International Journal Of General Medicine[JOURNAL]
Sun
200 papers
Associations Between Exercise Blood Pressure Responses and Oxygen Pulse During Cardiopulmonary Exercise Testing: A Cross-Sectional Study.
Wang Y, Li Z, Wu F … +2 more , Li G, Tao M
Int J Gen Med · 2026 · PMID 42238359 · Full text
OBJECTIVE: To observe the impact of exaggerated blood pressure response during exercise on oxygen pulse (Opulse), facilitating earlier and more precise identification of the subclinical threat of hypertension. METHODS: T...
OBJECTIVE: To observe the impact of exaggerated blood pressure response during exercise on oxygen pulse (Opulse), facilitating earlier and more precise identification of the subclinical threat of hypertension. METHODS: This cross-sectional study consecutively enrolled 262 patients with exaggerated blood pressure response (EBPR) (March 2023-March 2025). Based on peak Opulse ≥80% of predicted value, patients were divided into Normal (n=149) and Reduced Opulse (n=113) groups. Baseline characteristics, laboratory findings, and CPET parameters were collected. Binary logistic regression analysis was used to identify independent factors associated with reduced peak Opulse ratio. Multiple linear regression models were employed with the relative increase of Opulse before and after the anaerobic threshold (AT) as dependent variables to explore the associations of blood pressure increase and metabolic equivalent (MET)-adjusted blood pressure increase with changes in Opulse relative increase. RESULTS: Compared with the Normal Opulse group, the Reduced Opulse group had a higher proportion of males, younger age, higher BMI, and worse metabolic profiles. Logistic regression identified advanced age and alcohol consumption as independent risk factors for reduced peak Opulse, while female sex was protective. Regarding blood pressure, unadjusted SBP increase correlated positively with peak Opulse ratio and Opulse relative increase, whereas MET‑adjusted SBP increase showed a significant negative correlation with both. This inverse association suggests that an exaggerated blood pressure response per unit metabolic demand is linked to compromised cardiac pumping efficiency. CONCLUSION: The negative correlation between ΔSBP/MET and Opulse suggests that an exaggerated blood pressure response may come at the cost of compromised cardiac pumping efficiency. An excessively high ΔSBP/MET value often indicates more significant changes in the structure and function of the heart, and is an aspect that requires particular attention in the future.
AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions.
Tang Q, Deng K, Cui Y … +2 more , Liu H, Qian B
Int J Gen Med · 2026 · PMID 42238358 · Full text
Structural heart disease (SHD), including left ventricular systolic dysfunction, valvular heart disease, hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary hypertension, remains underdiagnosed despite the in...
Structural heart disease (SHD), including left ventricular systolic dysfunction, valvular heart disease, hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary hypertension, remains underdiagnosed despite the increasing availability of disease-modifying therapies. Echocardiography is the principal confirmatory test, but its broad use as a screening tool is constrained by imaging capacity, cost, and referral efficiency. This review evaluates artificial intelligence-enabled 12-lead electrocardiography (AI-ECG) as a pre-echocardiographic triage tool for SHD. We synthesize evidence across reduced left ventricular ejection fraction, valvular disease, hypertrophic cardiomyopathy, cardiac amyloidosis, pulmonary hypertension, and composite SHD models, and distinguish two intended-use orientations: safety-net screening, in which a positive AI-ECG result serves as an additive trigger for confirmatory evaluation, and gatekeeper triage, in which a negative or low-risk AI-ECG result may support deferring or de-prioritizing echocardiography in selected low-risk settings. Current evidence most strongly supports low-LVEF detection, where pragmatic randomized implementation and early economic data are available. Valvular and composite SHD models are promising for referral enrichment, whereas hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary hypertension remain earlier or pathway-incomplete applications. We also review false-positive interpretation, stepwise confirmation with point-of-care ultrasound, threshold selection, workflow integration, equity, regulation, and health economics. Overall, AI-ECG is currently best positioned as an additive safety-net tool to improve case finding upstream of echocardiography. Gatekeeper use remains investigational and requires prospective pathway-level validation, calibration, and operational safeguards before routine imaging deferral can be justified.
Factors Associated with Malignant Gastric Ulcers: A 10-year Retrospective Cohort Study.
Zayad A, Yahia Y, Chandra P … +4 more , Obeidat I, Safieh M, Alnakhala S, Saffo HA
Int J Gen Med · 2026 · PMID 42238357 · Full text
BACKGROUND: Gastric ulcers carry a recognized risk of underlying malignancy. Regional evidence remains limited in the Middle East, where historically high prevalence contrasts with comparatively low gastric cancer incid...
