American journal of medicine open最新文献

{"title":"Postacute Sequelae From SARS-CoV-2 at the University of Illinois Hospital and Clinics: An Examination of the Effects of Long COVID in an Underserved Population Utilizing Manual Extraction of Electronic Health Records","authors":"John Musachia,&nbsp;Jon Radosta,&nbsp;Dirin Ukwade,&nbsp;Shahrukh Rizvi,&nbsp;Romani Wahba","doi":"10.1016/j.ajmo.2025.100095","DOIUrl":"10.1016/j.ajmo.2025.100095","url":null,"abstract":"<div><h3>Background</h3><div>Although there has been a steady decrease in morbidity and mortality from the SARS-CoV-2 virus since the 2020-2021 period, thousands of Americans are still infected with the virus daily. Some proportion of these infected individuals will go on to develop postacute sequelae from SARS-CoV-2 (PASC, or Long COVID), manifesting symptoms 4 weeks or more after recovery from COVID-19. PASC and its underlying pathophysiology are still poorly described and understood. Although hundreds of peer-reviewed, published investigations on Long COVID exist, few have focused on underserved urban patient populations. Most of the published research has involved reviews of diagnostic codes from electronic health records, or responses to questionnaires.</div></div><div><h3>Methods</h3><div>We sought to review Long COVID in an underserved population in Chicago, and to go beyond electronic health record reviews of diagnostic codes, utilizing in-depth chart reviews, gleaned via manual extraction, focusing on notations of care providers. We investigated which specific preexisting conditions, if any, might be associated with specific Long COVID symptomatology's, and if any preexisting conditions predicted Long COVID. Study participants included 204 Long COVID patients, 98 COVID-19–positive patients, and 104 healthy (no history of COVID-19 infection) patients from an inner-city health system caring for underserved communities, whose records were reviewed via manual data extraction from electronic health records, focusing on provider notes in patient charts.</div></div><div><h3>Results</h3><div>Our Long COVID symptom frequencies were distinct compared to frequencies from other reviews that did not focus on underserved populations and done with medical records when only diagnostic codes are utilized. Preexisting medical conditions did not predict similar Long COVID symptomologies, save for the significant association between preexisting cough/dyspnea/pulmonary conditions and preexisting migraine/headache and their analogous Long COVID symptoms.</div></div><div><h3>Conclusions</h3><div>The odds of having Long COVID increased comparatively in subjects hospitalized with COVID-19, subjects with BMI &gt;30, and female subjects.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Returning Individual-Level Urgent or Emergent Research Results to Participants: The Project Baseline Health Study Experience","authors":"Neha Pagidipati ,&nbsp;Brooke Heidenfelder ,&nbsp;Lydia Coulter Kwee ,&nbsp;Fatima Rodriguez ,&nbsp;Ranee Chatterjee ,&nbsp;Kishan S. Parikh ,&nbsp;Michel G. Khouri ,&nbsp;Jennifer Stiller ,&nbsp;Julie Eckstrand ,&nbsp;P. Kelly Marcom ,&nbsp;Priyatham S. Mettu ,&nbsp;Glenn J. Jaffe ,&nbsp;Sumana Shashidhar ,&nbsp;Susan Swope ,&nbsp;Susan Spielman ,&nbsp;Elizabeth Fraulo ,&nbsp;L. Kristin Newby ,&nbsp;Pamela Douglas ,&nbsp;Charlene Wong ,&nbsp;Robert Green ,&nbsp;Svati H. Shah","doi":"10.1016/j.ajmo.2025.100092","DOIUrl":"10.1016/j.ajmo.2025.100092","url":null,"abstract":"<div><h3>Background</h3><div>Returning results to research participants is increasingly recognized as an ethical mandate, yet little is known about best practices to optimally communicate urgent or emergent results.</div></div><div><h3>Methods</h3><div>We describe the development of and experience with a process to return results to participants in the Project Baseline Health Study (PBHS), which was a prospective observational cohort study of 2502 participants enrolled from 2017 to 2019 and followed through 2023. Urgent or emergent results were returned during or after the baseline visit from vital signs; clinical laboratory testing; and ocular, cardiovascular, and pulmonary imaging.