590/emj/10308161","url":null,"abstract":"Methotrexate is a common first-line treatment for rheumatoid arthritis, yet its widespread and habitual usage often leads physicians to overlook the choice of administration route when planning management strategies. A recent survey involving 30 consultant rheumatologists from France, Germany, Italy, Poland, Spain, and the UK, identified variation in the utilisation and perceptions regarding oral versus subcutaneous delivery for methotrexate. In November 2023, EMJ interviewed Roberto Caporali, Professor of Rheumatology at the University of Milan, and Head of the Department of Rheumatology and Medical Sciences at Gaetano Pini Hospital, Milan, Italy. Caporali’s expertise is in clinical practice, teaching, and research in rheumatology, mainly rheumatoid arthritis and other immune-mediated inflammatory diseases, with a focus on prognostic factors, biomarkers, and treatment for patients with moderate-to-severe active rheumatoid arthritis. During this interview, Caporali discussed the decision-making process for treating rheumatoid arthritis, with a particular focus on the use of methotrexate. The purpose was to gain insights from a rheumatology expert regarding the prevalence and management goals of the disease, and available treatment options. The interview considered key decision-making drivers and barriers to healthcare professionals when selecting the route of administration. Caporali suggested that the efficacy and safety profile of methotrexate when delivered subcutaneously may be the optimal choice for patients, often resulting in higher adherence compared to oral dosing. Caporali recommended education and re-evaluation of local guidelines to improve patient outcomes by better understanding the optimal use and efficacy of methotrexate.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139180196","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":"Effect of Liraglutide on Weight Loss and BMI Among Patients Who Are Overweight and Obese with Type 2 Diabetes: A Systematic Review and Meta-analysis","authors":"C. Zorampari, Rachna Gupta, Lalit K. Gupta","doi":"10.33590/emj/10306493","DOIUrl":"https://doi.org/10.33590/emj/10306493","url":null,"abstract":"Objectives: This study assessed the effect of liraglutide as a monotherapy and add-on to metformin on weight loss and BMI, among patients with Type 2 diabetes (T2D) who are overweight or obese. Methods: The following databases were assessed to identify relevant papers published until July 2023: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), clinicaltrial.gov, and Web of Science. All clinical trials evaluating the effect of liraglutide on weight loss and BMI in patients with T2D who are obese or overweight, treated for at least 2 months, were included in the review. All analysis and risk of bias assessment was done using Cochrane Review Manager software, version 5.4.1 (Cochrane, London, UK). A random-effects model with inverse variance was used to synthesise the results. Results: In total, 10 randomised controlled trials involving 945 participants were included in the meta-analysis. Treatment with liraglutide with or without metformin for more than 2 months led to a significant weight loss (mean difference: -4.75 kg; 95% confidence interval: -7.02–-2.48; p<0.01). Liraglutide supplementation also led to a significant decrease in BMI (mean difference: -2.07; 95% confidence interval: -2.75–-1.39; p<0.01). However, the decrease in weight and BMI was not statistically significant as compared to treatment with other oral hypoglycaemic drugs or placebo. Conclusion: Liraglutide used alone or as adjunctive therapy to metformin produces reduction in weight and BMI when administered in adult patients with T2D who are obese or overweight.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139179465","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":"Redefining Renal Cell Carcinoma: A Molecular Perspective on Classification and Clinical Implications","authors":"A. A. Raghavan, Ian W Gibson, Robert Wightman, Piotr Czaykowski, Jeffrey Graham","doi":"10.33590/emj/10301071","DOIUrl":"https://doi.org/10.33590/emj/10301071","url":null,"abstract":"Renal cell carcinoma (RCC) is the most common primary tumour of the kidney. RCC is a clinically and pathologically heterogenous entity, which has traditionally been classified under two broad categories: clear-cell and non-clear cell. With improved molecular diagnostic methodologies and genetic testing, the classification of RCC has shifted from a morphological basis to a molecular/genetic focus, and has been systematically updated to reflect these advancements. The new 2022 World Health Organization (WHO) classification of RCC is the most recent of these updates, and contains significant changes, as compared to the previous 2016 classification. The most substantial of these changes is the establishment of a new category of molecularly-defined RCC, including TFE3-rearranged RCC, TFEB-altered RCC, ELOC-mutated RCC, fumarate hydratase-deficient RCC, succinate dehydrogenase-deficient RCC, ALK-rearranged RCC, and SMARCB1-deficient renal medullary carcinoma. In this narrative review, the authors briefly summarise the histopathological characteristics, clinical course, current treatment standards, and future treatment directions of each of these molecularly-defined RCC subtypes.