The American journal of the medical sciences最新文献

Octreotide therapy in patients with a left ventricular assist device and bleeding gastrointestinal angiodysplasias.

The American journal of the medical sciences Pub Date : 2025-03-12 DOI: 10.1016/j.amjms.2025.03.008

Ahmed Ibrahim, Jad Allam, Don C Rockey

{"title":"Octreotide therapy in patients with a left ventricular assist device and bleeding gastrointestinal angiodysplasias.","authors":"Ahmed Ibrahim, Jad Allam, Don C Rockey","doi":"10.1016/j.amjms.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.03.008","url":null,"abstract":"Background: Angiodysplasias commonly develop in patients with left ventricular assist devices (LVADs) and often bleed recurrently. Whether octreotide reduces the burden of angiodysplasia or the frequency of bleeding in these patients is controversial. Hence, we aimed to study the effect of long-acting octreotide on angiodysplasia bleeding in LVAD patients.Methods: Between May 2012 and December 2023, 65 patients with LVAD and angiodysplasia were identified at our tertiary care medical center. Of those, 33 patients received octreotide therapy. Complete clinical data were abstracted from the medical record, and outcomes pre and post octreotide therapy were examined.Results: In 33 patients (61±8 years old and 9 women) who received long-acting octreotide for recurrent angiodysplasia bleeding that failed to respond to endoscopic therapy, the small intestine was the most common site involved. Prior to octreotide, patients received an average of 2.0±3.0 units/month of PRBCs over an average of 16 months, which decreased to 0.5±0.8 units/month over 31 months on therapy. Over an average period of 31 months on octreotide therapy, GI bleeding events and the number of endoscopic therapies per month decreased from 0.4±0.2 to 0.1±0.2 (p= 0.01) and from 0.7±0.8 to 0.1±0.2 (p= 0.001), respectively. Finally, hemoglobin and hematocrit levels increased over the 31 month follow-up period while on octreotide therapy.Conclusion: In patients with an LVAD and recurrent angiodysplasia bleeding, octreotide appeared to reduce the number of GI bleeding events, the need for GI endoscopic therapies, and the frequency of PRBC transfusions.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631152","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}

引用次数: 0

Geographic Disparities and Emerging Hotspot Trends of Long COVID in the United States.

The American journal of the medical sciences Pub Date : 2025-03-12 DOI: 10.1016/j.amjms.2025.03.005

Anand Gourishankar

{"title":"Geographic Disparities and Emerging Hotspot Trends of Long COVID in the United States.","authors":"Anand Gourishankar","doi":"10.1016/j.amjms.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.03.005","url":null,"abstract":"Objectives: To study the emerging hotspot pattern of Long COVID (LC) in the U.S. population and investigate the correlation between Long COVID and state health system performance.Methods: Using 2022 to 2024 Center for Disease Control and Prevention adult LC data, I applied the Getis-Ord Gi* statistic with the Mann-Kendall trend test to determine emerging temporal trends associated with local clustering patterns across the contiguous states. A Pearson's correlation tested LC rates and state health system performance.Results: A spatiotemporal trend map described discrete patterns. In 2023, Long COVID rates were highest in Southeastern states such as Mississippi and West Virginia, but by 2024, mixed patterns were observed in some states. The LC rates showed an inverse relationship with state health outcome scores (r = -0.69, P < 0.001). Emerging hotspot analysis identified Mississippi as a persistent hotspot for Long COVID. Northeastern states showed consistently persistent cold spots.Conclusions: The states with better health outcomes showed a lower frequency of long COVID. The geographically emerging hot spots can guide focused intervention and resource allocation for these patients.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631151","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}

引用次数: 0

Protein Energy Malnutrition is Associated with Worse Clinical Outcomes in Asthma Hospitalization: A Nationwide Analysis.