</div></div><div><h3>Results</h3><div>Among 2002 participants in this analysis, 39.7% had at least one urgent or emergent finding returned, representing a total of 1159 results returned over 3 years. The most commonly returned results were eye findings (<em>n</em> = 246), pulmonary nodules (<em>n</em> = 159), abnormal stress echocardiograms (<em>n</em> = 123), abnormal rest electrocardiograms (bradycardia) (<em>n</em> = 74), and lung parenchyma findings (<em>n</em> = 55). Participants with urgent or emergent incidental findings were older (mean [SD] 58.0 [16.2] years vs 48.0 [16.6] years) with a greater burden of cardiovascular, metabolic, or cancer comorbidities than those without urgent or emergent incidental findings.</div></div><div><h3>Conclusions</h3><div>This report from the PBHS study is one of the first to describe a process to systematically return urgent or emergent results to research participants. This process led to the successful return of clinically important results to participants but also required significant time and effort from study clinicians and staff.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Bad Reputation of Digoxin in Atrial Fibrillation—Causality or Bias? Nationwide Nested Case-Control Study","authors":"Anders Holt ,&nbsp;Jarl Emanuel Strange ,&nbsp;Morten Lock Hansen ,&nbsp;Morten Lamberts ,&nbsp;Peter Vibe Rasmussen","doi":"10.1016/j.ajmo.2025.100093","DOIUrl":"10.1016/j.ajmo.2025.100093","url":null,"abstract":"<div><h3>Aims</h3><div>Studies have reported excess risk of mortality associated with digoxin in atrial fibrillation (AF).</div><div>This study sought to investigate if these findings could be replicated and whether a potential association could be explained by bias.</div></div><div><h3>Methods</h3><div>Using Danish Nationwide registers, a nested-case control study from 2012 to 2022 was conducted in a cohort of patients with AF. Cases were defined as death of any cause and the exposure was treatment with digoxin compared with beta blockers/verapamil. To investigate bias, additional analyses with negative control outcomes as case definitions—in which we would not expect a plausible association (eg, nursing home admission)—were employed. Associations were reported as hazard ratios (HRs) with 95% confidence intervals (95% CI).</div></div><div><h3>Results</h3><div>A total of 59,748 cases were identified and matched 1:10 with controls (53% men, median age: 84 [IQR: 77-89]). Digoxin was associated with increased rates of mortality in the entire cohort (HR 1.85, 95% CI 1.78-1.92) as well as subgroups such as patients with heart failure (HR 1.84, 95% CI 1.65-2.06), diabetes (HR 1.85, 95% CI 1.6-2.14), and kidney disease (HR 1.37, 95% CI 1.04-1.8). Significant associations with all negative control outcomes were also found, most notably nursing home admissions (HR 1.79, 95% CI 1.67-1.93).</div></div><div><h3>Conclusion</h3><div>Digoxin use was associated with increased mortality in AF. However, negative control outcomes were also associated with digoxin use indicating that the described association between digoxin and mortality is likely not causal and being prescribed digoxin is merely a marker of more advanced disease and frailty.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Great Mimicker: Forgotten but not Gone","authors":"Blayne E. Fenner ,&nbsp;Kevin M. Burningham ,&nbsp;Jamael L. Thomas ,&nbsp;Brent C. Kelly ,&nbsp;Auris O. Huen ,&nbsp;Stephen K. Tyring","doi":"10.1016/j.ajmo.2025.100094","DOIUrl":"10.1016/j.ajmo.2025.100094","url":null,"abstract":"<div><div>Once subdued after the advent of penicillin, syphilis has re-emerged in recent years, with incidence rates rising in many countries, including the United States. Its reputation as “the great imitator” is well earned due to its widely variable presentation, particularly in its second stage. This contributes to a high rate of delayed diagnosis and misdiagnosis, adding significant burden to patients and the health care system generally. Herein, we present 2 cases in which syphilis was misdiagnosed, leading to unnecessary therapies and delay of symptom clearance until treponemal tests were performed. In the context of recent epidemiologic trends and its notorious difficulty to clinically define, syphilis should always be considered in the differential diagnosis of diffuse cutaneous eruptions.