Postgraduate medicine最新文献

{"title":"BMI and sex disparity in uric acid level improvement in patients with obesity and diabetes following laparoscopic sleeve gastrectomy.","authors":"Bian Wu, Kunlin Li, Junyu Wang, Guishun Sun, Shiwen Li, Xuan He, Rongzhuang Zou, Lihong Jiang","doi":"10.1080/00325481.2025.2493040","DOIUrl":"10.1080/00325481.2025.2493040","url":null,"abstract":"<p><strong>Background: </strong>The potential improvement in uric acid (UA) levels following laparoscopic sleeve gastrectomy (LSG) in patients with obesity and type II diabetes mellitus (T2DM) has not been systematically studied. Our aim was to investigate the influencing factors of UA level improvement following LSG and its correlation with glucose metabolism and lipid metabolism.</p><p><strong>Methods: </strong>A total of 392 patients with obesity and T2DM were prospectively recruited from 1 November 2022 to 31 December 2023. All patients underwent LSG surgery and were followed at 1, 2, 3, 6, 12 months after surgery. The presurgical and postsurgical levels of body-mass index(BMI), UA and indicators of glucose metabolism and lipid metabolism were recorded.</p><p><strong>Results: </strong>Distinct UA improvement was observed between males and females and among different BMI groups following LSG. Female patients exhibited more sustained and greater recovery of UA level up to 12 months than male patients in all BMI groups, although male patients showed a sharper UA level decrease in the first two months. Furthermore, patients with BMI ≥ 37.5 appeared to have significantly greater UA level decrease than other patients up to 12 months. UA level improvement showed significant correlation with BMI improvement in all three BMI groups in females while only in BMI 28-32.5 group in males. For glucose metabolism, a significant linear correlation between UA level changes and fasting blood glucose (FBG), fasting blood insulin (FBI), glycosylated hemoglobin A1c (HbA1c) and C-peptide (CP) was found in patients with presurgical elevated UA level group, and in female patients for FBI and CP. For lipid metabolism, a significant linear correlation was only observed between UA level changes and HDL in female and those with high presurgical UA levels.</p><p><strong>Conclusions: </strong>Sex and presurgical BMI appeared to influence the UA improvement following LSG. Females and those with presurgical elevated UA levels exhibited the most significant UA level alleviation. UA level changes also correlated with glucose metabolism and lipid metabolism.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"261-273"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002266","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":"Beta-cell preservation in T2DM using a pathophysiologic approach.","authors":"Konstantino Papatheodorou, Jay H Shubrook","doi":"10.1080/00325481.2025.2494502","DOIUrl":"10.1080/00325481.2025.2494502","url":null,"abstract":"<p><p>Type 2 diabetes and obesity rates continue to rise. Type 2 diabetes affects 1-2 million new individuals annually. Despite a wide range of treatment options for type 2 diabetes, many people still fail to achieve therapeutic goals. Treating type 2 diabetes more proactively with a pathophysiologic approach can ensure higher rates of success and reduce complications. This article summarizes the progressive understanding of the pathophysiology of diabetes, draws a connection between illness and beta-cell health, and introduces the pathophysiologic approach to type 2 diabetes and its focus on beta-cell preservation. This article compiled clinical data, evidence-based medicine, and experimental results to create a comprehensive narrative review.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"235-242"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032918","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":"Prognostic value of liver fibrosis scores in ambulatory patients with heart failure.","authors":"Ariana Varela-Cancelo, Eduardo Barge-Caballero, Gonzalo Barge-Caballero, David Couto-Mallón, M J Paniagua-Martín, Milena Antúnez-Ballesteros, Daniel Enríquez-Vázquez, Zulaika Grille-Cancela, Javier Muñiz, José M Vázquez-Rodríguez, María G Crespo-Leiro","doi":"10.1080/00325481.2025.2468149","DOIUrl":"10.1080/00325481.2025.2468149","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association of four liver fibrosis scores - Fibrosis-4 (FIB-4), AST/ALT ratio, AST-to-platelet ratio index (APRI) and Gamma-glutamyl transferase-to-platelet ratio index (GPRI) - and clinical outcomes in ambulatory patients with heart failure (HF).