Delayed diagnosis and fragmented care remain persistent challenges across women's health, due in part to limitations in evaluating the dynamic female hormone profile. Current clinical approaches to hormonal assessment often rely on single timepoint assessments that fail to capture hormonal variability, leading to incomplete or misleading insight into hormonal health. Recent technological advancements now allow for quantitative measurement of key reproductive hormones in urine using smartphone-compatible, at-home devices, making daily hormone monitoring across the menstrual cycle and reproductive lifespan feasible. The purpose of this illustrative, case-based perspective is to provide insight into: 1) when and why comprehensive at-home, daily hormone monitoring could be implemented; 2) how comprehensive hormone monitoring gives insight into the health state of women at different reproductive stages; and 3) how such information can inform lifestyle or medical recommendations. Illustrative case-based examples are given to demonstrate the potential applications of comprehensive at-home, daily hormone monitoring across the reproductive lifespan, including low energy availability (LEA), postpartum return to exercise, polyendocrine metabolic ovarian syndrome (PMOS), and perimenopause. Across cases, daily monitoring of reproductive hormones revealed hormone patterns that were not identifiable using traditional methods. In many cases, clinically meaningful patterns of ovulatory function, luteal phase quality, or reproductive stage were identified within one to two cycles, allowing more individualized lifestyle or medical interventions to be implemented. Collectively, these illustrative cases demonstrate that, when integrated with comprehensive clinical assessment and practitioner expertise, daily hormone monitoring can provide actionable insight into female physiology, support earlier identification of hormonal dysregulation, and inform personalized medicine and lifestyle changes across the reproductive lifespan.
OBJECTIVES:Chronic urticaria (CU) is a common dermatologic condition that significantly affects quality of life and is frequently first managed in primary care. This study aimed to evaluate the awareness, knowledge, and clinical practices of primary care physicians (PCPs) regarding CU management. METHODS:This cross-sectional study was conducted among PCPs working across Turkey. Data were collected through an online questionnaire distributed nationwide. The questionnaire assessed demographic characteristics, knowledge of CU diagnosis and treatment, and clinical attitudes and practices. Total knowledge scores (TKS) were calculated according to correct responses. RESULTS:A total of 274 physicians participated in the study; 55.1% were female, and the mean age was 38.2 ± 9.2 years. Most participants reported recognizing urticarial lesions (82.5%) and correctly identified antihistamines as first-line treatment (90.1%). However, only 42.3% correctly distinguished acute from chronic and identified dose escalation of second-generation antihistamines as the recommended next treatment step in unresponsive cases. Awareness and use of omalizumab were limited (33.2%). Routine skin prick testing and pseudoallergen-restricted diets were still commonly recommended. Specialists had significantly higher TKS scores than general practitioners and resident physicians (p = 0.005). Professional experience was negatively associated with TKS (β = -0.175, p = 0.005). Although most physicians supported lifestyle modification and psychiatric referral when necessary, 65.0% reported feeling inadequate in the follow-up of CU patients. CONCLUSION:Primary care physicians demonstrated a basic level of knowledge regarding CU; however, important gaps remain, particularly in treatment escalation, follow-up strategies, and appropriate use of diagnostic tests. These findings highlight the need for targeted educational interventions and guideline-based training to improve CU management in primary care.
