Romanian Journal of Internal Medicine Feed

Polypharmacy and Potentially Inappropriate Medications: Cognitive Consequences in Older Heart Failure Outpatients

Fri, 02 Oct 2026 00:00:00 GMT

IntroductionCognitive impairment is prevalent among older heart failure (HF) outpatients. Polypharmacy and potentially inappropriate medications (PIMs) may contribute to cognitive vulnerability, yet evidence using the Beers Criteria 2023 with locally validated cognitive screening in Indonesia remains limited.MethodsA cross-sectional analytic study enrolled 107 consecutive HF outpatients aged 60 years or older at a tertiary teaching hospital in Medan, North Sumatra, Indonesia (August to October 2025). Polypharmacy was categorized as non-polypharmacy, polypharmacy, or hyperpolypharmacy. PIM exposure was classified by Beers Criteria 2023. Cognitive function was assessed by MoCA-INA v7.1. Proportional-odds ordinal logistic regression was used with collinearity assessed by variance inflation factors.ResultsMean age was 67.6±6.2 years; 59 (55%) were female. Polypharmacy (72%) and hyperpolypharmacy (23%) were prevalent; severe PIM exposure occurred in 39%. Mean MoCA-INA was 22.0±3.3; 78% had mild cognitive impairment and 10% had mild to moderate dementia. Cognitive category correlated with polypharmacy (ρ=0.276; p=0.004) and PIM level (ρ=0.264; p=0.006). All VIFs were below 1.5. In the fully adjusted model, education was independently protective (aOR 0.82 per year; 95% CI 0.68 to 0.99; p=0.04) and HFrEF was associated with worse cognition (aOR 6.10; 95% CI 1.25 to 29.87; p=0.03). Polypharmacy (aOR 2.88; p=0.10) and PIM burden (aOR 1.70; p=0.10) showed directionally consistent but inconclusive adjusted associations (Nagelkerke R2=0.368).ConclusionHigher medication burden and Beers-2023 PIM exposure were associated with worse cognitive status in unadjusted analyses; adjusted models showed directionally consistent but statistically inconclusive associations (polypharmacy aOR=2.88, p=0.099; PIM burden aOR=1.70, p=0.098). HFrEF was the most robust independent predictor of worse cognitive status (aOR 6.10; 95% CI 1.25 to 29.87; p=0.03), consistent across all three adjusted models. Education was independently protective. Routine cognitive screening integrated with structured medication review is warranted in HF outpatient care, with particular attention to patients with HFrEF phenotype.

Real-World Effectiveness of Biologic Therapy in Patients with Psoriasis: Metabolic Comorbidities and Treatment Outcomes

Wed, 23 Sep 2026 00:00:00 GMT

IntroductionPsoriasis is a chronic systemic inflammatory disease, frequently associated with metabolic comorbidities that may influence therapeutic outcomes. Real-world evidence on the effectiveness of biologic therapy in this complex clinical context remains limited.ObjectivesTo assess the prevalence of comorbidities in patients with psoriasis receiving biologic therapy and to identify factors associated with treatment response.MethodsA retrospective observational study including 121 patients with chronic plaque psoriasis. Demographic data, comorbidities, biologic treatment class, and PASI/DLQI evolution at baseline and at standardized 6 and 12 months assessments was analyzed, together with the latest available clinical assessment recorded in 2025 after variable treatment durations.ResultsComorbidities were present in 84.3% of patients, most frequently hepatic steatosis (73.6%), obesity (45.5%), hypertension (41.3%), and diabetes (19%). A significant improvement in PASI and DLQI scores was observed at all follow-up points (p < 0.001). Complete skin clearance (PASI 100) was achieved by 18.1% of the patients at 6 months and by 44.6% at 12 months. In multivariable logistic regression analysis, lower PASI scores at six months were independently associated with a higher likelihood of achieving PASI 100 at one year.ConclusionsBiologic therapy was associated with marked clinical and quality-of-life improvement. Although metabolic comorbidities were highly prevalent, no significant association between metabolic comorbidities and PASI 100 response at one year was identified in the analyses performed.

