Am J Med Sci
· 2026 Jun · PMID 42250645
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Parasitic infections in solid organ transplant recipients are uncommon but potentially devastating. Transmission may occur through donor-derived infection, reactivation of latent disease, or post-transplant environmental...Parasitic infections in solid organ transplant recipients are uncommon but potentially devastating. Transmission may occur through donor-derived infection, reactivation of latent disease, or post-transplant environmental exposure, often with nonspecific presentations that delay diagnosis. Clinically important pathogens include Toxoplasma gondii, Plasmodium spp., Babesia spp., Trypanosoma cruzi, Strongyloides stercoralis, Schistosoma spp., and selected free-living amoebae and intestinal apicomplexans. Diagnosis requires integration of epidemiologic risk, microscopy, serology, molecular testing, and tissue evaluation, each with limitations in immunocompromised hosts. Prevention relies on targeted donor and recipient screening, prophylaxis when indicated, and careful post-transplant surveillance. Because delayed recognition can lead to severe disseminated disease and high mortality, a systematic risk-based approach is essential to improve outcomes in this vulnerable population.
Am J Med Sci
· 2026 Jun · PMID 42248559
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BACKGROUND: Barrett's esophagus (BE) is seen in individuals with GERD. It can progress into dysplasia and cancer, so detection and surveillance are necessary. We report on a retrospective analysis of patient endoscopy re...BACKGROUND: Barrett's esophagus (BE) is seen in individuals with GERD. It can progress into dysplasia and cancer, so detection and surveillance are necessary. We report on a retrospective analysis of patient endoscopy reports identifying factors influencing surface progression of BE. METHODS: Patient demographics: age, sex, Body Mass Index, Proton-Pump Inhibitor treatment and BE segment length at index endoscopy were collected for analysis. Prague criteria circumferential (C) and longitudinal (M) extent of the BE lesion progression were evaluated. Long-segment BE was defined as M > 3 cm. BE lesion surface area was quantified using ImageJ on 81 patients' endoscopic images. 200 patients were identified with average time to follow-up of 2.4 years. Multivariate regression analysis was used to determine features associated with dysplasia. RESULTS: Surface progression of C (dC) or M (dM) had no significant association with age, sex, or BMI, however, differences were seen between initial endoscopy segment length. Both mean dM in long and short segment groups (t = 4.61, df=195, p < 0.0001) and mean dC (t = 3.343, df=195, p = 0.0010) were found to be significantly different. On quantitative image analysis, long-segment BE showed significant decrease (t = 1.999, p < 0.05). Any increase in circumferential BE (C) was associated with increased odds of dysplasia OR 3.0 (95% CI: 1.0-9.0, p = 0.05). CONCLUSIONS: This preliminary work suggests that BE is a dynamic entity with poorly understood surface progression patterns. Surface progression risk appears to be independent of many risk factors associated with BE. While additional work is required to better elucidate this link, our work suggests that surface lesion changes are noteworthy.
Am J Med Sci
· 2026 Jun · PMID 42242577
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OBJECTIVE: To develop and validate a urine microRNA (miR)-based risk model using LASSO-logistic regression for early prediction of sepsis-associated acute kidney injury (SA-AKI). METHODS: We enrolled 210 septic patients...OBJECTIVE: To develop and validate a urine microRNA (miR)-based risk model using LASSO-logistic regression for early prediction of sepsis-associated acute kidney injury (SA-AKI). METHODS: We enrolled 210 septic patients admitted between June 2023 and May 2025. Patients were stratified into AKI (n = 72) and non-AKI (n = 138) groups based on AKI onset within 7 days of admission. Clinical variables and urinary miRNA levels (miR-16, miR-21, miR-142, miR-30c, miR-31) were analyzed by RT-qPCR. LASSO regression identified key predictors; multivariate logistic modeling generated a nomogram for SA-AKI risk prediction. Performance was assessed using ROC analysis and calibration plots. RESULTS: SA-AKI patients had lower MAP, reduced first 24-hour urine output, higher lactate levels, and elevated SOFA scores (P < 0.05). LASSO selected seven predictors: miR-21, miR-142, miR-16, Lactate, MAP, SOFA score, and urine output. Multivariate analysis confirmed mir-16, miR-21, miR-142, Lactate, and SOFA as independent risk factors (P < 0.05), while higher urine output in first 24 hour and MAP were protective (P < 0.05). The nomogram achieved an AUC of 0.993 (95% CI: 0.986-0.999) with near-perfect calibration (c-index = 0.992, 95% CI: 0.987 - 0.998). CONCLUSIONS: A urine miRNA and clinical parameter-based LASSO-logistic model offers exceptional accuracy in predicting early SA-AKI, enabling timely risk stratification.
