General Internal Medicine
Peer-reviewed articles on the diagnosis and management of adult patients in general internal medicine.
This page brings together peer-reviewed articles on the care of adult patients across general internal medicine: diagnosis, management, prevention and the organisation of care. It includes original research, systematic and narrative reviews, and clinical case reports, most of them from ASIDE Internal Medicine and ASIDE Case Reports. Many articles look at how illness is distributed across populations and at the gaps in care that different patient groups experience. Every article is free to read under a CC BY 4.0 licence, and authors pay no fee to publish. Articles are listed newest first; follow a title to read the abstract and full text, or browse the other topics for related specialties.
Articles from ASIDE Case Reports and ASIDE Internal Medicine, newest first.
Articles
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Pulmonary Alveolar Microlithiasis-like Process in Pregnancy with Concurrent Pneumothorax: A Case Report
Background. Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive lung disease caused by biallelic pathogenic mutations in the SLC34A2 gene, leading to calcium phosphate microlith accumulation in alveoli. Methods. We report a case of suspected PAM-like disease…
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Fatal Septic Shock with Presumed Urinary Source in a Patient with Clinically Suspected, Previously Undiagnosed Von Hippel–Lindau Disease: A Case Report and Literature Review
Background: Von Hippel-Lindau disease is a rare form of autosomal dominant cancer syndrome that affects multiple organs, such as the retina and brain hemangioblastoma, renal disease, and other visceral malignancies. Delayed diagnosis is a significant reason for avoidable…
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Psychological Burden in Behçet Disease: A Narrative Review Across Mucocutaneous, Articular, and Ocular Manifestations
Background: Behçet disease is a chronic, relapsing, multisystem inflammatory vasculitis in which mucocutaneous, articular, and ocular manifestations may coexist with substantial psychological burden. Methods: This narrative review synthesized English-language literature…
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Rash, Fever, and a Diagnostic Puzzle: Recognizing MIS-C Among Mimicking Illnesses in a Child After COVID-19 Exposure — A Case Report
Multisystem inflammatory syndrome in children (MIS-C) is a delayed hyperinflammatory condition following SARS-CoV-2 infection that can mimic Kawasaki disease, sepsis, and toxic shock. A previously healthy 9-year-old boy presented on illness day 5 with fever (102.9°F)…
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Pseudomyxoma Peritonei Masquerading as Decompensated Cirrhosis: A Diagnostic Challenge with Surgical Management in a Resource-Limited Setting in Tanzania
Pseudomyxoma peritonei (PMP) is a rare syndrome of mucinous ascites that often mimics common conditions such as decompensated cirrhosis. Diagnostic delays are frequent, especially in resource-limited settings where advanced imaging and histopathology are unavailable. A…
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Primary Epstein-Barr Virus Infection Causing Severe Acute Hepatocellular Liver Injury With Evolving Cholestatic Features in a Young Adult: A Case Report and Contextual Review of Published Adult Cases
Primary Epstein-Barr virus (EBV) infection usually causes mild aminotransferase elevation. Severe jaundiced hepatitis without encephalopathy is uncommon in adults. We describe a 20-year-old woman with primary EBV-associated acute liver injury and summarize a March 2026…
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Polymyxin B–Induced Bartter-Like Tubulopathy: A Case Report of Severe Potassium and Magnesium Wasting
Bartter syndrome is a rare inherited salt-wasting tubulopathy characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypercalciuria. Although typically genetic, Bartter-like phenotypes can occur secondary to nephrotoxic medications such as polymyxins, which…
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Life-Threatening Pulmonary Embolism in a Patient with Suspected Antiphospholipid Syndrome and Severe Thrombocytopenia: A Case Report
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis and obstetric complications in the presence of persistent antiphospholipid antibodies (aPL). Pulmonary embolism (PE), a frequent thrombotic manifestation of APS, can be…
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Overlapping Hyperemesis Gravidarum, Gestational Thyrotoxicosis, and Transaminitis in Early Pregnancy: A Case Report
Hyperemesis Gravidarum (HG), characterized by excessive emesis, fluid depletion, electrolyte imbalance, and weight loss, is a condition that affects approximately 0.3-2% of pregnancies. In this case report, we highlight the importance of careful investigation, evaluation, and…