BACKGROUND: Gastric ulcers carry a recognized risk of underlying malignancy. Regional evidence remains limited in the Middle East, where historically high prevalence contrasts with comparatively low gastric cancer incidence. This study evaluated the prevalence of malignant gastric ulcers and identified clinical and endoscopic predictors of malignancy. METHODS: A retrospective cohort of all patients diagnosed with gastric ulcer between 2014 and 2024 at Hamad Medical Corporation was analyzed. Local protocols mandate biopsy and follow-up endoscopy, although real-world adherence varies. Collected variables included demographics, ulcer morphology, status, and clinical exposures. Ulcer size was categorized as small (<1.25 cm), medium (1.25-3.0 cm), and large (>3.0 cm). Logistic regression and ROC analyses were used to evaluate predictors and model performance. RESULTS: Among 473 patients, 39 (8.2%) had malignant ulcers. Ulcer size was the strongest predictor of malignancy; medium and large ulcers demonstrated markedly increased odds in univariate and multivariable analyses. Age, sex, smoking, alcohol use, status, and ulcer location showed no independent associations. The multivariable model achieved an AUC of 0.868, compared with 0.790 using ulcer size alone. Adenocarcinoma was the predominant subtype. CONCLUSION: Malignant gastric ulcers accounted for a meaningful minority of ulcer presentations. Ulcer size was the dominant predictor of malignancy, while demographic, lifestyle, and microbial factors added limited discriminatory value. These findings support emphasizing ulcer size in risk stratification and ensuring universal biopsy of all gastric ulcers, with timely follow-up for medium and large lesions.
An Evidence Atlas of Diagnostic Tests for Genitourinary Tuberculosis: A Laboratory-Centered Framework.
Zeng H, Zhang Q
Int J Gen Med · 2026 · PMID 42232022 · Full text
BACKGROUND: Genitourinary tuberculosis (GUTB) remains difficult to diagnose because of nonspecific clinical manifestations, low bacterial burden, and variability in diagnostic performance across laboratory methods and sp...
BACKGROUND: Genitourinary tuberculosis (GUTB) remains difficult to diagnose because of nonspecific clinical manifestations, low bacterial burden, and variability in diagnostic performance across laboratory methods and specimen types. However, the current evidence landscape of laboratory diagnostic tests for GUTB remains fragmented. METHODS: A systematic literature review was conducted using PubMed, Embase, and Web of Science. Studies reporting laboratory diagnostic methods and diagnostic performance for GUTB were included. Core data regarding diagnostic methods, specimen types, diagnostic sensitivity, and turnaround time were extracted and integrated into an evidence atlas using evidence matrices, bubble plots, and Sankey diagrams. RESULTS: A total of 21 studies were included in the evidence atlas. Urine-related specimens were reported in 19 of 21 studies (90.5%), while first-morning urine specimens were used in 9 studies (42.9%). Molecular diagnostic methods, particularly Xpert MTB/RIF, polymerase chain reaction/nucleic acid amplification tests (PCR/NAAT), and simultaneous amplification testing for tuberculosis (SAT-TB), represented the most frequently investigated diagnostic approaches in urine-based specimens. PCR/NAAT-based methods showed reported diagnostic sensitivity ranging from 42.9% to 94.3%, whereas Xpert MTB/RIF demonstrated reported sensitivity ranging from 39.0% to 89.0% across included studies. Evidence matrix and Sankey diagram analyses showed that urine and first-morning urine combined with molecular diagnostic methods represented the most evidence-rich diagnostic pathway in the current literature. In contrast, evidence related to special specimen types, histological examinations, and emerging molecular diagnostic technologies remained limited. CONCLUSION: This evidence atlas provides a structured overview of the current evidence landscape of laboratory diagnostic tests for genitourinary tuberculosis. Urine-based specimens combined with molecular diagnostic methods currently represent the most extensively studied diagnostic pathway. Further studies involving special specimen types, emerging molecular diagnostic technologies, and high-risk populations are needed to strengthen the evidence base for laboratory diagnosis of genitourinary tuberculosis.
Serum Untargeted Metabolomics Profiling of Esophageal Squamous Cell Carcinoma in High-Incidence Areas of China.
Li Y, Zhou L, Huang R … +7 more , Wu Z, Guan J, Qiao X, Kong Y, Gan Y, Zhang Y, Li J
Int J Gen Med · 2026 · PMID 42226806 · Full text
BACKGROUND: As a frequent malignant tumor arising in the upper gastrointestinal tract, esophageal squamous cell carcinoma (ESCC) exhibits an exceptionally high prevalence in China. Metabolic reprogramming is a hallmark o...
