Postgraduate medicine最新文献

{"title":"Referral pathway for adults with chronic cough in Switzerland from a Delphi-based consensus study.","authors":"Martin Brutsche, Barbara Ballmer-Weber, Emanuel Burri, Christian Clarenbach, Manuela Funke Chambour, Jörg D Leuppi, Michael B Soyka, Christophe von Garnier, Andreas Zeller","doi":"10.1080/00325481.2026.2663615","DOIUrl":"10.1080/00325481.2026.2663615","url":null,"abstract":"<p><strong>Objectives: </strong>The etiology of chronic cough (CC) is varied, making it difficult to manage, particularly when the cough persists despite appropriate treatment of underlying disease (refractory CC) or when no underlying disease or cause can be identified (unexplained CC). There are currently no recommendations in Switzerland outlining how general practitioners (GPs) should approach the management of CC. The aim of this study was to establish a consensus among physicians from various specialties in Switzerland regarding the assessment, treatment, and referral of CC patients.</p><p><strong>Methods: </strong>This Delphi-based consensus study included two survey rounds (May-December 2023) evaluating 71 statements on the assessment of CC and referral pathways among a panel of GPs, pulmonologists, allergologists, gastroenterologists, and ear nose and throat (ENT) specialists with experience managing CC in Switzerland (<i>N</i> = 50). A 9-point scale was used to rate agreement with statements; consensus in agreement or disagreement was achieved when the median of responses fell within 7-9 or 1-3, respectively, less than one third voted outside these ranges, and the interquartile range (IQR) was <4. An interdisciplinary Scientific Committee with representatives from medical disciplines involved in managing CC led the study and provided the context for the referral pathways proposed.</p><p><strong>Results: </strong>Consensus was reached on 84.5% of statements. Agreement was reached on general considerations for CC, initial actions to be taken in primary care, including clinical evaluation, 'red flags' to identify, pathologies to investigate, treatments to consider, and referral route. Two schematics were produced outlining 1) how to perform a basic assessment of CC patients in primary care, and 2) how and when to refer patients to specialists if CC persists.</p><p><strong>Conclusions: </strong>This study provides valuable recommendations for management of CC, promoting standardized assessment and referral of patients, which is not currently achieved in Switzerland.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"293-308"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848116","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":"Nonlinear relationship between the CHG index and MASLD in type 2 diabetes mellitus: mediating role of immunoinflammatory markers.","authors":"Binjing Pan, Xiaoyu Lv, Xinyuan Guo, Jingfang Liu","doi":"10.1080/00325481.2026.2661571","DOIUrl":"10.1080/00325481.2026.2661571","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the relationship between cholesterol, high-density lipoprotein, and glucose (CHG) index and metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>1,789 patients with T2DM aged ≥50 years were divided into MASLD (age: 62.56 ± 7.59) and non-MASLD groups (age: 62.78 ± 7.79). Adjusted regression models, threshold analysis, mediation analysis, and receiver operating characteristic (ROC) curves were used. Based on CHG index levels and various immunoinflammatory markers, patients with T2DM were divided into different groups, and the prevalence of MASLD was compared.</p><p><strong>Results: </strong>The CHG index, neutrophil-to-albumin ratio (NAR), neutrophil-to-lymphocyte ratio (NLR,) systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI) were higher in the MASLD group than in the non-MASLD group (<i>p</i> < 0.05). Multiple logistic regression analysis showed that the CHG index, NAR, NLR, SII, SIRI, and AISI were positively correlated with MASLD risk (all <i>p</i> < 0.05). Threshold analysis showed that when the CHG index was <5.474, it was positively associated with MASLD risk (<i>p</i> < 0.05). MASLD prevalence increased with increasing levels of inflammatory markers and the CHG index (<i>p</i> < 0.05). Mediation analysis of NAR, NLR, and SII between the CHG index and MASLD showed that the total effect estimates were 0.0159, 0.0153, and 0.0157, respectively; the direct effect estimates were 0.0107, 0.0134, and 0.0120; and the mediation effect estimates were 0.0053, 0.0019 and 0.0037, with the mediated proportions accounting for 27.25%, 11.47%, and 27.25% of the total effect, respectively. ROC curve analysis showed that the CHG index combined with SIRI had improved diagnostic performance for MASLD, with an area under the curve of 0.71.