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Probable Ocular Syphilis Presenting as Bilateral Panuveitis with Retinal Vasculitis in an HIV-Positive Patient with Concurrent Tuberculous Lymphadenitis: A Case Report
Ocular inflammation in people living with HIV presents diagnostic challenges when multiple opportunistic infections coexist. Attribution of ocular pathology becomes critical when microbiologic certainty is incomplete. A man in his 20s with newly diagnosed HIV presented with…
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Oral Sodium Bicarbonate as Adjunctive Therapy for Suspected Propafenone Cardiotoxicity in a Hemodynamically Stable Patient: A Case Report with Literature Review
We present the case of a 74-year-old male with a history of paroxysmal atrial fibrillation (PAF) and chronic kidney disease (CKD) who presented with fatigue. During hospitalization, telemetry captured an episode of hemodynamically stable wide-complex tachycardia consistent with…
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Kidney Transplantation in a Patient with Smoldering Multiple Myeloma: A Case Report and Narrative Literature Review
Chronic kidney disease and end-stage kidney disease are frequently observed in patients with plasma cell dyscrasias, including monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, and multiple myeloma, although kidney failure is not always directly…
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HSV-2–Associated Mollaret’s Meningitis in a Patient with History of Prior Episodes: A Case Report
Mollaret meningitis is a rare, recurrent form of aseptic lymphocytic meningitis, most commonly caused by herpes simplex virus type 2 infection. The clinical presentation includes sudden, recurring attacks of headache, meningismus, and lymphocytic cerebrospinal fluid pleocytosis…
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First Video-Documented Vine Snake (Thelotornis Capensis) Envenomation in a Healthy Adult: A Rare Case Report from South Africa
Vine snake (Thelotornis capensis) envenomation is rare but can cause life-threatening coagulopathy. We report the 10th documented case of envenomation: a 42-year-old male who misidentified a vine snake as a juvenile python and sustained a bite while filming snake handling…
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Silicone-Associated Still’s-Like Inflammatory Syndrome after Ruptured Silicone Breast Implant Treated with Adalimumab: A Case Report
Silicone breast implants have been associated with systemic inflammatory and autoimmune-like syndromes, although the underlying mechanisms remain debated. We report the case of a 49-year-old woman who presented with several months of chronic fever, profound fatigue, anemia…
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Subacute Cutaneous Lupus Erythematosus Following COVID-19 Vaccination: A Case Report after BNT162b2 Vaccine and Literature Review
Background: COVID-19 vaccines have demonstrated a favorable safety profile in diverse populations, including patients with autoimmune rheumatic diseases. However, rare adverse events such as disease flares and vaccine-triggered autoimmune manifestations have been reported. This…
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Efficacy and Safety of Isotretinoin Plus Desloratadine versus Isotretinoin Alone for Acne Vulgaris: Systematic Review and Meta-analysis
Introduction: Acne vulgaris is a common inflammatory skin disorder affecting the sebaceous glands–rich areas, including the face, chest, and back. It typically arises during adolescence but can persist or appear in adulthood. Recent findings suggest that histamine, via H1…
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Losartan Monotherapy vs Combination Regimens in IgA Nephropathy: A Systematic Review and Network Meta-analysis
Background: IgA nephropathy (IgAN) is a disorder in which Immunoglobulin A (IgA) antibodies build up, causing kidney damage. Losartan, an Angiotensin Receptor Blocker (ARB), has shown promise in patients with IgAN. However, a comparison of losartan with other IgAN therapies is…
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Motion-Artifact ‘Pseudo–Type A Dissection’ on Ungated CTA in a Morbidly Obese Patient with Resolution on ECG-Gated CTA: A Case Report
We present a case of acute chest pain in a 48-year-old morbidly obese female with multiple comorbidities that raised suspicion for Acute Aortic Syndrome (AAS). The initial ungated PE-protocol CT angiogram (CTA) revealed a linear low-attenuation band in the ascending aorta…
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Low-Grade Inflammation and Oxidative Stress as Drivers of Obesity-Related Complications: A Narrative Review