BACKGROUND: As a frequent malignant tumor arising in the upper gastrointestinal tract, esophageal squamous cell carcinoma (ESCC) exhibits an exceptionally high prevalence in China. Metabolic reprogramming is a hallmark of cancer, and serum metabolites have been implicated in the development of various gastrointestinal cancers. However, their role in ESCC remains to be further elucidated. OBJECTIVE: The present research sought to characterize the differences in serum metabolism between patients with ESCC and healthy controls (HCs), and explore their potential roles in ESCC initiation. METHODS: From September 2023 to September 2024, 70 previously untreated ESCC patients and 72 matched HCs were recruited. Serum untargeted metabolomics was analyzed by ultra‑high performance liquid chromatography‑Orbitrap‑tandem mass spectrometry (UHPLC‑Orbitrap‑MS/MS), followed by bioinformatic analysis. RESULTS: Compared with HCs, 713 differentially expressed metabolites were identified in ESCC patients, with lipids and lipid‑like molecules representing the biggest category (16.1%). Enrichment analysis of metabolic pathways indicated that biosynthesis of unsaturated fatty acids (UFAs) was the most significantly dysregulated pathway (<0.001), involving a total of seven key metabolites: cis-11-eicosenoic acid, cis-11,14-eicosadienoic acid, docosapentaenoic acid, erucic acid, linoleic acid, oleic acid, and palmitic acid. All seven metabolites were significantly elevated in both early‑stage (Stage I-II) and locally advanced (Stage III) ESCC patients versus HCs, with no significant differences between the two patient groups. A diagnostic signature derived from these metabolites displayed an area under the curve (AUC) of 0.804 (95% confidence interval: 0.729-0.880). CONCLUSION: This study demonstrates significant serum metabolic alterations in ESCC patients, particularly in lipid metabolism and UFA biosynthesis. The seven‑metabolite panel shows favorable discriminatory performance for ESCC, suggesting their potential as biomarkers.
Unaddressed Biases in a Retrospective Study of Anticoagulant Prophylaxis in Trauma Patients [Letter].
Lu CW, Chang KC
Int J Gen Med · 2026 · PMID 42226805 · Full text
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Synergistic Effects of Thymoquinone, 3-Hydrazinoquinoxaline-2-Thiol, and Amphotericin B Against Methicillin-Resistant : In vitro and in silico Evaluation.
Ibrahem K, Alfadil A
Int J Gen Med · 2026 · PMID 42221845 · Full text
INTRODUCTION: Bacterial infections continue to pose a major global health challenge, intensified by the increasing prevalence of antimicrobial-resistant pathogens such as Methicillin-resistant (MRSA). The emergence of r...
INTRODUCTION: Bacterial infections continue to pose a major global health challenge, intensified by the increasing prevalence of antimicrobial-resistant pathogens such as Methicillin-resistant (MRSA). The emergence of resistance mechanisms, particularly the gene encoding PBP2a, significantly reduces the effectiveness of existing antibiotics, including advanced agents like linezolid and daptomycin. Although vancomycin remains a cornerstone therapy, its variable tissue penetration and growing resistance emphasize the urgent need for alternative treatments. This study explores the potential synergistic effects of 3-hydrazinoquinoxaline-2-thiol (3HTQ), thymoquinone (THQ), and amphotericin B against clinical MRSA isolates. METHODS: Antibacterial activity was evaluated using broth microdilution and checkerboard assays. Molecular docking and molecular dynamics (MD) simulations were performed to assess binding interactions and complex stability. Minimum inhibitory concentrations (MICs) were determined for each compound and their combinations. RESULTS: Amphotericin B alone exhibited limited antibacterial activity with baseline MIC values ranging from 16-64 μg/mL; however, when combined with THQ and 3HTQ, the MIC values were markedly reduced-up to 32-fold in some MRSA isolates. Checkerboard analysis confirmed synergism, with fractional inhibitory concentration index (FICI) values ≤0.5. Molecular docking suggested potential interactions with key MRSA proteins, particularly PBP2a, while MD simulations indicated relative stability of these complexes. CONCLUSION: The proposed mechanisms are based solely on in silico analyses and computational modeling, rather than direct biological or molecular experiments. These findings, supported by in vitro data and computational analyses, suggest that combining 3HTQ, THQ, and amphotericin B could be explored as a potential approach for managing MRSA infections and overcoming emerging antimicrobial resistance.
Integrated Transcriptomics and Experimental Validation Reveal Müller Cell-Driven PANoptosis in Diabetic Retinopathy via PSAP-GPR37 Signaling.
Li J, Chen Y, Chao Y … +3 more , Zhang Y, Gan F, You Z
Int J Gen Med · 2026 · PMID 42221844 · Full text
BACKGROUND: Diabetic retinopathy (DR) is a major complication of diabetes leading to severe visual impairment. PANoptosis, a pro-inflammatory programmed cell death (PCD), has emerged as a potential pathological mechanism...
