American Journal of the Medical Sciences最新文献

{"title":"Hepatitis C virus infection associated with coronary and thoracic aortic atherosclerosis","authors":"","doi":"10.1016/j.amjms.2024.02.004","DOIUrl":"10.1016/j.amjms.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Coronary and thoracic aortic calcification was associated with stroke, coronary heart, and peripheral vascular disease. Hepatitis C virus (HCV) infection is significantly associated with insulin resistance, diabetes mellitus and </span>hepatic steatosis<span>. We aimed to investigate the relationship between HCV<span> infection and coronary, thoracic aortic atherosclerosis.</span></span></p></div><div><h3>Materials and methods</h3><p><span><span>Calcification was detected by chest computed tomography and defined as any </span>Agatston score<span> greater than zero. Metabolic syndrome<span> was based on the modified Adult Treatment Panel III criteria. Fibrosis-4 (FIB-4) and AST-to-platelet ratio (APRI) was calculated. The anti-HCV signal-to-cutoff (S/CO) ratio was determined by the third generation ELISA kit. </span></span></span>Atherosclerosis<span> risk was estimated by using multiple logistic regression modeling.</span></p></div><div><h3>Results</h3><p><span>Being positive for both metabolic syndrome and HCV infection (OR = 2.65, 95% CI: 1.26–5.59, </span><em>p</em> = 0.007), negative for metabolic syndrome and positive for HCV infection (OR = 2.75, 95% CI: 1.48–5.30, <em>p</em> = 0.001), and positive for metabolic syndrome and negative for HCV infection (OR = 2.42, 95% CI: 1.92–3.07, <em>p</em> &lt; 0.001) were associated with atherosclerosis compared with being negative for both metabolic syndrome and HCV infection (P_trend<span>&lt; 0.001). HCV infection with liver fibrosis (HCV</span>^FIB4&gt;1.4; OR = 2.16, 95% CI: 1.22–3.82, <em>p</em> = 0.008), or (HCV^APRI&gt;0.5; OR = 3.40, 95% CI: 1.28–9.06, <em>p</em> = 0.014) and elevated anti-HCV S/CO ratio (anti-HCV^S/CO&gt;10.0; OR = 1.72, 95% CI: 1.01–2.93, <em>p</em> = 0.045) was associated with atherosclerosis.</p></div><div><h3>Conclusions</h3><p>HCV infection with metabolic syndrome, liver fibrosis and elevated anti-HCV S/CO ratio was associated with atherosclerosis.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139901108","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":"Surreptitious Intramuscular Cysticercosis","authors":"Sourabh Sharma MD, DNB Nephrology, MNAMS, FASN, FISN (Assistant Professor) ,&nbsp;Himanshu Verma MD, DM (Professor) ,&nbsp;Sanjay Kalra MD, DM","doi":"10.1016/j.amjms.2024.02.006","DOIUrl":"10.1016/j.amjms.2024.02.006","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747974","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":"Paget disease of bone in a southeastern Veteran population","authors":"Mariana Urquiaga MD ,&nbsp;Angelo Gaffo MD MsPH FACP","doi":"10.1016/j.amjms.2024.02.005","DOIUrl":"10.1016/j.amjms.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>Paget disease of bone (PDB) is a disorder of accelerated bone remodeling resulting in bone overgrowth and impaired integrity that traditionally is described to be more frequent in individuals of European descent. Based on clinical observation, we hypothesized that among the US Southeastern Veteran population, the disease is more common among African American patients.</p></div><div><h3>Materials and methods</h3><p>We conducted a cross-sectional study using the Veterans Affairs’ Clinical Data Warehouse (CDW) and review of electronic medical records (EMR). Using the CDW, we identified patients from the Birmingham VA Medical Center (BVAMC) with an International Classification of Diseases code for PDB between January 2000 and December 2020. We extracted their self-reported race from the CDW and determined the proportion of African American patients, which we compared to the proportion of White patients. As a secondary goal, we extracted relevant clinical characteristics from the EMR. The statistical analysis was done using Stata/SE 14.2 for Mac.</p></div><div><h3>Results</h3><p>We identified 285 individuals from the BVAMC with PDB between January 2000 and December 2020. The proportion of African American patients was significantly higher than White patients (0.51 vs. 0.4, <em>p</em> = 0.0036). African American patients presented at a younger age than their peers (mean[standard deviation] age at diagnosis: 64.6[11.6] vs. 70.1[10.7] years, <em>p</em> = 0.0009) but did not have higher alkaline phosphatase levels, higher proportion of polyostotic disease, or of symptoms and complications.