Kidess GG, Hamza M, Basit J
… +2 more, Alraiyes M, Alraies MC
Am J Med Sci
· 2026 May · PMID 41580283
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BACKGROUND: Mixed aortic valve disease (MAVD) is defined by the presence of concurrent aortic stenosis (AS) and aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is effective in MAVD patients with...BACKGROUND: Mixed aortic valve disease (MAVD) is defined by the presence of concurrent aortic stenosis (AS) and aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is effective in MAVD patients with mortality rates comparable to pure aortic stenosis (PAS). While most TAVR complications also occur at similar rates between the MAVD and PAS populations, recent studies have shown conflicting results. METHODS: A systematic literature review was conducted on PubMed and Embase for studies on the outcomes of TAVR in MAVD from inception until May 2024. Primary outcomes were short- and long-term mortality. Secondary outcomes were paravalvular regurgitation (PVR), vascular and bleeding complications, pacemaker implantation, and cerebrovascular complications. A random-effects model was used to pool risk ratios (RR) and 95 % confidence intervals (CI). RESULTS: Eleven observational studies, including 133,558 patients, were included in the analysis. There were no significant differences in primary endpoints (p > 0.05). MAVD was associated with a higher risk of paravalvular regurgitation (RR: 1.29, 95 % CI: 1.07-1.55) and higher risk of vascular complications (RR: 1.20, 95 % CI: 1.01-1.44). No significant differences were noted in other secondary outcomes (p > 0.05), although there was a nonsignificant trend towards a decreased risk of cerebrovascular complications associated with TAVR in MAVD patients. CONCLUSIONS: TAVR is an intervention with similar mortality and complication risk in MAVD and PAS patients. Future research is needed to further clarify the outcomes of TAVR in patients with MAVD, especially regarding cerebrovascular complications, long-term mortality, and the association of paravalvular regurgitation with mortality.
Bilici D, Doğan C, Aşik M
… +2 more, Menek G, Kazci ZN
Am J Med Sci
· 2026 May · PMID 41544958
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AIM: To investigate the ultrasonographic (US) imaging of the lung parenchyma of patients with stable-period chronic obstructive pulmonary disease (COPD) and compare detected A-line and B-line artifacts (ALAs/BLAs) with t...AIM: To investigate the ultrasonographic (US) imaging of the lung parenchyma of patients with stable-period chronic obstructive pulmonary disease (COPD) and compare detected A-line and B-line artifacts (ALAs/BLAs) with those of a healthy-volunteer control group. MATERIALS AND METHODS: Patients with stable-period COPD and healthy patients who presented to the Chest Diseases Clinic between May 2023 and June 2024 were included in the study. The clinical, demographic, spirometric, and radiologic characteristics of the patients were recorded. The patients were evaluated using US from a total of six predetermined anatomic lines, and ALA/BLA counts were recorded. Visual scoring [Goddard scores (GS)] was used for the assessment of emphysema on thorax computed tomography and images were graded from mild to severe (≤25 %- >75 %). Data of the COPD and control groups were compared with each other. RESULTS: A total of 44 patients with COPD with a mean age of 64.9 ± 8.5 years and 34 control group patients with a mean age of 61.7 ± 6.5 years were included in the present study. The average ALA and BLA was 4.7 ± 1.4 and 3.1 ± 1 in the COPD group and 3.7 ± 0.7 and 1 ± 0.1 in the control group, respectively (p = 0.001 and p < 0.001, respectively). A correlation was observed between GSs, which indicate the degree of emphysema, and ALA counts in the COPD group. CONCLUSIONS: Some changes can be detected using US in COPD. ALA/BLA counts may increase in patients with COPD. US, which is an alternative modality to other conventional imaging modalities, may be useful in patients with stable COPD.
