Journal of clinical medicine research最新文献

{"title":"Spatial SRY-Box Transcription Factor 2 Expression and Stemness-Associated Markers Refine Risk Stratification in Barrett's Esophagus: A Digital Pathology Study of 217 Patients.","authors":"Paata Meshveliani, Giogi Didava, Giorgi Tomadze, Giorgi Burkadze, Shota Kepuladze","doi":"10.14740/jocmr6562","DOIUrl":"10.14740/jocmr6562","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is a precursor lesion of esophageal adenocarcinoma (EAC), but current risk stratification remains largely dependent on dysplasia grade and segment length. We investigated whether spatial SRY-box transcription factor 2 (SOX2) expression patterns could improve prediction of neoplastic progression in BE.</p><p><strong>Methods: </strong>This retrospective multicenter study included 217 patients with reflux esophagitis, non-dysplastic BE (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal EAC (EAC_T1a). Immunohistochemistry for SOX2, cluster of differentiation 44 (CD44), E-cadherin, p53, Ki-67 proliferation antigen (Ki67), and caudal-type homeobox transcription factor 2 (CDX2) was performed on formalin-fixed paraffin-embedded tissue. SOX2 expression was evaluated at the squamo-columnar junction and in deep Barrett glands, and a SOX2 gradient was calculated. Digital image analysis was used to assess SOX2 spatial heterogeneity and SOX2/CD44 co-localization. Associations with progression were analyzed using non-parametric tests and logistic regression models.</p><p><strong>Results: </strong>Progressive dysplastic transformation was associated with inversion of the SOX2 gradient, increased SOX2 spatial heterogeneity, and expansion of SOX2/CD44 double-positive glands. Median SOX2_Gradient shifted from positive values in reflux esophagitis and NDBE to strongly negative values in HGD and EAC_T1a (P < 0.001). SOX2_Tile_Gini and CD44_HScore increased significantly with histologic severity and progression status (both, P < 0.001). Lower SOX2_Gradient, higher SOX2_Tile_Gini, higher CD44_HScore, and longer Prague M length were significantly associated with progression to HGD/EAC.</p><p><strong>Conclusions: </strong>Spatial remodeling of SOX2 expression is strongly associated with dysplasia grade and neoplastic progression in BE. Integration of SOX2 spatial metrics with established biomarkers may improve risk stratification beyond conventional histopathologic assessment.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 5","pages":"343-351"},"PeriodicalIF":2.2,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Rituximab Maintenance Therapy: Outcomes of Extended-Interval Dosing in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder.","authors":"Supawit Kittipadakul, Tatchaporn Ongphichetmetha, Sasitorn Siritho, Ekdanai Uawithya, Naraporn Prayoonwiwat, Natthapon Rattanathamsakul, Jiraporn Jitprapaikulsan","doi":"10.14740/jocmr6529","DOIUrl":"10.14740/jocmr6529","url":null,"abstract":"<p><strong>Background: </strong>In many low-resource settings, access to several therapies for multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) is still limited. Although rituximab (RTX) is considered off-label for some indications, it provides a relatively affordable alternative. However, its long-term use raises concerns about adverse effects such as secondary hypogammaglobulinemia and infection. Extending the dosing interval according to circulating cluster of differentiation 19 (CD19) B-cell counts has been proposed to preserve efficacy while minimizing complication and cost.</p><p><strong>Methods: </strong>This study retrospectively assessed the long-term efficacy and safety of RTX with CD19-guided, extended dosing intervals in patients with MS and aquaporin-4 immunoglobulin G-positive NMOSD. All treatments were delivered at Siriraj Hospital, Thailand, between January 1994 and February 2025. Clinical data, CD19 lymphocyte profiles, immunoglobulin levels and imaging findings were extracted for patients who had received RTX for at least 2 years.