Tag: pubmed

Am J Cardiovasc Drugs. 2024 Dec 2. doi: 10.1007/s40256-024-00697-7. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have become a first-line therapy for heart failure (HF) in adults. However, data on their use in HF associated with adult congenital heart disease (ACHD) are limited. This systematic review and meta-analysis evaluated the safety, tolerability, and efficacy of SGLT2is in ACHD HF patients, supplementing guideline-directed medical therapy.

METHODS: A comprehensive systematic search and meta-analysis were conducted on studies examining SGLT2i use in ACHD HF patients. The primary endpoint was the change in the New York Heart Association (NYHA) functional class (FC), with secondary endpoints including changes in ventricular function and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels. Additionally, the safety and tolerability of SGLT2is were evaluated.

RESULTS: The meta-analysis included eight studies with 287 patients aged 19-67 years (median age 37.5 years). Adding SGLT2is to combined therapies significantly improved NYHA FC (log odds ratio 1.3, 95% confidence interval [CI] 0.37-2.23, p = 0.01) and reduced NT-proBNP levels (mean difference [MD] -0.43, 95% CI -0.70 to -0.16, p < 0.001). A notable decrease in systolic blood pressure was observed (MD -0.32, 95% CI -0.51 to -0.14, p = 0.00). The adverse effect profile was comparable to that seen in routine HF, with fewer HF hospitalizations post-SGLT2i initiation. Urinary tract infections occurred in 14 patients (5%), with no instances of hypoglycemia or ketoacidosis reported. Medication withdrawal due to adverse effects was noted in 19 patients (7%).

CONCLUSIONS: SGLT2is are well tolerated in ACHD HF patients. Notably, SGLT2is improved NYHA FC and reduced NT-proBNP levels across a diverse ACHD HF patient cohort. However, further prospective, multicenter studies are needed to confirm the safety and efficacy of SGLT2is in this unique patient population.

PMID:39621203 | DOI:10.1007/s40256-024-00697-7

Arch Dermatol Res. 2024 Dec 2;317(1):63. doi: 10.1007/s00403-024-03575-z.

ABSTRACT

Pityriasis versicolor (PV) is a common skin condition associated with Malassezia species. Factors influencing PV development, such as sebum and skin hydration levels, are not fully understood, especially among adolescents. This study aimed to determine Malassezia speciation and assess sebum and hydration levels in secondary school students with PV in Ibadan, Nigeria. A cross-sectional study was conducted among secondary school students with PV and a control group. Sebum and hydration levels were measured using a sebumeter and corneometer, respectively. Malassezia speciation was determined through KOH microscopy and PCR-RFLP. Sebum levels were significantly higher in PV patients compared to controls. Skin hydration was lower in PV patients. Malassezia globosa was the predominant species, followed by Malassezia restricta and Malassezia sympodialis. No significant correlations were found between Malassezia species and clinical features. Increased sebum levels and decreased skin hydration are associated with PV in adolescents. Malassezia globosa is the primary species involved. Further research is needed to elucidate the complex relationship between these factors and PV pathogenesis. Clinical trial number Not applicable.

PMID:39621191 | DOI:10.1007/s00403-024-03575-z

Sleep Breath. 2024 Dec 2;29(1):38. doi: 10.1007/s11325-024-03222-x.

ABSTRACT

PURPOSE: Patients with Obstructive Sleep Apnea (OSA) often experience poor sleep quality and excessive daytime sleepiness, which significantly affect their daily lives. Among the therapeutic options, Barbed Pharyngoplasty (BP) is widely used, showing an overall improvement in the primary efficacy parameters. However, the impact of this surgical intervention on sleep architecture remains unclear. The purpose of this study is to assess potential changes in sleep architecture in patients with moderate to severe OSA who have successfully undergone BP.

METHODS: Adult patients affected by moderate-severe OSA who underwent Alianza BP were enrolled. Each patient underwent polysomnography preoperatively and six months postoperatively, using the WatchPAT device for consistent data acquisition.

RESULTS: This study enrolled 27 patients. Although not statistically significant, improvements were observed in Total Sleep Time (TST), Sleep Efficiency, REM, light, and deep sleep, significant improvements were noted in the Apnea-Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), Respiratory Disturbance Index (RDI), and Epworth Sleepiness Scale (ESS). Positive correlations were found between AHI improvement and changes in light sleep and negative correlations with deep sleep. ODI and RDI improvement correlated positively with light sleep and negatively with deep and REM sleep. No correlations were found between these indices and TST and sleep efficiency.

CONCLUSION: A noteworthy correlation was found between AHI improvement and changes in sleep stages. Increased AHI gain and surgical success were associated with improved deep sleep and reduced light sleep, even though REM sleep remained relatively unchanged. Indeed, BP could be a valid surgical option for improving sleep architecture, by promoting better sleep quality.