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139180422","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":"Becker Muscular Dystrophy: Could Altering the Natural History of Decline Help Tackle Unmet Medical Need?","authors":"Amanda Barrell","doi":"10.33590/emj/10300460","DOIUrl":"https://doi.org/10.33590/emj/10300460","url":null,"abstract":"This symposium was held as part of the 28th International Annual Congress of the World Muscle Society (WMS), held in Charleston, South Carolina, USA. Speakers reviewed the natural history of Becker muscular dystrophy (Becker), outlined the top line, 12-month data from the ARCH open label study of investigational agent EDG-5506, and aimed to put those results into clinical context. Becker is a serious rare disease with significant physical, emotional, financial, and social impact on the affected individuals and their caregivers. Once function begins to decline, males affected by the progressive X-linked genetic disorder continue to irreversibly lose muscle, ultimately leading to the loss of ambulatory and cardiopulmonary function. After discussing the aetiology of the condition, Erik Niks, Paediatric and Adult Neurologist, Leiden University Medical Center (LUMC), the Netherlands, presented the findings of natural history studies. They showed that while the age at which decline begins varies, once it does start, patients tend to experience a consistent decline in function equivalent to around 1.2–1.3 North Star Ambulatory Assessment (NSAA) points each year. This finding, combined with data on using MRI as a biomarker of disease progression, provides an evidence-based framework for clinical trial design, he argued. Sam Collins, Vice President of clinical development, Edgewise Therapeutics, Boulder, Colorado, USA, then presented topline 12-month data from the ARCH study. It found that EDG-5506 was well tolerated, and, importantly, recorded the stabilisation of functional assessments, including the NSAA, with a trend towards improvement, as well as rapid, sustained, and significant decreases in biomarkers of progression, including those related to muscle damage. Putting the ARCH study data into context, Barry Byrne, Director of the Health Center for Advanced Therapeutics and Powell Gene Therapy Center, University of Florida (UF), Gainesville, USA, explained exactly how declining NSAA status translated into life-altering function loss. Stabilising function, or even reducing the speed of decline, was an important goal for patients, he said, adding that meeting it could help to address significant unmet medical need.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139180480","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":"Perimenopause and Menopause: An Opportunity to Engage, Inform, and Empower Women to Live Well","authors":"Amanda Barrell","doi":"10.33590/emj/10306944","DOIUrl":"https://doi.org/10.33590/emj/10306944","url":null,"abstract":"While awareness of the issues facing women leading up to, during, and following the menopause has increased in recent years, it remains a condition of significant unmet need. Reasons include a stigma around asking for help, and a lack of awareness of the symptoms and associated risks among women and healthcare professionals alike. Standard medical training includes limited education on perimenopausal and post-reproductive healthcare, meaning clinicians are often ill-prepared to intervene. However, there is much that healthcare professionals, regardless of their specialty, can do to help women entering their post-reproductive years, say Rossella Nappi, Chief of the Research Centre for Reproductive Medicine and Director of the Gynecological Endocrinology and Menopause Unit at IRCCS San Matteo Foundation, University of Pavia, in Italy; and Katrin Schaudig, co-founder of the Centre for Gynaecological Endocrinology, Hormone Hamburg, Germany, and President of the German Menopause Society. Moreover, perimenopause represents an important opportunity to engage, inform, and empower women to take charge of their health for years to come. In this key opinion leader interview, Nappi and Schaudig explain the physiological changes associated with menopause, their clinical manifestations, and their associated risk factors. They talk about the need to tackle the stigma that is often attached to this phase of life, and why healthcare professionals have a duty to work with women to spot the signs of menopausal transition from an early stage. They argue that holistic care, which focuses as much on the prevention of chronic disease as it does on the treatment of menopausal symptoms, is key to ensuring women stay physically and mentally fit and healthy as they get older.