Am J Med Sci
· 2026 Apr · PMID 41513127
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Cefepime, a fourth-generation cephalosporin, has traditionally been administered via 30-minute standard infusions. However, an extended infusion of cefepime, administered over 3-4 h, has demonstrated improved pharmacodyn...Cefepime, a fourth-generation cephalosporin, has traditionally been administered via 30-minute standard infusions. However, an extended infusion of cefepime, administered over 3-4 h, has demonstrated improved pharmacodynamic target attainment. This narrative review evaluates the clinical impact of extended infusion cefepime across diverse infections and patient populations. While retrospective studies suggest improved outcomes, such as reduced mortality and faster defervescence in patients with Pseudomonas aeruginosa infections or febrile neutropenia, prospective trials have not consistently shown significant benefits, particularly in mortality reduction. Potential risks of extended infusions, including neurotoxicity and complications from increased IV access, remain under-researched, especially in adult populations. Overall, the extended infusion is non-inferior to the standard infusion length and may be superior to the standard infusion in certain contexts. Further prospective, controlled studies are warranted to determine the clinical efficacy and safety of EI cefepime in comparison to standard infusion in various patient populations.
Am J Med Sci
· 2026 May · PMID 41513126
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BACKGROUND: The elevated average mean corpuscular volume (MCV) of adults with hemochromatosis and HFE p.C282Y (rs1800562) homozygosity is incompletely understood. METHODS: We retrospectively measured percentages of small...BACKGROUND: The elevated average mean corpuscular volume (MCV) of adults with hemochromatosis and HFE p.C282Y (rs1800562) homozygosity is incompletely understood. METHODS: We retrospectively measured percentages of small (100.0-109.9 fL) and large (110.0-200.0 fL) macrocytes in automated hematology analyzer erythrocyte volume histograms of hemochromatosis probands with p.C282Y homozygosity and iron overload without cirrhosis. We evaluated associations of small and large macrocyte percentages with age, sex, body mass index (BMI), daily alcohol consumption, diabetes, hemochromatosis arthropathy, transferrin saturation (TS), and serum ferritin (SF) at diagnosis. RESULTS: There were 69 probands (46 men, 23 women) of mean age 49 ± 15 y. Median BMI was 27.5 kg/m (16.9, 46.3). Ten probands (14.5%) had diabetes and seven (10.1%) had arthropathy. Mean TS, SF, and MCV were 81 ± 14%, 791 ± 480 µg/L, and 95.5 ± 4.1 fL, respectively. Mean small and large macrocyte percentages were 17.9 ± 14.3 % and 31.3 ± 8.2 %, respectively. Correlations of small and large macrocyte percentages with age were significant (r = 0.3937; p = 0.0008 and r = 0.2634; p = 0.0288, respectively). The mean small macrocyte percentage of 11 probands who reported daily alcohol consumption was greater than that of the 58 other probands (20.6 ± 2.9 % and 17.4 ± 4.4 %, respectively; p = 0.0070). The correlation of large macrocyte percentages with TS was significant (r = 0.2661; p = 0.0271). Linear regressions confirmed these positive associations: small macrocyte percentages with age (p = 0.0012) and daily alcohol consumption (p = 0.0355); and large macrocyte percentages with age (p = 0.0306) and TS (p = 0.0247). CONCLUSIONS: In HFE p.C282Y homozygotes, small macrocyte percentages are associated with age and daily alcohol consumption and large macrocyte percentages are associated with age and TS.