BACKGROUND: Diabetic retinopathy (DR) is a major complication of diabetes leading to severe visual impairment. PANoptosis, a pro-inflammatory programmed cell death (PCD), has emerged as a potential pathological mechanism. This study aimed to elucidate the role of membrane protein-mediated PANoptosis in key cell populations during DR progression and to screen for coregulated genes with therapeutic potential. METHODS: We integrated rat single-cell (scRNA-seq) and human bulk transcriptomes to identify differentially expressed PANoptosis-related genes (DE-PRGs). Single-sample gene set enrichment analysis (ssGSEA) was used to score PANoptosis activity, and CellChat was employed to examine ligand-receptor communications. Key cell subpopulations were characterized, and a protein-protein interaction (PPI) network was constructed to identify hub genes. Drug targets were predicted via the DGIDB database. Key findings were validated in a DR rat model and high-glucose-treated retinal Müller cells (RMC-1) using qRT-PCR, Western blotting, cell death assays, and siRNA-mediated PSAP knockdown. RESULTS: We identified 27 DE-PRGs enriched in TNF, PCD, and p53 signaling pathways. Müller cells exhibited significantly elevated PANoptosis scores in the DR group. Intercellular communication analysis indicated that Müller cells transmit pro-apoptotic signals via the PSAP-GPR37 ligand-receptor axis. Sub-clustering identified "Müller2" as the key pathogenic subpopulation, characterized by high PSAP-GPR37 expression. Ten hub genes were screened, yielding 26 potential drug targets. Validation confirmed the downregulation of DLG4 and the upregulation of FN1, EMP3, PDGFRβ, and PSAP in DR models. In vitro, high glucose induced cell death and upregulated PANoptosis markers (NLRP3, cleaved caspase-8, and the p-MLKL/MLKL ratio). Notably, siRNA-mediated PSAP knockdown effectively attenuated the high glucose-induced elevation of these PANoptosis proteins. CONCLUSION: Integrating single-cell and bulk transcriptomics, this study suggests Müller cells-specifically the Müller2 subpopulation-as central drivers of PANoptosis in DR via PSAP-GPR37 signaling. Furthermore, the identified hub genes and PSAP provide a theoretical basis for precise, cell-subpopulation-specific intervention strategies.
IL18 Works Like a Two-Side Coin in Acute Pancreatitis.
Zhou K, Liu L, Bao J … +4 more , Wang C, Wang X, Jiang W, Wan R
Int J Gen Med · 2026 · PMID 42221843 · Full text
PURPOSE: Acute pancreatitis is a common disease with limited supportive treatments. Finding effective biomarkers is of great significance for early diagnosis and therapy, as well as to achieve better prognosis. MATERIALS...
PURPOSE: Acute pancreatitis is a common disease with limited supportive treatments. Finding effective biomarkers is of great significance for early diagnosis and therapy, as well as to achieve better prognosis. MATERIALS AND METHODS: The core genes of AP were identified through bioinformatics and machine learning. The expression, clinical features, biological function and immunological effects of the characteristic gene were also evaluated. AP murine models were constructed to verify the results in vivo. Finally, Mendelian randomization studies were performed to determine the causal relationship between IL-18 and AP through genome-wide association studies. RESULTS: A total of 100 core genes were obtained, and IL18 was identified as the characteristic gene for AP. The expression of IL18 was increased in AP (<0.001) with an AUC value of 0.917. And some immune responses were inhibited when IL18 is highly expressed. In addition, the OR for IL18 and AP was 0.908 (95% CI = 0.843-0.978, =0.011) via inverse variance weighting (IVW). CONCLUSION: Elevated IL18 can be used to predict the clinical prognosis and immune responses in AP. Meanwhile, MR suggests that an increase in IL18 indicates a low risk of AP, implying that the course of AP often presents a self-limiting feature in clinic.
Andrographolide in Sepsis: Mechanistic Basis, New Drug States, and Advanced Delivery Systems.
Zhu Q, Hu D, Xing J … +1 more , Zhao Q
Int J Gen Med · 2026 · PMID 42221842 · Full text
Sepsis is a leading cause of preventable mortality, and effective adjunct therapies that recalibrate the host response remain scarce. Andrographolide, a diterpenoid lactone from Andrographis paniculata, shows anti-inflam...
Sepsis is a leading cause of preventable mortality, and effective adjunct therapies that recalibrate the host response remain scarce. Andrographolide, a diterpenoid lactone from Andrographis paniculata, shows anti-inflammatory, antioxidant, endothelial-protective, and immunomodulatory activity in experimental sepsis and related inflammatory models. This narrative review examines both the mechanistic basis and the translational constraints of andrographolide in sepsis, with emphasis on modulation of Toll-like receptor 4 signaling and downstream NF-κB/MAPK activation, restraint of NLRP3 inflammasome activity, mitigation of mitochondrial stress and danger-signal amplification, and preservation of endothelial barrier function while partially maintaining bacterial clearance. We also discuss the major pharmaceutical liabilities of andrographolide, including extremely low aqueous solubility and limited systemic exposure, and distinguish exposure-enabling solid-state strategies from delivery platforms with potential relevance to acute sepsis care. Because the direct evidence base remains largely preclinical and the available human data derive mainly from non-sepsis conditions, current findings support hypothesis generation and translational exploration rather than clinical positioning in sepsis. Future priorities include septic PK/PD definition, route-appropriate formulation development, entity-specific safety evaluation, and rigorous validation in clinically relevant models and trials.
Targeting Ferroptosis for Cerebral Neuroprotection in Ischemic Stroke: Pathophysiological Insights.
Song C, Tang S, Huang Y … +2 more , Xie G, Tang J
Int J Gen Med · 2026 · PMID 42221841 · Full text
Acute ischemic stroke, a leading cause of neurological disability, stemed from cerebral hypoperfusion-induced ischemia/reperfusion (I/R) injury. Ferroptosis, an iron-dependent, lipid peroxidation-driven cell death, has e...