BACKGROUND:Patients with psoriatic disease present a distinctive metabolic phenotype, yet the optimal anthropometric marker to capture cardiometabolic risk remains unclear. We evaluated whether waist circumference provides superior cardiometabolic discrimination and reclassification compared with BMI in psoriatic disease. METHODS:In this cross-sectional study, we assessed consecutive patients with psoriasis and/or psoriatic arthritis (n = 572). The primary outcome was clustered cardiometabolic burden (≥2 predefined cardiometabolic abnormalities). Waist circumference and BMI were compared using principal component analysis (PCA), ROC curves, Youden-derived sex-specific thresholds, and both categorical and continuous reclassification metrics (NRI and IDI), overall and stratified by sex. Additional sensitivity analyses used standard metabolic cutoffs (ATP III/IDF). RESULTS:Waist circumference and BMI showed the highest loadings on the first principal component representing the cardiometabolic axis, with a slightly higher contribution from waist circumference (loading 0.864 vs 0.826). Waist circumference showed modest but statistically significant improvement in discrimination compared with BMI for clustered cardiometabolic abnormalities (AUC 0.78 vs 0.73 for ≥2 factors, DeLong p = 0.003; AUC 0.78 vs 0.71 for ≥3 factors, DeLong p < 0.001). Waist circumference-derived thresholds provided incremental risk stratification beyond BMI, with consistent improvements in reclassification metrics across cardiometabolic burden definitions. Youden-derived thresholds (100 cm in men and 99 cm in women) showed better balance between sensitivity and specificity than ATP III and IDF criteria, while maintaining clinically relevant likelihood ratios. Sensitivity analyses incorporating waist-to-height ratio showed similar findings without additional benefit over waist circumference alone. CONCLUSION:Waist circumference provided consistently better overall cardiometabolic discrimination than BMI and may represent a more informative anthropometric marker for cardiometabolic risk assessment in psoriatic disease.
BACKGROUND:Severe pneumonia requiring intensive care unit (ICU) admission is associated with high short-term mortality. Early risk stratification in emergency settings is essential to guide clinical decisions. The APUA and APUA-RO2 scores have been proposed as simplified prognostic tools, but their performance in critically ill pneumonia patients remains unclear. OBJECTIVE:To compare the prognostic performance of APUA, APUA-RO2, and CURB-65 scores in emergency department patients with pneumonia and ICU indications. METHODS:This retrospective, single-center study included adult patients with community-acquired pneumonia who were evaluated for ICU admission in the emergency department between 1 September 2024, and 1 September 2025. Demographic, clinical, and laboratory data were extracted from electronic medical records. APUA, APUA-RO2, and CURB-65 scores were calculated at presentation. The primary outcome was 30-day in-hospital mortality. Discriminative ability was assessed using receiver operating characteristic curves and area under the curve (AUC) analysis. Multivariable logistic regression was performed to identify independent predictors of mortality. RESULTS:Among 191 patients, 121 (63.4%) died within 30 days. Non-survivors had higher respiratory rates, CRP, LDH, creatinine, and pneumonia severity scores (APUA, APUA-RO2, CURB-65; all p < .001). All three scores demonstrated moderate discriminative performance, with AUCs of 0.732 for APUA, 0.765 for APUA-RO2, and 0.697 for CURB-65. Model performance was highest for APUA-RO2 (AUC 0.825, sensitivity 87.6%, specificity 55%). Pairwise AUC comparisons did not reach statistical significance, although APUA-RO2 showed a trend toward better performance. Multivariable analysis confirmed that malignancy and higher pneumonia severity scores were independent predictors of mortality. CONCLUSIONS:All three severity scores demonstrated moderate discriminative ability for predicting 30-day mortality in critically ill pneumonia patients. Among them, APUA-RO2 showed the highest prognostic performance, although its overall discrimination remained moderate. Therefore, these scores may assist, but should not replace, clinical judgment when assessing critically ill patients. Prospective multicenter validation is warranted.
INTRODUCTION:Reliable biomarkers reflecting acute seizure activity in patients presenting to the emergency department remain insufficiently defined. This study aimed to compare serum nesfatin-1 levels in patients presenting with epileptic seizures and healthy controls, and to evaluate their associations with clinical, demographic, and inflammatory parameters. METHODS:This cross-sectional study included 216 participants, comprising 131 patients admitted to the emergency department due to epileptic seizures and 85 age- and sex-matched healthy controls. Demographic characteristics, comorbidities, antiseizure medication use, seizure features, and laboratory parameters were recorded. Serum nesfatin-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Group comparisons were performed using the Mann-Whitney U test, and correlations were analyzed with Spearman's correlation coefficient. RESULTS:Serum nesfatin-1 levels were significantly higher in patients with epileptic seizures compared with controls (p < 0.001). C-reactive protein (CRP) levels were also elevated in the patient group (p < 0.05). Nesfatin-1 concentrations showed positive correlations with age, CRP levels, and seizure duration, and negative correlations with height and body weight (all p < 0.05). Additionally, sex, diabetes mellitus, congestive heart failure, and type of antiseizure medication were significantly associated with circulating nesfatin-1 levels. CONCLUSION:Serum nesfatin-1 levels are elevated in patients presenting with epileptic seizures and are associated with inflammatory markers, seizure duration, and metabolic parameters. These findings suggest that nesfatin-1 may reflect integrated neuroinflammatory and metabolic responses occurring during acute seizure episodes. Further prospective studies are required to determine its clinical utility and prognostic value.