Brereton B, Desai R, Nathani PS
… +9 more, Prakash SH, Nair A, Lewis C, Sidhu A, Usman S, Chauhan S, Vivekanand VA, Nanjundappa A, Sunkara P
Am J Med Sci
· 2026 Mar · PMID 41429636
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BACKGROUND: Lipoprotein (a) [Lp (a)] may confer pro-thrombotic potential, and high concentrations may be an independent risk for MI. This systematic review sought to investigate the association of Lp (a) levels with post...BACKGROUND: Lipoprotein (a) [Lp (a)] may confer pro-thrombotic potential, and high concentrations may be an independent risk for MI. This systematic review sought to investigate the association of Lp (a) levels with post-revascularization Major Adverse Cardiac Events (MACE) in patients with CAD, ACS, and DM. METHODS: A systematic literature search for original investigations was performed using PubMed/MEDLINE, Embase, Scopus, and Google Scholar, searching for articles (meeting inclusion criteria) focusing on the relationship between Lp(a), DM, and PCI in patients with ACS, MI, or IHD and the impact on cardiovascular outcomes. The data was abstracted and descriptively summarized. RESULTS: The systematic review selected four relevant articles: 3 prospective Konishi et al., (2016); Silverio et al., (2022); and Li et al., (2023) and one retrospective (Takahashi et al., 2020). Total population: 4624, total males: 3719. Konishi et al. (2016) concluded that an elevated Lp(a) is an independent risk factor for cardiac death and/or ACS recurrence in diabetics undergoing PCI. The adjusted OR for cardiac death and ACS in the high Lp(a) group vs. the low Lp(a) group was 1.20 (CI 1.00-1.42), p = 0.04. Takahashi et al. (2020) showed that after adjusting for clinical covariates, high Lp(a) was independently associated with a higher frequency of MACE and poorer long-term outcomes compared to low Lp(a). The adjusted OR for the risk of MACE in patients with high Lp (a) vs. low Lp (a) was 1.83 (CI 1.16-2.95), p = 0.009. Silverio et al. (2022) showed that while there was an increased risk of recurrent MI in this patient population without DM, it was not confirmed in patients with DM. Compared with the lowest Lp (a) category, non-DM patients with very high Lp (a) >70 mg/dl vs. low Lp (a) showed a higher risk of recurrent MI and all-cause death; adjusted OR 2.839 (CI 1.382-5.832), p = 0.005. In diabetics, high Lp (a) vs. low Lp (a) = 1.115 (CI 0.405-3.071), p = 0.833. CONCLUSIONS: There is some evidence that Lp (a) levels are an independent risk factor for MACE in patients who underwent PCI for CAD. There is also some evidence that elevated Lp (a) levels are associated with a worse prognosis in patients with DM after PCI, but this association is not consistent in the literature. Further prospective multicenter studies are required in order to elucidate this association.
Zahiriharsini A, Rostami M, Hurd C
… +11 more, Vakilian F, Brar G, Wang T, Mullie T, Basiuk S, Mann B, Castilho CD, Smith M, Lam G, Ho C, Manhas KP
Am J Med Sci
· 2026 Apr · PMID 41412286
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BACKGROUND: Long COVID presents a substantial and evolving challenge to individuals and health systems. Despite growing interest in interdisciplinary care models, empirical evidence on their structure, utilization, and e...BACKGROUND: Long COVID presents a substantial and evolving challenge to individuals and health systems. Despite growing interest in interdisciplinary care models, empirical evidence on their structure, utilization, and effectiveness remains limited. This study examined the delivery and outcomes of specialized outpatient programs for long COVID in Alberta, Canada, focusing on: (a) patterns of program utilization; (b) patient-reported health outcomes; and (c) impacts on healthcare system utilization and costs. METHODS: A retrospective observational study was conducted using administrative health records, electronic medical records, and patient-reported outcome measures (PROMs) between April 2022 and September 2023. Adults (≥18 years) with persistent symptoms ≥12 weeks post-infection were included. Healthcare utilization and costs were assessed over 180-day pre- and post-enrollment periods. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER). RESULTS: Of 2819 referrals, 81% (n = 2287) were accepted. Most patients were female (68%), aged 48.2 years on average, and referred by community physicians. Site-level differences were observed in staffing models, care delivery modalities, and wait times. Following enrollment, patients reported small but statistically significant improvements in functional status and quality of life. Symptoms of depression, as measured by the PHQ-9, decreased by an average of 0.9 points (p < 0.05), though below thresholds for clinical significance. Anxiety levels, assessed by the GAD-7, did not change significantly. EQ-5D VAS scores improved by 4.6 points (p = 0.003). Modest reductions in inpatient, ambulatory, and physician service costs were observed. The ICER was $31,140 per quality-adjusted life year (QALY), approaching the Canadian cost-effectiveness threshold. CONCLUSIONS: In this observational analysis, program participation was associated with small improvements in patient-reported health status and modest cost patterns. Because natural recovery, regression to the mean, and concurrent system changes may also explain these trends, the findings should be interpreted as preliminary associations rather than causal effects. Prospective controlled studies are needed to confirm effectiveness and economic value.