Am J Med Sci
· 2026 May · PMID 42219109
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BACKGROUND: Chronic relapsing pruritic rash (CRPR) is a common and impactful symptom-defined syndrome encompassing several chronic inflammatory skin conditions, most notably atopic dermatitis (AD). The associations of in...BACKGROUND: Chronic relapsing pruritic rash (CRPR) is a common and impactful symptom-defined syndrome encompassing several chronic inflammatory skin conditions, most notably atopic dermatitis (AD). The associations of indoor allergen exposure and peripheral blood eosinophil counts with this syndrome remain unclear. OBJECTIVE: This study aimed to examine the associations of common indoor allergen concentrations and peripheral blood eosinophil counts with the prevalence and clinical course of CRPR. In this study, CRPR is used solely as a historical, symptom-based operational construct derived from the NHANES 2005-2006 questionnaire, rather than as a contemporary stand-alone clinical diagnosis. METHODS: We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. CRPR was defined as a positive response to the questionnaire item "have you ever had an itchy rash which was coming and going for at least 6 months?". Extracted variables included basic demographic information, concentrations of various indoor allergens, and peripheral blood eosinophil counts. Multivariable logistic regression models were used to analyze the associations between these variables and the prevalence and severity of CRPR. RESULTS: A total of 6,068 participants were included, of whom 877 (14.4%) met the CRPR criteria. Multivariable regression analysis, adjusted for demographic factors, revealed that higher concentrations of German cockroach allergen (Bla g 1) (OR=1.32, 95% CI: 1.15-1.52, P<0.001) and elevated peripheral blood eosinophil counts (OR=1.58, 95% CI: 1.42-1.76, P<0.001) were independently associated with higher odds of CRPR. Among individuals with CRPR, 81.0% (710/877) had experienced an episode in the past year. In this group, higher concentrations of Alternaria allergen (Alt a 1) were associated with a lower risk of exacerbations, whereas higher concentrations of rat allergen (Rat n 1) were associated with an increased risk. Furthermore, moderate indoor concentrations of mouse allergen (Mus m 1) were associated with a higher likelihood of rash resolution among these individuals. CONCLUSIONS: In this large U.S. cohort, CRPR was associated with peripheral eosinophilia and German cockroach allergen exposure. These findings suggest that peripheral eosinophilia may represent a relevant inflammatory correlate in a subset of individuals with CRPR, while the observed associations should be interpreted considering the syndrome's diagnostic heterogeneity.
Am J Med Sci
· 2026 May · PMID 42219107
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BACKGROUND: Cancer and cardiovascular disease (CVD) are the two leading causes of death in the United States. Whether their coexistence confers excess mortality risk remains insufficiently characterized. This study looks...BACKGROUND: Cancer and cardiovascular disease (CVD) are the two leading causes of death in the United States. Whether their coexistence confers excess mortality risk remains insufficiently characterized. This study looks to examine the cross-sectional association between cancer history and prevalent CVD and evaluate their joint association with all-cause mortality. METHODS: We analyzed 8,525 participants from the Third National Health and Nutrition Examination Survey. Cancer history was self-reported and categorized as skin or non-skin cancer. CVD was defined by self-reported clinical disease or major electrocardiographic abnormalities. Cross-sectional associations between cancer and prevalent CVD were evaluated using multivariable logistic regression. Longitudinal associations with all-cause mortality were examined using Cox proportional hazards models with joint exposure categories, adjusting for sociodemographic and cardiometabolic covariates. Interaction testing assessed effect modification. RESULTS: Cancer history was not independently associated with prevalent CVD after multivariable adjustment (skin cancer OR 1.05, 95% CI 0.84-1.30; non-skin cancer OR 1.21, 95% CI 0.97-1.50). Both CVD (adjusted HR 1.45, 95% CI 1.36-1.56) and cancer (skin cancer HR 1.15, 95% CI 1.02-1.29; non-skin cancer HR 1.54, 95% CI 1.37-1.72) were independently associated with higher all-cause mortality. The highest risk was observed among individuals with both CVD and non-skin cancer (adjusted HR 2.42, 95% CI 2.04-2.88). The CVD-cancer interaction was not statistically significant (p=0.596). CONCLUSIONS: The coexistence of cancer and CVD identified a population at markedly elevated mortality risk, consistent with an additive rather than synergistic joint association, highlighting the need for integrated cardio-oncologic risk stratification.
