American Journal of Medicine最新文献

{"title":"Statin Therapy, Inflammation, and Outcomes in Patients Hospitalized for COVID-19: A Prospective Multicenter Cohort Study.","authors":"Anis Ismail, Husam R Shadid, Yiyuan Huang, Christina G Hutten, Alexi Vasbinder, Ian Pizzo, Tonimarie Claire Catalan, Kristen Machado Diaz, Pennelope Kunkle, Mousumi Banerjee, Melvyn Rubenfire, Eric J Brandt, Geoffery Williams, Rodica Pop-Busui, Salim S Hayek","doi":"10.1016/j.amjmed.2024.08.011","DOIUrl":"10.1016/j.amjmed.2024.08.011","url":null,"abstract":"<p><strong>Background: </strong>Statins are lipid-lowering agents with anti-inflammatory effects. Data surrounding the benefits of statins in patients with coronavirus disease 2019 (COVID-19) are conflicting. We sought to better understand the impact of statins in the context of COVID-19-related inflammation.</p><p><strong>Methods: </strong>We leveraged the International Study of Inflammation in COVID-19, a prospective multicenter cohort of patients hospitalized for COVID-19 between February 2020 and October 2022. Participants underwent systematic assessment of biomarkers of inflammation. We used logistic regression modeling and inverse probability-of-treatment weighting (IPTW) to examine the association between prior statin use and the composite outcome of in-hospital death, need for mechanical ventilation, and need for renal replacement therapy.</p><p><strong>Results: </strong>A total of 4464 patients were included in the study, of whom 1364 (27.5%) were taking a statin prior to admission. There were 1061 primary outcome events, including 540 deaths, 854 mechanical ventilation and 313 renal replacement therapy. Amongst biomarkers of inflammation, statin use was associated solely with lower levels of soluble urokinase plasminogen activator receptor (suPAR) after adjusting for known confounders. In multivariable logistic regression analysis, statin use was associated with lower odds of the composite outcome (adjusted odds ratio (aOR) 0.63, 95% CI [0.53-0.76]) compared to patients not on statins. Findings were consistent with IPTW (aOR 0.92, 95% CI [0.89- 0.95]). The proportion of the effect of statin on the primary outcome mediated by suPAR was estimated at 31.5%.</p><p><strong>Conclusion: </strong>Prior-statin use is associated with improved outcomes and lower inflammation as measured by suPAR levels in patients hospitalized for COVID-19.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047469","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":"Adult Outpatients with Long COVID Infected with SARS-CoV-2 Omicron Variant. Part 1: Oral Microbiota Alterations.","authors":"Jianchao Xu, Di Wu, Jie Yang, Yinuo Zhao, Xuzhao Liu, Yingying Chang, Yao Tang, Feng Sun, Yubin Zhao","doi":"10.1016/j.amjmed.2024.07.030","DOIUrl":"10.1016/j.amjmed.2024.07.030","url":null,"abstract":"<p><strong>Background: </strong>Many individuals experience long COVID after SARS-CoV-2 infection. As microbiota can influence health, it may change with COVID-19. This study investigated differences in oral microbiota between COVID-19 patients with and without long COVID.</p><p><strong>Methods: </strong>Based on a prospective follow-up investigation, this nested case-control study evaluated the differences in oral microbiota in individuals with and without long COVID (Symptomatic and Asymptomatic groups), which were assessed by 16S rRNA sequencing on tongue coating samples. A predictive model was established using machine learning based on specific differential microbial communities.</p><p><strong>Results: </strong>One-hundred-and-eight patients were included (n=54 Symptomatic group). The Symptomatic group had higher Alpha diversity indices (observed_otus, Chao1, Shannon, and Simpson indices), differences in microbial composition (Beta diversity), and microbial dysbiosis with increased diversity and relative abundance of pathogenic bacteria. Marker bacteria (c__Campylobacterota, o__Coriobacteriales, o__Pseudomonadales, and o__Campylobacterales) were associated with long COVID by linear discriminant analysis effect size and receiver operating characteristic curves (AUC 0.821).</p><p><strong>Conclusion: </strong>There were distinct variations in oral microbiota between COVID-19 patients with and without long COVID. Changes in oral microbiota may indicate long COVID.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996896","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":"Heads-Up! A Caregiver's Perspective on Lewy Body Dementia.","authors":"Freda Spector Warrington","doi":"10.1016/j.amjmed.2024.08.001","DOIUrl":"10.1016/j.amjmed.2024.08.001","url":null,"abstract":"<p><p>This narrative review takes a personal approach in detailing the progression of cognitive decline in a loved one, and the measures taken to care for the patient. The author provides suggestions for a compassionate care plan and advice for clinicians helpful to both patient and caregiver.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996897","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":"Using Mixed Reality to Teach Medical Students Lumbar Punctures.","authors":"Pete Meliagros, Jayson Diener-Brazelle, Adam Garber","doi":"10.1016/j.amjmed.2024.08.003","DOIUrl":"10.1016/j.amjmed.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>Gaining familiarity with bedside procedures during medical school is essential for preparing medical students for intern year. However, this is often not a core component of undergraduate medical education, and students often feel unprepared to perform bedside procedures upon graduation from medical school. Extended reality technologies have rapidly developed in the past few years, become more accessible, and show great promise in education, most recently in healthcare. We aim to show the feasibility and usability of a mixed-reality lumbar puncture simulated experience.