Postgraduate medicine最新文献

{"title":"Characteristics and outcomes of Middle Eastern patients with atrial fibrillation and history of prior stroke or systemic embolism.","authors":"Nasr Alrabadi, Mohammed Al-Nusair, Razan Haddad, Batool Alwaqfi, Mohammad Shalabi, Farah K El-Zubi, Mohamad Jarrah, Rania Harati, Karem H Alzoubi, Ayman Hammoudeh","doi":"10.1080/00325481.2025.2529775","DOIUrl":"10.1080/00325481.2025.2529775","url":null,"abstract":"<p><strong>Objective: </strong>To describe the sociodemographic and clinical characteristics of Middle Eastern patients with atrial fibrillation (AF) and a history of prior ischemic stroke/systemic embolism (SSE) and compare the risk of adverse events between AF patients with and without prior SSE from the Middle East.</p><p><strong>Methods: </strong>The study population was recruited from the JoFib study, a multicenter, nationwide, prospective registry of patients with AF from the Middle East. Patients were categorized into two study groups according to the history of prior SSE.</p><p><strong>Results: </strong>The current study population consisted of 2003 AF patients divided into two groups: a prior SSE group of 318 (15.9%) patients and a no prior SSE group of 1685 (84.1%). Patients with prior SSE were older than those without prior SSE (45.3% vs. 30.4%, < 0.001). Compared to the no prior SSE group, patients with prior SSE were less symptomatic (61.3% vs. 72.8%, <i>p</i> < 0.001), had a higher prevalence of diabetes (49.1% vs. 42.4%, <i>p</i> = 0.03) and dyslipidemia (51.9% vs. 43.6%, <i>p</i> = 0.007), and were less commonly obese (34.0% vs. 42.2%, <i>p</i> = 0.009). Rhythm-control strategies were less frequently pursued in patients with prior SSE compared to the no prior SSE group (16.0% vs. 22.0%, <i>p</i> = 0.02). Antithrombotic medications were used more frequently by the prior SSE group, including anticoagulants (89.0% vs. 80.7%, <i>p</i> < 0.001) and antiplatelets (48.4% vs. 37.6%, <i>p</i> < 0.001). Compared to the no prior SSE group, the prior SSE group was at greater risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted sub-hazard ratio [aSHR], 95% CI: 1.50, 1.04-2.16), non-cardiovascular death (1.76, 1.00-3.08), and SSE (3.05, 1.83-5.07). History of prior SSE did not significantly alter the risk of major bleeding (0.67, 0.27-1.65) or CRNMB (AOR 0.79, 95% CI 0.47-1.33).</p><p><strong>Conclusion: </strong>A F patients with prior SSE are at higher risk of adverse events compared to patients without prior SSE.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556324","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":"Analysis of frailty determinants in chronic stroke patients.","authors":"Ioan Chirap-Mitulschi, Sabina Antoniu","doi":"10.1080/00325481.2025.2530921","DOIUrl":"10.1080/00325481.2025.2530921","url":null,"abstract":"<p><strong>Objective: </strong>Frailty is becoming more widely acknowledged as a critical factor that impacts the quality of life and health outcomes of patients with chronic conditions, including those who have experienced a stroke. This study aims to analyze the determinants of frailty in a prospective cohort of chronic stroke patients undergoing rehabilitation via relevant clinical, functional, and quality-of-life measures.</p><p><strong>Methods: </strong>In this prospective study, 124 chronic stroke patients (mean age: 63.3 years, SD = 10.5) were assessed for frailty using the Edmonton Frailty Scale (EFS). Variables included age, stroke severity indices, functional status, and quality of life. Descriptive and inferential analyses was performed.</p><p><strong>Results: </strong>The majority (81.5%) of patients had ischemic strokes. Frail patients were older (mean age: 64.6 vs. 55.2 years, <i>p</i> < 0.005), had more severe strokes (modified Rankin scale (mRS) 3.87 vs. 2.53, <i>p</i> < 0.005; National Institutes of Health Stroke Scale (NIHSS) 6.08 vs. 3.47, <i>p</i> < 0.005), greater functional impairment (Barthel Index 52.9 vs. 80.6, <i>p</i> < 0.005), and lower quality of life (2.78 vs. 4.02, <i>p</i> < 0.005). Logistic regression showed that advanced age and lower self-efficacy significantly predicted frailty (age: OR = 1.1, 95% CI: 1.01-1.21; Stroke Self-Efficacy Questionnaire (SSEQ): OR = 0.72, 95% CI: 0.55-0.95). The ROC analysis demonstrated that age had an AUC of 0.742 (95% CI: 0.65-0.86, <i>p</i> < 0.001), whereas the AUC for SSEQ was 0.924 (95% CI: 0.86-0.96, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In patients with chronic stroke, frailty, as measured with the EFS, is best predicted by age and by the stroke-related impaired self-efficacy. Interestingly, the latter is a stronger frailty predictor, especially in younger patients. These findings indicate that both physiological and disease-related functional declines contribute to the development of frailty. However, additional longitudinal studies are necessary to validate the causal association and to account for potential confounding factors like depression or social support.