The American journal of the medical sciences Pub Date : 2025-03-11 DOI: 10.1016/j.amjms.2025.03.001

Mubarak Hassan Yusuf, Faridat Moyosore Abdulkarim, Malina Mohtadi, Mohammed Raaid Oyiwe Musa, Maryam Yusuf, Mazhar Mustafa, Laxminarayan Prabhakar, Mourad Ismail

{"title":"Protein Energy Malnutrition is Associated with Worse Clinical Outcomes in Asthma Hospitalization: A Nationwide Analysis.","authors":"Mubarak Hassan Yusuf, Faridat Moyosore Abdulkarim, Malina Mohtadi, Mohammed Raaid Oyiwe Musa, Maryam Yusuf, Mazhar Mustafa, Laxminarayan Prabhakar, Mourad Ismail","doi":"10.1016/j.amjms.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.03.001","url":null,"abstract":"Background: Several studies have highlighted the negative clinical impact of malnutrition in individuals with various disease conditions, including diseases related to the respiratory system. Our study sought to investigate the relationship between protein-energy malnutrition and asthma exacerbation.Methods: We retrospectively searched the National Inpatient Sample (NIS) from 2018-2021. We searched the NIS for adult patients hospitalized with asthma exacerbation (AE) as the principal diagnosis and protein energy malnutrition (PEM) as a secondary diagnosis using ICD-10 codes. The primary outcome measures were inpatient mortality, while the secondary outcomes were length of stay (LOS), odds of respiratory failure (RF), cardiac arrest, pneumothorax, need for invasive mechanical ventilation, need for ECMO and health cost utilization, defined by total hospitalization costs. Multivariate logistic and Poisson regression analyses were applied to estimate the correlations.Results: A total of 325,510 patients were admitted for AE, 2,965 (0.91%) of whom had underlying PEM. The PEM cohort had increased odds of mortality (aOR 3.70, p <0.001). Similarly, the PEM cohort had increased odds of cardiac arrest (aOR 2.45, p = 0.008), pneumothorax (aOR 4.94, p < 0.001), acute respiratory failure (aOR 2.07, p =0.001), and need for invasive mechanical ventilation (aOR 3.52, p < 0.001). The study group had a significant increase in length of stay (adjusted mean difference 3.67, p = 0.0001) and charge of care (adjusted mean difference 52,819 $, p <0.0001).Conclusions: Our study indicated that protein-energy malnutrition is associated with increased mortality and adverse clinical outcomes during hospitalization for asthma. PEMs also contributed to increased healthcare resource utilization.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627042","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}

引用次数: 0

Understanding Mortality Patterns in Elderly Cancer Patients with Atrial Fibrillation: A Comprehensive Data Analysis.

The American journal of the medical sciences Pub Date : 2025-03-11 DOI: 10.1016/j.amjms.2025.03.004

Muhammad Abdullah Naveed, Sivaram Neppala, Shehroze Tabassum, Ahila Ali, Himaja Dutt Chigurupati, Muhammad Omer Rehan, Rabia Iqbal, Bazil Azeem, Hamza Naveed, Mushood Ahmed, Jamal Rana, Bilal Munir

{"title":"Understanding Mortality Patterns in Elderly Cancer Patients with Atrial Fibrillation: A Comprehensive Data Analysis.","authors":"Muhammad Abdullah Naveed, Sivaram Neppala, Shehroze Tabassum, Ahila Ali, Himaja Dutt Chigurupati, Muhammad Omer Rehan, Rabia Iqbal, Bazil Azeem, Hamza Naveed, Mushood Ahmed, Jamal Rana, Bilal Munir","doi":"10.1016/j.amjms.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.03.004","url":null,"abstract":"Background: Atrial Fibrillation (AF) among patients with cancer is a significant health concern for older adults in the United States. This study analyzes trends and demographic disparities in mortality rates related to AF in patients with cancer aged 65+.Methods: The CDC WONDER database was used to analyze Age-adjusted mortality rates (AAMRs) for to AF in patients with cancer (ICD-10 I48, C00- C97) from 1999 to 2023, stratified by sex, race, geography, and metropolitan status. Average Annual Percentage Changes (AAPCs) and Annual Percentage Changes (APCs) per 100,000 with 95% confidence intervals (CI) calculated using Joinpoint regression.Results: From 1999 to 2023, AF in patients with cancer caused 421,247 deaths among U.S. adults 65+. The overall AAMR rose from 24.1 in 1999 to 61.1 in 2023, with a 3.92 AAPC (95% CI: 3.81 to 4.05). AAMR increased significantly from 1999 to 2018 (APC: 3.12), surged from 2018 to 2021 (APC: 10.93), then rose slightly until 2023 (APC: 1.40), all p <0.01. From 1999 to 2023, Men had higher AAMRs than women (53.8 vs. 27.2) while NH Whites had the highest AAMRs (42.2), followed by NH Blacks (23.1). Vermont has the highest AAMR (60.0), Nevada the lowest (17.3), and the Western region had the highest AAMR (40.8), while rural areas had slightly higher AAMRs than urban areas (39.1 vs 34.8).Conclusion: The AAMR for AF in patients with cancer in the U.S. has doubled over the past two decades, particularly during the COVID-19 pandemic. These findings highlight the urgent need for targeted interventions and enhanced access to care.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627052","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}