</p><p><strong>Results: </strong>Eighty-seven patients satisfied the inclusion criteria. In the MS cohort of 43 patients, treatment duration (mean ± standard deviation (SD)) was 4.10 ± 1.42 years, and the mean dosing interval was 32.61 ± 4.87 weeks. In 44 NMOSD patients, corresponding values were 4.92 ± 2.32 years and 33.87 ± 8.67 weeks. RTX reduced the median annualized relapse rate from 0.55 to 0.00 in MS and from 1.15 to 0.00 in NMOSD (both P < 0.001). The median Expanded Disability Status Scale scores improved from 2.0 to 0.0 in MS (P = 0.006) and from 4.5 to 4.0 in NMOSD (P < 0.001). Four patients maintained dosing intervals exceeding 48 weeks without relapse, and their CD19-positive B-cell proportion remained below 1%. Adverse events occurred in 32.6% of MS patients and 43.2% of NMOSD patients, most commonly infusion reactions (16.3% and 15.9%, respectively) or infections (14.0% and 27.3%, respectively). Leukopenia was documented in 4.7% of MS and 6.8% of NMOSD patients, whereas hypogammaglobulinemia arose only in NMOSD (6.7%); no fatal events were recorded.</p><p><strong>Conclusions: </strong>CD19-guided, extended-interval RTX is associated with relapse control, disability score improvement and favorable tolerability, while potentially lowering infusion frequency and healthcare costs in resource-constrained settings. Nonetheless, repopulation of CD19-positive B cells during prolonged intervals warrants vigilance because it may signal an increased risk of relapse.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 5","pages":"301-312"},"PeriodicalIF":2.2,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhabdomyolysis and Acute Kidney Injury: A Retrospective Cohort Study at a Tertiary University Hospital.","authors":"Yannik Brien, Oliver Ritter, Daniel Patschan","doi":"10.14740/jocmr6533","DOIUrl":"10.14740/jocmr6533","url":null,"abstract":"<p><strong>Background: </strong>Rhabdomyolysis is a serious condition caused by rapid skeletal muscle breakdown, releasing substances like creatine kinase (CK) and myoglobin into the blood. If not recognized or treated, it can lead to acute kidney injury (AKI), which significantly increases health risks. This study systematically examines the epidemiology, causes, and key kidney-related outcomes of rhabdomyolysis at a tertiary university hospital.</p><p><strong>Methods: </strong>We performed a retrospective observational cohort study at the University Hospital Brandenburg, Germany, including hospitalized patients from January 1, 2023, to December 31, 2024. Inclusion required a total CK activity ≥ 500 U/L, a threshold reported in the literature to indicate increased risk for clinically relevant kidney dysfunction. Clinical endpoints were AKI as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria (2012), the need for kidney replacement therapy (KRT) and recovery of kidney function (ROKF).</p><p><strong>Results: </strong>Of 100 included patients (mean age 67.1 ± 19.4 years; 37% female), 60% developed AKI (KDIGO 1: 25.0%, 2: 36.7%, 3: 38.3%). AKI was significantly associated with higher age, cardiovascular/metabolic comorbidities, and elevated inflammatory and myoglobin markers. Lower urine pH in AKI patients suggests a role for aciduria in renal injury. While 49% of AKI patients showed renal recovery, 12% of the total cohort required KRT. KRT requirement was associated with younger age and higher creatinine levels, but not with peak CK or myoglobin values. Absent or incomplete renal recovery was significantly linked only to higher initial and peak creatinine levels.</p><p><strong>Conclusions: </strong>In this tertiary university care cohort, AKI was common among rhabdomyolysis patients, especially older individuals and those with cardiovascular or metabolic conditions. Inflammatory markers, myoglobin levels, and urine pH were key predictors of AKI. Despite intensive care, many required KRT and experienced incomplete renal recovery. Early diagnosis, risk stratification, and standardized criteria are needed to improve outcomes.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 4","pages":"243-250"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Strong Correlation Between Pleural Fluid and Serum C-Reactive Protein Levels Across a Spectrum of Pleural Effusions.","authors":"Majed Odeh, Yana Kogan, Edmond Sabo","doi":"10.14740/jocmr6513","DOIUrl":"10.14740/jocmr6513","url":null,"abstract":"<p><strong>Background: </strong>C-reactive protein (CRP) is a key acute-phase reactant, primarily synthesized by hepatocytes and released into the bloodstream. Both serum CRP (CRPs) and pleural fluid CRP (CRPpf) have been shown to aid in distinguishing between different types of pleural effusion (PE). As CRPpf is largely derived from CRPs, a strong correlation between their levels is expected. However, limited data exist regarding this relationship, and no previous studies have compared the strength of this correlation across different PE etiologies. This retrospective study aimed to evaluate the correlation between CRPpf and CRPs levels in various PE types and, for the first time, to compare the strength of this association between groups.