Postgraduate medicine最新文献

{"title":"Investigating the 'Diabetes Paradox' in Takotsubo Cardiomyopathy.","authors":"Song Peng Ang, Jia Ee Chia, Kwan Lee, Madhan Shanmugasundaram, Abhishek J Deshmukh, Chayakrit Krittanawong, Jose Iglesias, Debabrata Mukherjee, Carl J Lavie","doi":"10.1080/00325481.2025.2502315","DOIUrl":"10.1080/00325481.2025.2502315","url":null,"abstract":"<p><strong>Background: </strong>The impact of diabetes mellitus (DM) on outcomes of Takotsubo cardiomyopathy (TC) remains unclear, with conflicting evidence suggesting either protective or harmful effects. This study evaluates the association between DM and in-hospital outcomes in TC patients.</p><p><strong>Methods: </strong>A retrospective analysis of the National Inpatient Sample database (2016-2019) was conducted to compare in-hospital outcomes in TC patients with and without DM. The primary outcome was in-hospital mortality, while secondary outcomes included cardiac arrest, cardiogenic shock, and acute kidney injury (AKI). Propensity-score matching (PSM) was applied to balance covariates, and multivariable logistic regression was used to evaluate DM as an independent predictor of mortality, with results reported as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Of 63,155 TC hospitalizations 13,380 (21.2%) involved patients with DM, who were older and had higher rates of comorbidities. PSM analysis revealed a higher risk of AKI in DM patients (20.13% vs. 15.91%; OR, 1.33; 95% CI, 1.16-1.54; <i>p</i> < 0.001), with no significant differences in mortality, cardiogenic shock, or cardiac arrest. Patients with diabetic neuropathy showed a non-significant trend toward increased AKI risk (27.04% vs. 20.44%; OR, 1.44; 95% CI, 1.00-2.09; <i>p</i> = 0.053). Multivariable analysis identified comorbidities like CKD, liver disease, and coagulopathy as mortality predictors, but not DM.</p><p><strong>Conclusion: </strong>DM was associated with a higher risk of AKI but did not affect in-hospital mortality or major cardiac events in TC patients. These findings suggest that DM has a neutral impact on TC outcomes, highlighting the need for further investigation.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"352-358"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060628","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 comprehensive review of inpatient heart failure management for the hospitalist.","authors":"Athul Rajesh, Ryan Kovacik, Beman Wasef, Kristin Lohr, Eric Kasprowicz","doi":"10.1080/00325481.2025.2503696","DOIUrl":"10.1080/00325481.2025.2503696","url":null,"abstract":"<p><p>Acute decompensated heart failure (ADHF) is a leading cause of hospital admissions and is associated with significant increases in morbidity and mortality, as well as marked impacts on quality of life. This review aims to guide hospital medicine providers in the management of ADHF from hospital admission to safe discharge. Hospitalists commonly care for HF patients in the acute phase, and a clear understanding of HF classification and etiologies is vital for guiding the evaluation and treatment of HF decompensation. Medical management of HF is centered around guideline-directed medical therapy (GDMT), agents which have been shown in large-scale studies to improve morbidity and mortality, while diuretics are used in adjunct to alleviate symptoms and improve volume status. As patients approach discharge, a multidisciplinary approach centering on patient education, counseling, and coordination of transitional care services can help to improve outcomes and reduce readmission risk.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"327-337"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061723","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":"The effect of peanut ball use on labor memory, labor satisfaction, delivery length, and neonatal APGAR score: a randomized controlled trial.","authors":"Seyhan Çankaya, Hacer Alan Dikmen, Ayşenur Ataş","doi":"10.1080/00325481.2025.2510198","DOIUrl":"10.1080/00325481.2025.2510198","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to evaluate the effect of using peanut balls during labor-on-labor memory, labor satisfaction, labor length, and neonatal APGAR scores.</p><p><strong>Methods: </strong>This randomized, controlled, single-blind trial was conducted in 140 primiparous pregnant women (peanut ball group <i>n</i> = 70, control group <i>n</i> = 70) who delivered between January 2023 and March 2024. The study was conducted in the Obstetrics Clinic of a Medical Faculty Hospital in the Central Anatolian region of Turkey. Pregnant women in the peanut ball group were instructed to perform movements with the peanut ball after cervical dilation reached 5 cm. The control group received only standard intrapartum midwifery care. Data were collected by personal information form, labor and postpartum follow-up form (APGAR score, etc.), Birth Memory and Recall Scale, and Birth Satisfaction Scales.