Am J Med Sci
· 2026 May · PMID 42217735
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BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of global mortality and disease burden, necessitating simple, rapid community screening methods. Exhaled breath analysis offers a promising no...BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of global mortality and disease burden, necessitating simple, rapid community screening methods. Exhaled breath analysis offers a promising non-invasive approach for identifying high-risk ASCVD patients. METHOD: This cross-sectional study involved 1,790 participants from a China-based community cohort. Comprehensive assessments included demographic data, fasting venous blood analysis for glucose and lipids (TC, TG, LDL-C, HDL-C), and stratification into high-risk (10-year ASCVD risk ≥5%) and low-risk (<5%) groups using the China-PAR model. Exhaled breath samples were collected after 12-hour fasting using standardized devices, with volatile organic compounds (VOCs) profiled via high-performance photon ionization time-of-flight mass spectrometry (HPPI-TOFMS). The cohort was randomly split into discovery and tuning sets for feature selection and model testing, respectively, using random forest algorithms with cross-validation. RESULTS: Of 1,442 eligible participants (1,040 high-risk, 402 low-risk), 402 matched pairs were created via propensity score matching (PSM). The developed ASCVD risk prediction model, integrating clinical risk factors and breath VOCs, showed strong performance in distinguishing high-risk individuals (SEN=78.5%, SPE=79.3%, ACC=78.9%, AUC=0.867). Additionally, ten differentially expressed VOC ions with significant concentration variations between high- and low-risk groups were identified. CONCLUSIONS: This study establishes a novel framework for community-based ASCVD risk screening using exhaled breath biomarkers. While demonstrating breath analysis's potential as a non-invasive tool, further clinical validation is needed to confirm its predictive accuracy for individual-level ASCVD risk assessment.
Am J Med Sci
· 2026 May · PMID 42167409
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BACKGROUND: This randomized controlled trial evaluated the efficacy and safety of dapagliflozin-spironolactone combination therapy versus monotherapy in reducing urinary albumin excretion rate (UAER) and mitigating hyper...BACKGROUND: This randomized controlled trial evaluated the efficacy and safety of dapagliflozin-spironolactone combination therapy versus monotherapy in reducing urinary albumin excretion rate (UAER) and mitigating hyperkalemia risk in elderly patients with early type 2 diabetic nephropathy (DN) receiving high-dose renin-angiotensin system inhibitors (RASi). METHODS: In this prospective, open-label, parallel-group study, 168 elderly patients with early DN and mild-to-moderate hypertension were randomized to Group A (irbesartan 300 mg/d plus dapagliflozin 10 mg/d), Group B (irbesartan 300 mg/d plus spironolactone 20 mg/d), or Group C (irbesartan plus dapagliflozin and spironolactone). The primary endpoint was the change in UAER from baseline to week 72. Secondary outcomes included changes in blood pressure, serum potassium levels, and safety profiles. RESULTS: Baseline characteristics were well-balanced (P > 0.05). Blood pressure remained comparable across groups during follow-up (P > 0.05). After 72 weeks, intention-to-treat analysis showed that Group C achieved a significantly greater UAER reduction compared to Group A and Group B (P < 0.05). Additionally, Group B exhibited higher serum potassium levels than Group A and Group C (P < 0.05), leading to a higher discontinuation rate due to hyperkalemia (P < 0.05). CONCLUSIONS: In elderly patients with early DN on high-dose RASi, dapagliflozin-spironolactone combination therapy achieved superior albuminuria reduction compared with either monotherapy, while attenuating the risk of spironolactone-associated hyperkalemia. Although no case of hyperkalemia occurred in the combination group in our trial, serum potassium was notably elevated relative to dapagliflozin monotherapy, underscoring the importance of regular monitoring in this population.