A Novel Metabolic Liver Fibrosis Risk Score for the Identification of Elevated Liver Stiffness in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Pilot Study

Tue, 15 Sep 2026 00:00:00 GMT

Forced Vital Capacity and Six-Minute Walk Test as Indicators of Interstitial Lung Disease Extent on High-Resolution Computed Tomography in Systemic Sclerosis

Mon, 07 Sep 2026 00:00:00 GMT

IntroductionInterstitial lung disease (ILD) is a leading cause of morbidity and mortality in systemic sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for assessing ILD extent but is limited by cost, availability, and radiation exposure. Practical functional tools are thus needed to identify extensive ILD in routine practice.MethodsThis cross-sectional study enrolled adult patients with SSc-associated ILD at a tertiary referral hospital in Jakarta, Indonesia. All participants underwent spirometry and the six-minute walk test (6MWT). Forced vital capacity (FVC), 6MWT distance, and exertional oxygen desaturation were evaluated. ILD extent on HRCT was classified as non-extensive (<20%) or extensive (≥20%). Associations were analyzed using bivariate analysis, receiver operating characteristic (ROC) curves, and multivariable Poisson regression with robust standard errors.ResultsA total of 83 patients were included; 21 (25%) had extensive ILD. Six-minute walk test distance did not differ significantly between groups (p = 0.492; AUC 0.550). Exertional oxygen desaturation ≥4% and FVC <70% predicted were each significantly associated with extensive ILD. FVC alone achieved an AUC of 0.795, whereas adding 6MWT distance resulted in only a marginal improvement in discrimination (AUC 0.799; ΔAUC 0.005), with adequate calibration and stable internal validation.ConclusionFVC alone may serve as a practical functional indicator of ILD extent, particularly where HRCT access is limited. Routine addition of 6MWT distance is not justified solely for estimating ILD extent, although the 6MWT remains valuable for assessing functional capacity and exertional desaturation.

Primary Angiitis of the Central Nervous System: A Medical Mystery

Thu, 06 Aug 2026 00:00:00 GMT

Primary angiitis of the central nervous system is an extremely rare diagnosis, with an incidence of 2.4 cases per 1,000,000 person-years. The exact cause of PACNS remains unknown, and typically cases present with a long prodrome. It is a diagnosis of exclusion, and various infectious, autoimmune, and malignant processes must be excluded prior to final diagnosis. Given the rarity of this condition, there is often a delay in diagnosis that can range from 6 to 23 months. It is imperative that all clinical providers be aware of this diagnosis when managing patients who present with insidious and non-specific neurological symptoms. We present a case of PACNS that responded well to a therapeutic regimen of high-dose steroids and cyclophosphamide.

Cotton wool spots as the only fundoscopic manifestation of giant cell arteritis: A scoping review

Mon, 03 Aug 2026 00:00:00 GMT

This study aimed to review and describe isolated cotton wool spots (CWS) on retinal examination in patients with systemic or occult presentation of giant cell arteritis (GCA).Material and MethodsIn this scoping review, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews, PubMed, Scopus, and Web of Science were searched for peer-reviewed articles reporting an association between GCA and CWS from 1960 to 13th of June 2026. Case reports and case series of confirmed GCA with CWS as the sole fundoscopic finding were included. Data were charted independently by two reviewers using a standardized Excel extraction form.ResultsSixteen articles, including fifteen case reports and one case series, were included in the study. 76.19% of patients had concurrent systemic symptoms, while the remaining 23.81% had an occult presentation. Patients with occult GCA tended to be younger at presentation compared with those with systemic disease. No difference in inflammatory markers was observed between the occult and the systemic presentation of the disease.ConclusionThis review summarizes the current evidence and characteristics of CWS as an isolated retinal manifestation of GCA. The included evidence suggests that this atypical presentation may occur even in the absence of systemic symptoms, highlighting the importance of early clinical recognition, as delayed diagnosis may lead to irreversible visual loss.