Ezenna C, Abdulelah H, Nadeem S
… +9 more, Shah H, Ramesh P, Hama J, Seraj S, Abbas R, Murali Krishna M, Joseph M, Goldsweig AM, Abdulelah M
Am J Med Sci
· 2026 Apr · PMID 41412285
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BACKGROUND: Sex, racial, and ethnic disparities have been documented in survival after cardiac arrest. Whether knowledge of these disparities has led to their mitigation remains unclear. We evaluated trends in sex and ra...BACKGROUND: Sex, racial, and ethnic disparities have been documented in survival after cardiac arrest. Whether knowledge of these disparities has led to their mitigation remains unclear. We evaluated trends in sex and racial disparities in cardiac arrest mortality over a 22-year period. METHODS: Crude death rates (CDRs) for cardiac arrest per 100,000 individuals aged ≥15 years were obtained from the CDC WONDER database from 1999 through 2020. Inferential statistics and linear regression were performed to assess average annual percentage change (AAPC). RESULTS: Among 364,531 cardiac arrest deaths (CDR of 6.7 per 100,000; 95 % confidence interval [CI] 6.7-6.8), mortality declined significantly from 1999 through 2020 (slope -0.1, 95 % CI -0.14 to -0.05; p < 0.001). No difference was noted in CDR between Women and Men (6.59 vs 6.97; p = 0.117). By race, African Americans had the highest CDR (8.68), and Native Americans had the lowest (2.32), with significant differences across races (p < 0.001). Hispanics had a significantly lower CDR (1.38) than non-Hispanics (7.64; p < 0.001). Trend analysis showed a significant decline in CDR (AAPC -1.4, 95 % CI -1.4 to -1.7), with women experiencing a greater reduction (-2.1) than men (-0.88). Whites had the largest AAPC decline (-1.6; p < 0.001), while African Americans had the smallest (-0.6; p = 0.04). Hispanics showed a non-significant AAPC increase (0.77; p = 0.28). CONCLUSIONS: Cardiac arrest mortality declined over two decades, but the decline was not equal across sexes, races, and ethnicities. Further work is required to develop interventions to address these disparities.
Obimba D, Shaykevich A, Vitale DR
… +2 more, Rudmann CA, Geneva II
Am J Med Sci
· 2026 Apr · PMID 41412284
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BACKGROUND: Distinguishing between viral and bacterial pneumonia is paramount for antimicrobial stewardship. The biomarker procalcitonin has shown potential-its serum levels rise with bacterial infection and remain norma...BACKGROUND: Distinguishing between viral and bacterial pneumonia is paramount for antimicrobial stewardship. The biomarker procalcitonin has shown potential-its serum levels rise with bacterial infection and remain normal in its absence. Yet its application in medical practice remains controversial. Not using antibiotics based on procalcitonin-driven guidelines can be considered as a legal liability. Since the USA features more aggressive medical litigation practices compared with Europe, we hypothesized that there should also be an intercontinental difference for the use of procalcitonin. METHODS: Systematic review of original research on procalcitonin used for pneumonia in the USA and Europe, identified via PubMed and Medline covering 2013-2024. PRISMA flow diagram and risk bias assessment were applied. RESULTS: Thirty reports met our inclusion and exclusion criteria (17 from Europe, 12 from the USA, and 1 mixed, 24 covered adults, 6 were pediatric). For adults, the vast majority of European and all US-based studies demonstrated an association between higher procalcitonin levels and bacterial pneumonia. Regarding children, all European studies demonstrated correlation while in the USA the results were mixed. The effect of procalcitonin-based guidelines on antibiotic use yielded mixed results among adults in both Europe and the USA, with about half of the studies showing antibiotic stewardship benefit. There were too few pediatric studies covering this research end point to allow for comparison. CONCLUSIONS: Procalcitonin proved a useful tool for differentiating bacteria from viral pneumonia in both Europe and the USA. No consistent intercontinental differences were identified regarding the application of procalcitonin-driven antibiotics stewardship for pneumonia.