</p><p><strong>Results: </strong>It was determined that the birth memory and recall memories of the pregnant women in the peanut ball group were more positive and their birth satisfaction was higher than the pregnant women in the control group (<i>p</i> < 0.001). The 1st minute APGAR scores (8.3 ± 0.6) and 5th minute APGAR scores (9.2 ± 0.7) of the newborns of the peanut ball group were higher than the 1st minute APGAR scores (7.8 ± 0.7) and 5th minute APGAR scores (8.5 ± 0.7) of the newborns of the control group (<i>p</i> < 0.001). The duration of the first stage (209.3 ± 38.6) and second stage (27.4 ± 13.7) of labor in the peanut ball group was shorter than the duration of the first stage (250.3 ± 54.6) and second stage (32.3 ± 11.3) of labor in the control group (<i>p</i> < 0.001, <i>p</i> = 0.021, respectively).</p><p><strong>Conclusion: </strong>This study found that peanut ball application positively affected women's labor memory and recall, and increased labor satisfaction. In addition, we found that peanut ball application increased neonatal APGAR scores and shortened the duration of the first and second stages of labor.</p><p><strong>Clinical trial registration: </strong>www.clinicaltrials.gov (NCT06387680).</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"368-378"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113151","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":"Abstracts from the 19th Annual Cardiometabolic Health Congress.","authors":"","doi":"10.1080/00325481.2025.2476828","DOIUrl":"10.1080/00325481.2025.2476828","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756970","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":"Treating obesity in patients with depression: a narrative review and treatment recommendation.","authors":"Pamela Kushner, Scott Kahan, Roger S McIntyre","doi":"10.1080/00325481.2025.2478812","DOIUrl":"10.1080/00325481.2025.2478812","url":null,"abstract":"<p><p>The high morbidity of obesity and depression pose significant public health concerns, with the prevalence of obesity doubling in the US between 1990 and 2022 and patients frequently presenting with both. Untreated obesity and depression can greatly impact patient health and well-being, as both obesity and depression are associated with a number of comorbidities including sleep apnea, type 2 diabetes mellitus, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease. This narrative review aims to provide a comprehensive and current overview of the overlapping etiologies between obesity and depression as well as the available treatment options that may be recommended by primary care professionals to treat these patients with concomitant obesity and depression. With the considerable overlap in the population of patients with obesity and depression, as well as the overlap in the neurobiological, hormonal, and inflammatory pathways underlying both diseases, primary care professionals should consider screening patients presenting with obesity for depression. Holistic treatment options, including lifestyle and behavioral modifications, and pharmacotherapy for both depression and obesity and bariatric surgery for obesity are critical to manage both conditions simultaneously. Therefore, due to the overlapping neurobiological pathways and mechanisms responsible for the incidence and progression of both obesity and depression, a holistic treatment plan including strategies with efficacy for both conditions and any additional comorbidities may improve the clinical approach for patients with concomitant obesity and depression.