Withdrawal versus continuation of guideline-directed medical therapy in heart failure with improved ejection fraction: a systematic review and meta-analysis

Wed, 22 Jul 2026 00:00:00 GMT

BackgroundHeart failure with improved ejection fraction (HFimpEF) is characterized by recovery of left ventricular systolic function after treatment for heart failure with reduced ejection fraction. The safety of withdrawing guideline-directed medical therapy (GDMT) after recovery remains uncertain.ObjectiveTo evaluate the effects of GDMT withdrawal versus continuation in patients with recovered or improved left ventricular systolic function.MethodsA systematic review was conducted according to PRISMA 2020 guidelines. MEDLINE, Embase, LILACS, and the Cochrane Central Register of Controlled Trials were searched through March 2025. Comparative studies evaluating GDMT withdrawal versus continuation in HFimpEF were included. The primary outcome was relapse of left ventricular systolic dysfunction. Secondary outcomes were heart failure hospitalization, mortality, and quality of life.ResultsEight studies were included. Relapse of left ventricular dysfunction occurred in up to 58% of patients after therapy withdrawal in recovered dilated cardiomyopathy, whereas most patients with atrial fibrillation–mediated cardiomyopathy maintained preserved ventricular function during short-term follow-up. In a meta-analysis of three prospective studies (n = 133), GDMT withdrawal was associated with a significantly increased risk of relapse compared with continued therapy (OR 15.37, 95% CI 2.75–85.82; I2 = 0%). Observational studies consistently reported higher rates of heart failure hospitalization and adverse cardiovascular outcomes after treatment withdrawal.ConclusionsGDMT withdrawal may increase the risk of recurrent ventricular dysfunction and adverse cardiovascular outcomes in HFimpEF. The available evidence supports continuation of therapy in most patients, although further randomized studies are needed to identify patients who may safely discontinue treatment.

Severe persistent hypereosinophilia of undetermined significance: diagnostic challenges in clinical practice and two-year follow-up

Tue, 23 Jun 2026 00:00:00 GMT

BackgroundHypereosinophilia of undetermined significance (HE-US) represents a rare subtype of hypereosinophilia (HE) defined by a persistent absolute eosinophil count (AEC) ≥ 1500/uL without an identifiable reactive or clonal cause, and importantly, without evidence of eosinophil-mediated end-organ damage. Long-term structured follow-up is essential due to its unpredictable outcome and the risk of transition into overt hypereosinophilic syndrome (HES) or occult malignancies.Case presentationWe report the case of a 47-year-old woman with severe, persistent blood hypereosinophilia (up to 13600/uL) accompanied by chronic inconstant fixed erythematous-violaceous skin lesions. Extensive diagnostic evaluation for secondary, autoimmune, and clonal etiologies was negative, including fluorescence in situ hybridization (FISH) for FIP1L1-PDGFRA mutation. Bone marrow biopsy showed granulocytic hyperplasia with eosinophils <10% and mild reticulin fibrosis (MF-1). Whole-body computed tomography (CT) revealed small generalized lymphadenopathy (≤ 11 mm) without parenchymal infiltration. The patient declined lymph-node biopsy. Although skin biopsy revealed eosinophilic infiltration, it was characterized as a non-specific reactive pattern without objective evidence of eosinophil-mediated cytotoxicity. The case was provisionally diagnosed as HE-US, acknowledging that lymphoproliferative disease could not be definitively excluded in the absence of the lymph-node biopsy. Intermittent systemic corticosteroids provide rapid hematologic response, but prompted immediate recurrence when tapered.ConclusionThe reported case underscores the diagnostic complexity and difficulties in managing hypereosinophilia of undetermined significance in clinical practice. While current evidence suggests a generally benign course, rare progression to hypereosinophilic syndrome or other malignancies requires structured long-term monitoring and individualized therapeutic decision-making.

