Postgraduate medicine最新文献

{"title":"Extracorporeal membrane oxygenation in cardiogenic shock: evidence, limitations, and patient selection in the contemporary era.","authors":"Udit Choubey, Kartik Mehta, Sreshatha Vashist, Heena Arshad, Namita Ruhela, Nabeel Akhtar, Rohit Jain","doi":"10.1080/00325481.2026.2679308","DOIUrl":"10.1080/00325481.2026.2679308","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a life-threatening condition with severely impaired myocardial contractility, causing systemic hypoperfusion, tissue hypoxia, and organ dysfunction. Despite the advances in revascularisation and pharmacological therapies, CS carries high mortality among patients with acute myocardial infarctions and other acute cardiac syndromes. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) offers short-term mechanical circulatory support in refractory CS by restoring systemic perfusion and maintaining end-organ oxygenation. This narrative review aims to explain the physiological basis of V-A ECMO, summarize the findings from randomized clinical trials (RCTs) and observational studies, and evaluate the clinical factors that affect mortality outcomes in CS. Recent RCTs assessing routine early V-A ECMO initiation in acute myocardial infarction - related CS include ECLS-SHOCK, ECMO-CS, and EURO-SHOCK. The results did not show a clear early mortality benefit with routine ECMO initiation and reported higher rates of bleeding and vascular complications. Appropriate patient selection based on shock phenotype, optimal timing of support, clinical assessment, and management of V-A ECMO-associated complications are critical determinants of clinical effectiveness. It is still a valuable rescue option for refractory CS when appropriately selected based on reversibility potential and institutional capabilities, rather than as routine first-line therapy for all patients with acute MI-related shock.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"530-539"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019809","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":"Predicting the metabolically obese normal weight phenotype: sex-specific diagnostic accuracy of traditional and novel anthropometric indices.","authors":"Kevser Tari, Sedat Arslan","doi":"10.1080/00325481.2026.2683173","DOIUrl":"10.1080/00325481.2026.2683173","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare the sex-specific diagnostic performance of traditional anthropometric indices, including Body Mass Index (BMI), Waist Circumference (WC), Waist-Hip Ratio (WHR), and Waist-to-Height Ratio (WHtR), with novel indices such as A Body Shape Index (ABSI), Body Roundness Index (BRI), Abdominal Volume Index (AVI), Weight-Adjusted Waist Index (WWI), Body Adiposity Index (BAI), Conicity Index (CI), and Waist-Hip-Height Ratio (WHHR) in predicting the Metabolically Obese Normal Weight (MONW) phenotype in adults.</p><p><strong>Methods: </strong>This diagnostic accuracy study involved 504 adults aged 19-64 years who met specific inclusion and exclusion criteria. Metabolic abnormalities were evaluated according to NCEP-ATP III criteria to identify the MONW phenotype. The ability of the anthropometric indices to discriminate MONW individuals was assessed using Receiver Operating Characteristic (ROC) curves, with optimal cutoff points determined by the Youden index. Results: Results indicated that 18.10% of adults had the MONW phenotype, and the proportion of men with MONW was higher than that of women (<i>p</i> < 0.05). ROC analysis revealed that among women, WHtR (AUC: 0.715, 95% CI: 0.598-0.832) among traditional indices and BRI (AUC: 0.712, 95% CI: 0.594-0.830) among novel indices showed fair predictive ability, while other indices demonstrated weak or no predictive power. In men, all indices exhibited poor or no performance in predicting the MONW phenotype.</p><p><strong>Conclusion: </strong>These findings suggest that anthropometric indices alone have limited capacity to identify MONW, especially in men, emphasizing the importance of comprehensive, multi-parameter assessments to detect high-risk normal-weight adults.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"593-603"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146013","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":"Type 1 diabetic ketoacidosis characterized by vomiting and Hamman's syndrome: case report and literature review.","authors":"Dan Li, Wenwen Zhu, Jianping Yao, Weiqin Ye","doi":"10.1080/00325481.2026.2690292","DOIUrl":"10.1080/00325481.2026.2690292","url":null,"abstract":"<p><strong>Background: </strong>Hamman's syndrome, a form of spontaneous pneumomediastinum, exhibits a low incidence and is seldom secondary to ketoacidosis.