Acute ischemic stroke, a leading cause of neurological disability, stemed from cerebral hypoperfusion-induced ischemia/reperfusion (I/R) injury. Ferroptosis, an iron-dependent, lipid peroxidation-driven cell death, has emerged as a key pathological driver. Unlike apoptosis, ferroptosis involves glutathione peroxidase 4 (GPX4) inactivation, iron dysregulation, and lethal lipid peroxides. Its preclinical inhibition reduced neuronal loss, demonstrating therapeutic promise. Ischemic injury activated accidental/regulated cell death pathways, with ferroptosis, apoptosis, and pyroptosis dynamically regulated by ischemia duration/severity. Convergent mechanisms included hypoxia-induced mitochondrial dysfunction, iron/lipid peroxidation disrupting blood-brain barrier integrity, glutamate-ferroptosis oxidative crosstalk, and Ca overload via reversed Na/Ca exchange and NMDA hyperactivity. Clinically, cerebrospinal ferritin elevation and parenchymal iron deposition predicted poor outcomes, prioritizing iron homeostasis modulation. GPX4 activation, ACSL4/LOX inhibition, and ACSL3-mediated MUFA integration have showed efficacy in preclinical models. Translational barriers included poor blood-brain barrier permeability of inhibitors, unvalidated human pathways, and lack of relevant comorbid models. Advancing therapies required biomarker discovery, human tissue validation, and integrated models to bridge mechanisms and clinical translation. Ferroptosis inhibition emerged as a neuroprotective strategy with transformative therapeutic potential for acute ischemic stroke, offering a novel avenue to mitigate neuronal injury and improve clinical outcomes.
Functional Recovery After Chemotherapy- and Radiotherapy-Induced Gastrointestinal Injury: Mechanisms, Clinical Assessment, and Management.
Ju K, Shan Y, Pan L
Int J Gen Med · 2026 · PMID 42221840 · Full text
Chemotherapy- and radiotherapy-induced gastrointestinal injury is a common complication of cancer treatment and may present with diarrhea, abdominal pain, urgency, bloating, rectal bleeding, and reduced oral intake. Alth...
Chemotherapy- and radiotherapy-induced gastrointestinal injury is a common complication of cancer treatment and may present with diarrhea, abdominal pain, urgency, bloating, rectal bleeding, and reduced oral intake. Although many cases improve after treatment completion, some patients develop persistent or late bowel dysfunction that impairs nutrition, treatment tolerance, daily functioning, and quality of life. Conventional terms such as toxicity, mucositis, and enteritis are clinically useful, but they do not fully capture the problem of incomplete functional recovery. We propose a practical recovery-oriented framework that operationalizes meaningful recovery across four interconnected domains: structural recovery, barrier recovery, clinical recovery, and patient-centered recovery. Using this framework, we summarize the acute-to-chronic clinical spectrum of luminal gastrointestinal injury, examine mechanisms of failed recovery, review clinical assessment and management, and discuss emerging strategies including biomarker-guided monitoring, microbiome-directed interventions, organoid-based platforms, and regenerative therapies. Current care remains largely supportive and symptom-centered. A recovery-oriented model may improve clinical decision-making by integrating symptom trajectory, nutritional status, treatment tolerance, patient-reported burden, and selected biological signals to better monitor and restore gastrointestinal function.
Medication Use and Guideline Adherence in Inflammatory Bowel Disease Management: A Retrospective Study from a Tertiary Care Hospital in Pakistan (2019-2024).
Yasin H, Jamshed S, Balquis F … +9 more , Ibrar F, Chaudhry SR, Ahmad J, Mohamad Ibrahim MI, Sivanandy P, Iqbal A, Syed W, Alharbi BS, Aljabri MM
Int J Gen Med · 2026 · PMID 42221839 · Full text
BACKGROUND: Inflammatory bowel disease (IBD) remains understudied in Pakistan. This retrospective observational study assessed the management of IBD patients at Shifa International Hospital, Islamabad, from January 2019...
