Canadian Medical Association journal最新文献

{"title":"Mortality risk among people receiving acute hospital care for hallucinogen use compared with the general population.","authors":"Daniel T Myran, Jennifer Xiao, Nicholas Fabiano, Michael Pugliese, Tyler S Kaster, Joshua D Rosenblat, M Ishrat Husain, Jess G Fiedorowicz, Stanley Wong, Peter Tanuseputro, Marco Solmi","doi":"10.1503/cmaj.241191","DOIUrl":"10.1503/cmaj.241191","url":null,"abstract":"<p><strong>Background: </strong>Although clinical trials involving psychedelic-assisted psychotherapy have not observed short-term increases in the risk of death, limited data exist on mortality associated with hallucinogen use outside of controlled trial settings. We sought to determine whether people with an emergency department visit or hospital admission involving hallucinogen use were at increased risk of all-cause death compared with the general population and with people with acute care presentations involving other substances.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using linked health administrative data on all people aged 15 years and older living in Ontario, Canada, from 2006 to 2022. We compared overall and cause-specific mortality between members of the general population and people with incident acute care (an emergency department visit or hospital admission) involving hallucinogens and other substances.</p><p><strong>Results: </strong>We included 11 415 713 people; 7953 (0.07%) had incident acute care involving hallucinogens. In a matched analysis with 77 101 people with a median follow-up of 7 (interquartile range 3-11) years, acute care involving hallucinogens was associated with a 2.6-fold (hazard ratio [HR] 2.57, 95% confidence interval [CI] 2.09-3.15) increased all-cause mortality within 5 years (<i>n</i> = 482, absolute risk 6.1%) relative to the general population (<i>n</i> = 460, absolute risk 0.6%). Analyses excluding people with comorbid mental or substance use disorders showed similar elevations in mortality risk for acute care involving hallucinogens relative to the general population (HR 3.25, 95% CI 2.27-4.63). People with acute care involving hallucinogens were at a significantly elevated risk of death by unintentional drug poisoning (HR 2.03, 95% CI 1.02-4.05), suicide (HR 5.23, 95% CI 1.38-19.74), respiratory disease (HR 2.46, 95% CI 1.18-5.11), and cancer (HR 2.88, 95% CI 1.61-5.14) relative to the general population.</p><p><strong>Interpretation: </strong>Requiring hospital-based care for hallucinogen use was associated with increases in risk of death relative to the general population, particularly from suicide. These findings should be considered in clinical and policy decision-making, given the increasing use of hallucinogens and associated problematic use.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 8","pages":"E204-E213"},"PeriodicalIF":9.4,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avis de décès pour février 2025.","authors":"","doi":"10.1503/cmaj.250164-f","DOIUrl":"10.1503/cmaj.250164-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 8","pages":"E233-E235"},"PeriodicalIF":9.4,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An afternoon on the hospice piano.","authors":"Shreya Jha","doi":"10.1503/cmaj.241730","DOIUrl":"10.1503/cmaj.241730","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 8","pages":"E216"},"PeriodicalIF":9.4,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trouble dysphorique prémenstruel.","authors":"Bethany J Sander, Jennifer L Gordon, Erin A Brennand","doi":"10.1503/cmaj.240865-f","DOIUrl":"10.1503/cmaj.240865-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 8","pages":"E229-E230"},"PeriodicalIF":9.4,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus vulgaris in a 58-year-old man.","authors":"Chen Wang, Jianjun Qiao","doi":"10.1503/cmaj.241343","DOIUrl":"10.1503/cmaj.241343","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 8","pages":"E215"},"PeriodicalIF":9.4,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les personnes en fauteuil roulant.","authors":"Lisa Freeman","doi":"10.1503/cmaj.241433-f","DOIUrl":"10.1503/cmaj.241433-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 7","pages":"E201-E202"},"PeriodicalIF":9.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose cotransporter 2 (SGLT2) inhibitors and risk of chronic kidney disease-mineral and bone disorders in patients with type 2 diabetes mellitus and stage 1-3 chronic kidney disease.","authors":"Daniel Hsiang-Te Tsai, Albert Tzu-Ming Chuang, Kuan-Hung Liu, Shih-Chieh Shao, Edward Chia-Cheng Lai","doi":"10.1503/cmaj.240922","DOIUrl":"10.1503/cmaj.240922","url":null,"abstract":"<p><strong>Background: </strong>In patients with type 2 diabetes mellitus and chronic kidney disease (CKD), sodium-glucose cotransporter 2 (SGLT2) inhibitors improve renal outcomes, but may transiently affect biochemical markers of CKD-mineral and bone disorders (CKD-MBD). We sought to evaluate the long-term risk of CKD-MBD associated with use of SGLT2 inhibitors in this patient population.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study, employing a target trial emulation framework and using electronic medical records of patients from 9 hospitals in Taiwan (2016-2023). We included adults with type 2 diabetes mellitus and stage 1-3 CKD who had newly started either an SGLT2 inhibitor or, as a comparison group, a glucagon-like peptide-1 receptor agonist (GLP-1 RA). The primary outcome was a composite of incident biochemical abnormalities (serum phosphate > 1.5 mmol/L, serum calcium < 2.1 mmol/L, serum intact parathyroid hormone [iPTH] > 6.9 pmol/L, or serum 25-hydroxyvitamin D < 49.9 nmol/L).</p><p><strong>Results: </strong>The cohort included 13 379 patients receiving SGLT2 inhibitors (<i>n</i> = 11 920) or GLP-1 RAs (<i>n</i> = 1459) with a median follow-up of 3.3 years. Compared with GLP-1 RAs, SGLT2 inhibitors were associated with a lower cumulative incidence of the composite primary outcome (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.79-0.86), hyperphosphatemia (HR 0.83, 95% CI 0.76-0.91), hypocalcemia (HR 0.82, 95% CI 0.78-0.86), high serum iPTH levels (HR 0.66, 95% CI 0.57-0.78), and low serum 25-hydroxyvitamin D levels (HR 0.65, 95% CI 0.47-0.90).</p><p><strong>Interpretation: </strong>Use of SGLT2 inhibitors was associated with a lower incidence of biochemical abnormalities related to CKD-MBD than GLP-1 RAs. These agents may be considered to reduce risk of CKD-MBD in patients with type 2 diabetes mellitus and stage 1-3 CKD.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 7","pages":"E178-E189"},"PeriodicalIF":9.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Petechial periflexural exanthem associated with parvovirus B19 infection in an 18-year-old.","authors":"Emilio Berna-Rico, Carlos Azcarraga-Llobet, Javier Pérez-Bootello","doi":"10.1503/cmaj.241176","DOIUrl":"10.1503/cmaj.241176","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 7","pages":"E191"},"PeriodicalIF":9.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypotension posturale chez un patient VIH-positif : Insuffisance surrénalienne due aux interactions fluticasone–cobicistat.","authors":"Serena Dienes, Robert Nunn, Alison Lai","doi":"10.1503/cmaj.240796-f","DOIUrl":"10.1503/cmaj.240796-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 7","pages":"E195-E198"},"PeriodicalIF":9.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saignement post-amygdalectomie chez l’enfant.","authors":"Jennifer M Siu, Evan J Propst, Nikolaus E Wolter","doi":"10.1503/cmaj.240891-f","DOIUrl":"10.1503/cmaj.240891-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"197 7","pages":"E199-E200"},"PeriodicalIF":9.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}