BACKGROUND:Optimizing colistin dosing in patients with renal impairment, particularly those undergoing renal replacement therapy (RRT), remains a major challenge due to complex and variable pharmacokinetics. This systematic review identifies key covariates affecting pharmacokinetics of colistimethate sodium (CMS) and its active form colistin and evaluates dosing variability in patients with renal impairment, including those receiving RRT. METHODS:Systematic searches of PubMed, Embase, Scopus, and Cochrane Library (up to November 2025) identified studies reporting the pharmacokinetics of intravenous CMS, formed colistin or colistin sulfate (nebulized CMS used as adjuvant in some studies) in adults with renal impairment or on RRT. Data on dosing regimens, dialysis characteristics, pharmacokinetic parameters, and covariates were extracted, and methodological quality was appraised using validated pharmacokinetic criteria. RESULTS:Thirteen studies (n = 450) met inclusion. CMS clearance was primarily determined by renal function and dialysis-related parameters were the most consistent determinants of pharmacokinetics, while additional covariates such as cystatin C, ALT, hematocrit, and body weight were identified in individual studies. In patients undergoing SLEDD, extracorporeal clearance was reported to account for up to 67% of total drug clearance in a single study. Standardized CMS dosing regimens often failed to achieve pharmacodynamic targets for formed colistin (fAUC/MIC ≥12). CONCLUSIONS:Colistin pharmacokinetics in patients with renal impairment and those receiving renal replacement therapy are highly variable and influenced by both renal and non-renal factors, including dialysis modality. Standard dosing regimens frequently fail to achieve pharmacodynamic targets, highlighting the need for individualized, physiology-based dosing strategies. Integration of renal function, RRT parameters, and emerging biomarkers such as cystatin C, alongside therapeutic drug monitoring, is essential to optimize efficacy while minimizing toxicity in this high-risk population. PROSPERO:www.crd.york.ac.uk/prospero identifier is CRD42021294141.
BACK AND OBJECTIVES:Pregnancy is a biopsychosocial process in which personality traits may influence the perception of physical symptoms and emotional adaptation to motherhood. Type D personality, defined by negative affectivity (NA) and social inhibition (SI), has been associated with adverse mental health outcomes, yet its relationship with pregnancy symptom burden and maternal ambivalence remains unclear. This study aimed to investigate the associations between Type D personality characteristics, pregnancy symptom frequency, symptom-related functional limitations, and maternal ambivalence. METHODS:This cross-sectional study included 336 pregnant women attending a tertiary care hospital. Participants completed the Type D Personality Scale (DS-14), the Pregnancy Symptom Inventory (PSI), and the Maternal Ambivalence Scale (MAS). Crude and adjusted linear regression models were used to examine the associations of negative affectivity, social inhibition, and their interaction with pregnancy symptom frequency, symptom-related functional limitations, and maternal ambivalence. RESULTS:Type D personality was identified in 12.2% of participants. In adjusted models, NA was significantly associated with increased pregnancy symptom frequency (β = 0.412, p < 0.001) and greater symptom-related functional limitations (β = 0.343, p < 0.001), whereas SI and the NA × SI interaction were not significantly associated with these physical symptom outcomes. For maternal ambivalence, nominal associations were observed for NA and SI across several domains. After false discovery rate correction, the most robust adjusted associations were observed between SI and total maternal ambivalence and between NA and the doubt dimension. The NA × SI interaction for suppression was nominally significant but did not remain significant after false discovery rate correction. CONCLUSIONS:Negative affectivity appears to be the main Type D personality component associated with pregnancy-related symptom burden and functional limitations. Social inhibition may be relevant to maternal ambivalence, particularly the total score, while the possible role of the combined NA × SI profile in suppression of ambivalent maternal emotions requires cautious interpretation. These findings highlight the importance of considering personality-related psychosocial characteristics in antenatal assessment.