</p><p><strong>Methods: </strong>A total of 492 patients with PE were included: 210 with transudative PE (TrPE), 86 with uncomplicated parapneumonic effusion (UCPPE), 60 with complicated parapneumonic effusion (CPPE), 126 with malignant PE (MPE), and 10 with tuberculous PE (TPE). Data are presented as mean ± standard deviation.</p><p><strong>Results: </strong>Mean CRPs and CRPpf levels, respectively, were as follows: TrPE (11.3 ± 5.7 mg/L; 4.6 ± 2.8 mg/L), UCPPE (145.3 ± 67.6 mg/L; 58.5 ± 38.5 mg/L), CPPE (302.2 ± 75.6 mg/L; 112 ± 65 mg/L), MPE (56.1 ± 39.5 mg/L; 18.9 ± 13.9 mg/L), and TPE (98.7 ± 12.9 mg/L; 45.0 ± 9.4 mg/L). A statistically significant positive correlation between CRPpf and CRPs was observed in all groups: TrPE (r = 0.81, P < 0.0001), UCPPE (r = 0.90, P < 0.0001), CPPE (r = 0.57, P < 0.0001), MPE (r = 0.81, P < 0.0001), and TPE (r = 0.91, P < 0.0001). The correlation was significantly stronger in the UCPPE and TPE groups compared to the others, while the CPPE group showed the weakest correlation. Correlation strength in the TrPE and MPE groups was intermediate, but significantly greater than that in CPPE.</p><p><strong>Conclusions: </strong>A strong and statistically significant correlation between CRPpf and CRPs levels exists across all major types of PE. The varying strength of this correlation among groups-highest in UCPPE and TPE, and lowest in CPPE-may reflect the influence of local pleural factors, such as inflammation, cellular injury, local CRP synthesis, and lymphatic drainage impairment, on pleural CRP levels.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 4","pages":"251-260"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PIFA-N Multifactor Model to Predict Adverse Outcomes for Chronic Heart Failure Patients.","authors":"Natalia A Dragomiretskaya, Anastasia V Tolmacheva, Aida I Tarzimanova, Anna E Pokrovskaya, Tatiana S Vargina, Tatiana A Safronova, Ivan D Medvedev, Antonina A Abramova, Daria D Vanina, Valery I Podzolkov","doi":"10.14740/jocmr6518","DOIUrl":"10.14740/jocmr6518","url":null,"abstract":"<p><strong>Background: </strong>In recent years, special attention has been given to developing multifactor models that support a more personal approach to assessing prognosis for chronic heart failure (CHF) patients with varying degrees of systolic dysfunction. The existing scales, namely the Seattle Heart Failure Model (SHFM), Meta-Analysis Global Group in Chronic HF (MAGGIC-HF), PARADIGM Risk of Events and Death in the Contemporary Treatment (PREDICT-HF), and the Barcelona Bio-HF (BCN-Bio-HF) risk calculator, contain numerous variables and biomarkers not readily accessible in actual clinical practice and thus fall short of meeting physicians' requirements. The study aimed to develop a multifactor model for assessing the risk of comorbid CHF patients developing adverse outcomes.</p><p><strong>Methods: </strong>Our study included 233 patients (129 male and 104 female) aged 73.2 ± 12.4 years, admitted to the Internal Medicine Clinic of the Sechenov University Clinical Hospital No. 4 with symptoms of New York Heart Association Functional Classification (NYHA FC) II to IV CHF, including 91 patients with heart failure with preserved ejection fraction (CHFpEF), 69 with heart failure with mildly reduced ejection fraction (CHFmrEF), and 63 with heart failure with reduced ejection fraction (CHFrEF). All the patients had given their informed and written consent to take part in the study. They were given a standard clinical examination and additionally tested for N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble interleukin-like protein receptor (sST2), galectin-3, hepcidin, and copeptin levels. Prospective follow-up lasted for 36 ± 3 months. The primary endpoint was defined as death from all causes. The findings were processed statistically using Statistica 12.0 and SPSS software.