引用次数: 0

Russian riddles Dostoevsky's seizures, Dyspnea and death.

The American journal of the medical sciences Pub Date : 2025-03-11 DOI: 10.1016/j.amjms.2025.03.007

Philip A Mackowiak

引用次数: 0

Short Telomere Syndrome in a patient with Primary Sjögren's Syndrome related Interstitial Lung Disease.

The American journal of the medical sciences Pub Date : 2025-03-09 DOI: 10.1016/j.amjms.2025.03.003

Kristina Akopyan, Moustafa Younis, Amir M Emtiazjoo, Cynthia Gries, Parnia Khamooshi, Mindaugas Rackauskas, Biplab K Saha

引用次数: 0

AC074117.1/miR-193a-3p axis regulates the malignant progression of uterine corpus endometrial carcinoma via the m6A-related gene ALKBH5.

The American journal of the medical sciences Pub Date : 2025-03-08 DOI: 10.1016/j.amjms.2025.03.002

Zhuyun Ding, Fu Lirong, Qian Zhu, Shu Bian, Min Cui, Yan Li, Xiaoyan Ying

{"title":"AC074117.1/miR-193a-3p axis regulates the malignant progression of uterine corpus endometrial carcinoma via the m6A-related gene ALKBH5.","authors":"Zhuyun Ding, Fu Lirong, Qian Zhu, Shu Bian, Min Cui, Yan Li, Xiaoyan Ying","doi":"10.1016/j.amjms.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.03.002","url":null,"abstract":"Uterine corpus endometrial carcinoma (UCEC) is one of the most common gynecological malignancies, with an annually increasing incidence and a poor prognosis. lncRNAs and microRNAs regulate the progression of UCEC through ceRNA networks. Additionally, m6A modification plays various roles in UCEC, and abnormal regulation of it can directly affect tumor progression. However, the role of m6A-associated ceRNA networks in UCEC remains unclear. This study showed that the AC074117.1/miR-193a-3p axis promoted the malignant progression of UCEC through ALKBH5, an m6A demethylase. MeRIP assay indicated that ALKBH5 regulated m6A modification in UCEC. Gene set enrichment analysis and cell proliferation and migration assays showed that the AC074117.1/miR-193a-3p/ALKBH5 axis regulated the proliferation and migration of UCEC cells. With regard to mechanistic analysis, dual-luciferase reporter assay demonstrated that AC074117.1 acted as a ceRNA for miR-193a-3p, influencing the expression of ALKBH5. Furthermore, rescue experiments validated that the regulatory effects of miR-193a-3p on the malignant progression of UCEC relied on ALKBH5 to some extent. Altogether, this study revealed an m6A-related ceRNA network in UCEC, which may serve as a target for early diagnosis and treatment.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598680","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}

引用次数: 0

ScreenDx, an artificial intelligence-based algorithm for the incidental detection of pulmonary fibrosis. ScreenDx，一种基于人工智能的算法，用于偶然检测肺纤维化。

The American journal of the medical sciences Pub Date : 2025-02-26 DOI: 10.1016/j.amjms.2025.02.011

Nikolas Touloumes, Georgia Gagianas, James Bradley, Michael Muelly, Angad Kalra, Joshua Reicher