Am J Med Sci
· 2026 May · PMID 42142844
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Lactic acidosis is a common feature of patients presenting with sepsis, volume depletion due to ketoacidosis, tissue ischemia, shock and liver disease. These cases typically presume tissue hypoxia and anaerobic metabolis...Lactic acidosis is a common feature of patients presenting with sepsis, volume depletion due to ketoacidosis, tissue ischemia, shock and liver disease. These cases typically presume tissue hypoxia and anaerobic metabolism leading to lactic acidosis. Thiamine deficiency is an underappreciated cause of type B lactic acidosis, which is not caused by anaerobic metabolism. We present a case series of 11 patients admitted to the medicine service who were not in shock, and who had a lactic acidosis (average of 4.5 mmol/L) that improved after thiamine administration (resolving to <2 mmol/L in 10 of 11 patients). We then review thiamine and lactate physiology, and provide clinicians with evidence based recommendations to consider when treating patients with persistent lactic acidosis who are vitally stable.
Am J Med Sci
· 2026 May · PMID 42140557
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With the increased longevity in modern western society, multiple chronic illnesses that have been historically seen primarily in younger individuals have persisted into middle age and more recently elderly (>65) individu...With the increased longevity in modern western society, multiple chronic illnesses that have been historically seen primarily in younger individuals have persisted into middle age and more recently elderly (>65) individuals. This is particularly relevant to mast cell- and eosinophil-mediated diseases such as allergic sensitization (rhinitis, eczema, gastrointestinal diseases) and asthma. The reasons for this persistence into patients' later years of life are not fully understood but likely involve changes in external environmental influences (e.g. pollution, climate change, altered food sources and dietary habits) and internal environmental influences (e.g. sleep disturbances, decreased physical condition, increased depression, anxiety and stress perception). Optimal approaches to diagnosis demand obtaining an accurate medical history and physical examination in order to link variable clinical presentations to specific allergic (IgE)-mediated diseases. Therapies typically used for younger patients can also be used in elderly patients but with caution regarding potential direct adverse effects due to concomitant medical comorbidities and associated drug-drug interactions.
Am J Med Sci
· 2026 Jul · PMID 42031165
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BACKGROUND: Carpal tunnel syndrome (CTS) is an entrapment neuropathy resulting from compression of the median nerve at the wrist level. The aim of the study was to investigate the efficacy of tumor necrosis factor-like w...BACKGROUND: Carpal tunnel syndrome (CTS) is an entrapment neuropathy resulting from compression of the median nerve at the wrist level. The aim of the study was to investigate the efficacy of tumor necrosis factor-like weak apoptosis inducer (TWEAK) and its receptor, inducible fibroblast growth factor 14 (Fn14) axis in CTS and to conduct a preliminary study on the usability of TWEAK/Fn14 as a new pharmacological treatment target in CTS. METHODS: A total of 93 participants were included in the study: 48 individuals in the CTS group and 45 individuals in the control group. CTS patients were electrophysiologically divided into three different groups: mild, moderate, and severe. Serum TWEAK, Fn14, and TGF-β1 levels of the groups were measured and compared between groups. RESULTS: Serum TWEAK, Fn14, and TGF-β1 levels were found to be statistically significantly higher in the CTS group compared to the control group (p < 0.05). TWEAK level was observed to be significantly higher in the severe CTS group compared to mild and moderate CTS groups (p < 0.05). Fn14 and TGF-β1 levels were found to be significantly higher in the severe CTS group compared to mild and moderate CTS groups. A strong positive correlation was observed between TWEAK level and CTS severity (r:0.76). A strong positive correlation was observed between serum TWEAK level and serum TGF-β1 levels in the CTS group. CONCLUSIONS: This study demonstrates that the TWEAK/Fn14 axis and TGF-β1 may play an important role in CTS pathogenesis.