</p><p><strong>Conclusion: </strong>The CHG index was positively associated with MASLD risk in patients with T2DM aged ≥50 years. NAR, NLR, and SII partially mediated this association, highlighting their potential application in MASLD diagnosis.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"345-356"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793512","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":"An assessment of neutrophil percentage‑to‑albumin ratio in Kawasaki disease.","authors":"Yunjia Tang, Jiaying Zhang, Xuan Li, Jin Ma, Wanping Zhou, Haitao Lv","doi":"10.1080/00325481.2026.2662041","DOIUrl":"10.1080/00325481.2026.2662041","url":null,"abstract":"<p><strong>Backgrounds: </strong>Kawasaki disease (KD) is an immune vasculitis of unknown etiology. Coronary artery lesions (CALs) and intravenous immunoglobulin resistance (IVIGR) are two major clinical challenges in KD. Previous studies had pointed out that neutrophil percentage‑to‑albumin ratio (NPAR) was associated with the prognosis of cardiac diseases. However, its role in KD has not been fully explored.</p><p><strong>Methods: </strong>We enrolled patients with the main diagnosis of KD admitted to Children's Hospital of Soochow University between December 2018 and June 2024. Patients were stratified into tertiles based on NPAR, and comparisons among groups were conducted. Univariate and multivariable logistic regression were carried out. Restricted cubic splines and fitted curves were used to examine the relationships between NPAR and the presence of CALs and IVIGR. Subgroup analyses were also investigated.</p><p><strong>Results: </strong>A total of 2371 patients were included in the present study. The incidences of IVIGR and CALs were 12.9% (305/2371) and 28.3% (670/2371), respectively. Patients with higher NPAR levels exhibited higher incidences of IVIGR. In contrast, NPAR was not associated with CALs. A positive linear relationship was noted between NPAR and IVIGR (<i>p</i> < 0.001). The expected presence of IVIGR was also positively related to NPAR. However, the association was modified by age and coronary artery status.</p><p><strong>Conclusions: </strong>NPAR may serve as a prognostic indicator for IVIGR, particularly in patients younger than 48 months and those without CALs, but not for CALs.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"377-383"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793380","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":"Hospital teaching status and COVID-19 outcomes: a multicenter retrospective cohort study in the emergency department.","authors":"Jerome Gnanaraj, Amteshwar Singh, Ram Agrawal, Parth Sheth, Srishty Agarwal, Waseem Khaliq","doi":"10.1080/00325481.2026.2662701","DOIUrl":"10.1080/00325481.2026.2662701","url":null,"abstract":"<p><strong>Objectives: </strong>Differences in COVID-19 outcomes may reflect variation in clinical expertise, institutional resources, and care coordination between academic teaching and non-teaching hospitals. We evaluated differences in patient characteristics, resource utilization, and mortality between hospital types during the early phase of the pandemic.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 2,767 adults (≥18 years) with COVID-19 presenting to five hospitals within the Johns Hopkins Health System between March 1 and 4 May 2020. Patient characteristics, clinical presentation, laboratory findings, and outcomes were compared between academic teaching and non-teaching hospitals. Group comparisons were performed using unpaired t-tests and chi-square tests. Multivariable logistic regression assessed the association between hospital teaching status and in-hospital mortality. A primary model included variables with minimal missing values, while a secondary model incorporated laboratory variables using complete-case analysis. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test.</p><p><strong>Results: </strong>Of 2,767 patients, 801 (29%) were evaluated at academic teaching hospitals. Patients at academic centers had higher comorbidity burden and more severe clinical presentation, whereas patients at non-teaching hospitals had lower access to healthcare resources. Emergency department length of stay (430 vs 269 minutes, <i>p</i> < 0.001), hospital length of stay (12.2 vs 4.4 days), and hospitalization costs ($55,868 vs $5,543, <i>p</i> < 0.001) were higher in teaching hospitals. Mortality was higher in non-teaching hospitals across both adjusted models. In the primary (<i>n</i> = 2,605) model (OR 6.86; 95% CI 5.18-9.10; AUC 0.70) and the secondary (<i>n</i> = 372) model (OR 13.4; 95% CI 7.28-24.7; AUC 0.82).