Background: The global prevalence of obesity continues to rise, with incidence rates differing markedly between regions. This narrative review synthesizes current evidence on how adipocyte dysfunction connects inflammatory and oxidative pathways to obesity-related complications…
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Demographic Factors of Colorectal Cancer (CRC) Patients with Paralytic Ileus Among Adults in the United States: A Retrospective Study for Mortality Trends
Background: Paralytic ileus is a serious postoperative complication among individuals with colorectal cancer (CRC). Although mortality trends for CRC and paralytic ileus have been described separately, long-term national patterns involving both conditions have not been examined…
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Posterior Reversible Encephalopathy Syndrome (PRES) Beyond Hypertension: Triggers, Pathophysiology, Management, and Outcomes
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurovascular disorder characterized by vasogenic edema, most often affecting the parieto-occipital lobes. Although typically reversible, some patients develop lasting neurological sequelae such as cognitive…
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Dexmedetomidine as an Adjuvant to Ropivacaine in Thoracic Paravertebral Block: A Systematic Review with Meta-analysis
Background: One of the ongoing challenges in thoracic surgeries, especially video-assisted thoracoscopic surgery (VATS), is effective postoperative pain management. The thoracic paravertebral block (TPVB) using ropivacaine provides targeted analgesia but suffers from a limited…
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Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA
Introduction: Angina is one of the ischemic heart diseases (IHD) that contributes to major cardiovascular complications up to death. We aim to assess angina-related mortality among adults aged ≥65 years in the U.S. Methods: Nationwide mortality records were obtained from the…
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VACTERL Associated with Lung Hypoplasia and Urinary Anomalies in a 20-Month-Old Boy: A Case Report
The VACTERL association is a rare group of birth defects, including vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb defects, with an incidence of 1 in 10,000 to 40,000 live births. Infants with lung hypoplasia and urinary…
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A Hidden Carcinoma with Mixed Squamous and Neuroendocrine Differentiation Revealed Through Paraneoplastic Hypercalcemia: A Case Report
Hypercalcemia of malignancy is most associated with squamous cell carcinomas, but can also be observed in many advanced cancers. It is usually mediated through parathyroid hormone-related protein and is known as humoral hypercalcemia of malignancy. We present a rare case of…
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Ellis–van Creveld Syndrome with Common Atrium: A Clinically Diagnosed Case Report with Literature Review
Ellis-van Creveld (EVC) syndrome is a rare, autosomal recessive disorder defined by a classic tetrad of features: chondroectodermal dysplasia causing disproportionate short stature, postaxial polydactyly, ectodermal defects affecting the nails and teeth, and congenital heart…
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Disparities and Trends in Polycythemia Vera–Related Mortality in U.S. Adults Aged ≥45 Years from 1999 to 2023
Background: Polycythemia vera (PV) is a rare myeloproliferative neoplasm characterized by excessive red blood cell production, leading to increased risk of thrombosis and other complications. Despite its clinical significance, trends in PV mortality across demographic groups in…
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Improving Inpatient Care for Acute Chronic Obstructive Pulmonary Disease Exacerbations: A Quality Improvement Initiative
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for high hospital use; guideline-concordant diagnostics, oxygen titration, and discharge planning are often under-delivered. We aim to measure baseline compliance with eight AECOPD process…
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Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Protein, and Skin Changes (POEMS) Syndrome in the Middle East: A Case Report
POEMS syndrome is a rare paraneoplastic syndrome characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein gammopathy, and skin changes. We report the first case of POEMS syndrome in Egypt. We report a 37-year-old Egyptian male who presented with left…
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Trends in Mortality from Leukemia and Ischemic Heart Disease: A 22-Year Analysis in the U.S. (1999-2020)
Introduction: Leukemia and ischemic heart disease (IHD) are major U.S. mortality causes. This study analyzes national mortality trends from 1999 to 2020 to assess the impact of public health efforts in leukemia-associated IHD mortality rates. Methods: This retrospective study…