</p><p><strong>Results: </strong>All-cause mortality was 33.1% in the cohort examined. We used uni- and multivariate regression analysis to develop a PIFA-N prognostic mathematical model of adverse outcome that factored in community-acquired pneumonia diagnosed on inclusion in the study (odds ratio (OR): 3.09, 95% confidence interval (CI) 1.13-8.5, P = 0.028), a previous myocardial infarction (OR: 4.26, 95% CI 1.54-11.7, P = 0.005), presence of any form of atrial fibrillation (OR: 3.13, 95% CI 1.05-9.2, P = 0.039) and/or anemia (OR: 3.18, 95% CI 1.003-10.1, P = 0.049), and NT-proBNP level (OR: 1.0005, 95% CI 1.0002-1.0008, P = 0.002). Other biomarkers studied showed no predictive value. Our PIFA-N model is 77.1% sensitive and 77.3% specific (area under receiver operating characteristic curve (ROC AUC) 0.845), which meets high efficiency criteria.</p><p><strong>Conclusion: </strong>We analyzed CHF patients' 3-year survival rate to develop an efficient prognostic model for assessing the risk of lethal outcome, whose arguments are easy-to-check conditions and routine laboratory test figures that can be established without any sophisticated examination techniques.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 4","pages":"261-269"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Blood Rheology as a Predictor of Primary Cardiovascular Disease Events in Patients With Stage G3 Chronic Kidney Disease.","authors":"Takashi Hitsumoto","doi":"10.14740/jocmr6541","DOIUrl":"10.14740/jocmr6541","url":null,"abstract":"<p><strong>Background: </strong>Several studies have highlighted that impairment of blood rheology plays a crucial role in the development of cardiovascular disease (CVD) and arteriosclerosis. However, the value of blood rheology as a potential predictor of the development of CVD in patients with chronic kidney disease (CKD) remains unknown. The objective of this prospective study was to investigate the utility of blood rheology using whole blood passage time (WBPT) as a predictor of primary CVD events in patients with stage G3 CKD, which is often encountered in daily practice.</p><p><strong>Methods: </strong>This study involved 417 outpatients with stage G3 CKD (male/female: 144/273) without history of CVD. WBPT was measured by microchannel array flow analyzer as a commercial device. Subsequently, the author evaluated the effectiveness of WBPT for the prediction of primary CVD events, which were defined as major adverse cardiovascular events (MACEs, i.e., cardiovascular death, nonfatal ischemic heart disease, and non-fatal ischemic stroke).</p><p><strong>Results: </strong>Patients were assigned into two groups according to the WBPT cut-off value, which was estimated by receiver operating characteristic curve analysis: low (group L, WBPT ≤ 74.3 s; n = 255) or high (group H, WBPT > 74.3 s; n = 162). During the median follow-up period of 76 months (range: 2-96 months), MACEs occurred in 74 patients (group L: n = 17 (6.7%) vs. group H: n = 57 (35.2%); P < 0.001, log-rank test). Multivariate Cox regression analysis revealed that patients in group H were at a significantly higher risk of developing MACEs than those in group L (hazard ratio: 3.89; 95% confidence interval: 2.12-7.10; P < 0.001).</p><p><strong>Conclusions: </strong>The present findings showed that impairment of blood rheology, determined using WBPT, is predictive of primary CVD events in patients with stage G3 CKD. Further large-scale studies are warranted to confirm whether various interventions can reduce the incidence of primary CVD events with improved WBPT in patients with stage G3 CKD.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 4","pages":"234-242"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to Low Body Temperature or Mild Hypothermia in the Geriatric Population: A Narrative Review.","authors":"Prabhpaul Dhami, Kannayiram Alagiakrishnan","doi":"10.14740/jocmr6490","DOIUrl":"10.14740/jocmr6490","url":null,"abstract":"<p><p>While normal human body temperature is often cited as 36.1-37.2 °C, there is high-quality evidence demonstrating that older adults typically have lower baseline body temperatures. In contrast to hypothermia (< 35 °C) which is well recognized as a medical emergency, there is emerging evidence that low body temperature (35.0-36.0 °C) may predict poor outcomes in the geriatric population. This narrative review synthesizes the current literature on the association between low body temperature in adults aged ≥ 65 years and