</p><p><strong>Methods: </strong>We created the mixed-reality simulation by filming a procedure conducted by an expert on a lumbar puncture simulator from the first-person view. We performed a study to assess the feasibility and usability of mixed-reality lumbar puncture training compared with traditional faculty-led high-fidelity mannikin-based simulation training. Fourth-year medical students were randomly selected to participate in the mixed-reality lumbar puncture training. Students watched the virtual first-person teaching via a virtual reality headset while mimicking hand movements on a lumbar puncture mannikin. Faculty taught students in the traditional high-fidelity group in small groups before practicing on the high-fidelity manikin. Students in both groups then performed the procedure entirely with performance assessed via a standardized checklist. Number of attempts to achieve a predetermined minimum passing score were recorded, and students were also surveyed regarding their experience with both simulations.</p><p><strong>Results: </strong>Fifty-nine percent of students felt comfortable using mixed reality as a training modality with less than 6% having any prior extended reality experience. More than 55% felt the mixed-reality experience was as effective as the traditional high-fidelity simulation training. Many students (72%) desired more mixed-reality opportunities. In terms of performance, 58.8% of students in the mixed-reality group vs 65.5% in the traditional group completed the checklist in 1 attempt (P = .79).</p><p><strong>Conclusions: </strong>We demonstrate that mixed reality is an acceptable and effective modality to train health care professionals in lumbar punctures with opportunities to further enhance the immersive learning experience.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996899","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":"Human Immortality: The Quest for Permanence.","authors":"Eli Y Adashi","doi":"10.1016/j.amjmed.2024.07.037","DOIUrl":"10.1016/j.amjmed.2024.07.037","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996898","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":"Constructing an Ideal History of Present Illness: Prescriptions for Medical Educators and Trainees.","authors":"Eleanor E A Smith, Daniel M Musher, Prathit A Kulkarni","doi":"10.1016/j.amjmed.2024.08.012","DOIUrl":"10.1016/j.amjmed.2024.08.012","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989453","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":"Evaluating Academic Physicians' Bibliographies: Criteria and Fairness.","authors":"Thomas J Beckman","doi":"10.1016/j.amjmed.2024.08.015","DOIUrl":"10.1016/j.amjmed.2024.08.015","url":null,"abstract":"<p><p>In the academic professions, publications are essential for high-stakes decisions about employment, recognition, and promotion. Therefore, impartial frameworks are needed for evaluating the rigor of scholarly physicians' bibliographies. This article provides objective criteria for evaluating bibliographies based on author position, publication type, impact, volume, thematic focus, and trajectory. Key threats to the fair assessment of physicians' bibliographies include disparities regarding underrepresentation and professional opportunities, not recognizing the successes of disadvantaged authors, and exploiting publications to gain favor and abuse positions of power. Unbiased criteria for evaluating bibliographies mitigate these threats to fair assessment.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989455","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":"Medical Aphorisms Redux.","authors":"Joseph S Alpert","doi":"10.1016/j.amjmed.2024.08.013","DOIUrl":"10.1016/j.amjmed.2024.08.013","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989456","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":"Circulating Tumor DNA for Solid Tumor Minimal/Molecular Residual Disease Detection in Cancer Survivors.","authors":"Steven Sorscher","doi":"10.1016/j.amjmed.2024.08.014","DOIUrl":"10.1016/j.amjmed.2024.08.014","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989452","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":"Arrhythmogenic Mitral Valve Prolapse Revisited: A Not Uncommon Cause of Youthful Sudden Death in Athletes and Women.","authors":"Kevin M Harris, Shannon Mackey-Bojack, Giselle Fisher, Darlington Nwaudo, Barry J Maron","doi":"10.1016/j.amjmed.2024.08.002","DOIUrl":"10.1016/j.amjmed.2024.08.002","url":null,"abstract":"<p><strong>Background: </strong>Sudden deaths (SDs) in young people, including competitive athletes, albeit uncommon, are usually attributable to genetic, congenital or acquired cardiovascular conditions. However, it is under-appreciated that mitral valve prolapse (MVP), a relatively common valvular heart disease, is associated with SD in this youthful population.</p><p><strong>Methods: </strong>Forty-three MVP-related SDs were identified from 2 large cardiovascular registries with pathologic, clinical, and demographic findings reported.</p><p><strong>Results: </strong>Events occurred in both sexes, but females were unexpectedly common (49%); median age was 22 ± 8 years, and 29 (67%) were engaged in competitive sports, including 17 with preparticipation examination. Of the 43 MVP cases, 21 died suddenly during or just after vigorous exercise, including 6 during organized sports. Sixteen (37%) had been evaluated by a cardiologist, resulting in confirmed MVP diagnosis in 11. Pathologic findings characteristic of MVP included bileaflet myxomatous involvement (in all cases) and areas of interstitial or replacement myocardial fibrosis (in 79%), most evident in posterolateral left ventricular wall.</p><p><strong>Conclusions: </strong>Arrhythmogenic myxomatous degeneration (MVP) is an under-recognized cause of SD in young people, including competitive athletes, disproportionally affecting females and requires a high index of clinical suspicion. Frequency of left ventricular fibrosis in these young people with MVP suggests a mechanism for ventricular tachyarrhythmias and SD, relevant to future risk stratification.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989451","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}