Medicine

Kim, Sun Oh; Park, Jong-Seon

doi: 10.1097/md.0000000000042097pmid: 40295307

Rationale: Hematoma of the iliacus muscle is a rare but acknowledged complication associated with anticoagulant therapy. This condition may lead to nerve dysfunction due to compression, particularly affecting the femoral nerve. While there is no established guideline for its management, there has been a consensus favoring surgical intervention in cases of large hematoma with worsening neurological deficits. Patient concerns: A 67-year-old female presented to emergency room with acute groin pain, numbness in her right leg, and motor weakness following strenuous squat exercises. The patient had been prescribed warfarin for valvular atrial fibrillation. Laboratory tests revealed anemia and prolonged prothrombin time. Abdominal computed tomography revealed contrast leakage within the iliacus muscle. Subsequent electromyography and nerve conduction studies indicated findings suggestive of femoral neuropathy. Diagnosis: The patient was diagnosed with an actively bleeding iliacus muscle hematoma with femoral neuropathy. Intervention: Angiography of the right internal iliac artery identified contrast extravasation at the branch of the iliolumbar artery. Selective embolization of the iliolumbar artery branch was performed. Outcomes: Following embolization, no further decline in hemoglobin level was observed. With discontinuation of anticoagulants and conservative management, the patient’s sensory function in the right leg recovered, and the motor grade for knee extension improved from 1 to 4 within 3 weeks. Lessons: Even in the case of large iliacus hematoma with femoral neuropathy, conservative management without surgery can be a viable option if bleeding is well controlled with intervention.

Wang, Lanying; Guo, Guixian; Tang, Shanshan; Sun, Shaoqin; Wu, Ran

doi: 10.1097/md.0000000000042354pmid: 40295230

Rationale: Currently, the main comorbidities of psoriasis are cardiovascular, metabolic, liver and kidney, autoimmune, and psychological disorders. Psoriasis associated with pemphigus is relatively rare. This rare disease presents with significant clinical, diagnostic, and therapeutic challenges. Patient concerns: The patient was a 71-year-old man with recurrent erythema, papules, and scales with itching all over the body for 11 years, accompanied by blisters and erosions for more than 1 month, and aggravated by generalized eruption for 1 week. The patient was diagnosed with pemphigus vulgaris and admitted to our hospital with intravenous methylprednisolone combined with a conventional oral antihistamine and topical hormonal ointment. The patient’s symptoms significantly disappeared. The patient complained that his condition recurred easily after discontinuing medication, which seriously affected his daily life and sleep. The patient also had essential hypertension, nail psoriasis, tinea pedis, and onychomycosis. Diagnoses: The patient was diagnosed with psoriasis vulgaris with coexisting pemphigus vulgaris. Interventions: The patient was treated with modest doses of glucocorticoids combined with secukinumab and methotrexate. Outcomes: The patient’s generalized skin lesions and fingernails and toenails of the hands and feet healed virtually. There was no recurrence at 8 months follow-up, and no adverse effects were noted. Lessons: Moderate-dose glucocorticoids combined with secukinumab and methotrexate may be an option for treating psoriasis and pemphigus vulgaris. This case allows us to consider whether we can treat psoriasis vulgaris combined with pemphigus vulgaris based on a common pathogenesis, and to guide us in clinical dosing.

Wu, Zhiyuan; Lin, Yi; Lin, Youlai

doi: 10.1097/md.0000000000041915pmid: 40295246

Background: It is unclear that the influence of age on degenerative joint disease (DJD) of the temporomandibular joint (TMJ). Methods: Relevant literature was retrieved from PubMed, Elsevier, Web of Science, and Google Scholar. EndNote 21 was used to consolidate the literature retrieved from these databases. Key information were extracted from the included studies, statistical analysis was performed using Stata 15.0. The quality of the studies was evaluated using the cross-sectional study evaluation criteria recommended by the Agency for Healthcare Research and Quality. Results: A total of 11 studies involving 2832 participants (1099 males, 1744 females) were included. The incidence of DJD of the TMJ was approximately 35% among individuals aged 20 to 39, 43% among those aged 40 to 59, and 54% among those aged 60–69. Conclusion: Age progression is a key risk factor for the development of DJD of the TMJ. The incidence of DJD of the TMJ increases progressively across different age groups, with a significant rise observed in middle to older age groups.

Lin, Yan; Qiu, Bin-Wei; Xu, Kai-Li; Lin, Jin-Liang

doi: 10.1097/md.0000000000042262pmid: 40295249

Asthma is a common chronic respiratory disease related to oxidative stress. Oxidative balance score (OBS) could assess systemic oxidative stress status. Thus, we tried to explore the prediction value of OBS in asthma and the disease course. The data were obtained from the National Health and Nutrition Examination Survey database. Asthma and the disease course were determined by the Patient Health Questionnaire. OBS was scored by 20 dietary and lifestyle components. The receiver operating characteristic and decision curve analysis were used to assess the prediction value of OBS. Logistic regression, XG Boost, and Random Forest methods were used to obtain an optimal OBS-based model and rank the importance of OBS components. Mediation analysis was used to explore the possible interplay of OBS components on the disease course of asthma. From 2011 to 2018, 7348 participants including 6597 participants without asthma and 751 participants with asthma were enrolled. Receiver operating characteristic and decision curve analysis curves exhibited that the OBS-based model showed an improved prediction value than the OBS for the disease course of asthma. Machine learning techniques results showed that the body mass index, niacin, and selenium were the key components of OBS. Besides, niacin had a direct relation with the disease course and could also regulate the course of asthma by regulating body mass index. OBS could predict the disease course of asthma, and niacin may be the most important component of OBS in the development of asthma.