Immune Checkpoint Inhibitor–Associated Myocarditis: A Retrospective Case Series

Mon, 22 Jun 2026 00:00:00 GMT

BackgroundImmune checkpoint inhibitors (ICIs) improve outcomes across malignancies but can cause immune-related adverse events (irAEs), notably myocarditis, with case-fatality up to 50%.MethodsWe retrospectively reviewed five patients with potential ICI-associated myocarditis treated at Mayo Clinic Florida (2019–2024) and summarize the existing literature. Cases were retrospectively categorized as definite, probable, or possible myocarditis according to cardiac magnetic resonance (CMR) findings and histopathology when available.ResultsThe median age was 74 years, and four of the five patients were male. Myocarditis developed between 5 and 30 days after initiation of anti–PD-1 therapy. Presentations included dyspnea (three patients), chest pain (one patient), and asymptomatic troponin elevation detected on routine monitoring (one patient). Troponin T elevation above the 99th percentile was seen in all five cases (normal <15 ng/L). Electrocardiograms (ECG) demonstrated conduction abnormalities or ventricular ectopy in each patient. Left ventricular ejection fraction was preserved in four patients and severely reduced in one.CMR provided findings supportive of myocarditis in two of the five cases, while one endomyocardial biopsy (EMB) was performed and did not demonstrate active inflammation. Based on predefined criteria, one case was classified as definite myocarditis, one as probable, and three as possible ICI-associated myocarditis.All five patients received corticosteroid therapy. Two required escalation of immunosuppression. One patient developed concurrent myasthenia gravis, consistent with myocarditis–myositis–myasthenia (MMM) overlap, and underwent plasmapheresis for the neuromuscular component. Three patients recovered. Two patients died during follow-up; in both cases, myocarditis was considered a contributing factor, although direct causality could not be definitively established.

Clinical construct validity and subgroup stability of the Romanian version of the Boston Carpal Tunnel Questionnaire in nerve-conduction-confirmed carpal tunnel syndrome – a cross-sectional study

Wed, 27 May 2026 00:00:00 GMT

IntroductionThe Romanian Boston Carpal Tunnel Questionnaire (BCTQ) has been linguistically and internally validated, but data on clinical construct validity and subgroup stability in routine practice are limited. This study evaluated its performance in a consecutive outpatient sample of patients with idiopathic, electrophysiology-confirmed carpal tunnel syndrome (CTS) after exclusion of major secondary causes.MethodsIn this cross-sectional study, consecutive patients with idiopathic CTS diagnosed according to AAOS guidelines and confirmed by nerve conduction studies (NCS) were included. Clinical examination, grip strength testing, BCTQ, EQ-5D-5L (analyzed as an exploratory unweighted severity index), and electrophysiological assessment were performed within 7 days. Hand-level analyses were conducted using linear mixed-effects models to account for within-patient correlation and to assess associations with demographic and clinical variables.ResultsA total of 193 hands met electrodiagnostic criteria for CTS. Overall BCTQ scores did not differ significantly across age, sex, or education groups. SSS and FSS correlated with grip strength (ρ = −0.16/−0.39; p < 0.03), sensory and motor conduction velocities (SCV ρ = −0.33/−0.31; MCV ρ = −0.19/−0.27; p ≤ 0.012), unweighted EQ-5D-5L severity index (ρ = 0.38/0.59; p < 0.001), and the presence of Tinel’s and Phalen’s signs. Higher BCTQ scores were associated with worse NCS grades. In multivariable models, grip strength, nerve velocities, EQ-5D-5L, and clinical signs remained significant predictors (all p < 0.001).ConclusionsThe Romanian BCTQ demonstrates expected associations with clinical, electrophysiological, and patient-reported measures, supporting its use as a complementary PRO in CTS assessment.

The Role of Probiotics, Prebiotics, and Synbiotics for Reducing Chemotherapy-Induced Gastrointestinal Toxicity: A Systematic Review and Meta-Analysis

Mon, 25 May 2026 00:00:00 GMT

BackgroundChemotherapy-induced gastrointestinal toxicity remains a major clinical problem that limits treatment adherence and quality of life in cancer patients. Microbiota-modulating interventions such as probiotics, prebiotics, and synbiotics have been proposed as supportive therapies, yet their comparative effectiveness remains unclear.ObjectiveThis systematic review and meta-analysis evaluated the effectiveness of probiotics, prebiotics, and synbiotics in reducing chemotherapy-induced gastrointestinal toxicity in cancer patients.MethodsA systematic search of PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov was performed between March and August 2025 to identify randomized controlled trials (RCTs) involving chemotherapy-treated cancer patients with gastrointestinal toxicities. Studies comparing probiotics, prebiotics, or synbiotics with placebo or standard care were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using standardized criteria. Meta-analysis was conducted using RevMan 5.4.ResultsTwenty-nine RCTs were included, comprising probiotics (n = 17), prebiotics (n = 6), and synbiotics (n = 6). Probiotic supplementation, predominantly containing Lactobacillus and Bifidobacterium species, significantly reduced the incidence of chemotherapy-induced diarrhea (RR = 0.67; 95% CI 0.47–0.95; p = 0.03). Synbiotics demonstrated an even greater protective effect (RR = 0.51; 95% CI 0.29–0.89; p = 0.02). Evidence supporting prebiotics alone was limited and inconsistent.ConclusionProbiotics and synbiotics may be effective in reducing chemotherapy-induced gastrointestinal toxicity, with the most consistent evidence for diarrhea.