</p></div><div><h3>Conclusions</h3><p>In the BVAMC population, PDB is more common among African American patients than White patients. Our findings and other publications hint at the existence of a cluster of PDB among the African American population in the US Southeast.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748011","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":"Estimated plasma volume status is a simple and quick tool that could help define the severity of patients with infection on arrival at the emergency department","authors":"Gianni Turcato MD ,&nbsp;Arian Zaboli RN ,&nbsp;Serena Sibilio RN ,&nbsp;Francesco Brigo MD","doi":"10.1016/j.amjms.2024.02.003","DOIUrl":"10.1016/j.amjms.2024.02.003","url":null,"abstract":"<div><h3>Background</h3><p>Infectious states are subtle and rapidly evolving conditions observed daily in the emergency department (ED), and their prognostic evaluation remains a complex clinical challenge. Recently, estimated plasma volume status (ePVS) has been suggested to have a prognostic role in conditions where volemic alteration is central to the pathophysiology. The aim of this study was to verify whether ePVS recorded at ED admission can provide prognostic indications of 30-day mortality in patients with infection.</p></div><div><h3>Methods</h3><p>A prospective observational study was performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital. All patients with infection were enrolled. ePVS values were derived from haemoglobin and haematocrit measured on the immediate arrival of patients in the ED. The predictive power of ePVS for 30-day mortality was assessed using a multivariate model adjusted for severity, comorbidity and urgency. Kaplan–Meier analysis was also performed.</p></div><div><h3>Results</h3><p>Of the 949 patients with infection enrolled in the study (47.9%, SOFA ≥2), 8.9% (84/949) died at 30 days. The median ePVS value was higher in patients who died at 30 days than in patients who survived (5.83 vs. 4.61, p &lt; 0.001). Multivariate analysis revealed that ePVS in both continuous and categorical form around the median was an independent risk factor for 30-day mortality even after adjusting for severity, comorbidity and urgency. Kaplan–Meier analysis confirmed an increased risk of death in patients with high ePVS values.</p></div><div><h3>Conclusions</h3><p>ePVS recorded on ED admission of patients with infection was an independent predictor of risk for 30-day mortality.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139737013","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":"Neighborhood-level disadvantages increase risk for invasive pneumococcal disease","authors":"Daniel Minassian BS ,&nbsp;Liang Shan PhD ,&nbsp;Chaoling Dong PhD ,&nbsp;Arzoo N. Charania ,&nbsp;Carlos J. Orihuela PhD ,&nbsp;Chao He MD, PhD","doi":"10.1016/j.amjms.2024.02.002","DOIUrl":"10.1016/j.amjms.2024.02.002","url":null,"abstract":"<div><h3>Background</h3><p><em>Streptococcus pneumoniae</em> (<em>Spn</em>) infection remains common worldwide despite recent vaccine efforts. Invasive pneumococcal disease (IPD) is the most severe form of <em>Spn</em> infection. Known individual risk factors for IPD include male gender and African American race. However, area-level socioeconomic factors have not been assessed. We examined the association of neighborhood-level disadvantages and risk of IPD in a tertiary medical center located in a socioeconomic diverse urban area in the Southeastern United States.</p></div><div><h3>Methods</h3><p>Patients hospitalized with culture-confirmed <em>Streptococcus pneumoniae</em> (<em>Spn</em>) infection from 01/01/2010 - 12/31/2019 were identified from electronic health record (EHR). The cohort's demographic and clinical information were obtained from EHR. Patients’ residential address was geocoded and matched to 2015 area deprivation index (ADI). The association of ADI and IPD was evaluated using logistic regression after controlling for the demographic information (age, sex, race) and clinical factors (BMI, smoking status, alcoholism, immunosuppressive status, vaccination status, comorbidities).