Chiou, Tz-Wei; Young, Chi-Kuang; Hsu, Ken-Hao; Liao, Chun-Ta; Hu, Yu-Feng; Kang, Chung-Jan; Huang, Shiang-Fu

doi: 10.1097/md.0000000000042181pmid: 40295278

This study aims to investigate the correlation between esophageal second primary neoplasm (ESPN) in head and neck cancers. Panendoscopy findings of ESPN can guide clinicians in timely interventions and improve patients’ outcomes. We performed a retrospective cohort study in Linkou Chang Gung Memorial Hospital, and 365 patients who met the criteria from 2015 to 2021 were enrolled. We collected the lifestyle habits and panendoscopy report after the HNC was diagnosed. Of 365 HNC patients, 37 (10.1%) had ESPNs, which included low dysplasia, high dysplasia, squamous cell carcinoma in situ and squamous cell carcinoma. We found that alcohol (P = .004) and areca-quids (AQs) consumption (P = .003) had significant differences in different HNC subsites. Oral cavity cancers had the highest association with alcohol and AQs consumption. Hypopharyngeal cancer has the highest ESPN incidence with highest odds ratio (OR = 13.3, P < .001), followed by oropharynx, larynx, and oral cavity. In addition, we found that alcohol (P = .002) and cigarette consumption (P = .040) were associated with the ESPN development. Other panendoscopy findings such as gastroesophageal reflux disease, esophageal mucosa break, gastritis ulceration, and gastritis showed insignificant correlations with the occurrence of ESPN. Half of the ESPN were found within 24 months after the diagnosis of HNC, especially for hypopharyngeal cancer, in which ESPN even occurs within 12 months of the diagnosis of primary tumor. Routine panendoscopy for patients with HNC is highly advised, and our study suggests having intensive surveys in the first 24 months after the diagnosis of primary HNC; especially for hypopharyngeal cancer. This study was reported in strict compliance with the strengthening the reporting of observational studies in epidemiology (STROBE) guideline.

Oud, Lavi; Garza, John

doi: 10.1097/md.0000000000042219pmid: 40295292

The evidence on the temporal trends of short-term mortality among critically ill patients with status epilepticus (SE) is limited and relatively dated, with data lacking on the prognostic impact of the coronavirus disease 2019 (COVID-19) pandemic in these patients. We used statewide data to examine intensive care unit (ICU) admissions with SE aged ≥ 18 years in Texas during 2016 to 2022. Interrupted time series analyses using segmented hierarchical logistic models were fit to estimate trends in hospital mortality during the prepandemic and COVID-19 pandemic periods overall and within age, sex, and race and ethnicity strata, expressed as average marginal effects (AME). Separate hierarchical models were fit to forecast hospital mortality during the pandemic period had the pandemic not occurred (counterfactual). There were 27,885 ICU admissions with SE during the study period (33.1% aged ≥ 65 years, 58.8% racial and ethnic minority, 2.4% with COVID-19, 51.8% mechanically ventilated). Overall hospital mortality was 10.6%. On interrupted time series analyses, hospital mortality decreased during the prepandemic period overall (AME −0.31%/quarter [95% confidence interval −0.39 to −0.23]) and within all demographic strata, except those aged 18 to 44 years, whose hospital mortality was unchanged. During the pandemic period hospital mortality remained unchanged over time overall (AME −0.03%/quarter [95% confidence interval −0.18 to 0.11]) and for all demographic strata, and was consistently higher than counterfactual estimates, including following the exclusion of ICU admissions with COVID-19. Hospital mortality has decreased among critically ill patients with SE prior to the pandemic, except among younger adults. However, these outcome gains were stalled by the COVID-19 pandemic, with increased hospital deaths in this population. Determination of the specific contributions of the disruption in neurological and neuro-critical care support systems and of general health system factors to the adverse outcomes of critically ill patients with SE is paramount for future mitigation and recovery efforts. These data can inform effective implementation of care protocols in SE under population-wide health crises, as well as health policy and resource allocation. Finally, as the pandemic is receding, it is crucial to determine whether there is corresponding recovery of the prepandemic mortality trends in this population.