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracing the Rash: Diaphragmatic Paralysis Following Cervical Herpes Zoster","authors":"Yasuhiro Kano","doi":"10.1016/j.ajmo.2025.100088","DOIUrl":"10.1016/j.ajmo.2025.100088","url":null,"abstract":"<div><div>An 80-year-old man presented with a two-day history of anorexia and decreased daily activity. A physical examination revealed an erythematous, crusted, vesicular eruption distributed along the C3-C5 dermatome. Chest x-ray and computed tomography during inspiration and expiration demonstrated an elevation of the left hemidiaphragm with almost no movement of the left diaphragm during respiration. These findings were consistent with left diaphragmatic paralysis due to cervical herpes zoster. As a rare type of segmental motor paresis, cervical herpes zoster can cause phrenic nerve paralysis because the phrenic nerve originates in the anterior horn of the C3 to C5 roots. Diaphragmatic paralysis results in diminished vital capacity and can lead to a decline in exercise tolerance or daily activity, especially in elderly patients.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rate of Incidental Lung Nodule Follow-Up: A Cohort Study Evaluating Adherence to Guideline Recommendations","authors":"Zein Kattih ,&nbsp;Jonathan A Moore ,&nbsp;Brandon Wilson ,&nbsp;Sravani Gajjala ,&nbsp;Jacob Schwartz ,&nbsp;Josef Kushner ,&nbsp;Sean Zajac ,&nbsp;Akhilesh Mahajan ,&nbsp;Tungming Leung ,&nbsp;Priyanka Makkar","doi":"10.1016/j.ajmo.2025.100091","DOIUrl":"10.1016/j.ajmo.2025.100091","url":null,"abstract":"<div><h3>Background</h3><div>Solitary pulmonary nodules (SPNs) are commonly identified on imaging studies, and guidelines exist for follow-up. Adherence to guideline recommendations varies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review at a single center in a metropolitan hospital to identify characteristics of patients with lung nodules and determine the rate of follow-up of these patients. A total of 1266 patient records were reviewed, and 341 patients with solitary pulmonary nodules were identified.</div></div><div><h3>Results</h3><div>The presence of emphysema was associated with an increased rate of follow-up with an odds ratio of 1.9. Of the patients with SPNs, 52% do not receive appropriate follow-up. Of the nodules identified, 40% were noted to be enlarged compared to prior imaging.</div></div><div><h3>Conclusions</h3><div>Identification of SPNs requires a standard approach to ensure follow-up for early detection of potential malignancy. Appropriate follow-up allows improvement of the rate of early cancer detection.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821423","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":"Assessing the Relationship in Symptomology of Myalgic Encephalitis/Chronic Fatigue Syndrome and Long COVID","authors":"Nikitha Garapaty ,&nbsp;Kristina M. Reyes ,&nbsp;Lily Tehrani ,&nbsp;Maximiliano Barbosa Mendoza ,&nbsp;Patrick Hardigan","doi":"10.1016/j.ajmo.2024.100085","DOIUrl":"10.1016/j.ajmo.2024.100085","url":null,"abstract":"<div><div>The symptomology of Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS) shares many commonalities with Long COVID (LC). This study aimed to clearly define the comparison between ME/CFS and LC in terms of symptomology. A cross-sectional analysis of 27,651 interviewees from a National Health Interview Survey 2022 adult dataset was conducted. The data was controlled for subject's sex, race/ethnicity, age, life satisfaction, insurance coverage, poverty ratio, and comorbidities. A logistic regression was used to compare four groups: (1) LC individuals, (2) ME/CFS individuals, (3) LC with ME/CFS individuals, and (4) controls by symptoms of depression, anxiety, physical activity, fatigue, and memory. The results showed that subjects with both ME/CFS and LC were more likely to report memory issues, anxiety, depression, fatigue, and difficulty with physical activity followed by subjects with ME/CFS only, LC only, and the controls (<em>P</em> &lt; .01). Our study suggests a synergistic mechanism between ME/CFS and LC in developing issues with anxiety, depression, fatigue, and physically activity in patients. The study's conclusions highlight the need to elucidate the possible overlap in pathophysiological mechanisms of ME/CFS and LC in the symptomology of patients.