BACKGROUND:Patients who leave the emergency department (ED) without being seen (LWBS) represent a critical quality and safety metric. Although most LWBS cases involve low-acuity presentations, some may have time-sensitive conditions, leading to delayed diagnoses, adverse outcomes, and increased healthcare utilization. To determine the prevalence, characteristics, and predictors of LWBS over a multi-year period in a high-volume tertiary ED in Türkiye. METHODS:This retrospective case-control study included all adult ED visits between 1 January 2020, and 30 June 2025, at Taksim Training and Research Hospital. LWBS cases were identified from electronic medical records and compared with controls presenting during the same timeframes. Demographic, triage, temporal, and operational factors were analyzed, and binary logistic regression identified independent predictors. RESULTS:From a total of 1,058,817 adult emergency department (ED) visits during the study period, 9,737 LWBS cases were identified, corresponding to an overall LWBS incidence of 1.0%. Annual LWBS counts ranged from 1,447 (14.9%) in 2020 to a peak of 2,995 (30.8%) in 2022, before declining to 450 (4.6%) in 2024. Patients who left without being seen were younger (mean 36.1 ± 15.0 years) and predominantly male (61.6%).The highest frequency of LWBS occurred during the evening shift (16:00-00:00) and among green-triage patients, with multivariable analysis confirming increased odds in these groups (evening shift OR = 4.99; 95% CI, 3.18-8.09). Night-shift presentations were associated with reduced LWBS risk (OR = 0.54; p < 0.001). CONCLUSION:Younger age, evening presentation, and triage category were associated with LWBS in this high-volume tertiary emergency department. However, the predictive performance of the regression model was modest (AUC = 0.584), suggesting that additional patient-related, behavioral, and system-level factors may contribute to LWBS. Further studies are needed to better understand the determinants of this phenomenon.
Calcium channel blockers (CCBs) and statins are commonly combined to prevent cardiovascular diseases (CVDs). However, their concomitant use may lead to drug-drug interactions (DDIs) and increased adverse effects (AEs). This systematic review and meta-analysis aimed to evaluate the evidence of adverse effects (AEs) associated with the calcium channel blockers (CCBs) and statins concomitant use. We searched MEDLINE, Embase, Web of Science, and CENTRAL from database inception to 4 April 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies reporting AEs of CCB-statin combinations compared with CCB or statin treatment in adults. Outcomes assessed included CCBs- and statins-associated AEs, treatment discontinuation, hospitalization, and all-cause mortality. Meta-analyses of similar outcomes were performed to estimate pooled Odds Ratios (OR) with 95% confidence intervals (CI). Of 9,737 articles screened, 20 studies (n = 1,053,198) were included. Peripheral edema, myalgia, and discontinuation were most reported in 11, 7, and 9 studies, respectively. Meta-analyses demonstrated no significant differences in the risk of peripheral edema (OR 1.03, 95% CI 0.14-1.48), myalgia (OR 1.33, 95% CI 0.63-2.79), or discontinuation (OR 0.78, 95% CI 0.50-1.23 for CCB-statin vs. CCB; OR 0.97, 95% CI 0.68-1.38 for CCB-statin vs. statin). However, evidence of other AEs was inconsistent and limited. CCB-statin combination appears generally safe in a short-term use (3 to 6 months). Further research is warranted to clarify the long-term risk of AEs.