</p><p><strong>Methods: </strong>We conducted a retrospective study involving 2379 patients with HF referred to a specialized clinic from January 2010 to June 2022. We used multivariable Cox´s regression models to study the association between liver fibrosis scores and long-term clinical outcomes (all-cause death and the combined endpoints all-cause death or HF hospitalization and cardiovascular death or heart transplantation). Areas under receiver-operator curves were used to evaluate the discriminative capacity of each score for predicting 1-year clinical outcomes, as well as to analyze their incremental predictive value in addition to the broadly validated MAGGIC risk score.</p><p><strong>Results: </strong>Median follow up was 1568 days. GPRI was identified as an independent predictor of all-cause death or HF hospitalization (HR 1.12, 95% CI 1.07-1.18), all-cause death (HR 1.14, 95% CI 1.08-1.20) and cardiovascular death or heart transplantation (HR 1.10, 95% CI 1.03-1.17). FIB-4 and AST/ALT ratios were also independently associated with all-cause mortality. According to receiver-operator curve analyses, GPRI showed the best discriminative capacity among the four liver fibrosis scores evaluated in the study to predict 1-year clinical outcomes. The predictive value of GPRI was incremental to the one of the MAGGIC risk score.</p><p><strong>Conclusions: </strong>Liver fibrosis scores are associated with long-term clinical outcomes in ambulatory patients with HF. In our study, the predictive capacity of GPRI outperformed the one of FIB-4, APRI and AST/ALT and was incremental to the one of the MAGGIC risk score.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"274-286"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442702","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 prevalence of anemia, iron deficiency, and iron deficiency anemia in adult migrants in Nigde, Turkey.","authors":"Gonul Seyda Seydel, Muhammet Bayraktar, Durmus Ayan","doi":"10.1080/00325481.2025.2493608","DOIUrl":"10.1080/00325481.2025.2493608","url":null,"abstract":"<p><strong>Objectives: </strong>Anemia is a significant public health concern, particularly among migrants. The aim of this study was to evaluate the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among adult migrants in Nigde.</p><p><strong>Methods: </strong>This retrospective study included a total of 2378 adult migrants who were admitted to Nigde Omer Halisdemir University Training and Research Hospital. The complete blood count, serum iron, unsaturated iron-binding capacity, transferrin saturation, and serum ferritin levels of all migrants were analyzed. The status and severity of anemia and ID were determined according to the definitions of the World Health Organization.</p><p><strong>Results: </strong>Out of the migrants, 77.2% were female. The migrants originated from 40 different countries, with the majority of them coming from Syria (41.4%), followed by Afghanistan (27.3%), Iraq (9.1%), Iran (9.1%), and other countries (13.1%). The prevalence of anemia, ID, and IDA among adult migrants was 20.8%, 23.8%, and 14%, respectively. In females, the prevalence of anemia, ID, and IDA in 25.5%, 29.9%, and 17.7%, respectively. In males, the prevalence of anemia, ID, and IDA was 4.8%, 3.1%, and 1.6%, respectively. 57.5% of the anemia cases were mild anemia and 57.9% were microcytic anemia. IDA accounted for 67.6% of total cases of anemia, 69.4% of females with anemia, and 34.6% of males with anemia. Serum iron, ferritin, and mean corpuscular volume (MCV) levels in Syrians were significantly lower than those in all other countries.</p><p><strong>Conclusion: </strong>Anemia among adult migrants was a moderate public health concern. IDA is the most common cause of anemia in females, but not in males. The prevalence of anemia, ID and IDA varied significantly by geography and gender. Public awareness, screening and prevention programs on iron supplementation and food fortification should be implemented to reduce the prevalence of anemia in at-risk populations.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"318-325"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060047","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":"Introduction to Hospital Medicine.","authors":"Colleen O'Connor","doi":"10.1080/00325481.2025.2478813","DOIUrl":"10.1080/00325481.2025.2478813","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"220"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732905","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":"Clinical phenotypes of benign hepatic lesions: how age, sex, alkaline phosphatase, and hemoglobin can help differentiate.","authors":"Michael B Andrews, Manaswitha Thota, Jonathan Van Name, Tamas Gal, Richard Sterling","doi":"10.1080/00325481.2025.2490469","DOIUrl":"10.1080/00325481.2025.2490469","url":null,"abstract":"<p><strong>Objectives: </strong>Most benign hepatic lesions occur in isolation. The clinical and demographic phenotype in patients with more than one lesion can overlap complicating treatment decisions. This study aimed to describe the clinical and demographic characteristics of patients with benign hepatic lesions to predict the lesion using clinical data and oral contraceptive (OCP) use and find a 'clinical phenotype' to identify these patients.