</p></div><div><h3>Results</h3><p>A total of 268 patients were hospitalized with culture-positive <em>Streptococcus pneumoniae</em> infection and 92 (34.3%) of them had IPD. The analysis showed that higher neighborhood deprivation (ADI in 79–100) was associated with increased risk of developing IPD in younger patients with age less than 65 (<em>p</em> = 0.007) after controlling for the individual demographic information and clinical factors.</p></div><div><h3>Conclusions</h3><p>ADI is a risk factor for IPD in younger adults. Community-level socioeconomic risk factors should be considered when developing prevention strategies such as increasing vaccine uptake in high risk population to reduce the disease burden of IPD.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716785","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":"Impact of COVID-19 infection on baseline autonomic symptoms in patients with preexisting postural tachycardia syndrome and orthostatic intolerance: A retrospective study","authors":"Chandramohan Meenakshisundaram MD ,&nbsp;Abdelmoniem Moustafa MD ,&nbsp;Meghana Ranabothu ,&nbsp;Ahmed Maraey MD ,&nbsp;Blair Grubb MD","doi":"10.1016/j.amjms.2023.12.011","DOIUrl":"10.1016/j.amjms.2023.12.011","url":null,"abstract":"<div><h3>Background</h3><p>Postural orthostatic tachycardia syndrome (POTS) and dysautonomia following a SARS-CoV-2 infection have been recently reported. The underlying mechanism of dysautonomia is not well understood. The impact of this viral illness on the underlying autonomic symptoms has not been studied in patients with a pre-existing POTS diagnosis. Our study aims to report the impact of a COVID-19 infection on patients with preexisting POTS, both during the acute phase of the disease and post-recovery.</p></div><div><h3>Methods</h3><p>Institutional Review Board (IRB) approval was obtained to access charts of the study subjects. All patients with known POTS disease who acquired COVID-19 infection between April 2020 and May 2021 were included. The end point of the study was worsening POTS related symptoms including orthostatic dizziness, palpitation, fatigue and syncope/ presyncope post COVID-19 infection that required escalation of therapy. Basic demographics, details of POTS diagnosis, medications, Additional information regarding COVID 19 infection, duration of illness, need for hospitalization, worsening of POTS symptoms, need for ED visits, the type of persisting symptoms and vaccination status were obtained from the retrospective chart review.</p></div><div><h3>Results</h3><p>A total of 41 patients were studied. The alpha-variant was the most common causing SARS-CoV-2 infection. 27% (11 patients) of them had tested positive for COVID- 19 infection more than once. About 38 (92.7%) of them reported having worsening of their baseline POTS symptoms during the active infection phase. About 28 patients (68%) experienced worsening of their dysautonomia symptoms for at least 1–6 months post infection. Nearly 30 patients (73.2%) required additional therapy for their symptom control and improvement.</p></div><div><h3>Conclusions</h3><p>Patients with pre-existing POTS, most experienced a worsening of their baseline autonomic symptoms after suffering the COVID-19 infection which required additional pharmacotherapy for their symptom improvement.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716784","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":"Impact of elexacaftor/tezacaftor/ivacaftor on respiratory colonization in an adult cystic fibrosis clinic","authors":"Michelle M. Szabo PharmD ,&nbsp;Sarah E. Foushee PharmD, BCPS, CSP ,&nbsp;Chelsey M. McPheeters PharmD, BCPS, BCACP ,&nbsp;Adrian R. O'Hagan MD ,&nbsp;Allan M. Ramirez MD ,&nbsp;Emily A. O'Reilly PharmD, BCACP, CSP","doi":"10.1016/j.amjms.2024.02.001","DOIUrl":"10.1016/j.amjms.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Little research has been completed on the correlation between cystic fibrosis (CF) modulator therapy and its effect on respiratory cultures in CF patients. This study evaluated the effect of elexacaftor/tezacaftor/ivacaftor (ETI) on respiratory colonization with <em>Pseudomonas aeruginosa</em>.