</p><p><strong>Conclusions: </strong>These findings suggest that structural differences, including resource availability and healthcare access, may contribute to disparities in COVID-19 outcomes. Non-teaching hospitals, while managing high volumes with limited resources, had markedly higher mortality despite lower comorbidity burden. Further investigation of system-level determinants of outcomes during public health emergencies is warranted.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"315-323"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793542","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":"Urinary adiponectin as a non-invasive biomarker of renal impairment in type 2 diabetes mellitus: evidence from a cross-sectional study.","authors":"Gyanendra Singh, Sagar Dholariya, Mehul Kaliya, Anjali Modi, Amit Sonagra, Deepak Parchwani","doi":"10.1080/00325481.2026.2657057","DOIUrl":"10.1080/00325481.2026.2657057","url":null,"abstract":"<p><strong>Background: </strong>Early detection of diabetic kidney disease (DKD) is critical, yet current tools such as eGFR and albuminuria often reflect injury only after substantial renal damage. Urinary adiponectin has been proposed as a sensitive marker of glomerular barrier dysfunction. This study evaluated its association with renal outcomes and ability to distinguish kidney involvement stages in type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>A total of 385 individuals were evaluated, including 60 healthy volunteers and 325 with T2DM stratified into normo-, micro-, and macroalbuminuria. Clinical, biochemical, and demographic variables were compared across groups. Associations of urinary adiponectin with renal outcomes were tested using correlation analysis and multivariable regression models appropriate for each outcome distribution. For albuminuria, a gamma generalized linear model with log link was applied, whereas estimated glomerular filtration rate (eGFR) was analyzed using a gaussian generalized linear model. Confidence intervals were obtained using profile likelihood or bootstrap approaches. Diagnostic accuracy was tested with ROC curves.</p><p><strong>Results: </strong>Urinary adiponectin increased progressively from controls to those with advanced albuminuria (<i>p</i> < 0.001). It showed a moderate positive correlation with urine albumin-creatinine ratio (UACR) [<i>ρ</i> = 0.46, <i>p</i> < 0.001] and a weaker inverse association with eGFR (<i>ρ</i> = -0.12, <i>p</i> = 0.02). In multivariable analysis, adiponectin remained independently associated with UACR (β = 0.075, 95% CI: 0.024-0.129, <i>p</i> = 0.002), together with diabetes duration and systolic blood pressure. Its association with eGFR did not reach significance. Diagnostic testing demonstrated modest discrimination for early DKD, with the highest accuracy observed when distinguishing normo- from microalbuminuria (AUC 0.702, 95% CI: 0.635-0.769).</p><p><strong>Conclusion: </strong>Urinary adiponectin reflects renal impairment in T2DM and demonstrates moderate diagnostic accuracy for identifying early DKD. While not a standalone diagnostic tool, it holds potential as a complementary marker alongside conventional measures.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"332-344"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641065","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":"Designing contextually relevant emergency medicine simulation-based learning experiences for paediatric specialist training in South Africa: a narrative review.","authors":"Michelle Myburgh, Stephen Brown, Mathys Labuschagne","doi":"10.1080/00325481.2026.2658360","DOIUrl":"10.1080/00325481.2026.2658360","url":null,"abstract":"<p><p>Pediatric trainees in South Africa must acquire competence in managing life-threatening conditions to qualify as specialists, although limited supervision, inconsistent feedback in clinical settings, high clinical workloads, and local healthcare realities often impede learning. Simulation-based learning experiences (SBLEs) provide a safe environment for deliberate practice, feedback, and reflective learning. A South African university introduced time during the academic postgraduate program for simulation-based training for pediatric emergency medical conditions. The aim was to design context-specific SBLEs for pediatric emergency medicine training in South Africa, informed by the local burden of disease and aligned with program learning outcomes. A narrative review of publications in English from 2000 onward was conducted using multiple databases to describe patterns of pediatric morbidity and mortality in South African hospitals. Eligible publications included data from emergency centers, wards, high-care units, and intensive care units relating to case mixes and emergency presentations. The review findings guided the development of five medical SBLEs within a design-based research framework to allow for further iterative refinement in the program. Twenty-eight studies met the inclusion