OBJECTIVES:We aimed to investigate the extent to which frailty is associated with chronic disease-free life expectancy (LE), focusing on major chronic diseases such as cardiovascular disease [CVD], diabetes, dementia, and cancer, in both males and females. METHODS:Within the UK Biobank, 392,982 chronic disease-free participants (mean age: 55.8 ± 8.1 years; 55.1% female) were followed for up to 16 years. Frailty at baseline was assessed based on five criteria: self-reported weight loss, exhaustion, low physical activity, slow walking speed, and poor grip strength. All participants were categorized as non-frail (0 criteria), pre-frail (1-2 criteria), and frail (≥3 criteria). CVD, diabetes, dementia, cancer, and death were ascertained through medical records and the death registry. Data were analyzed using parametric proportional hazard regression models with a Gompertz distribution in a multi-state context. RESULTS:At baseline, there were 113,421 (64.3%), 59,553 (33.7%), and 3,516 (2.0%) non-frail, pre-frail, and frail males, respectively, and 125,285 (57.9%), 83,935 (38.8%), and 7,272 (3.3%) corresponding females. At age 50, the estimated chronic disease-free LE (95% confidence interval) for non-frail, pre-frail, and frail males were 20.64 (20.31, 21.01), 18.73 (18.41, 19.13), and 14.75 (14.40, 15.20), with corresponding LE for females of 25.77 (25.34, 26.15), 23.65 (23.22, 24.07), and 19.15 (18.70, 19.67). Respectively, chronic disease-free LE was 5.90 (3.95, 7.84) and 6.62 (4.47, 8.77) years shorter for males and females who were frail compared to non-frail. CONCLUSION:Frailty is associated with more than 5 years shorter chronic disease-free LE in both males and females.
BACKGROUND:Hamman's syndrome, a form of spontaneous pneumomediastinum, exhibits a low incidence and is seldom secondary to ketoacidosis. CASE PRESENTATION:This article presents a case of type 1 diabetic ketoacidosis where vomiting and Hamman's syndrome were the initial manifestations. Additionally, it reviews the data of 85 patients with Hamman's syndrome combined with diabetic ketoacidosis to summarize its traits, analyze its pathogenesis, and delineate its diagnostic approaches and therapeutic strategies. CONCLUSIONS:The prognosis of Hamman's syndrome is favorable; however, it must be discriminated from Boerhaave's syndrome, which is associated with a high mortality rate. Therefore, heightened awareness and understanding of this disease among clinicians are essential.
Oral semaglutide, the first oral glucagon-like peptide-1 (GLP-1) receptor agonist therapy approved for the treatment of type 2 diabetes, is now approved for obesity management and cardiovascular risk reduction in adults, demonstrating weight loss comparable to that of subcutaneous GLP-1 therapies, alongside improvements in cardiometabolic risk factors. The availability of oral semaglutide for the treatment of obesity provides healthcare professionals with additional opportunities to individualize therapy based on patient preferences, lifestyle, and clinical circumstances. However, the oral semaglutide formulation requires specific administration conditions to optimize absorption and effectiveness. Notably, oral semaglutide tablets should be taken first thing in the morning on an empty stomach with no more than half a glass of plain water (up to 120 mL or 4 fl oz), followed by 30 min before eating food, drinking additional fluids, or ingesting other oral medications. Person-centered clinical discussions between healthcare professionals (HCPs) and patients prior to treatment initiation are important to ensure patients understand administration requirements and why they are necessary, establish realistic expectations for obesity treatment targets, and cover approaches to maintain adherence. HCP-patient consultations should also include discussion of strategies to help patients minimize, prepare for, and manage adverse events. In this article, we provide practical guidance for incorporating oral semaglutide into obesity management, drawing on evidence from clinical trials, including the OASIS 4 trial, and the authors' clinical insights.