Zhang, Ling; Cao, Jing; Hu, Ji-Hong

doi: 10.1097/md.0000000000042021pmid: 40295234

This study explores the clinical application value of percutaneous endoscopic gastrostomy (PEG) in children with dysphagia after brain injury. Children with dysphagia after brain injury were selected and randomly divided into a treatment group and a control group using a random number table method, with 42 cases in each group. The control group received nutritional support using indwelling nasogastric tube technology, while the treatment group received nutritional support using PEG technology. Both groups received the same tube feeding nutrient solution. At the same time, both groups of patients received comprehensive training methods including oral sensation training, oral exercise training, and physical therapy for swallowing dysfunction. Weight, total serum protein, serum albumin, and hemoglobin of the patients were measured 1 day before treatment and 28 days after treatment, respectively. The degree of dysphagia was evaluated by the water swallow test and the dysphagia disorders survey of each patient 1 day before treatment and 28 days after treatment, respectively. Adverse events such as gastrointestinal bleeding, aspiration pneumonia, and reflux esophagitis were recorded. After 28 days of treatment, both the control group and the PEG group showed an increase in body weight, total serum protein, serum albumin, and hemoglobin compared to before treatment (P < .05), and the PEG group showed a more significant increase than the control group (P < .05). At the same time, swallowing function improved more significantly in the PEG group (P < .05), and the incidence of adverse events was lower compared to the control group (P < .05). The comprehensive training method for swallowing disorders combined with enteral PEG nutrition has a definite effect on children with swallowing disorders after traumatic brain injury.

Rossom, Rebecca C.; Yeh, Hsueh-Han; Ma, Lisiyu; Penfold, Robert B.; Hooker, Stephanie A.; Miller-Matero, Lisa R.; Simon, Gregory; Owen-Smith, Ashli; Borgert-Spaniol, Caitlin M.; Ahmedani, Brian

doi: 10.1097/md.0000000000042305pmid: 40295248

While depression and anxiety increased with the COVID-19 pandemic, mental health (MH) care access plummeted. This accelerated the uptake of virtual visits, but the degree to which these supplanted in-person visits is unknown. This study aims to assess in-person and virtual MH visits prior to and during the pandemic. Visits from HealthPartners (Minnesota, Wisconsin), Henry Ford (Michigan) and Kaiser Washington (Washington, Oregon) from 2018 to 2022 were stratified by site and study period in this observational cohort study. Segmented linear regression analysis identified changes in the trend over time by detecting optimal breakpoints. A total of 1333,966 patients received MH care. Average monthly MH service utilization was 11% higher from September 2020 to December 2022 compared to calendar year 2019, driven by more patients seeking care. At their peak in mid-2020, virtual visits accounted for 25.6% of visits compared to 1.8% pre-pandemic. MH care utilization increased by the end of 2022 compared to pre-pandemic levels, driven by more people seeking care and supported in part by an increase in virtual visits.

Li, Li; Xiao, Yubo; Wen, Wenwei; Liu, Qi; Wei, Le; Liu, Pinyue; Li, Ming

doi: 10.1097/md.0000000000042228pmid: 40295243

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among fertile women, which is influenced by genetics and environment. A recent study revealed that PCOS patients were in a chronic inflammatory state, and they had abnormally activated macrophages. This paper introduces the relationship between PCOS and macrophages. The forkhead box protein O1 (FOXO-1), migration inhibitory factor, sympathetic conservation disorder, and vitamin D are believed to influence macrophages in PCOS. There is evidence that PCOS-associated abnormalities are associated with macrophages, including insulin resistance, obesity, hyperandrogenism (HA), hyperhomocysteinemia (HHcy), cardiometabolic disorder and gut microbiota dysbiosis. This review summarizes the research status of macrophages in PCOS. Macrophages might be a potential PCOS treatment candidate.

Bakleezi, Asma; Taybeh, Esra’ O.; Binodeh, Abdalrahman; Alsharif, Alaa A.; Alhamed, Meshari; Naser, Abdallah Y.

doi: 10.1097/md.0000000000041986pmid: 40295289

Urinary tract infection (UTI) is prevalent among pregnant women, emerging as the most frequent type of infection during pregnancy. This study aimed to reveal UTI prevalence in Jordan, identify risk practices, assess antibiotic adherence, and evaluate UTI recurrence among pregnant women. A prospective observational cohort study, conducted from January to July 2023, was employed to Urinary tract infections (UTIs) during pregnancy. Participants were recruited during routine visits to Al-Bashir Governmental Hospital and Jamil Al-Totenji Governmental Hospital maternity clinics in Jordan. Binary logistic regression identified UTI predictors among pregnant women. Out of 536 participants, 34.3% of pregnant women were found to have UTIs. Amoxicillin/clavulanate demonstrated the highest level of resistance among the tested antibiotics and 42.4% of the pregnant participants adhered to the prescribed antibiotic regimen. Several factors were identified as contributing to an elevated risk of UTIs, including elevated body mass index (BMI) (P = .011), utilization of dry toilet paper (P = .023), frequent utilization of public restroom facilities (P < .001), delayed urination (P < .001), nonuse of cotton underwear (P = .019), frequent sexual activity (P < .001), lack of postcoital urination (P < .001), and inadequate genital hygiene before (P < .001) and after (P < .001) intercourse (including the husband’s). However, the use of wet wipes was the only factor associated with recurrent UTIs (P = .037). Emphasizing hygiene practices and managing BMI could play pivotal roles in reducing UTI risks among pregnant women.