BACKGROUND: Inflammatory bowel disease (IBD) remains understudied in Pakistan. This retrospective observational study assessed the management of IBD patients at Shifa International Hospital, Islamabad, from January 2019 to June 2024. METHODS: Adherence to UK NICE 2019 guidelines (NG129 for CD, NG130 for UC) was evaluated. Data from 167 adult IBD patients (from initial 238 identified; 141 ulcerative colitis, 26 Crohn's disease) were extracted from electronic medical records after excluding inactive cases (n = 60), paediatric patients (n = 7), pregnant women (n = 3), and unconfirmed diagnoses (n = 1). Demographics, medications, comorbidities, surgeries, and diagnostic findings were analysed. RESULTS: Steroids were administered to 54.5% of patients (52.7% UC, 1.8% CD), aminosalicylates to 53.9% (50.3% UC, 3.6% CD), and immunosuppressants to 43.7% (40.2% UC, 3.5% CD). Discharge medications included steroids (46.1%), aminosalicylates (49.1%), and immunosuppressants (31.1%). Only 3/9 UC and 5/9 CD guideline recommendations were followed. Biologic use (anti-TNF) was low (8.9%), and 18% underwent surgery (total proctocolectomy most common). Diabetes (31%) and hypertension (28%) were prevalent comorbidities. Abdominal pain (52%) and diarrhea (46%) were frequent complaints. Colonoscopy (43%) and biopsies (20.4%) were key diagnostic tools. Histopathology revealed mild inflammation (29.4%) and moderate-severe inflammation (17.4%). CONCLUSION: IBD management showed significant deviation from international guidelines, particularly regarding biologic utilization (8.9%) and surgical rates (18%). These findings highlight urgent need for resource-stratified treatment protocols and enhanced clinical training to bridge the gap between evidence-based recommendations and real-world practice in resource limited settings.
The Value of NLR, PLR, MLR, and SII Combined with Lower Respiratory Tract Symptoms in Predicting Pulmonary Complications in Non-Risk-Factor Influenza A Patients.
Ai S, Wu H, Gu R … +3 more , Zhang S, Luo J, Xu F
Int J Gen Med · 2026 · PMID 42211561 · Full text
OBJECTIVE: To analyze the predictive value of blood cell count results, derived indicators, and patient symptoms for pulmonary complications in non-risk-factor influenza A patients. METHODS: A retrospective cohort study...
OBJECTIVE: To analyze the predictive value of blood cell count results, derived indicators, and patient symptoms for pulmonary complications in non-risk-factor influenza A patients. METHODS: A retrospective cohort study analyzed 54 non-risk-factor influenza A patients. Those with pulmonary complications were assigned to the PC group, while the others were placed in the NPC group. Blood cell count and its derived indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII), were compared between the two groups. Four prediction models with different symptoms were established, and the ROC curve was used to verify their predictive value for pulmonary complications in non-risk-factor influenza A patients. Multivariate logistic regression was applied to the optimal prediction model. RESULTS: Lower respiratory tract symptoms were present in 63.6% of patients in the PC group, which was significantly higher than the 25.6% in the NPC group (P < 0.05). The PC group exhibited significantly higher levels of white blood cell (WBC) count (9.38 ± 3.98×10/L vs. 6.54 ± 2.37×10/L), neutrophil count (8.05 ± 3.94×10/L vs. 5.16 ± 2.25×10/L), NLR (13.36 ± 7.26 vs. 7.42 ± 4.04), and SII (2548.87 ± 1967.89 vs. 1437.40 ± 892.69) compared with the NPC group. In ROC, WBC, neutrophils, and NLR were valid predictors of pulmonary complications. Among them, NLR showed the best individual predictive performance (AUC = 0.746). All four combined models achieved higher AUC values than NLR alone, and Model 4 (lower respiratory tract symptoms + NLR) presented the highest AUC of 0.829. Multivariate logistic regression identified that an elevated NLR (OR = 1.34, 95% CI: 1.10-1.63, P = 0.004) and lower respiratory tract symptoms (OR = 15.26, 95% CI: 1.95-119.31, P = 0.009) were independent risk factors for pulmonary complications. CONCLUSION: Elevated NLR and lower respiratory tract symptoms are independent predictors of pulmonary complications in non-risk-factor influenza A patients. Their combination offers more accurate and effective predictive value for early risk stratification.
Maternal Diabetes and Attention Deficit/Hyperactivity Disorder Association: A Narrative Review on Emerging Evidence, Research Gaps and Future Directions.
Zhao C, Liu Y
Int J Gen Med · 2026 · PMID 42205682 · Full text
Maternal diabetes includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), with increasing prevalence globally. Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neur...
Maternal diabetes includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), with increasing prevalence globally. Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neurodevelopmental disorder. This narrative review synthesizes epidemiological and mechanistic evidence published mainly since 2023 to explore the association between maternal diabetes and ADHD in offspring. Pooled data show that maternal diabetes increases offspring ADHD risk by approximately 30%, with PGDM showing a stronger association than GDM, and poorly controlled diabetes or diabetes requiring medication conferring higher risk. Mechanistically, intrauterine hyperglycemia induces oxidative stress, inflammatory responses, placental dysfunction, neurotransmitter imbalance, and epigenetic alterations, which may impair fetal neurodevelopment. Inconsistencies remain in diabetes classification, diagnostic criteria, glycemic control level, and offspring assessment age. Most existing studies are observational and cannot confirm causality. This review identifies research limitations and provides a theoretical basis for prenatal glucose management and early intervention. These findings have important public health implications for reducing the burden of neurodevelopmental disorders.
Evolocumab Alters Transcriptomic Signatures and Identifies Inflammatory Biomarkers in Brain-Heart Syndrome with Coronary Heart Disease History.