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577481","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":"Maternal cardiac arrhythmia in congenital heart disease: identifying high-risk pregnancy indicators.","authors":"Hongwei Li, Qian Yin, Zhenbo Ouyang, Yanli Liu","doi":"10.1080/00325481.2025.2529771","DOIUrl":"10.1080/00325481.2025.2529771","url":null,"abstract":"<p><strong>Background: </strong>The onset of arrhythmia during pregnancy has been noted as a significant issue in clinical management of adult congenital heart disease. The authors sought to examine the actual incidence of arrhythmias in CHD patients during pregnancy, as well as to distinguish prognostic predictors of arrhythmia in CHD pregnant patients, specifically focusing on the predictive value of echocardiographic parameters.</p><p><strong>Methods: </strong>This retrospective study involved 244 pregnant patients with CHD in a tertiary hospital. Baseline characteristics and clinical presentation were systemically compared between the arrhythmia group and no arrhythmia group. Univariate analyses were performed to identify baseline characteristics and hemodynamic parameters associated with outcomes. Subsequent multivariate logistic regression model identified the adjusted odds ratio (aOR) and 95% CI to pinpoint the independent risk factors of arrhythmia in CHD pregnancy.</p><p><strong>Results: </strong>The prevalence of arrhythmia in CHD patients during pregnancy was 17.6% (43/244). The arrhythmia group had more parity than the no arrhythmia group (0.72 vs 0.43, <i>p</i> = 0.010). Compared with the no arrhythmia group, the arrhythmia group's QRS duration was longer (105.1 ± 24.7 vs 93.6 ± 18.1 ms, <i>p</i> = 0.001). Patients with arrhythmia had both larger atrium size than patients without arrhythmia (right atrium: 51.0 ± 9.1 vs 47.4 ± 7.0 mm, <i>p</i> = 0.005; left atrium: 38.8 ± 7.6 vs 34.4 ± 4.8 mm, <i>p</i> = 0.000) respectively. Left ventricle end systolic volume in CHD patients with arrhythmia were considered larger than those without arrhythmia (29.9 ± 6.7 vs 27.7 ± 4.0 mm, <i>p</i> = 0.007), while not in left ventricle end diastolic volume (46.6 ± 9.2 vs 44.7 ± 5.2 mm, <i>p</i> = 0.067). The arrhythmia group were more likely to be presented with atrioventricular valve regurgitation (53.5% vs 15.4%, <i>p</i> = 0.000) than the no arrhythmia group. Multivariate logistic regression identified parity (aOR:1.895[95%CI: 1.033-3.478]), left atrium size (aOR:1.089[95%CI: 1.008-1.175]), and moderate atrioventricular valve regurgitation (aOR:3.317[95%CI: 1.272-8.647]) as independent contributors for arrhythmia during CHD pregnancy.</p><p><strong>Conclusion: </strong>Early identification of risk factors that may predispose to arrhythmias favorably impacts long-term arrhythmia incidence and maternal neonatal outcome.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556325","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":"Giant sphenoid sinus fungal ball causing secondary hypopituitarism and infertility: a case report.","authors":"Hasan Ibrahim Al-Balas, Hassan Mahmoud Mistarihi, Esra Mohsen Rejoub, Almu'atasim Khamees","doi":"10.1080/00325481.2025.2530922","DOIUrl":"10.1080/00325481.2025.2530922","url":null,"abstract":"<p><strong>Background: </strong>Isolated sphenoid sinus fungal balls are a rare but clinically significant entity, often presenting with nonspecific symptoms. This case highlights the importance of multidisciplinary collaboration among different specialties to achieve optimal patient outcomes.</p><p><strong>Case presentation: </strong>We report a case of a 29-year-old female presenting with recurrent pregnancy loss, referred by obstetrics for neurosurgical evaluation. Imaging revealed a giant sphenoid sinus fungal ball causing secondary hypopituitarism and infertility, a very rare complication. Subsequently, she was referred to ENT specialists, who did more imaging tests and removed the mass, leading to the restoration of pituitary function and pregnancy.</p><p><strong>Conclusions: </strong>This case highlights the importance of considering sphenoid sinus pathology in patients with unexplained endocrine dysfunctions and the critical role of multidisciplinary collaboration in diagnosis and management. It also underscores the necessity of imaging the sphenoid sinus in patients with unexplained hyperprolactinemia and infertility, even in the absence of classic sinonasal symptoms. Early recognition and surgical intervention can lead to the resolution of symptoms and restoration of normal physiological functi[on, as demonstrated by the successful outcome in this patient.