Accelerated Biological Aging and a Nonlinear Risk Threshold for Sleep Apnea: Evidence from NHANES and Mediation by Oxidative-Metabolic Dysregulation

Mon, 18 May 2026 00:00:00 GMT

BackgroundThe association between accelerated biological aging and sleep apnea remains unclear. This study aimed to investigate the association of phenotypic aging (PhenoAge) with sleep apnea, identify nonlinear patterns and high-risk subgroups, and explore metabolic-oxidative stress (as measured by uric acid-to-HDL ratio, UHR) as a potential mediator.MethodsIn a cross-sectional analysis of 4,901 adults from NHANES 2005–2008, sleep apnea was self-reported. PhenoAge was calculated from clinical biomarkers. Associations were assessed using multivariable logistic regression and restricted cubic splines; potential mediation by UHR was evaluated.ResultsEach 1-year increase in PhenoAge was associated with a 3% higher odds of sleep apnea (OR = 1.03, 95% CI: 1.01–1.04). A statistically derived nonlinear inflection point at a PhenoAge of 44.09 years was observed. The association was significant only in adults ≥40 years (P-interaction = 0.001) and was strongest in males and individuals with obesity. UHR accounted for 6.27% of the association, primarily in adults ≥40 years and individuals with obesity.ConclusionIn this cross-sectional study, accelerated biological aging, measured by PhenoAge, was associated with sleep apnea in a dose-dependent and age-delimited manner, with a statistical inflection point at 44.09 years. The modest association via UHR suggests oxidative-metabolic dysregulation as one potential explanatory factor. These exploratory findings provide a framework for hypothesis generation regarding the role of biological aging in sleep apnea.

Contrast-enhanced Ultrasound and the Lerner Histopathological Grade in Gastrointestinal Graft-versus-host Disease: A Prospective Single-centre Study

Wed, 13 May 2026 00:00:00 GMT

IntroductionGastrointestinal graft-versus-host disease (GI GVHD) is a major complication of allogeneic haematopoietic stem-cell transplantation (allo-HSCT). Endoscopic biopsy with histopathological grading according to the Lerner system remains the diagnostic standard, although invasive sampling is frequently constrained in this fragile population. We assessed the relationship between a four-parameter contrast-enhanced ultrasound (CEUS) score and the Lerner histopathological grade.MethodsProspective, single-centre study (October 2018 – December 2025). Adult allo-HSCT recipients with new-onset gastrointestinal symptoms underwent multimodal abdominal ultrasound, including CEUS with sulphur hexafluoride microbubbles, followed by endoscopic biopsy. A composite CEUS-GVHD score (range 0–12) integrated bowel-wall thickness, bowel-loop dilatation, contrast wash-out, and transmural microbubble migration. The cohort comprised 51 episodes (in 41 unique patients) with histopathologically confirmed GI GVHD and Lerner grade I–IV. A within-patient sensitivity analysis was performed on the first chronologically documented episode per patient (n=41), and additional sensitivity analyses were performed by stratification according to concurrent gastrointestinal infection and according to GVHD form (acute vs chronic).ResultsThe total CEUS-GVHD score showed a positive correlation with the Lerner grade (p < 0.001). Median CEUS scores across grades were 5.5 (Lerner I), 7 (II), 8.5 (III), and 10 (IV) (p < 0.001). Among individual parameters, transmural microbubble migration showed the highest correlation, followed by bowel-wall thickness and contrast wash-out; these three correlations remained significant after Bonferroni correction. The bowel-loop dilatation correlation did not retain significance after correction. In an exploratory analysis, the area under the ROC curve of the total CEUS-GVHD score for discriminating severe (Lerner III–IV) from mild (Lerner I–II) histopathological GI GVHD was 0.853, with the same point estimate retained in the within-patient sensitivity analysis (AUC 0.853).ConclusionIn this single-centre cohort of biopsy-confirmed GI GVHD, the CEUS-GVHD score showed a moderate-to-strong association with Lerner histopathological grade. Because the study included only confirmed GI GVHD episodes, these findings support CEUS as a potential adjunct for severity assessment, not as a replacement for diagnostic biopsy. External multicentre validation with multiple operators is required.