common geriatric co-morbidities. Across observational and cohort studies, low body temperature has consistently been associated with adverse outcomes in chronic kidney disease, hypertension, diabetes, chronic obstructive pulmonary disease, various malignancies, frailty, and neurodegenerative disorders. Despite these associations, in the absence of hypothermia, low body temperature remains a neglected topic in geriatric medicine. Recognition of low body temperature may improve early detection of geriatric co-morbidities, guide medication review, and identify patients at risk for cognitive decline and frailty. Further prospective studies are needed to clarify causal relationships and provide more insight into therapeutic implications.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 4","pages":"219-233"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Predicting Diuretic Resistance in Patients With Acute Decompensated Heart Failure.","authors":"Rarsari Soerarso, Dian Yaniarti Hasanah, Emir Yonas, Ahmad Pandu Pratama, Sunu Budhi Raharjo, Bambang Budi Siswanto, Maarten J M Cramer, Pim van der Harst, Marish I F J Oerlemans","doi":"10.14740/jocmr6391","DOIUrl":"10.14740/jocmr6391","url":null,"abstract":"<p><strong>Background: </strong>Acute decompensated heart failure (ADHF) is a leading cause of mortality and morbidity in the world. Diuretic resistance occurs in 20-30% of patients with ADHF and is an independent predictor of worsening clinical outcomes, immediate post-treatment death, and re-admission events. This study aims to: 1) identify factors that influence the occurrence of diuretic resistance in ADHF patients based on the underlying disease, comorbidities, vital signs, left ventricular ejection fraction, and laboratory parameters, and 2) investigate the clinical characteristics that serve as indicators of diuretic resistance incidence in patients with ADHF.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 535 patients treated with ADHF during the period from January to December 2019. Diuretic resistance was defined as a diuresis response of less than 1,400 mL in the first 24 h after administration of 40 mg of intravenous (IV) furosemide (or equivalent). Subjects were observed for 24 h post 40 mg IV furosemide for occurrence of diuretic resistance. Bivariate and multivariate analyses were performed to synthesize clinical scoring system to predict occurrence of diuretic resistance.</p><p><strong>Results: </strong>Diuretic resistance occurs in 68% of patients. Independent predictors obtained from multivariate logistic regression analysis were: history of diabetes mellitus (DM, P = 0.013), history of using IV loop diuretics > 6 days (P = 0.002), oral loop diuretic dose > 80 mg/day (P = 0.006), left ventricular ejection fraction (LVEF) ≤ 49% (P = 0.002), blood urea nitrogen (BUN) ≥ 21 mg/dL (P < 0.001), and serum chloride < 98 mmol/L (P < 0.001). In addition, a scoring system has been made from the final model.</p><p><strong>Conclusion: </strong>DM, history of IV loop diuretic, daily loop diuretic dosage, LVEF < 49%, BUN > 21 mg/dL, and serum chloride < 98 mmol/L were found to be statistically significant in association with occurrence of diuretic resistance using multivariate analysis and can be synthesized into a clinical scoring system to help predict diuretic resistance.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 4","pages":"270-280"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restrictive Versus Liberal Fluid Strategy for Initial Resuscitation in Sepsis and Septic Shock: A Systematic Review and Meta Analysis.","authors":"Ahmed Osman Ali, Hossam Ahmad Adib Kordi, Marwa Hussein Said Ahmad Alhag, Abdelghafar Mohamed Abdelghafar Salama, Zahra Gumaid Alqarni, Abdallah Dwayat, Alam Eldin Musa Mustafa, Abdelhadi Okasha, Shouq Abdullah, Nada Saleem Mohammed Alali, Zainab Saleem Mohammed Alali, Manal Sa Hakami, Yazan Yousef A Alghammas, Niemat Mohammed Tahir Ali, Ali Alghannami","doi":"10.14740/jocmr6464","DOIUrl":"10.14740/jocmr6464","url":null,"abstract":"<p><strong>Background: </strong>Intravenous fluid resuscitation is essential in early management of sepsis, but the optimal volume and resuscitation strategy are uncertain. This systematic review and meta-analysis aimed to synthesize the evidence comparing the efficacy and safety of restrictive versus liberal fluid resuscitation strategies in adults with sepsis or septic shock.