Dong H, Gong X, Zhao Z … +3 more , Joyama Y, Ji X, Qu P
Int J Gen Med · 2026 · PMID 42205681 · Full text
PURPOSE: A history of coronary heart disease (CHD) increases the risk of Brain-Heart Syndrome (BHS) after acute stroke, partly through heightened inflammatory responses. Evolocumab, a PCSK9 inhibitor, has anti-inflammato...
PURPOSE: A history of coronary heart disease (CHD) increases the risk of Brain-Heart Syndrome (BHS) after acute stroke, partly through heightened inflammatory responses. Evolocumab, a PCSK9 inhibitor, has anti-inflammatory properties, but its transcriptomic effects in BHS patients with CHD remain unclear. This study aims to identify evolocumab-associated transcriptomic changes and inflammation-related biomarkers in this population. PATIENTS AND METHODS: Blood samples from 24 BHS patients with CHD history (12 receiving rosuvastatin alone, 12 receiving rosuvastatin plus evolocumab) underwent transcriptomic sequencing. Candidate biomarkers were identified via differential expression and machine learning, with functional enrichment and immune infiltration analyses conducted. RESULTS: Four candidate biomarkers were identified: , , and were upregulated, while was downregulated in the evolocumab combination group. These genes were enriched in pathways related to cell metabolism, signal transduction, and immune regulation. Immune infiltration analysis showed modest but detectable changes in B-cell subsets. External validation confirmed differential expression of these candidate biomarkers in CAD patients. CONCLUSION: This pilot study provides preliminary insights into the molecular mechanisms of evolocumab in treating Brain-Heart Syndrome with a coronary heart disease history, identifying four inflammation-related biomarkers. These findings suggest potential targets for future investigation; however, given the exploratory nature and small sample size, further experimental and clinical validation is required before any therapeutic application.
Construction and Validation of a Predictive Model for Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension Based on Lasso Regression.
Zhou Q, Zhu G, Zhang P … +1 more , Qi B
Int J Gen Med · 2026 · PMID 42199984 · Full text
PURPOSE: Chronic obstructive pulmonary disease (COPD) is often complicated by pulmonary hypertension (PH), leading to symptom exacerbation, increased mortality, and poor prognosis. Early identification of high-risk patie...
PURPOSE: Chronic obstructive pulmonary disease (COPD) is often complicated by pulmonary hypertension (PH), leading to symptom exacerbation, increased mortality, and poor prognosis. Early identification of high-risk patients is crucial for timely intervention. This study aims to construct and validate a machine learning-based predictive model for COPD patients with PH. PATIENTS AND METHODS: A retrospective analysis was conducted on 537 COPD patients admitted to Anhui NO.2 Provincial People's Hospital from December 2023 to November 2025. The patients were randomly divided into a model construction group (n=376) and an internal validation group (n=161) at a ratio of 7:3. Clinical and laboratory data were collected. LASSO regression, a method that effectively selects the most relevant predictors by shrinking less important variables to zero, was used to screen predictive variables. This was followed by the construction of a nomogram model through multivariate logistic regression. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and clinical impact curve. RESULTS: LASSO regression identified six independent predictors: Duration of COPD, Long-Term Domiciliary Oxygen Therapy, systemic inflammatory response index, red blood cell distribution width, arterial oxygen partial pressure, and B-type natriuretic peptide. The nomogram model demonstrated excellent discriminative power, with an AUC of 0.812 (95% CI: 0.762-0.863) in the model group and 0.826 (95% CI: 0.754-0.897) in the validation group. Calibration curves and clinical impact curves showed high consistency between predicted and observed values. CONCLUSION: Our study constructed and internally validated a nomogram model based on LASSO regression, incorporating six easily accessible clinical variables, which can be used to predict the risk of PH in COPD patients. The model facilitates early clinical identification of high-risk patients, risk stratification, and implementation of individualized management.
Patient Educational Needs and Communication Barriers in Dermatology Clinics in Saudi Arabia: A Cross-Sectional Survey.
Alshammarie FF, Alhobera A, Alshammari M
Int J Gen Med · 2026 · PMID 42199983 · Full text
PURPOSE: Understanding patient perspectives is essential to improving quality and satisfaction of care in dermatology clinics. In Saudi Arabia, limited national data exist on patients' educational needs and communication...
PURPOSE: Understanding patient perspectives is essential to improving quality and satisfaction of care in dermatology clinics. In Saudi Arabia, limited national data exist on patients' educational needs and communication barriers. This study aimed to assess patient satisfaction, identify educational gaps, and explore communication challenges in dermatology clinics across Saudi Arabia. PATIENTS AND METHODS: A national cross-sectional survey was conducted among 976 dermatology patients. A structured questionnaire evaluated demographics, perceived knowledge, satisfaction with information provided, communication barriers, and preferred educational methods. Descriptive statistics and chi-square tests were used for analysis. RESULTS: Among participants who had attended dermatology clinics (n = 795), 61.6% reported frequent or occasional confusion about their condition, and only 45.4% demonstrated high self-reported knowledge. Overall satisfaction was moderate, with 58.3% satisfied or very satisfied, while 9.9% reported dissatisfaction. The most reported communication barriers were limited consultation time (25.2%) and patient anxiety about asking questions (15.3%). Patients felt least informed about treatment options (22.6%), diagnosis (20.3%), and potential side effects (19.3%). Most participants (70.6%) preferred language communication to be in Arabic, and 78% favored face-to-face education consultation. Patient knowledge, barriers and preferences significantly differed with age, gender, and condition complexity (p < 0.05). CONCLUSION: Dermatology patients in Saudi Arabia report moderate satisfaction with substantial educational needs and communication barriers. Addressing consultation time constraints, fostering supportive communication environments, and providing patient-centered, language-appropriate education; particularly through face-to-face interactions will aid to enhance understanding, satisfaction, and engagement in for overall better provider-patient dermatologic care.