PMID:39621190 | DOI:10.1007/s11325-024-03222-x

Dig Dis Sci. 2024 Dec 2. doi: 10.1007/s10620-024-08742-w. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment for primary biliary cholangitis (PBC) was defined by its singular relationship with ursodeoxycholic acid (UDCA) for decades. However, nearly 40% of patients fail to achieve adequate biochemical response with UDCA, necessitating second-line therapies.

AIMS: The aim of our review was to assess the efficacy and safety of second-line therapies for PBC from phase three trials.

METHODS: We conducted a systematic review of PubMed, Medline, and ClinicalTrials.gov for published phase three trial data of second-line PBC therapies.

RESULTS: Four phase three clinical trial evaluating obeticholic acid, bezafibrate, seladelpar, and elafibranor, were identified. All trials but one defined the treatment endpoints of an alkaline phosphatase (ALP) less than 1.67 times the upper limit of normal (ULN), a 15% decrease of ALP from baseline, and normal total bilirubin (TB) after 12 months. All therapies demonstrated statistically significant achievement of primary endpoints relative to placebo. Reduction in ALP from baseline ranged from 113 to 133.9 U/L (- 34.6% to – 50%) across all trials. Primary endpoint treatment differences relative to placebo ranged between 31 and 47%. ALP normalization rates were described for three treatments and varied between 15 and 67% in treatment cohorts,compared to 0% to 2% of placebo cohorts. Only elafibranor and seladelpar demonstrated significant reduction in total 5D itch scale scores. Discontinuation rates across studies ranged from 1 to 14% due to adverse effects.

CONCLUSION: All reviewed therapies met their respective study endpoints. Effective second-line therapies area available and continue to receive long-term evaluation in patients with PBC.

PMID:39621183 | DOI:10.1007/s10620-024-08742-w

Eur J Orthop Surg Traumatol. 2024 Dec 2;35(1):33. doi: 10.1007/s00590-024-04162-8.

ABSTRACT

PURPOSE: The aims were to assess whether vitamin D deficiency influenced mortality risk and length of acute hospital stay in patients presenting with a hip fracture.

METHODS: A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels on admission, patient demographics, perioperative variables and mortality were collected. Cox regression analysis was utilised to determine the independent association between serum vitamin D levels and patient mortality.

RESULTS: The cohort consisted of 1510 patients with a mean age of 81.3 years and 1107 (71.4%) were female. 876 (58.0%) were vitamin D deficient (< 50 nmol/l). The median follow up was 405 (IQR 249 to 610) days. During follow-up there were 464 deaths (30.7%). Vitamin D deficiency was independently associated with higher mortality risk (hazard ratio [HR] 1.26, 95% confidence interval (CI) 1.03 to 1.53, P = 0.022). Male sex (HR 1.64, 95% CI 1.34 to 2.01, P < 0.001) was also associated with a higher mortality risk. Vitamin D deficiency was not associated with length of hospital stay (median difference 0 days, P = 0.207).

CONCLUSION: Vitamin D deficiency was independently associated with increased mortality in hip fracture patients, though this finding may be influenced by lack of comprehensive adjustment for comorbidity. While the value of routine serum vitamin D measurement is debated, supplementation during hospital stays is important to reduce falls and fracture risks associated with deficiency.

PMID:39621172 | DOI:10.1007/s00590-024-04162-8

J Interpers Violence. 2024 Nov 30:8862605241298301. doi: 10.1177/08862605241298301. Online ahead of print.

ABSTRACT

About one-third of sexual minority men (SMM) report intimate partner violence (IPV) victimization, and one-fourth report IPV perpetration, in their lifetime. IPV disclosure and help seeking are key processes of coping with or managing exposure to abuse. We surveyed 500 SMM residing across the United States who enrolled in project EROS (Empowering Relationships and Opportunities for Safety). In all, 201 participants reported any type of IPV in the past 6 months (including 109 who reported both victimization and perpetration); these men were then categorized as experiencing balanced bidirectional (n = 53), predominantly victimization (n = 113), and predominantly perpetration (n = 35) IPV. In each of these groups, close to one-third (25.7%-34.5%) had disclosed their IPV experience and one-fifth (13.2%-20.0%) had sought help; however, within the perpetration group, none of the 16 participants who only reported perpetration (the other 19 reported some victimization) disclosed their IPV. Group sizes allowed us to examine correlates of IPV disclosure and help seeking among the bidirectional and victimization groups, from among demographic, psychosocial, relational, and IPV characteristics, using bivariate statistics and multiple logistic regression. Greater IPV victimization was positively correlated with disclosure in both groups, and it was the lone independent correlate in multiple regression analysis (in the victimization group). Greater IPV victimization was also a strong positive and independent correlate of help seeking in multiple regression analysis within the victimization group, as was greater partner assertiveness in conflict resolution. There were no independent correlates of disclosure and help seeking within the bidirectional group. These findings highlight the need for efforts to empower SMM to seek support and services when exposed to IPV, and to do so early in the occurrence of IPV.

PMID:39614721 | DOI:10.1177/08862605241298301

BJU Int. 2024 Nov 30. doi: 10.1111/bju.16598. Online ahead of print.