OBJECTIVES:Children with type 1 diabetes mellitus (T1DM) have an increased risk of developing celiac disease (CD), frequently without typical symptoms. However, the optimal screening strategies and diagnostic threshold for tissue transglutaminase antibody immunoglobulin A (tTG-IgA) remain controversial. This study aimed to assess the performance of CD screening tests and identify optimal serological thresholds in children with T1DM. METHODS:This 12-year retrospective single-center cohort study from Türkiye included 282 newly diagnosed T1DM children without prior CD. Patients with <2 CD screenings performed ≥ 6 months apart or incomplete records were excluded. Among the remaining cohort, 206 patients had longitudinal screening for CD. Of them, only 24 patients who had seropositivity constituted the main analytical sample for assessing the diagnostic performance of tTG-IgA levels using receiver operating characteristic (ROC) analysis. RESULTS:Among the 206 patients with longitudinal CD screening, tTG-IgA positivity was observed in 24 patients (11.6%), either at T1DM diagnosis (70.8%) or during follow-up (29.2%). Biopsy-confirmed CD was diagnosed in 4.8% of the cohort. The remaining patients had fluctuations in tTG-IgA level; 50% became seronegative, but two-thirds became positive again. ROC analysis identified an optimal tTG-IgA threshold of ≥7.3× the upper limit of normal (ULN), yielding an area under the curve of 0.81, sensitivity of 70%, and specificity of 100%. Notably, 8.3% of biopsy-confirmed CD cases had tTG-IgA levels < 3×ULN. CONCLUSION:Although tTG-IgA level ≥7.3×ULN is highly predictive of CD in children with T1DM, lower levels may also be noteworthy. Continuous long-term monitoring and a multi-dimensional approach are crucial for early and accurate CD diagnosis in this high-risk group.
BACKGROUND:Chronic patellar tendon rupture (CPTR) represents a rare but disabling injury that presents major surgical and rehabilitative challenges, especially when diagnosis and repair are delayed. CASE PRESENTATION:This case describes a 33-year-old male who sustained a right knee injury during recreational sport that remained untreated for 12 months. Magnetic resonance imaging (MRI) confirmed CPTR with marked retraction and patella alta. Surgical reconstruction using a semitendinosus-gracilis autograft was followed by a six-month, phase-based rehabilitation program emphasizing protected mobility, progressive strengthening, and neuromuscular control. Throughout supervised sessions, the patient achieved clinically meaningful but partial functional improvement: pain decreased from VAS 6 to zero, and KOOS subscales improved relative to baseline values. Although postoperative MRI revealed partial graft rupture, residual laxity, and persistent patellar elevation, the patient regained independent ambulation, reported high satisfaction, and demonstrated a residual extension lag of 5-10°. CONCLUSION:This case underscores the complex relationship between structural imaging findings and functional recovery following delayed CPTR reconstruction, illustrating that partial functional improvement may coexist with persistent structural abnormalities. Additionally, socioeconomic barriers that delayed access to specialized care significantly shaped the recovery trajectory, reinforcing the importance of early diagnosis and integrated rehabilitation strategies in complex extensor-mechanism injuries.
BACKGROUND:The etiology of ischemic bowel disease (IBD) is complex and multifactorial, traditionally associated primarily with atherosclerosis, cardiogenic embolism, hypercoagulable states, and vascular surgery. However, IBD secondary to Sjögren's disease (SjD) remains rarely documented in the literature. CASE PRESENTATION:We report an 87-year-old female patient who was presented with abdominal pain and bloody stools. A diagnosis of IBD was considered following colonoscopy, and after a comprehensive workup to rule out common etiologies, the final diagnosis of intestinal ischemic lesions potentially associated with SjD was established. CONCLUSION:This case suggests that SjD may be a rare yet potential contributing factor of IBD - a condition that is often overlooked in clinical practice. It highlights the importance of including SjD in the differential diagnosis of unexplained IBD, beyond conventional etiologies.
BACKGROUND:In the post-MIST-2 era, conservative-first management of empyema (antibiotics plus drainage with IET) is widely adopted, yet the real-world clinical course and predictors of surgical escalation remain unclear. METHODS:Using HCUP-National Inpatient Sample (2016 through 2018), we identified adults hospitalized with a principal diagnosis of empyema (ICD-10-CM J86.9). We excluded interhospital transfers and cases with an initial invasive pleural procedure. Patients were grouped as (1) conservative only (needle drainage and/or tube thoracostomy and IET) or (2) surgical escalation after initial conservative care. Primary outcomes were escalation to invasive pleural procedures and hospital LOS; secondary outcomes included in-hospital mortality, discharge disposition, and costs. Multivariable logistic regression evaluated factors associated with escalation; negative binomial regression modeled LOS. RESULTS:Among 2,336 admissions, 1,972 (84.4%) were managed conservatively and 364 (15.6%) escalated. IET was documented in 345/2,336 (14.8%) admissions. Patients were similar in age and sex. Escalated patients underwent more procedures (mean 6.4 vs 3.7). LOS was longer in the escalated group (14.4 vs 11.0 days), and mean costs were higher ($38,638 vs $26,212). In-hospital mortality remained low in both cohorts (2.3% in the conservative group vs 1.1% in the escalated group). In adjusted analyses, IET was associated with lower odds of invasive escalation (aOR 0.23; p < 0.001), while Black race (aOR 1.76; p = 0.003) and Hispanic ethnicity (aOR 1.56; p = 0.04) were associated with higher odds. Escalation was associated with longer LOS (IRR 1.33; p < 0.001), and IET was associated with a modest increase in LOS (IRR 1.12; p = 0.001). CONCLUSIONS:Most adults with empyema managed initially with noninvasive pleural procedures did not require invasive escalation during index admission. Escalation was associated with greater procedural burden, longer LOS, and higher costs. IET was associated with lower odds of escalation but slightly longer LOS.