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823525","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":"Cavitary Pneumonia Causes in the Arid Landscapes of Southern Arizona","authors":"Rawan El Kurdi ,&nbsp;Krish H. Nayar ,&nbsp;Michael B. Gotway ,&nbsp;Janis Blair ,&nbsp;Sandhya Nagarakanti","doi":"10.1016/j.ajmo.2025.100090","DOIUrl":"10.1016/j.ajmo.2025.100090","url":null,"abstract":"<div><div>Cavitary pneumonia, characterized by gas-filled spaces within lung tissue, is commonly associated with bacterial pathogens, such as <em>Staphylococcus aureus, Streptococcus, Pseudomonas</em>, and <em>Klebsiella</em> species. This study aimed to investigate the most common causes of cavitary pneumonia in southern Arizona, where coccidioidomycosis is endemic. Fungal infections were the predominant cause of cavitary pneumonia (69%), either alone or in association with bacterial infections. Seven percent of patients had concurrent fungal and bacterial infections. Overall, coccidioidomycosis was the most common cause of cavitary pneumonia, accounting for 39% of all cases and 82% of fungal cases. Among these, 24% had proven coccidioidomycosis, 51% had probable infections, and 25% had possible infections. Bacterial infections accounted for 30% of cavitary pneumonia cases, with <em>Staphylococcus aureus</em> (12%), <em>Streptococcus</em> species (12%), and <em>Pseudomonas</em> species (11%) being the most prevalent organisms. Overall mortality was 25%, with 34% of deaths directly attributed to cavitary pneumonia.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Case-Based Narrative Review","authors":"Aamir Javaid ,&nbsp;Essa Hariri ,&nbsp;Bige Ozkan ,&nbsp;Katherine Lang ,&nbsp;Sadiya S. Khan ,&nbsp;Janani Rangaswami ,&nbsp;Neil J. Stone ,&nbsp;Roger S. Blumenthal ,&nbsp;Chiadi E. Ndumele","doi":"10.1016/j.ajmo.2025.100089","DOIUrl":"10.1016/j.ajmo.2025.100089","url":null,"abstract":"<div><div>These 4 hypothetical cases highlight new features of the American Heart Association cardiovascular-kidney-metabolic (CKM) health construct. The cases incorporate the CKM staging system, estimates from the PREVENT risk calculator, and clinical approaches related to CKM stages and individual risk profiles. Topics include management considerations for (1) a patient with stage 1 obesity and impaired glucose tolerance, (2) a patient with metabolic risk factors and moderate-risk chronic kidney disease (CKD), (3) a patient with subclinical atherosclerotic cardiovascular disease and multiple comorbid conditions, and (4) a patient with metabolic risk factors, prior myocardial infarction, new-onset heart failure, atrial fibrillation, and CKD.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparisons of risk factors and outcomes between abdominal aortic aneurysm and peripheral arterial disease: a case-control study","authors":"Ian Beeton ,&nbsp;Jay Acharya ,&nbsp;Bengisu Kesin Meric ,&nbsp;James Hobden ,&nbsp;Tahir Ali ,&nbsp;Thang S. Han","doi":"10.1016/j.ajmo.2025.100087","DOIUrl":"10.1016/j.ajmo.2025.100087","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of data on direct comparison of clinical measures in patients with abdominal aortic aneurysm (AAA) and those with peripheral arterial disease (PAD). Here, we examine the risk factors and outcomes between these 2 conditions.</div></div><div><h3>Methods</h3><div>Group differences were examined by Fisher's exact tests with Bonferroni correction, postoperative complications (including delirium and pneumonia) and LOS by logistic regression, and mortality by Cox regression, adjusted for age, sex, smoking, co-morbidities and medications.</div></div><div><h3>Results</h3><div>In total, 160 men and 33 women aged 74.5years (SD = 9.4) were referred for preoperative cardiac assessment for AAA (<em>n</em> = 70) and PAD (<em>n</em> = 123). Vascular surgery was performed in 148 patients (70% of AAA; 80.5% of PAD). Myocardial infarct was more prevalent in AAA, and diabetes more in PAD, whilst atrial fibrillation, stroke, congestive heart failure and hypertension did not differ between groups. Compared to patients with PAD, there were higher proportions of patients with AAA prescribed with cardiovascular medications, and developed post-operative complications in hospital: odds ratio = 7.34 (95% CI, 2.26-23.84, <em>P</em> &lt; .001), and stayed in hospital &gt;1week: odds ratio = 2.60 (95% CI, 1.15-5.85, <em>P</em> = .021). Compared to those with AAA, patients with PAD were at greater risk of death in the entire sample: hazard ratio = 3.34 (95% CI, 1.64-6.79), and in those who underwent vascular surgery: hazard ratio = 4.90 (95% CI, 1.88-12.79). Left ventricular function did not relate to outcomes.</div></div><div><h3>Conclusions</h3><div>Differences between AAA and PAD in risk profile and management which may have a bearing on higher risk of death associated with PAD. More intensive cardiovascular management may help improve their outcomes.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}