</p></div><div><h3>Methods</h3><p>This single center, IRB approved, retrospective chart review compared patient data two years immediately prior to ETI initiation with patient data two years post-initiation from January 2017-December 2022. Patients were included in the study if they were at least 18 years old with a diagnosis of CF and had at least one month of ETI dispensed, at least one sputum culture obtained, and were currently on ETI. Those who had not been seen since ETI initiation or received a bilateral lung transplant were excluded. The primary outcome was rate of patients with respiratory colonization post-ETI. Colonization was defined as two or more positive <em>P. aeruginosa</em> cultures in a 12-month period. Decolonization was defined as three consecutive negative <em>P. aeruginosa</em> cultures after previous colonization. Key secondary outcomes included average time to discontinuation of mucolytic therapy and relative risk of pulmonary exacerbation.</p></div><div><h3>Results</h3><p>A significant reduction (<em>p</em>&lt;0.001) in colonization with <em>P. aeruginosa</em> was observed with 49 patients in the pre-ETI group compared to 25 in the post-ETI group meeting the definition of colonization (n=79). Average time to discontinuation of mucolytic therapy was 14 months (<em>p</em>=0.002). Relative risk of pulmonary exacerbation was 4.80 (<em>p</em>&lt;0.001).</p></div><div><h3>Conclusions</h3><p>ETI use resulted in reduced colonization with <em>P. aeruginosa,</em> discontinuation of mucolytic therapy, and decreased frequency of pulmonary exacerbation.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713604","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":"Mortality of patients presented with acute ST-segment elevation myocardial infarction according to the status of standard modifiable cardiovascular risk factors","authors":"Kinga Glądys ,&nbsp;Zbigniew Siudak ,&nbsp;Przemysław Trzeciak ,&nbsp;Wojciech Siłka ,&nbsp;Michał Skrzypek ,&nbsp;Michał Chyrchel ,&nbsp;Mariusz Gąsior ,&nbsp;Rafał Januszek","doi":"10.1016/j.amjms.2024.01.025","DOIUrl":"10.1016/j.amjms.2024.01.025","url":null,"abstract":"<div><h3>Background</h3><p>Standard modifiable cardiovascular risk factors (SMuRFs) remain well-established elements of assessing cardiovascular risk scores. However, there is growing evidence that patients presented without known SMuRFs at admission demonstrate worse post-myocardial outcomes. The aim of the study was to assess the influence of the SMuRF status on short- and long-term mortality rates in patients with first-time ST-segment elevation myocardial infarction (STEMI).</p></div><div><h3>Methods</h3><p>This observational, cross-sectional study covered 182,726 patients admitted between 2003–2020 to the CathLabs, according to data from the Polish Registry of Acute Coronary Syndrome. Both baseline characteristics and mortality (in-hospital, 30-day, and 12-month) were examined and stratified by SMuRF status. The predictors of mortality were assessed at selected time points by multivariable analysis.</p></div><div><h3>Results</h3><p>The majority of STEMI patients had at least one SMuRF (88.7%), however, mortality rates of SMuRF-less individuals were greater at selected time points of the follow-up (<em>p &lt;</em> 0.001), and persisted at a higher level during each year of the follow-up period compared to the SMuRF group and general population. Furthermore, the SMuRFs status constituted an independent predictor of mortality at the 30-day (OR: 1.345; 95% CI: 1.142–1.585, <em>p &lt;</em> 0.001) and 12-month (OR: 1.174; 95% CI: 1.054–1.308, <em>p &lt;</em> 0.001) follow-ups.</p></div><div><h3>Conclusions</h3><p>SMuRF-less individuals presented with STEMI are at an increased risk of all-cause mortality compared to those with at least one SMuRF. Consequently, further investigations regarding the recognition and treatment of risk factors, irrespective of SMuRF status, are indicated.</p></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699200","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":"Landmine hidden in tracheostomy: An incidental case of neck arteriovenous malformations","authors":"Yan Li MM,&nbsp;Jianquan Zhong MM","doi":"10.1016/j.amjms.2024.01.024","DOIUrl":"10.1016/j.amjms.2024.01.024","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669943","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":"Barium aspiration","authors":"Qinguo Liu ,&nbsp;Zhi Hu","doi":"10.1016/j.amjms.2024.01.023","DOIUrl":"10.1016/j.amjms.2024.01.023","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663823","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}