</p><p><strong>Methods: </strong>A systematic search of PubMed, Web of Science (WoS), Scopus, and CENTRAL was conducted from inception to November 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Randomized controlled trials (RCTs) and observational cohort studies comparing protocolized restrictive fluid strategies with liberal or standard care were included. Primary outcomes were all-cause mortality and acute kidney injury (AKI). Random-effects models were used to calculate pooled risk ratios (RRs) and mean differences (MDs), while trial sequential analysis (TSA) assessed the conclusiveness of evidence.</p><p><strong>Results: </strong>Sixteen reports from 15 unique studies (nine RCTs and six observational studies) involving 5,013 patients were included. In the analysis of RCTs, restrictive fluid therapy resulted in no significant difference in all-cause mortality (RR = 0.99; 95% CI, 0.90-1.08; I² = 0%); however, observational studies showed a significant mortality reduction (RR = 0.69), suggesting confounding by indication in observational datasets. TSA of the RCT data indicated insufficient evidence for mortality benefit. Restrictive strategies were associated with a lower risk of AKI (RR = 0.89; 95% CI, 0.81-0.99; P = 0.02; I² = 0%) and a reduced incidence of acute respiratory distress syndrome (ARDS) (RR = 0.69; 95% CI, 0.56-0.85; P < 0.001; I² = 0%). No significant differences were observed in other ischemic, metabolic, or organ support outcomes. However, restrictive fluid therapy reduced the need for mechanical ventilation, shortened the ventilation duration and vasopressin use, and increased ventilator-free days.</p><p><strong>Conclusions: </strong>Restrictive fluid resuscitation does not reduce overall mortality in adults with sepsis or septic shock, but it is associated with lower AKI and ARDS risk and decreased dependence on mechanical ventilation. Evidence regarding mortality is inconclusive, highlighting the need for large-scale trials to validate this finding.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 3","pages":"177-195"},"PeriodicalIF":2.2,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-Care Ultrasound to Evaluate Gastric Volumes During Gastric and Post-Pyloric Enteral Feeds in Infants and Children Undergoing Mechanical Ventilation: A Pilot Study to Assess Feasibility Study.","authors":"Timothy Montet, Ada Lin, Sibelle Aurelie Yemele Kitio, Joseph D Tobias, Alok Moharir","doi":"10.14740/jocmr6506","DOIUrl":"10.14740/jocmr6506","url":null,"abstract":"<p><strong>Background: </strong>In all acutely ill patients, adequate nutrition is essential to restore physiologic homeostasis and improve outcomes. Whenever feasible, the enteral route is preferred. In various settings, post-pyloric (nasoduodenal (ND) or nasojejunal (NJ)) feeds may be preferred not only to accelerate attainment of goal feeding volumes, but also to limit gastric volumes in order to decrease the potential risk of aspiration. The current study uses point-of-care ultrasound (POCUS) to evaluate gastric volume and content during enteral feedings in pediatric-aged patients receiving mechanical ventilation in the pediatric intensive care unit (ICU).</p><p><strong>Methods: </strong>Gastric POCUS was performed to evaluate gastric contents in pediatric ICU patients, aged 0-18 years, receiving either gastric or post-pyloric enteral feedings at ≥ 50% goal. The patients were endotracheally intubated and receiving mechanical ventilation.</p><p><strong>Results: </strong>The study cohort included 45 patients, 29 receiving nasogastric (NG) feeds and 16 receiving NJ feeds. The majority of patients (81%) receiving post-pyloric feeds had gastric volumes ≤ 0.4 mL/kg and none had volumes ≥ 2 mL/kg while more than half of NG-fed patients (53%) had gastric volumes ≥ 2 mL/kg. Only three of 18 patients (18.8%) receiving NJ feeds had a gastric volume greater than 0.4 mL/kg. When grading the aspiration risk, there was a higher aspiration risk with NG feeds compared to NJ feeds (33/39 versus 0/18, P < 0.001).</p><p><strong>Conclusion: </strong>Gastric volumes and hence the potential aspiration risk is decreased in patients receiving post-pyloric compared to NG feeds.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"18 3","pages":"205-210"},"PeriodicalIF":2.2,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}