</p><p><strong>Case presentation: </strong>This article presents a case of type 1 diabetic ketoacidosis where vomiting and Hamman's syndrome were the initial manifestations. Additionally, it reviews the data of 85 patients with Hamman's syndrome combined with diabetic ketoacidosis to summarize its traits, analyze its pathogenesis, and delineate its diagnostic approaches and therapeutic strategies.</p><p><strong>Conclusions: </strong>The prognosis of Hamman's syndrome is favorable; however, it must be discriminated from Boerhaave's syndrome, which is associated with a high mortality rate. Therefore, heightened awareness and understanding of this disease among clinicians are essential.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"511-516"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274591","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 'Extracorporeal shock wave lithotripsy with pancreatic stent prevents spontaneous clearance of stone'.","authors":"İbrahim Ethem Güven","doi":"10.1080/00325481.2026.2664926","DOIUrl":"10.1080/00325481.2026.2664926","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"385-386"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793454","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":"Misclassification of type 1 diabetes as type 2 diabetes in adults: practical guidance for screening and diagnosis for primary care providers.","authors":"Eugene E Wright, Cecilia C Low Wang, Lucia M Novak, Jay H Shubrook","doi":"10.1080/00325481.2026.2672192","DOIUrl":"10.1080/00325481.2026.2672192","url":null,"abstract":"<p><p>Although type 2 diabetes (T2D) is more common in adults than type 1 diabetes (T1D), over half of individuals with T1D are diagnosed as adults. The onset of T1D in adulthood leads to a high prevalence of misclassification of diabetes, resulting in delayed or inadequate treatment and increased risk of complications. This review uses case studies to highlight clinical features that can aid in identifying adults who may have T1D, including family history of T1D, family or personal history of other autoimmune disorders, lack of metabolic syndrome features, and poor response to non-insulin diabetes medications. Practical recommendations for confirmatory testing are described, including autoantibody and C-peptide testing, while noting important limitations of these tests, to support clinicians in accurately classifying T1D in adults.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"396-407"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978091","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":"Characteristics and outcomes among patients with stercoral colitis - a retrospective cohort study.","authors":"Alexander J Ryu, Shant Ayanian, Heather O'Connor, Nital Vaghela, Wyatt Pruter, Sandeep Pagali","doi":"10.1080/00325481.2026.2672177","DOIUrl":"10.1080/00325481.2026.2672177","url":null,"abstract":"<p><strong>Background: </strong>Stercoral colitis is a rare, but potentially serious, complication of chronic constipation. Limited literature exists, pertaining to stercoral colitis-related management and outcomes. We aim to study characteristics and outcomes of stercoral colitis patients presenting to emergency department.</p><p><strong>Methods: </strong>We compiled a cohort of patients who presented to one of 21 EDs between 1 January 2024 and 31 January 2025 and had a radiological finding of stercoral colitis on CT imaging. We manually extracted details regarding their ED presentation and disposition, hospital course, and any acute adverse outcomes defined as inpatient endoscopy, inpatient surgery, and death within 90 days of the ED visit related to stercoral colitis. Additional chart review was performed in patients who experienced adverse outcomes to study the clinical circumstances.</p><p><strong>Results: </strong>Three hundred and eighty-one patient encounters (358, unique patients) were identified with stercoral colitis. Only seven patients (2.0%) experienced acute adverse outcomes, though four of these were not attributed to stercoral colitis. Two hundred and seventy-two patient encounters (71.4%) were admitted to the hospital, among which 114 encounters (29.9%) had primary admitting diagnoses related to stercoral colitis. Of the 109 (28.6%) encounters discharged from ED, 2 patients returned to ED within 72 hours. Management of hospitalized stercoral colitis patients mostly included disimpaction and bowel regimen medications.</p><p><strong>Conclusions: </strong>Stercoral colitis is an uncommon diagnosis, and adverse outcomes are rare. The decision to hospitalize should be based on the overall clinical picture, considering need for hospital-based interventions, or assistance with bowel regimen. The Age-Friendly Health System framework can facilitate an optimal management approach.