OBJECTIVES:The aim of this study was to compare the sex-specific diagnostic performance of traditional anthropometric indices, including Body Mass Index (BMI), Waist Circumference (WC), Waist-Hip Ratio (WHR), and Waist-to-Height Ratio (WHtR), with novel indices such as A Body Shape Index (ABSI), Body Roundness Index (BRI), Abdominal Volume Index (AVI), Weight-Adjusted Waist Index (WWI), Body Adiposity Index (BAI), Conicity Index (CI), and Waist-Hip-Height Ratio (WHHR) in predicting the Metabolically Obese Normal Weight (MONW) phenotype in adults. METHODS:This diagnostic accuracy study involved 504 adults aged 19-64 years who met specific inclusion and exclusion criteria. Metabolic abnormalities were evaluated according to NCEP-ATP III criteria to identify the MONW phenotype. The ability of the anthropometric indices to discriminate MONW individuals was assessed using Receiver Operating Characteristic (ROC) curves, with optimal cutoff points determined by the Youden index. Results: Results indicated that 18.10% of adults had the MONW phenotype, and the proportion of men with MONW was higher than that of women (p < 0.05). ROC analysis revealed that among women, WHtR (AUC: 0.715, 95% CI: 0.598-0.832) among traditional indices and BRI (AUC: 0.712, 95% CI: 0.594-0.830) among novel indices showed fair predictive ability, while other indices demonstrated weak or no predictive power. In men, all indices exhibited poor or no performance in predicting the MONW phenotype. CONCLUSION:These findings suggest that anthropometric indices alone have limited capacity to identify MONW, especially in men, emphasizing the importance of comprehensive, multi-parameter assessments to detect high-risk normal-weight adults.
BACKGROUND:Shock index (SI) is a simple parameter in various diseases. Its performance in acute coronary syndrome (ACS) varies across studies. This systematic review evaluates SI's performance for ACS mortality prediction. METHOD:On 16 March 2025, we systematically searched six databases. This study included observational studies examining mortality outcomes in patients with ACS. Using random-effect models, we estimated the pooled odds ratio (OR), sensitivity, and specificity of SI in predicting ACS mortality. Additionally, we generated a summary receiver operating characteristics (sROC) curve and its area under the curve (AUC). RESULTS:This systematic review included 18 studies with 75,237 patients. High SI was significantly associated with all-time mortality (OR 4.82; OR 2.71 after publication bias adjustment). The association was stronger for in-hospital mortality (OR 6.46) but decreased for long-term mortality (OR 4.00). The SI cutoff values varied across studies, ranging from 0.5 to 1.6. The sensitivity and specificity of SI in predicting all-time mortality were 67.11% (95% CI: 61.48-72.74) and 73.21% (95% CI: 67.21-79.22), respectively, with an AUC of 0.69 (95% CI: 0.65-0.72). Its performance was higher for in-hospital mortality (sensitivity 64.22%, specificity 78.96%, AUC 0.71) and long-term mortality (sensitivity 61.23%, specificity 63.99%, AUC 0.70). CONCLUSION:High SI was associated with and has predictive value for short-term and long-term mortality prediction in ACS setting.