criteria. Respiratory illnesses accounted for approximately 42% of admissions, followed by neurological (12%), cardiovascular (11%), gastrointestinal (7%), and septic (12%) conditions. Malnutrition was a frequent comorbidity across all settings. These data informed the design of five SBLEs focusing on (i) respiratory failure and difficult airway management, (ii) convulsive status epilepticus with hypoglycemia, (iii) severe acute malnutrition with gastroenteritis and hypokalaemia, (iv) sepsis and application of the Phoenix criteria, and (v) bradycardia with transcutaneous pacing. This narrative review used South African pediatric morbidity and mortality data to inform the design of five contextually relevant simulation-based learning experiences for postgraduate training. Developed within a design-based research framework, this potentially transferable approach aims to strengthen technical and non-technical competencies for safer practice in resource-constrained settings.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"265-271"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701424","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":"Takotsubo syndrome in the context of pre-existing non-ischemic cardiomyopathy: mechanistic and clinical implications.","authors":"Uğur Özkan, Kenan Yalta","doi":"10.1080/00325481.2026.2658365","DOIUrl":"10.1080/00325481.2026.2658365","url":null,"abstract":"<p><p>Takotsubo syndrome (TTS), a transient left ventricular (LV) dysfunction typically precipitated by acute emotional or physical stress, is classically observed in individuals with structurally normal hearts. However, its occurrence in patients with established non-ischemic cardiomyopathy (NICMP) represents a striking clinical paradox that challenges our current understanding of both disease entities. This comprehensive review examines the complex pathophysiological mechanisms underlying this phenomenon, with particular emphasis on supraphysiological catecholamine surge and biased β-adrenergic receptor signaling, inflammatory-mediated sensitization, intrinsic mitochondrial dysfunction and mechanically-induced cytokine amplification.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"272-282"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679832","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":"Intercontinental difference in the association between obesity and falls among older persons.","authors":"Sheron Sir Loon Goh, Sheng Hui Kioh, Sumaiyah Mat, Shahrul Bahyah Kamaruzzaman, Noran Naqiah Hairi, Ellen Freiberger, Robert Kob, Phyo Kyaw Myint, Maw Pin Tan","doi":"10.1080/00325481.2026.2657055","DOIUrl":"10.1080/00325481.2026.2657055","url":null,"abstract":"<p><strong>Background: </strong>Obesity in older persons may increase the risk of falls, but this relationship may vary depending on body composition and cultural behaviors, which may vary across regions and ethnic groups. This study aims to explore the differences in the association between increased BMI and falls among Asian and Caucasian populations, using data from the Malaysian Elders Longitudinal Research (MELoR), the Bavarian Research Association-Sarcopenia and Osteoporosis (FORMOsA) and the 3rd Health Check for European Prospective Investigation of Cancer-Norfolk (EPIC-NORFOLK) studies.</p><p><strong>Methods: </strong>We analyzed baseline data from the MELoR, FORMOsA, and EPIC-NORFOLK cohorts, focusing on older women aged ≥65 years (MELoR), ≥70 years (FORMOsA), and ≥55 years (EPIC-NORFOLK). We assessed body mass index (BMI), body composition, fall risk, and physical performance (gait speed, handgrip strength) to explore the relationship between BMI and falls, conducting cross-country and ethnic subgroup analyses. Statistical analysis was performed using multivariable logistic regression to controlling for confounding factors.</p><p><strong>Results: </strong>A total of 10,265 participants aged 55 and over were eligible to be included. The prevalence of people with falls was higher in FORMOsA (54.4%) compared to both MELoR (22.5%) and EPIC-NORFOLK (26.9%) cohorts. It found significant differences in age, gender, BMI, body fat, and fall prevalence across the three cohorts. BMI was significantly associated with fall risk in both the MELoR and FORMOsA studies, but not the EPIC-NORFOLK study. The relationship between BMI and falls remained unchanged after adjustment for age, gender, marital status, education level, smoking status, number of medications and medical comorbidities.</p><p><strong>Conclusion: </strong>Intercontinental and international variations were observed in the relationship between BMI and falls among adults aged 55 and older. While higher BMI was linked to increased fall risk in some populations, these associations varied by body composition and country, suggesting the need for culturally tailored fall prevention strategies among older persons.