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"221-234"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664893","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":"Junctional ectopic tachycardia revisited.","authors":"Raimundo Carmona-Puerta, Elibet Chávez-González, Elizabeth Lorenzo-Martínez","doi":"10.1080/00325481.2025.2485672","DOIUrl":"10.1080/00325481.2025.2485672","url":null,"abstract":"<p><p>Junctional ectopic tachycardia (JET) is an uncommon arrhythmia, but it can have devastating consequences when it occurs. Most physicians are not familiar with its diagnosis, which can seriously compromise management in emergency rooms. Many cases arise in the postoperative period following cardiovascular surgery. In this context, the arrhythmia significantly worsens the prognosis of patients. A particularly severe form of JET is congenital, which has a mortality rate of up to 35%. The diagnosis can be made from the fetal period to six months of age. JET is infrequently diagnosed in otherwise healthy adults. Some medical conditions have been associated with the occurrence of JET. In the electrocardiogram, the most prominent characteristics of the arrhythmia are atrioventricular dissociation, narrow QRS complexes, and R-R interval irregularity due to intermittent ventricular captures. A notable feature of JET is the lack of response to treatment in many patients. Management options are divided into general and specific measures. General measures include avoiding hyperthermia, pain control, and minimizing the use of exogenous catecholamines. Specific treatment involves antiarrhythmic drugs, temporary atrial pacing, and ablation.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"243-250"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723055","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":"Semaglutide 2.4 mg long-term clinical outcomes in patients with obesity or overweight: a real-world retrospective cohort study in the United States (SCOPE 12 months).","authors":"Aleksandrina Ruseva, Firas Dabbous, Nina Ding, Anthony Fabricatore, Samuel Huse, Wojciech Michalak, Beth Nordstrom, Bríain Ó Hartaigh, Zhenxiang Zhao, Devika Umashanker","doi":"10.1080/00325481.2025.2482274","DOIUrl":"10.1080/00325481.2025.2482274","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effectiveness of semaglutide 2.4 mg for weight reduction and improvement in cardiometabolic biomarkers at 52 and 68 weeks in a real-world setting in the United States.</p><p><strong>Methods: </strong>This noninterventional, retrospective cohort study used the Komodo Health database and included adults with obesity or overweight with ≥1 weight-related condition who initiated treatment with semaglutide 2.4 mg between June 2021 and August 2022 and remained on treatment for 1 year. A paired t-test was used to assess changes in weight, body mass index (BMI), and cardiometabolic biomarkers (systolic blood pressure [SBP], diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], HDL [high-density lipoprotein] cholesterol, LDL [low-density lipoprotein] cholesterol, and triglycerides) from baseline to 52-week and 68-week follow-up.</p><p><strong>Results: </strong>Among 4,424 eligible patients, 77% were women and the mean (SD) age was 46.7 (10.0) years and BMI was 36.6 (3.6) kg/m². Dyslipidemia and hypertension were the most common obesity-related comorbidities at baseline. The mean (%) change in weight from baseline was -15.5 kg (-14.5%; <i>p</i> < 0.001; <i>n</i> = 594) at 52 weeks and -15.9 kg (-14.8%; <i>p</i> < 0.001; <i>n</i> = 391) at 68 weeks. The mean change in BMI from baseline was - 4.8 kg/m² (<i>n</i> = 1124) at 52 weeks and - 4.9 kg/m² (<i>n</i> = 700) at 68 weeks. At 52weeks, statistically significant improvements in mean values were observed for SBP (-6.3 mmHg), DBP (-3.1 mmHg), HbA1c (-0.4%), LDL cholesterol (-8.1 mg/dL), and triglycerides (-38.4 mg/dL) (all <i>p</i> < 0.001). Mean change at 52 weeks for HDL cholesterol was 1.0 mg/dL; <i>p</i> = 0.109. Results at 68 weeks were similar.</p><p><strong>Conclusions: </strong>In this retrospective cohort study, the real-world effectiveness of semaglutide 2.4 mg was demonstrated by reductions in weight and BMI along with improvements in BP, HbA1c, and lipid panel among patients with obesity or overweight.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"251-260"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695019","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":"Unveiling the effectiveness and safety spectrum of biologic therapies in psoriasis: a three-year real-world analysis.","authors":"Abdullah Demirbas, Esin Diremsizoglu, Mustafa Esen, Gozde Ulutas Demirbas","doi":"10.1080/00325481.2025.2493042","DOIUrl":"10.1080/00325481.2025.2493042","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis vulgaris is a chronic immune-mediated inflammatory disease that significantly affects quality of life, particularly in severe cases and anatomically challenging areas. Biologic therapies targeting immune pathways have improved clinical outcomes; however, variability in effectiveness, safety, and drug survival necessitates further investigation.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effectiveness, safety, and drug survival of biologic therapies in patients with moderate-to-severe psoriasis vulgaris.