</p><p><strong>Methods: </strong>This retrospective cohort study compared demographics, laboratory values, and OCP use in patients with hepatic adenoma (HA), focal nodular hyperplasia (FNH), hemangioma (HM), and cystic lesions on imaging. Differences between groups were assessed to identify independent factors associated with the different lesions.</p><p><strong>Results: </strong>The cohort (<i>n</i> = 216) contained 90 (41%) FNH, 75 (34%) cystic lesions, 47 (21%) HA, 26 (12%) HM, and 3 (1.4%) FNH+HA. Combination lesions were observed in 27 (12%) patients: HM+cyst (<i>n</i> = 2; 0.9%), FNH+cyst (<i>n</i> = 8; 3.7%), HA+cyst (<i>n</i> = 4; 1.9%), FNH+HM (<i>n</i> = 7; 3.2%), HA+HM (<i>n</i> = 2; 0.9%), FNH+HM+cyst (<i>n</i> = 1; 0.5%), and HA+FNH (<i>n</i> = 3; 1.4%). FNH were youngest and female. HA were young and female with highest OCP use. Patients with cystic lesions were oldest with the least OCP use. HM were male with the highest overall alkaline phosphatase (ALP) levels. Between HA and FNH, HA had significantly higher aspartate aminotransferase, alanine aminotransferase, and ALP levels with lower Hgb levels.</p><p><strong>Conclusion: </strong>Predicting the etiology of benign hepatic lesions based on patient demographics, common laboratory values, and a brief history including OCP use alone is difficult. However, we identified the most important demographic and laboratory values to assist in building a differential.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"287-293"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805252","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":"Abdominal cancer pain admission in emergency department vs. oncology emergency department.","authors":"Kristina Zaslavsky, Ofir Morag, Menucha Jurkowicz, Galia Pesah, Michelle Nigri Levitan, Itay Goor-Aryeh","doi":"10.1080/00325481.2025.2491296","DOIUrl":"10.1080/00325481.2025.2491296","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the rates of hospitalization, opioid prescription, supportive care, hospice referral, and 30-day all-cause mortality in patients with metastatic cancer and abdominal pain admitted to either the Emergency Department (ED) or the Oncology ED.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with metastatic cancer and abdominal pain admitted to the ED or Oncology ED at a tertiary medical center between June 2020 and May 2022. The MDClone ADAMS Platform, a healthcare data analytics environment, was used for data collection. Inverse probability weighting (IPW) based on propensity scoring was used to balance and compare characteristics of patient groups admitted to both ED settings.</p><p><strong>Results: </strong>Weighted multivariable logistic regression found that metastatic cancer patients with abdominal pain complaints visiting the Oncology ED were 66% less likely to be admitted to the hospital (OR 0.34, 95% CI [0.16, 0.72], p-value = 0.005), and more likely to receive a supportive care consultation (OR 4.67, 95% CI [1.45, 15.05], p-value = 0.010), compared with the ED. Our study found that an Oncology ED, due to its expertise and immediate access to supportive care services due to their physical location within the same facility, enables prompt intervention for symptom management and psychosocial support, besides providing further oncology outpatient clinics follow-up for patients with metastatic cancer.</p><p><strong>Conclusions: </strong>We believe that a developed oncology emergency care with specialized staff has the potential to reduce hospitalization rates.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"294-298"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045280","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":"Administration of COVID-19 vaccination to adult caregivers in pediatric outpatient clinics: a vaccination cocooning project.","authors":"Lauren Rostkowski Jensen, Molly Posa, Stephanie Filipp, Maria Kelly, Jaclyn Otero","doi":"10.1080/00325481.2025.2482513","DOIUrl":"10.1080/00325481.2025.2482513","url":null,"abstract":"<p><strong>Background: </strong>Vaccination against COVID-19 is safe for patients greater than 6 months of age and reduces virus infectivity and severity. One strategy for protecting children unable to be vaccinated is cocooning, a concept that protects at-risk individuals by vaccinating adult caregivers (ACs). This study evaluates AC characteristics of those receiving COVID-19 vaccination in pediatric healthcare clinics.