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586021","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":"Prevalence of children's mental health disorders and implications in pharmacotherapy: a systematic review and meta-analysis.","authors":"Xiangyu Zhao, Luofei Zhang, Laurie Kramer, Bode Wang, Ming Guan, Qing Ma","doi":"10.1080/00325481.2025.2529772","DOIUrl":"https://doi.org/10.1080/00325481.2025.2529772","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood and adolescence are critical stages during which mental health disorders may develop and profoundly impact individuals and families in the future. Understanding the prevalence and distribution of these disorders is crucial for public health policies and interventions. This analysis aims to summarize current evidence of the prevalence and geographic distribution of mental health disorders among children and adolescents to inform the development of effective psychopharmacological treatments.</p><p><strong>Methods: </strong>The data were systematically gathered from the most commonly used databases worldwide, including PubMed, PsycINFO, EMBASE, PSYNDEX, MEDLINE, and the Global Burden of Disease (GBD), as well as from current literature to ensure comprehensive coverage. The studies using standardized assessment procedures and recognized diagnostic standards (i.e. DSM, DC, SDQ) were included in the final analysis.</p><p><strong>Findings: </strong>Our findings indicated that the prevalence of mental health disorders in children and adolescents is higher than previously reported and varies widely across the regions. The analysis underlines the imperative for extensive, culturally attuned research and fortifies the call for global cooperation to surmount the challenges posed by these mental health disorders. It accentuates the need to appreciate the intricate interplay of cultural, socioeconomic, and healthcare factors to improve mental healthcare infrastructure and endorse equitable care access worldwide.</p><p><strong>Conclusion: </strong>The pursuit of evidence-based public health policies and pharmacotherapy is deemed crucial for improving the prevention and management of mental illnesses in children and adolescents.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568289","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":"How treatment with SGLT2 inhibitors can help people with chronic kidney disease: a plain language summary.","authors":"Lance Sloan","doi":"10.1080/00325481.2025.2517531","DOIUrl":"https://doi.org/10.1080/00325481.2025.2517531","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319077","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":"A US-based practitioner's guide to diagnosis, evaluation, and evidence-based treatment of agitation in Alzheimer's dementia - recommendations of an expert, multispecialty advisory panel.","authors":"George T Grossberg, Angela Sanford, C Brendan Montano, Anton P Porsteinsson, Susan Scanland, Chad Worz, Shirley McMillian, Alireza Atri","doi":"10.1080/00325481.2025.2517535","DOIUrl":"10.1080/00325481.2025.2517535","url":null,"abstract":"<p><strong>Background: </strong>Agitation in Alzheimer's dementia has a substantial impact on patients, caregivers/family, and healthcare systems. As new evidence surrounding the treatment of agitation emerges, a roundtable of multispecialty experts convened to review published literature (from a PubMed database search on 1 October 2024) and provide evidence-based clinical practice consensus recommendations for the diagnosis and management of agitation in Alzheimer's dementia for US-based primary care providers.</p><p><strong>Aim: </strong>The main objective of this article is to summarize key recommendations from the roundtable on identification, differential diagnosis, current clinical practice, nonpharmacologic interventions, pharmacologic interventions, and treatment and communication considerations for residential care facilities/home care settings and caregivers.