Stirrat T, Bejugam D, Kim S
… +4 more, Dahmani S, Atarere J, Alukal J, Kanth P
Am J Med Sci
· 2026 Mar · PMID 41389908
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INTRODUCTION: Stercoral colitis is an underrecognized, life-threatening complication of refractory constipation. METHODS: We systematically reviewed Embase, PubMed/MEDLINE, Web of Science, and CINAHL for presentation, im...INTRODUCTION: Stercoral colitis is an underrecognized, life-threatening complication of refractory constipation. METHODS: We systematically reviewed Embase, PubMed/MEDLINE, Web of Science, and CINAHL for presentation, imaging, management, and outcomes. Fifty-three studies (58 patients) met inclusion. Mean age was 55.8 years (range 9-94); 62.1% were female. Chronic constipation (75.9%) and opioid exposure (13.8%) were common. CT was used in 86.2%, showing fecaloma and wall thickening (65.5%); perforation occurred in 29.3% and ischemic colitis in 44.8%. Conservative measures, manual disimpaction, enemas, laxatives, were common; endoscopic disimpaction was rare; surgery was reserved for deterioration, peritonitis, or perforation. Overall in-hospital/30-day mortality was 22.4% (operative 26.9% vs non-operative 0.0%). CONCLUSIONS: SC should be suspected in at-risk patients with refractory constipation; only 75.9% had abdominal pain, so its absence does not exclude disease. Early CT, especially with elevated WBC, CRP, or lactate, and severity-guided escalation to conservative therapy or timely surgery are essential; standardized criteria and prospective studies are needed.
Afsar B, Afsar RE, Maddukuri G
… +1 more, Lentine KL
Am J Med Sci
· 2026 Jun · PMID 41354348
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Acute kidney injury (AKI) is common both general population and in hospitalized patients. Previously, AKI was considered reversible condition without long-term adverse impacts, but it is now recognized that AKI predicts...Acute kidney injury (AKI) is common both general population and in hospitalized patients. Previously, AKI was considered reversible condition without long-term adverse impacts, but it is now recognized that AKI predicts future adverse clinical outcomes such as chronic kidney disease, cerebrovascular disease and heart disease. In addition, recent studies showed that future cognitive dysfunction and dementia risk are increased after AKI. Although the mechanisms regarding acute cognitive dysfunction during AKI are considerably understood, the underlying pathologies causing chronic cognitive dysfunction and increased long term dementia risk after AKI are not well elucidated. Potential culprits include persistent systemic inflammation and structural brain alterations after AKI. In this review, we first summarized the studies investigating the impact of AKI on future dementia risk and cognitive function. Then, we highlighted the mechanisms regarding acute cognitive decline during AKI, and also discuss potential mechanisms regarding chronic cognitive decline after AKI. Lastly, we discussed potential therapeutic options to mitigate future cognitive decline after AKI.