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139180179","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 Horizons in IgA Nephropathy: A Focus on Current Treatment and Emerging Solutions","authors":"Eleanor Roberts","doi":"10.33590/emj/10303661","DOIUrl":"https://doi.org/10.33590/emj/10303661","url":null,"abstract":"IgA nephropathy (IgAN) is a common form of glomerular disease, with wide heterogeneity of symptom occurrence and progression. Diagnosis is based on kidney biopsy findings. IgAN initiates in the mucosa with development of galactose-deficient IgA1 (Gd-IgA1) and anti-Gd-IgA1 autoantibodies, leading to deposition of these complexes in glomerular mesangium with resulting fibrosis, inflammation, tubulointerstitial scarring, and glomerular injury. This can lead to chronic kidney disease (CKD), kidney failure, and death. IgAN treatment involves optimised supportive care, including individualised strategies to address symptoms, such as high blood pressure control and cardiovascular risks. Drug treatment includes renin-angiotensin-aldosterone system (RAAS) inhibitors and immunosuppressant therapies. While the latter can successfully lower proteinuria, and have a positive effect on estimated glomerular filtration rate (eGFR), adverse effects can limit treatment duration, and increasing proteinuria and decreasing eGFR can return following treatment discontinuation. New formulations of immunosuppressant therapies include delayed-release budesonide with targeted release in the lower part of the small intestine where Gd-IgA1 production occurs. Although treatment with this drug can reduce proteinuria and sustain eGFR levels, similar to other immunosuppressant therapies, effects seem to be predominantly limited to the active treatment period. Targeting a different mechanism, sparsentan is a dual endothelin A receptor (ETA) and angiotensin II receptor type 1 (AT1) blocker that targets endothelin-1 (ET-1) and angiotensin II, both involved in IgAN progression. Initial Phase III trial results show significant differences, favouring sparsentan, compared with the AT1 blocker irbesartan, on proteinuria, with similar adverse event profiles. These agents, and several other drugs in development, will widen the armamentarium of therapies for people with IgAN, which, when used in combination, can target different aspects of IgAN pathogenesis for a more individualised treatment approach.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139179235","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":"Spasticity Matters: A Call to Action Following an Acute Stroke","authors":"Nicola Humphry","doi":"10.33590/emj/10304502","DOIUrl":"https://doi.org/10.33590/emj/10304502","url":null,"abstract":"More than half of survivors of stroke experience some degree of motor impairment, and spasticity can develop within days of the initial event. Patients with post-stroke spasticity (PSS) report a lower quality of life than those without spasticity, and they require regular long-term follow-up and monitoring within the healthcare system. This symposium supported a non-promotional discussion regarding the prevalence, burden, consequences, and need for identification of PSS. The benefits of PSS identification within 3 months of stroke were discussed by a panel of key opinion leaders, including Ted Wein, Neurologist and Assistant Professor of Neurology and Neurosurgery at McGill University, Montréal, Quebec, Canada; Ganesh Bavikatte, Consultant and Clinical Lead in rehabilitation medicine at the Walton Centre, Liverpool, and Honorary Senior Clinical Lecturer at the University of Liverpool, UK; and Sean Savitz, Professor of Neurology and Physical Medicine and Rehabilitation, Frank M. Yatsu MD Chair in Neurology, and Director of the Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston (UTHealth), Texas, US. These key opinion leaders explained that early prediction of PSS could be improved by increased awareness of the associated risk factors and tools, such as the Post-Stroke Checklist (PSC), the Spasticity Screening Tool, and the PSS Referral Tool. Finally, potential barriers to the early identification of PSS were presented, alongside strategies to overcome these barriers.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139179367","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":"Spontaneous Subcapsular Hepatic Haematoma: A Rare Case Report","authors":"Roisin Burrows-O’Donoghue, Rowena Donnison, Emmanuel D’Almeida","doi":"10.33590/emj/10300184","DOIUrl":"https://doi.org/10.33590/emj/10300184","url":null,"abstract":"A spontaneous subscapular hepatic haematoma is a rare condition that has not widely been reported in literature. Subscapular hepatic haematoma has a high mortality rate, especially if the haematoma ruptures, so early diagnosis is imperative. In this case report, the authors present an unusual case of subscapular hepatic haematoma of a female in her 70s, who, in her first few days of admission for the management of acute calculus cholecystitis, developed acute onset right upper quadrant and epigastric pain radiating to her back. Her haemoglobin dropped from 112 g/L to 54 g/L, and her liver function tests and coagulation studies became deranged. Abdominal and pelvic CT and angiography showed a subscapular liver haematoma without active bleeding. The patient received a blood transfusion and was managed conservatively, with no obvious cause being identified.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139239603","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}