ABSTRACT

OBJECTIVE: To define the natural history, patterns of recurrence and treatment modalities for local prostate cancer (PCa) recurrence following radical prostatectomy (RP) and radiation therapy (RT), and to investigate factors that could predict metastasis-free survival (MFS) in this unique patient population.

METHODS: We queried a prospectively maintained PCa registry to identify men developing in-field recurrence (IFR) following RP and RT from 2008 to 2021 at a single institution. IFR was defined as biopsy-proven recurrent PCa or the presence of persistent positron emission tomography-avid lesions in the prior radiation field without evidence of metastasis. Cox regression was conducted to determine predictors of MFS. Kaplan-Meier methods were used to calculate MFS, cancer-specific survival (CSS) and overall survival (OS) for patients in three primary therapy categories: cryoablation, androgen deprivation therapy (ADT) alone, and surveillance.

RESULTS: Of 4575 patients from our registry, 108 (2.3%) with IFR were identified. The median (interquartile range [IQR]) time to IFR from salvage treatment was 78 (50-126) months. A total of 29 patients (26%) were managed with cryoablation, 23 (21%) with ADT, and 28 (25%) with surveillance. The median (IQR) follow-up was 76 (48-100) months. There were no statistically significant differences in MFS (P = 0.67) or OS (P = 0.07) among the three primary treatment cohorts. Patients treated with ADT or cryoablation had longer CSS compared to patients managed with surveillance (P = 0.047).

CONCLUSIONS: We found that IFR may present years after completion of primary treatment for PCa. While curative management strategies may be attempted, local and distant metastatic recurrence is common and often requires systemic therapy.

PMID:39614716 | DOI:10.1111/bju.16598

Inquiry. 2024 Jan-Dec;61:469580241304244. doi: 10.1177/00469580241304244.

ABSTRACT

This study analyzes hospital bed capacity and resource allocation using inflow and outflow indices to identify disparities in bed utilization. The COVID-19 pandemic highlighted the need for effective healthcare management, particularly in the allocation of specialized beds such as those in intensive care units (ICU). Despite a high bed-to-population ratio, South Korea faces regional disparities in bed distribution, especially in Seoul, which accounts for 12.4% of the nation’s hospital beds. Hospital beds were categorized based on the Medical Service Act, and the Relevance Index (RI) and Commitment Index (CI) were used to assess patient flow in 2019 across different bed types and functions. Data from the “Statistical Yearbook on the Usage of Medical Service by Region” provided insights into utilization patterns in tertiary referral hospitals, general hospitals, hospitals, and long-term care facilities. The analysis revealed high RIs for tertiary referral hospitals, indicating strong patient retention and minimal outflow, whereas lower RIs for long-term care hospitals suggested underutilization. Regional analysis within Seoul found a concentration of tertiary referral hospitals in the Southeast and a shortage of ICU beds in the Northwest and Southwest regions. The Inflow and Outflow Index confirmed significant patient inflow into tertiary referral hospitals, with some areas experiencing higher outflows, particularly for long-term care beds. These findings underscore the need for strategic hospital bed capacity management, prioritizing essential beds in underserved regions. Future research should incorporate more recent data and employ direct patient flow analysis to optimize resource allocation, addressing evolving healthcare demands, such as an aging population and new infectious diseases. This study offers valuable insights for regional health policy, aiming to enhance functional hospital bed management and improve overall healthcare resource utilization.

PMID:39614715 | DOI:10.1177/00469580241304244

Inquiry. 2024 Jan-Dec;61:469580241301528. doi: 10.1177/00469580241301528.

ABSTRACT

Scientific research has shown that the sustainability of public health insurance is crucial for governments to effectively manage the risks associated with populations aging. In response, the Chinese government has initiated efforts to ensure the long-term viability of its medical insurance funds. This study utilizes data from 24 484 respondents in the 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), treating the digital supervision of medical insurance funds as a quasi-natural experiment. The study employs a difference-in-differences (DID) model to evaluate the policy effects and uses heterogeneity analysis to explore variations in impact. The objective is to assess the effectiveness of digital supervision and understand how it achieves its policy goals. The findings indicate that digital supervision of medical insurance funds has a significant positive impact on residents’ out-of-pocket medical expenditure. Heterogeneity analysis reveals that the policy’s effect is particularly strong in urban samples, especially among younger and elderly urban residents, while showing no significant impact on rural populations. This suggests that the policy has a greater influence on groups with higher moral hazard. By implementing digital supervision of medical insurance funds, the Chinese government has ensured the sustainability of these funds, laying a foundation for mitigating the risks associated with population aging. Additionally, the policy has contributed to promoting healthcare equity and reducing the waste of medical resources.

PMID:39614714 | DOI:10.1177/00469580241301528

J Foot Ankle Res. 2024 Dec;17(4):e70015. doi: 10.1002/jfa2.70015.

ABSTRACT

BACKGROUND: Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student’s ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

METHODS: A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

PMID:39614694 | DOI:10.1002/jfa2.70015