The Utility of Sex-Specific Cut-offs for High-Sensitivity Troponin T for Long-Term All-cause Mortality Risk Assessment in Heart Failure

Tue, 28 Apr 2026 00:00:00 GMT

IntroductionHigh-sensitivity troponin T (hs-TnT) is commonly elevated in heart failure (HF) and may have different prognostic meaning in women and men. We assessed sex-related differences in hs-TnT and whether sex-aware interpretation improves long-term risk stratification after HF hospitalization.Materials and MethodsWe conducted a retrospective single-center cohort study derived from the HI-HF registry (2011–2014). The analysis included adults hospitalized for HF with admission hs-TnT, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and in-hospital echocardiography. We derived outcome-optimized sex-specific hs-TnT cut-offs by ROC analysis. The endpoint was long-term all-cause mortality (ascertained through August 2024). Kaplan-Meier and multivariable Cox models (including sex stratification, interaction testing, and landmark/time-dependent analyses) were performed.ResultsOur cohort included 404 patients. Over a median follow-up of 5.72 years (IQR 3.38–6.87), 149 deaths (36.9%) occurred.Women had lower hs-TnT concentrations than men (median 14.18 vs 22.44 pg/mL). ROC-derived sex-specific mortality prognostic cut-offs were >15.83 pg/mL for women (AUC 0.773; sensitivity 70.7%; specificity 78.3%) and >19.02 pg/mL for men (AUC 0.725; sensitivity 75.0%; specificity 65.0%). Compared to the conventional cut-off of 14 pg/mL, the gender-adjusted values improved risk stratification by 22% for women and 23% for men.For each gender-defined subgroup, increased hs-TnT levels were independently associated with all-cause long-term mortality in Cox analysis alongside NT-proBNP and hemoglobin levels in men (HR 1.91 (1.07 – 3.41), p=0.029), and NT-proBNP and age in women (HR 3.54 (2.07 – 6.07), p<0.001).Prognostic effects were time-dependent, with stronger sex-related divergence beyond 1 year.ConclusionsSex-specific hs-TnT cut-off recalibration improved long-term mortality risk stratification in hospitalized heart failure patients. Increased levels of hs-TnT defined by the gender-specific analysis were independent predictors of the outcome in both men and women.

The Prognostic Implication of Chronic Hyperglycemia in Acute Ischemic Strokes of Different Etiologic Subtypes

Thu, 16 Apr 2026 00:00:00 GMT

BackgroundThe relationship of chronic hyperglycemia (CH) reflected by glycated hemoglobin A1c (HbA1c) with functional recovery in patients having acute ischemic stroke (AIS) remains controversial. This study evaluated how HbA1c values at admission could influence functional recovery following AIS of various etiologies.MethodsIn total, 518 patients with AIS were included. Stroke etiology was determined by TOAST criteria. The modified Rankin Scale (mRS) was applied to evaluate the functional recovery. Independent-samples Mann–Whitney U test was applied to assess the distribution of HbA1c across different subtypes. The relationship between HbA1c levels and functional recovery was analyzed applying multivariate logistic regression for adjustment of variables. Models predicting poor functional recovery, without and with HbA1c were developed utilizing binary logistic regression.ResultsHbA1c levels were significantly elevated among patients with poor functional recovery (p <0.001). The highest HbA1c values, median (IQR) [8.15(6.5–10.9)] were observed in patients with large artery atherosclerosis (LAA) subtype. Subgroup analyses by stroke subtype revealed significant associations of elevated HbA1c levels with poor functional recovery in the SVO (p = 0.021), LAA (p = 0.027), and cardio-embolic (CE), p = 0.046 groups. Elevated HbA1c remained independently associated with poor functional recovery (p = <0.001; OR = 1.27; 95% CI = 1.12–1.45) after full adjustment for clinical variables.ConclusionsElevated admission HbA1c levels showed a fair to modest association with poorer functional recovery among patients with SVO, LAA, and CE stroke subtypes, which requires further external validation to establish its clinical implications and to consider HbA1c as an independent prognostic biomarker.