</p><p><strong>Results: </strong>Active communication between healthcare providers, patients, and caregivers/family is critical for early recognition, accurate diagnosis, and appropriate management and prevention of agitation. The foundation of treatment always begins with individualized psychoeducation and nonpharmacologic interventions based on the patient's personality, interests, and level of functioning. Pharmacologic interventions are strongly considered when agitated behaviors become highly intense, disturbing, and disruptive or if major safety concerns cannot be otherwise addressed, and only when the healthcare provider is confident that the agitation can be sufficiently managed or mitigated with a pharmacologic intervention possessing a favorable individual risk-benefit profile. While several pharmacologic agents have been studied in high-quality clinical trials for the treatment of agitation in Alzheimer's dementia, brexpiprazole is the only US Food and Drug Administration - approved treatment and it can be prescribed if warranted. Interventions should be continuously evaluated to optimize treatment and monitor and minimize potential side effects. A patient-centered approach that includes a strong partnership with caregivers/family as a vital part of the patient's larger care team is encouraged.</p><p><strong>Conclusion: </strong>Following these recommendations for timely detection, accurate diagnosis, and appropriate management of agitation in patients with Alzheimer's dementia is likely to improve outcomes for most patients and caregivers.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268295","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":"Efficacy and safety of rimegepant 75 mg for acute treatment of migraine: a pooled analysis of four randomized, placebo-controlled trials.","authors":"Stewart J Tepper, Jelena M Pavlovic, Shengyuan Yu, Richard B Lipton, Glenn Pixton, Yunjun Zou, Robert J Fountaine, David Semel","doi":"10.1080/00325481.2025.2518043","DOIUrl":"10.1080/00325481.2025.2518043","url":null,"abstract":"<p><strong>Objective: </strong>This pooled analysis of data from four randomized placebo-controlled trials summarizes the efficacy and safety of rimegepant for acute treatment of migraine.</p><p><strong>Methods: </strong>In all studies, participants were aged ≥18 years and had a ≥ 1-year history of migraine, two to eight migraine attacks of moderate or severe pain intensity per month, and attacks lasting 4-72 hours if untreated. Participants were provided with a single dose of rimegepant 75 mg or placebo to treat a single migraine attack of moderate or severe pain intensity within the next 45 days. Co-primary endpoints at 2 hours post-dose were pain freedom and freedom from the most bothersome symptom (MBS). Treatment comparisons utilized Mantel-Haenszel risk estimation with stratification by study and prophylactic migraine medication use randomization stratum; <i>p</i> values are nominal. On-treatment adverse events (AEs) were also assessed.</p><p><strong>Results: </strong>Overall, 4,895 participants received rimegepant (<i>n</i> = 2,439) or placebo (<i>n</i> = 2,456). For the co-primary endpoints, the proportion of participants with pain freedom 2 hours post-dose (20.0% vs. 11.8%; <i>p</i> < 0.0001) and MBS freedom 2 hours post-dose (40.2% vs. 29.2%; <i>p</i> < 0.0001) was higher in the rimegepant vs. the placebo group. Rimegepant also demonstrated improvements over placebo in nearly all secondary and exploratory efficacy endpoints. AEs were reported in 11.1% and 9.6% of participants in the rimegepant and placebo groups, respectively. The only AE reported in > 1% of participants was nausea (rimegepant = 1.4%, placebo = 1.3%). Severe AEs occurred in 0.3% and 0.1% of participants in the rimegepant and placebo groups, respectively. Serious AEs occurred in 0.1% of participants in both groups; none were deemed related to study treatment.</p><p><strong>Conclusion: </strong>In this pooled analysis of four randomized placebo-controlled trials, a single dose of rimegepant 75 mg demonstrated efficacy and a favorable safety profile for the acute treatment of a migraine attack with moderate or severe pain.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259776","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":"Comment on \"newborn screening programs promote vaccine acceptance among parents in Turkey\".","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1080/00325481.2025.2517536","DOIUrl":"10.1080/00325481.2025.2517536","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236349","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":"A reply to the letter: comment on \"newborn screening programs promote vaccine acceptance among parents in Turkey\".","authors":"İzzet Erdal, Ayça Burcu Kahraman, Yılmaz Yıldız, Siddika Songül Yalçin","doi":"10.1080/00325481.2025.2517532","DOIUrl":"10.1080/00325481.2025.2517532","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236348","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}