</p><p><strong>Methods: </strong>This study is a retrospective chart review that identified ACs greater than 21 years of age who received a COVID-19 vaccine at one of six UFHealth pediatric offices between March 2021-April 2022. Investigators collected demographic information of the AC and corresponding child.</p><p><strong>Results: </strong>The AC sample was predominantly female (79.8%), parents (75.3% mothers, 19.3% fathers), White (48.2%) or Black/African American (33.7%). Those who completed both primary doses had higher rates of children less than 5 years compared to those who did not (48.2%, 37.2%; p-value: 0.0225). ACs completing both primary doses were also younger compared to their counterparts (37.0, 39.9 years; p-value: 0.0017), with double the rate of government-funded insurance (42.9%, 20.9%; p-value: <0.0001), and significantly different racial/ethnic distribution (p-value 0.0021).</p><p><strong>Conclusions: </strong>ACs who completed both primary doses were younger females and had higher rates of children under 5 years old. We believe these results reflect the convenience of offering AC vaccines at pediatric healthcare clinics because of the high frequency of well-child checks within the first 5 years of life. This cohort also had double the rate of government-funded insurance, attributable to the free administration of COVID-19 vaccines at UF-affiliated pediatric clinics.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712636","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":"<i>Moraxella catarrhalis</i> bacteremia in adult with cardiogenic pulmonary edema.","authors":"Naoto Ishimaru, Motohiro Shingu, Jun Ohnishi, Shimpei Mizuki, Yohei Kanzawa, Takahiro Nakajima, Saori Kinami","doi":"10.1080/00325481.2025.2463877","DOIUrl":"10.1080/00325481.2025.2463877","url":null,"abstract":"<p><p>Bacteremia due to <i>Moraxella Catarrhalis</i> is rare. An 85-year-old Japanese woman had productive cough, dyspnea, and fever. She had type 2 diabetes mellitus and chronic heart failure. Infiltration shown on chest radiography could be explained by heart failure or pneumonia. Initial blood culture yielded Gram-negative cocci, identified as <i>M. catarrhalis</i>. We therefore diagnosed cardiogenic pulmonary edema and <i>M. catarrhalis</i> pneumonia. <i>M. catarrhalis</i> has a high prevalence of β-lactamase production, so treatment comprised ampicillin/sulbactam. The clinical outcomes were favorable. Our case shows the importance of consideration of <i>M. catarrhalis</i> when patients with heart failure have pneumonia and the importance of blood culture for such patients.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"121-125"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191702","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 review of venous thromboembolism for the hospitalist.","authors":"Kelly Szymanski, Carly Weber, Kaitlin Daugherty, David A Cohen","doi":"10.1080/00325481.2025.2452155","DOIUrl":"10.1080/00325481.2025.2452155","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an extremely common condition both in the United States and worldwide. Not only is the diagnosis associated with significant morbidity and mortality for patients but it also imposes a deleterious financial burden on the US healthcare system. Diagnosis may be challenging due to variability in clinical presentation and requires a sequential workup including assessment of clinical pretest probability for VTE, D-dimer testing, and imaging. Following diagnosis, proper risk stratification is necessary to determine the appropriate treatment as well as the need for inpatient care. Elucidation of underlying major or minor risk factors at the time of diagnosis is essential as the presence of which may influence the duration of therapy. First-line treatment for most patients is anticoagulation with a direct oral anticoagulant (DOAC) for a minimum of 3-6 months. In multiple clinical trials, DOACs have proven to be non-inferior to vitamin K antagonists for the treatment of VTE with a lower risk of bleeding. Special consideration should be taken in the choice of agent and duration of treatment for patients who have underlying thrombophilias or malignancy and who are pregnant.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"131-138"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981083","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}