Real-world Screening for Interstitial Lung Disease in Rheumatoid Arthritis: The Value of Spirometry, DLCO, and Clinical Risk Factors

Mon, 13 Apr 2026 00:00:00 GMT

ObjectiveThis study aimed to characterize pulmonary function patterns in rheumatoid arthritis (RA), explore their clinical and serologic correlates, and evaluate the ability of spirometry and DLCO together with routine clinical factors to identify patients with high-resolution computed tomography (hrCT)-confirmed interstitial lung disease (ILD).MethodsIn this cross-sectional observational study, consecutive adults with RA underwent pulmonary function testing (PFT) and chest radiography irrespective of respiratory symptoms. Patients with unexplained dyspnea, abnormal PFT, or abnormal chest X-ray were referred for hrCT.ResultsAmong the 106 included patients (81.1% women; mean age 65.3±9.7 years), DLCO correlated negatively with age and inflammatory markers, while FVC and FEV1 showed associations with serologic status, treatment exposure, and radiographic abnormalities. Forty-seven patients (44.3%) underwent hrCT, of whom 24 (51.1%) had ILD, corresponding to an overall prevalence of 22.6%. In the hrCT subgroup, swollen joint count at RA diagnosis was higher in ILD cases, whereas radiographic emphysema occurred only in non-ILD patients. In multivariable analysis, age, smoking history, and DAS28-CRP were not independently associated with ILD (AUC=0.634; 95%CI=0.451–0.807). ROC analyses demonstrated poor discrimination of ILD by PFT z-scores: DLCO AUC=0.431, FVC AUC=0.562, and FEV1 AUC=0.444, with high sensitivity but low specificity at optimal thresholds.ConclusionsIn this real-world RA cohort, spirometry/DLCO showed limited ability to discriminate hrCT-confirmed ILD once patients were clinically selected for imaging. These findings support an integrated screening strategy in which PFT results are interpreted alongside clinical and radiographic risk factors to guide hrCT referral rather than used as standalone screening tools.

Blood Pressure Alterations in CML Patients Treated with Imatinib vs. Nilotinib: A Clinical Insight

Mon, 06 Apr 2026 00:00:00 GMT

IntroductionChronic Myeloid Leukemia is a hematologic malignancy characterized by the BCR-ABL fusion gene. Tyrosine Kinase Inhibitors such as imatinib and nilotinib have significantly improved the prognosis for CML patients. However, prolonged TKI therapy is associated with cardiovascular side effects, particularly hypertension. This study aims to compare the effects of imatinib and nilotinib on blood pressure in CML patients over a 12-month period.MethodsA retrospective cohort study was conducted at Wahidin Sudirohusodo Hospital, including 148 adult CML patients who received imatinib or nilotinib for at least 12 months. BP measurements were taken at baseline, and at 3, 6, 9, and 12 months. Statistical analyses included paired t-tests and multivariate regression to evaluate BP changes and their associations with demographic and treatment variables.ResultsBoth systolic and diastolic BP significantly increased in both groups over 12 months. In the imatinib group, systolic BP rose from 112 mmHg to 125 mmHg, and diastolic BP increased from 72 mmHg to 81 mmHg. In the nilotinib group, systolic BP increased from 111 mmHg to 130 mmHg, and diastolic BP rose from 70 mmHg to 83 mmHg. These increases were more pronounced in the nilotinib group (p < 0.001 for systolic and p = 0.006 for diastolic).ConclusionBoth imatinib and nilotinib therapies lead to significant increases in BP, with nilotinib showing a greater hypertensive effect. Monitoring BP is crucial, especially for patients on second-generation TKIs, to manage cardiovascular risks associated with long-term treatment.