{"title":"ScreenDx, an artificial intelligence-based algorithm for the incidental detection of pulmonary fibrosis.","authors":"Nikolas Touloumes, Georgia Gagianas, James Bradley, Michael Muelly, Angad Kalra, Joshua Reicher","doi":"10.1016/j.amjms.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.02.011","url":null,"abstract":"Background: Nonspecific symptoms and variability in radiographic reporting patterns contribute to a diagnostic delay of the diagnosis of pulmonary fibrosis. An attractive solution is the use of machine-learning algorithms to screen for radiographic features suggestive of pulmonary fibrosis. Thus, we developed and validated a machine learning classifier algorithm (ScreenDx) to screen computed tomography imaging and identify incidental cases of pulmonary fibrosis.Methods: ScreenDx is a deep learning convolutional neural network that was developed from a multi-source dataset (cohort A) of 3,658 cases of normal and abnormal CT's, including CT's from patients with COPD, emphysema, and community-acquired pneumonia. Cohort B, a US-based cohort (n=381) was used for tuning the algorithm, and external validation was performed on cohort C (n=683), a separate international dataset.Results: At the optimal threshold, the sensitivity and specificity for detection of pulmonary fibrosis in cohort B was 0.91 (95% CI 88-94%) and 0.95 (95% CI 93-97%), respectively, with AUC 0.98. In the external validation dataset (cohort C), the sensitivity and specificity were 1.0 (95% 99.9-100.0) and 0.98 (95% CI 97.9-99.6), respectively, with AUC 0.997. There were no significant differences in the ability of ScreenDx to identify pulmonary fibrosis based on CT manufacturer (Phillips, Toshiba, GE Healthcare, or Siemens) or slice thickness (2 mm vs 2-4 mm vs 4 mm).Conclusion: Regardless of CT manufacturer or slice thickness, ScreenDx demonstrated high performance across two, multi-site datasets for identifying incidental cases of pulmonary fibrosis. This suggest that the algorithm may be generalizable across patient populations and different healthcare systems.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532279","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}

引用次数: 0

Bronchobiliary Fistulas.

The American journal of the medical sciences Pub Date : 2025-02-21 DOI: 10.1016/j.amjms.2025.02.010

Carter Edmunds, Jessica Hollingsworth, Brian Kouri, Rishi Pawa, Swati Pawa

引用次数: 0

The utility of inpatient work-up of incidental anemia during hospitalization for an acute medical condition: A retrospective cohort study.

The American journal of the medical sciences Pub Date : 2025-02-15 DOI: 10.1016/j.amjms.2025.02.009

Genady Drozdinsky, Erez Halperin, Shiri Kushnir, Yaron Rudman, Anat Gafter-Gvili

{"title":"The utility of inpatient work-up of incidental anemia during hospitalization for an acute medical condition: A retrospective cohort study.","authors":"Genady Drozdinsky, Erez Halperin, Shiri Kushnir, Yaron Rudman, Anat Gafter-Gvili","doi":"10.1016/j.amjms.2025.02.009","DOIUrl":"10.1016/j.amjms.2025.02.009","url":null,"abstract":"Introduction: The best timing for evaluation of anemia is not well defined and the clinical yield of performing workup during non-anemia-related hospitalization is unclear. We aimed to evaluate the prognostic value of inpatient laboratory anemia evaluation.Methods: This was a retrospective propensity-matched cohort study between the years 2013-2022 in Rabin Medical Center Israel. We included all patients admitted for non-anemia-related reasons and were found to be anemic. Patients were divided into groups based on basic laboratory anemia evaluation. Outcomes were cancer diagnosis, colonoscopy rate, duration of admission, and all-cause mortality. Multivariable analysis with competing risk of death was performed and a p-value of 5 % was considered significant.Results: Following matching, 4,238 patients were included in the evaluation group compared to 7,680 in the no-evaluation group. In-patient laboratory anemia evaluation was associated with gastrointestinal cancer and any cancer diagnosis - HR of 1.53 (95 % CI, 1.15- 2.05) and HR of 1.23 (95 % CI, 1.11-1.37) respectively. The rate of colonoscopy was higher, and anemia prevalence was lower in the evaluation group after 1-year follow-up. Intravenous iron treatment was more prevalent in the evaluation group. The laboratory anemia evaluation prolonged the admission (5 vs 4 days). There was no difference in the all-cause mortality across the 10-year follow-up.Conclusion: Inpatient anemia evaluation with basic laboratory tests was found to be associated with an increase in outpatient gastrointestinal cancer diagnosis and showed clinical and diagnostic advantages. For patients who can benefit from early gastrointestinal cancer diagnosis, admission holds a valid opportunity to initiate the evaluation.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434818","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}

引用次数: 0