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"324-331"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679829","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 gut-Joint axis: investigating functional gastrointestinal disorders as risk factors for prosthetic joint infections a retrospective case-control study.","authors":"Dongsheng Guo, Yang Song, Liufeng Yuan, Wenya Chu, Yuefu Dong, Donglai Wang","doi":"10.1080/00325481.2026.2619422","DOIUrl":"10.1080/00325481.2026.2619422","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA), with traditional risk factors including diabetes and obesity. Emerging evidence suggests functional gastrointestinal disorders (FGIDs) may influence systemic inflammation and infection susceptibility. This study investigated whether preexisting FGIDs are independent risk factors for PJI.</p><p><strong>Methods: </strong>A retrospective 1:1 matched case-control study analyzed 896 patients (448 PJI vs. 448 non-PJI) undergoing primary TJA (2013-2023). PJI was diagnosed using modified 2018 Musculoskeletal Infection Society criteria, and FGIDs (irritable bowel syndrome [IBS], functional diarrhea [FD], functional constipation [FC]) were classified per Rome IV criteria. Multivariable logistic regression identified PJI risk factors after adjusting for demographics, comorbidities, and surgical variables.</p><p><strong>Results: </strong>Univariate analysis revealed significantly higher FC prevalence in PJI cases (14.3% vs. 8.3%, <i>p</i> = 0.0043), while IBS and FD showed no association. Multivariate analysis confirmed FC as an independent PJI risk factor (odds ratio [OR] = 1.844, 95% confidence interval [CI]:1.199-2.872, <i>p</i> = 0.0059), alongside diabetes (OR = 1.714, 95%CI:1.116-2.661, <i>p</i> = 0.0148), and surgery duration >2 hours (OR = 2.220, 95%CI:1.242-4.125, <i>p</i> = 0.0088). Perioperative antibiotic usage reduced PJI risk (OR = 0.405, 95%CI:0.232-0.686, <i>p</i> = 0.0010).</p><p><strong>Conclusion: </strong>Functional constipation was identified as a novel independent risk factor for PJI, alongside established metabolic comorbidities and prolonged surgery. These findings underscore the gut-joint axis in PJI pathogenesis and advocate integrating FGID screening into preoperative risk stratification. Antibiotic prophylaxis remains critical for minimizing infection risk in TJA patients.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"357-362"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013957","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":"Modified shock index multiplied by gestational age as a predictor of the need for blood transfusion in patients with postpartum hemorrhage.","authors":"Zekiye Soykan Sert, Ayşegül Evren Dilmaç, Nazlı Sarıkuş","doi":"10.1080/00325481.2026.2658362","DOIUrl":"10.1080/00325481.2026.2658362","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have demonstrated that the shock index (SI), calculated as the ratio of heart rate (HR) to systolic blood pressure (SBP), and the modified shock index (MSI), calculated as the ratio of HR to mean arterial pressure (MAP), are reliable predictors of blood transfusion requirements in postpartum hemorrhage (PPH) patients. This study aimed to evaluate the predictive value of the modified shock index multiplied by gestational age (MSIGA) in comparison to traditional shock indices, including SI, reverse SI (RSI), and MSI, for predicting the need for blood transfusion in PPH.</p><p><strong>Methods: </strong>This retrospective study included women diagnosed with PPH who delivered at our clinic between 2020 and 2023. Patients were divided into two groups: transfusion and non-transfusion. The transfusion group included patients who required at least one blood and/or blood product transfusion within 24 hours after delivery. Receiver operating characteristic curve analysis was used to calculate the area under the curve (AUC) and to compare the predictive performance of SI, RSI, MSI, and MSIGA.</p><p><strong>Results: </strong>The study included 271 patients, of whom 102 required blood transfusion and 169 did not. The AUC for SI, RSI, MSI, and MSIGA were 0.732 (95% confidence interval [CI], 0.673-0.791), 0.732 (95% CI, 0.672-0.791), 0.785 (95% CI, 0.732-0.839), and 0.826 (95% CI, 0.778-0.874), respectively. MSIGA demonstrated superior performance in predicting the need for blood transfusion compared to traditional shock indices.</p><p><strong>Conclusion: </strong>MSIGA may be a practical and effective tool to predict blood transfusion requirements in patients with PPH.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"363-369"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694463","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}