Anti-MDA5 Dermatomyositis with RP-ILD and CMV Reactivation: A Case Report

Tue, 31 Mar 2026 00:00:00 GMT

Anti–melanoma differentiation–associated gene 5 (anti-MDA5) dermatomyositis is a distinct subtype of dermatomyositis frequently associated with clinically amyopathic disease and rapidly progressive interstitial lung disease (RP-ILD), a complication characterized by high mortality despite aggressive treatment. Early recognition and prompt immunomodulatory therapy are therefore critical. We report a fatal case of anti-MDA5 dermatomyositis complicated by RP-ILD with concomitant cytomegalovirus (CMV) reactivation. A 40-year-old woman with known dermatomyositis presented with progressive dyspnea, fever, and hypoxemia. Physical examination revealed typical cutaneous findings, including Gottron’s sign and papules. Laboratory evaluation demonstrated elevated inflammatory markers and marked lymphopenia. Anti-MDA5 antibody testing was positive. Chest computed tomography showed rapidly progressive bilateral fibrotic interstitial lung disease compared with imaging obtained 10 days earlier. Despite empirical antimicrobial therapy, mycophenolate discontinuation, and initiation of intravenous immunoglobulin, respiratory failure progressed rapidly, requiring mechanical ventilation. Infectious investigations were negative except for low-level CMV viremia. Due to the absence of lung-specific diagnostic evidence, CMV was interpreted as reactivation related to immunosuppression rather than a primary cause of pulmonary injury. The patient subsequently developed multiorgan failure and died on the fifth day of intensive care. This case highlights the fulminant course and poor prognosis of anti-MDA5–associated RP-ILD. Severe lymphopenia and CMV reactivation may represent markers of immune dysregulation rather than direct etiologic drivers. Anti-MDA5 positivity should be recognized as a high-risk biomarker warranting early risk stratification, rapid initiation of immunomodulatory therapy, and close monitoring for opportunistic infections.

A Comprehensive Review of the Association between Sarcopenia and COPD

Mon, 02 Mar 2026 00:00:00 GMT

COPD is a complex disease with pulmonary and extrapulmonary manifestations intensively studied due to the numerous pathologic processes involved. Its prevalence is increasing, representing the fourth leading cause of mortality worldwide. Sarcopenia can occur in COPD patients with common risk factors. Sarcopenia is characterized by a decrease in muscle mass and function with consequences on muscle performance. Muscle changes can be measured by different methods: MRI, DXA, BIA, CT or biopsy. The prevalence of sarcopenia has been studied in numerous studies with varying results. This review identifies the main risk factors that contribute to the variable outcomes with a focus on the characteristics of the studied population, the criteria for defining sarcopenia and the methods used to measure muscle mass, strength and physical performance.

Clinical Prognostic Scoring Systems in Heart Failure with Preserved Ejection Fraction: An Integrative Review of Risk Prediction Models

Mon, 02 Mar 2026 00:00:00 GMT

IntroductionRisk stratification in heart failure with preserved ejection fraction (HFpEF) remains inconsistent in routine care despite multiple prognostic scores. Key controversies persist. One concerns broad, clinically derived scores versus pathophysiology-grounded tools, including diagnostic frameworks used pragmatically for prognostication. Another concern is the distinction between static baseline risk and dynamic risk states that change across hospitalization and follow-up.MethodsWe performed a narrative, comparative synthesis of clinician-usable prognostic instruments in HFpEF across conceptual domains and care settings. We extracted study context, endpoints, follow-up, and performance metrics. We emphasized feasibility and clinical interpretability.ResultsAcross studies, discrimination of baseline-only clinical instruments is generally moderate. Performance is often higher for tools that reflect congestion and physiological changes, particularly when reassessed at clinically meaningful time points. Discharge lung ultrasound B-lines, reflecting residual pulmonary congestion, frequently predict early post-discharge events. Immuno-nutritional indices derived from routine laboratory tests provide a complementary prognostic signal, especially in older or recently hospitalized patients. Serial trajectories appear more informative than single measurements. Patient-reported health adds independent prognostic information and supports risk communication. Diagnostic frameworks can stratify risk when constituent data are available, and phenotype distributions are compatible, but transportability and calibration remain recurrent limitations.ConclusionHFpEF prognostication is best supported by a layered, phenotype-aware strategy. This approach integrates global clinical risk, selected biomarkers, discharge congestion assessment, and serial reassessment, rather than relying on a single score.