Am J Med Sci
· 2026 Apr · PMID 41354347
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BACKGROUND/AIMS: The Lipoprotein(a) (LPA) rs3798220 and rs10455872 polymorphisms have been indicated to be involved with the coronary heart disease (CHD) susceptibility. However, there are still differences between the i...BACKGROUND/AIMS: The Lipoprotein(a) (LPA) rs3798220 and rs10455872 polymorphisms have been indicated to be involved with the coronary heart disease (CHD) susceptibility. However, there are still differences between the individual studies. METHODS: To explore the correlation of LPA gene rs3798220 and rs10455872 polymorphisms and CHD, the current meta-analysis was performed. The random or fixed effect genetic models were used to calculate the pooled odds ratios (ORs) and their corresponding 95 % confidence intervals (CI). RESULTS: A significant association was found between LPA rs3798220 polymorphism and CHD under allelic (OR: 1.488), recessive (OR: 1.543), dominant (OR: 1.534), homozygous (OR: 1.544), heterozygous (OR: 1.498) and additive genetic models (OR: 1.531). There was also a significant association between LPA rs10455872 polymorphism and CHD under allelic (OR: 1.607), dominant (OR: 1.751), heterozygous (OR: 1.723) and additive genetic models (OR: 1.686). CONCLUSIONS: LPA rs3798220 and rs10455872 polymorphisms were significantly associated with increased CAD risk. The persons carrying C allele of LPA rs3798220 and G allele of LPA rs10455872 polymorphisms might have higher CHD risk than the T allele of rs3798220 or A allele of rs10455872 carriers.
Liu F, Ding S, Chen A
… +7 more, Song J, Li J, Xu W, Cheng Z, Xie Y, Gu X, Wang X
Am J Med Sci
· 2026 Apr · PMID 41317901
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OBJECTIVE: To investigate the correlation between the inflammatory composite index [the product of absolute neutrophil count (NE) and free triiodothyronine (FT3)] and coronary heart disease in patients. METHOD: A retrosp...OBJECTIVE: To investigate the correlation between the inflammatory composite index [the product of absolute neutrophil count (NE) and free triiodothyronine (FT3)] and coronary heart disease in patients. METHOD: A retrospective study was conducted, continuously including 1481 patients with coronary heart disease admitted to the Affiliated Hospital of Jiangnan University and 810 patients with coronary heart disease admitted to the Second Affiliated Hospital of Soochow University between January 2022 and July 2023. Patients were grouped according to acute coronary syndrome (ACS) and chronic coronary syndromes (CCS), and all patients underwent coronary angiography (CAG). Collect the clinical general data and laboratory test results of all patients. Binary logistic regression analysis was used to screen risk factors, and ROC curve was used to evaluate the predictive value. RESULTS: The inflammatory complex index (ICI) in the ACS group was significantly higher than that in the CCS group, and the difference was statistically significant (p < 0.001). Multivariate binary logistic regression analysis showed that the inflammatory composite index was a risk factor for the occurrence of ACS in patients with coronary heart disease (OR=1.099, 95% CI: 1.074-1.126, p < 0.001); The ROC curve analysis results showed that the area under the curve (AUC) of ICI and total cholesterol (TC) were 0.693 and 0.676, respectively. When ICI and TC were jointly diagnosed, the AUC was 0.740, which was significantly higher than that of ICI and TC alone (p < 0.001). CONCLUSIONS: The inflammation composite index is correlated with the occurrence of ACS in patients with coronary heart disease, and it has certain diagnostic efficacy when combined with TC for diagnosis.
Am J Med Sci
· 2026 Feb · PMID 41314423
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Vector-borne diseases (VBDs) are spread by ticks and mosquitoes on every inhabitable continent and pose a persistent and escalating threat to global public health. The incidence of the vector-borne RNA viruses, which are...Vector-borne diseases (VBDs) are spread by ticks and mosquitoes on every inhabitable continent and pose a persistent and escalating threat to global public health. The incidence of the vector-borne RNA viruses, which are the focus of this article, has increased in recent decades. This diverse group comprises multiple genera of viruses, ranging from dengue, the most common mosquito-borne virus in the world, to more obscure viruses like Oropouche virus, circulating in South America, and multiple orthonairoviruses recently identified in China. The transmission dynamics of these diseases are shaped by a complex interplay of ecological, environmental, immunological, and socioeconomic factors, which creates challenges for diagnosis, management, surveillance, clinical management, and prevention. In this article, we present select viruses or concepts to highlight, prioritizing major and/or recent findings that represent novel discoveries, new insights, or events that change the current approach to clinical management or public health control programs to combat emerging VBD.