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"443-449"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864796","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":"Life-threatening neurotoxicity following off-label ivermectin use in metastatic breast cancer: a case report.","authors":"Yiela Saperstein, Elie Bou Sanayeh, Pola Boazak, Hadi Itani, Elie Moussa, Thomas Gut","doi":"10.1080/00325481.2026.2672183","DOIUrl":"10.1080/00325481.2026.2672183","url":null,"abstract":"<p><strong>Background: </strong>The United States Food and Drug Administration (FDA) has explicitly discouraged the use of ivermectin for the treatment of cancer outside of clinical trials. Nevertheless, patient self-administration persists, frequently influenced by information encountered online. Cases of ivermectin neurotoxicity in the oncology setting remain underreported despite growing off-label use driven by online misinformation. We present a case of severe neurotoxicity following unintentional high-dose self-administration of ivermectin as an off-label attempt to treat breast cancer.</p><p><strong>Case presentation: </strong>A 73-year-old female with metastatic breast cancer self-administered high doses of ivermectin based on information obtained online. She subsequently developed acute altered mental status, generalized seizures, and respiratory failure. Her clinical course was consistent with severe ivermectin-induced neurotoxicity, necessitating supportive management including intubation, mechanical ventilation, intravenous fluids, and anticonvulsant therapy. The patient demonstrated full neurological recovery to baseline within 48 hours.</p><p><strong>Conclusion: </strong>This case highlights the potential for life-threatening neurotoxicity associated with high-dose ivermectin use. Increasing online health misinformation has led to the self-administration of unproven therapies; therefore, clinicians should counsel patients on the risks of non-evidence-based treatments. A thorough exposure history is essential to identify uncommon causes and maintain vigilance for severe adverse reactions.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"391-395"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990598","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 an exercise program to enhance lactation on breastfeeding self-efficacy, breastfeeding success, and the amount of breast milk received by the infant: a randomized controlled trial.","authors":"Beyza Nur Aslantaş, Seyhan Çankaya","doi":"10.1080/00325481.2026.2672182","DOIUrl":"10.1080/00325481.2026.2672182","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to examine the impact of an exercise program designed to enhance lactation on breastfeeding self-efficacy, breastfeeding performance, and breast milk output.</p><p><strong>Methods: </strong>This randomized controlled study was conducted in Konya, Turkey, and data were collected from 122 mothers in their 8th week postpartum between January and March 2025. The study sample comprised 61 mothers in the exercise group (EG) and 61 mothers in the control group (CG). The EG received a 6-week exercise program designed to increase breast milk. Mothers in the CG received standard breastfeeding counseling.</p><p><strong>Results: </strong>The mean breastfeeding self-efficacy score in the exercise group (EG) was significantly higher (<i>M</i> = 57.8, SD = 8.3) than in the control group (CG) (<i>M</i> = 48.0, SD = 6.6), with a mean difference of 9.8 points (<i>p</i> < 0.001, Cohen's d ≈ 1.31). The mean LATCH score in the EG was 9.1 (SD = 0.9), significantly higher than the CG's mean of 8.6 (SD = 0.9), with a mean difference of 0.5 points (<i>p</i> = 0.001, Cohen's d ≈ 0.56). Similarly, the mean score for perceived breast milk adequacy, measured via the IMDAT tool, was significantly higher in the EG (<i>M</i> = 8.5, SD = 1.0) compared to the CG (<i>M</i> = 7.7, SD = 1.4), showing a mean difference of 0.8 points (<i>p</i> = 0.002, Cohen's d ≈ 0.66). The mean infant weight in the EG (<i>M</i> = 6730.8 g, SD = 892.6) was significantly greater than that in the CG (<i>M</i> = 6193.4 g, SD = 860.5), with a mean difference of 537.4 grams (<i>p</i> = 0.001, Cohen's d ≈ 0.61,). Conversely, formula supplementation use was significantly lower among mothers in the EG (<i>M</i> = 56.7 ml, SD = 68.3) compared to the CG (<i>M</i> = 81.8 ml, SD = 35.8), with a mean difference of 25.1 ml (<i>p</i> = 0.013, Cohen's d ≈ 0.46).</p><p><strong>Conclusion: </strong>The findings of the study indicated that the exercise program designed to enhance lactation significantly improved breastfeeding self-efficacy, increased LATCH scores and perceived breast milk adequacy, and reduced infant feeding practices (such as formula use).</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier is NCT06723613.