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 400 psoriasis patients treated with IL-17, IL-12/23, and IL-23 inhibitors. Clinical outcomes were assessed using PASI, DLQI, PSSI, NAPSI, and ppPASI scores. Kaplan-Meier survival analysis and Cox regression were employed to identify predictors of drug survival.</p><p><strong>Results: </strong>Ixekizumab demonstrated superior effectiveness in achieving PASI 100 and improving scalp psoriasis, while Guselkumab provided the most sustained improvements in palmoplantar and nail involvement. Adverse events were most frequently associated with IL-17 inhibitors, particularly upper respiratory tract infections. Guselkumab and Secukinumab demonstrated the highest drug survival rates, whereas Ixekizumab had the lowest. Early improvements in PASI and DLQI scores were strong predictors of drug survival.</p><p><strong>Conclusion: </strong>Personalized treatment approaches are crucial, given the varied effectiveness, safety profiles, and drug survival among biologic therapies.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"299-308"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001085","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":"Daily solriamfetol improved performance on a memory and attention task in people with obstructive sleep apnea and excessive daytime sleepiness: a plain language summary.","authors":"Eileen B Leary, Hans P A Van Dongen, Christopher Drake, Richard Bogan, Judith Jaeger, Caroline Streicher, Herriot Tabuteau","doi":"10.1080/00325481.2025.2494499","DOIUrl":"10.1080/00325481.2025.2494499","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"209-219"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055598","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":"Comparative assessment of left and right atrial deformation using 2D and 3D speckle-tracking echocardiography in healthy individuals and rheumatic mitral stenosis patients with/without atrial fibrillation.","authors":"Özden Seçkin Göbüt, Serkan Ünlü, Gülten Taçoy Aydoğdu","doi":"10.1080/00325481.2025.2478819","DOIUrl":"10.1080/00325481.2025.2478819","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic mitral stenosis continues to be a significant public health issue in developing countries. Advances in echocardiography have made it possible to non-invasively assess atrial physiomechanics. In our study, we aimed to evaluate the changes in left and right atrial phasic functions in patients with have mitral stenosis and to investigate the relationship of these changes with clinical signs, symptoms, and intervention decisions.</p><p><strong>Methods: </strong>Patients with rheumatic mitral stenosis who did not have comorbidities affecting cardiac function were included in this single-center, prospective study. The study population consisted of 122 subjects: 30 healthy controls with no chronic diseases and normal cardiac function confirmed by clinical and echocardiographic evaluations, 31 patients with moderate mitral stenosis, 31 patients with severe mitral stenosis and 30 patients with severe mitral stenosis with valvular atrial fibrillation. In addition to conventional echocardiographic parameters, biventricular deformation analyses were assessed using 2D-STE. Right and left atrial phasic functions were evaluated using both 2D and 3D-STE analysis and compared with clinical findings.</p><p><strong>Results: </strong>In the patient group with severe mitral stenosis in sinus rhythm, the contractile left atrial strain values were significantly higher. The left atrial peak longitudinal (reservoir) strain values were found to be significantly lowest in the group with severe mitral stenosis accompanied by atrial fibrillation. Similarly, in the group with severe mitral stenosis accompanied by atrial fibrillation, the right atrial phasic strain values were significantly lower in both 2D and 3D measurements.</p><p><strong>Conclusion: </strong>Mitral stenosis, the increased left atrial afterload in patients with sinus rhythm is compensated by an increase in contractile function. However, this compensatory increase is insufficient to preserve left atrial reservoir function. Patients with mitral stenosis who develop atrial fibrillation lack the compensatory contractile function, and this deficiency underlies the increased clinical deterioration associated with the development of atrial fibrillation.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"309-317"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652940","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}