Association of the National Database Code "General Anesthesia" and Mechanical Ventilation with New-Onset Neuro-Psychiatric Medication Use in Sepsis Survivors Aged ≥90 Years: A Nationwide Retrospective Cohort Study.
Shimoyama Y, Kadono N, Umegaki O
Int J Gen Med · 2026 · PMID 42199982 · Full text
PURPOSE: As the global population ages, Post-Intensive Care Syndrome (PICS) has emerged as a critical public health concern. However, in sepsis survivors aged 90 years or older, the etiology of cognitive and mental decli...
PURPOSE: As the global population ages, Post-Intensive Care Syndrome (PICS) has emerged as a critical public health concern. However, in sepsis survivors aged 90 years or older, the etiology of cognitive and mental decline remains obscured by the natural aging process. A pivotal unresolved debate in critical care is distinguishing whether this neuro-psychiatric decline is driven by "mechanical ventilation" (associated with sedation and immobilization) or "general anesthesia" (representing surgical stress and systemic inflammation). This study aimed to evaluate the association of the National Database (NDB) codes for general anesthesia and mechanical ventilation with the new-onset neuro-psychiatric medication use in sepsis survivors aged ≥ 90 years. PATIENTS AND METHODS: In this retrospective cohort study using the National Database of Japan, we identified a previously independent cohort of sepsis survivors aged ≥ 90 years without prior psychotropic use or home care. The primary outcome was new CNS-active medication initiation within 6 months. We performed multivariate logistic regression, utilizing Variance Inflation Factor (VIF) analysis to mathematically rule out multicollinearity between anesthesia and ventilation. RESULTS: Among 269 strictly selected independent survivors, 83 (30.9%) initiated new CNS-active medications. VIF analysis confirmed the complete statistical independence of the two factors (VIF < 1.02). General anesthesia independently predicted the outcome (Odds Ratio [OR] 1.85; 95% CI 1.05-3.25; P = 0.032), whereas mechanical ventilation did not (OR 0.82; P = 0.502). Phenotypic analysis revealed general anesthesia shifted risks toward sleep-wake (50.0%) and sensory dysregulation (43.8%) rather than frank dementia (27.3%). Furthermore, general anesthesia was associated with a significant concurrent loss of physical and mental autonomy (P = 0.036). CONCLUSION: Supported by VIF analysis, the general anesthesia code was independently associated with systemic neuro-vulnerability in nonagenarians. Surgical stress is specifically associated with a phenotypic shift toward sleep and sensory dysregulation and concurrent loss of autonomy, necessitating a paradigm shift in surgical decision-making.
Phytochemical Monomers Derived from Traditional Chinese Medicine May Prevent and Treat Atherosclerosis by Modulating the Macrophage Mitochondrial-Lysosomal Senescence Axis.
Zhao H, Ren W, Jiang H … +4 more , Zhou R, Deng Y, Huang H, Wang P
Int J Gen Med · 2026 · PMID 42199981 · Full text
The pathogenesis of atherosclerosis (AS) is evolving from a lipid-centric view to a paradigm of immunosenescence. Stress-induced senescence of plaque macrophages is associated with inflammation and instability via the se...
The pathogenesis of atherosclerosis (AS) is evolving from a lipid-centric view to a paradigm of immunosenescence. Stress-induced senescence of plaque macrophages is associated with inflammation and instability via the senescence-associated secretory phenotype (SASP). Dysfunction of the integrated "mitochondria-lysosome senescence axis" is thought to play a key role in maintaining this senescent state, which correlates with lipid overload, impaired efferocytosis, and fibrous cap degradation. Multi-targ et monomers from Traditional Chinese Medicine (TCM) such as quercetin, Tanshinone IIA, berberine, and baicalein have been shown to modulate senescent macrophages, potentially via this axis. Proposed mechanisms include inhibiting p38 MAPK/p16 signaling, reducing scavenger receptor-mediated lipid uptake, enhancing cholesterol efflux, suppressing the NF-κB/NLRP3 inflammasome, promoting efferocytosis via TAM receptors, and restoring metabolic support for lysosomal acidification. This review synthesizes the role of the mitochondria-lysosome axis in AS and highlights the potential of TCM monomers to stabilize plaques, providing a novel framework for therapeutic development.
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