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"466-478"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147877061","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":"Mortality and hospitalization of heart failure patients between rural and urban areas: a systematic review and meta-analysis of 18 million patients.","authors":"Jannatin N Arnindita, Pandit B T Saputra, Shinta Dewi Rasti, Nando R Pratama, Ariikah D Lamara, Zakiyyatul Aflakha, Irma Maghfirah, Yudi H Oktaviono, Firas F Alkaff","doi":"10.1080/00325481.2026.2672190","DOIUrl":"10.1080/00325481.2026.2672190","url":null,"abstract":"<p><strong>Objectives: </strong>Challenges in social determinants of health, fewer hospitals, further referral sites, and specialist scarcity in rural areas may hinder medical care, thus resulting in poorer outcomes for heart failure patients. This meta-analysis aims to assess the differences in mortality and other clinical outcomes of HF patients between rural and urban areas.</p><p><strong>Methods: </strong>A systematic search for eligible studies was conducted in PubMed, Embase, Medline, Science Direct, and Scopus databases. Primary outcomes were in-hospital, 30-day, and long-term mortality. Secondary outcomes were physician revisit and rehospitalization, ER readmission, and length of stay. Twenty studies with 18,893,519 participants were included. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) from each study were analyzed using Review Manager 5.4.</p><p><strong>Results: </strong>HF patients in rural areas showed more significant long-term mortality (aOR = 1.09; 95% CI: 1.07-1.10; I² = 0%; <i>p</i> < 0.001) and 30-day mortality (OR =1.14; 95% CI: 1.12-1.16; I² = 33%; <i>p</i> < 0.001). Hospitalizations in rural areas resulted in shorter length of stay (MD = -0.95; 95% CI: -1.17-(-0.74); I² = 32%; <i>p</i> < 0.001). Rural patients had more frequent 1-year ER readmission (OR =1.34; 95% CI: 1.03-1.76; I² = 91%; <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>In conclusion, HF patients in rural areas demonstrated poorer outcomes, which may be related to shorter lengths of stay and suboptimal healthcare utilization.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"408-416"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936661","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":"Symptomatic presentation of cancer in patients diagnosed following emergency self-referral and prior general practice consultations.","authors":"Xavier Bosch, Elisabet Montori-Palacin, Margalida Cadena-Rutllan, Tiago Mota-Gomes, Marc Montoya, Pedro Moreno, José Naval-Álvarez, Alfonso López-Soto","doi":"10.1080/00325481.2026.2674374","DOIUrl":"10.1080/00325481.2026.2674374","url":null,"abstract":"<p><strong>Objectives: </strong>Research indicates that approximately 70% of cancer cases diagnosed after emergency presentation involve patients who presented themselves to the emergency department. However, information on those who consulted primary care (PC) before self-referring as emergencies is lacking. We explored the characteristics, including the symptom signature of cancers and the cancer site case-mix of presenting symptoms, of patients who self-referred as emergencies after consulting PC (consulters), and compared them to those who self-referred but never consulted PC (nonconsulters).</p><p><strong>Methods: </strong>Eligibility was restricted to patients diagnosed with 20 cancer sites over an 11-year period. The relative frequency of presenting symptoms was analyzed both across subgroup populations and by cancer site, as it was the range and relative frequency of cancers diagnosed following presentation with each symptom. Presenting symptoms were classified into alarm and nonalarm symptoms.</p><p><strong>Results: </strong>The study comprised 1118 consulters and 987 nonconsulters. Certain cancers in both patient subgroups, notably pancreatic cancer, had a broad symptom signature, predominantly consisting of nonalarm symptoms, and patients presenting with nonalarm symptoms, especially consulters, were diagnosed with a wide variety of cancers. Pancreatic cancer in consulters presented with a wide range of symptoms, largely nonalarm symptoms, such as abdominal pain, documented in 28% (95% CI 24-33) of cases. Among consulters presenting with abdominal pain, 17% were diagnosed with colorectal, 41% with pancreatic, 11% with ovarian, and 31% with another 6 cancer sites. Conversely, the symptom signatures of other cancers, including breast cancer, were defined by one or two alarm symptoms, which were associated with specific cancer sites, particularly in nonconsulters.</p><p><strong>Conclusion: </strong>These findings advance the understanding and discussion of emergency presentations and support the formulation of policies and health programs to reduce emergency self-referrals. These include updated suspected cancer referral guidelines, diagnostic pathways for patients with nonalarm symptoms, cancer awareness initiatives, and safety-netting procedures.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"450-465"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966248","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}