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Amiodarone-Induced Thyrotoxicosis Presenting as Congestive Heart Failure Exacerbation and Thyroid Storm: Role of Plasmapheresis in Management and Prevention of Complications
Amiodarone-induced thyrotoxicosis (AIT) is a subtype of thyrotoxicosis caused by the long-term administration of the antiarrhythmic drug amiodarone. It’s classified into type 1 AIT, which is defined as hypersecretion of the thyroid hormone, while type 2 AIT is destructive…
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Prolonged Immunosuppressive Therapy in Immune Complex-Membranoproliferative Glomerulonephritis: A Case Report of Sustained Partial Remission Over Three Years
The prevalence of membranoproliferative glomerulonephritis (MPGN) is very low among primary glomerulonephritis. Once MPGN is diagnosed, it is essential to classify the type of MPGN [immune complex (IC), complement-mediated, and without complement or IC deposition]. In cases of…
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Outcome of Kidney Transplant Patients Following Treatment with Checkpoint Inhibitors: A Case Series
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enhancing immune surveillance against tumors. However, their use in kidney transplant recipients presents a significant challenge due to the risk of immune-mediated graft rejection. This retrospective…
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Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Case Report With Vertigo, Dysmetria, And Impaired Tandem Gait
SMART syndrome is a rare, delayed complication of brain radiation. The acronym SMART stands for stroke-like migraine attacks following radiation therapy. This case is one of the first to describe episodic vertigo, dysmetria, and impaired tandem gait following proton beam…
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Bridging the Gap between Evidence and Practice: Nationwide Retrospective Analysis of Lipid-Modifying Therapy Prescription Patterns in 5 Million Patients with Type 2 Diabetes Mellitus
Introduction: Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia and significantly increased cardiovascular risk, making lipid-modifying therapy a crucial preventive intervention in these patients. Despite clear guidelines recommending statin therapy for both…
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Lifestyle Practices in Reducing Cardiovascular Diseases: A Prospective Cohort Study from Pakistan
Background: Cardiovascular diseases (CVD) remain the leading cause of global mortality, especially in individuals with comorbidities like type II diabetes and hypertension. While pharmacological therapies are vital, lifestyle interventions may offer additional benefits in…
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Bone Marrow Necrosis in A Male Patient with Anti-Phospholipid Syndrome: A Case Report with Literature Review
Anti-phospholipid syndrome (APS) is a systemic autoimmune disease causing arterial and venous thrombosis, leading to macrovascular and microvascular complications. Bone marrow necrosis (BMN) is defined as the death of hematopoietic tissue and the loss of fat cells in a bone…
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Management of Venous Thromboembolism in a Patient with Duplicated Inferior Vena Cava: A Case Report and Literature Review
Anatomic variations of the inferior vena cava (IVC) are rare, occurring in less than 3% of the population, yet they can pose significant clinical and procedural challenges. We report the case of a 68-year-old male with a contraindication to anticoagulation due to…
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Rare Case of Disseminated Nocardiosis with Simultaneous Lung, Brain, and Spinal Cord Involvement in a Patient with Sarcoidosis
Nocardiosis is an uncommon opportunistic infection commonly affecting the lungs in immunocompromised individuals. We present an unusual case of disseminated nocardiosis involving the spinal cord and brain in a patient previously diagnosed with sarcoidosis and treated with…
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Benign Pheochromocytoma Coming Back with Bony Metastasis: A Case Report and Literature Review
Pheochromocytoma is an uncommon adrenal medulla tumor that secretes catecholamines. It is usually a benign condition and is generally treated with adrenalectomy; in a small proportion of cases, however, it might return or spread. Pheochromocytoma is uncommon to recur or…
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Esophageal Stenting and Endoscopic Vacuum Therapy for Esophageal Defects: A Systematic Review and Meta-Analysis
Background: Spontaneous esophageal perforation, particularly Boerhaave syndrome, is a life-threatening condition associated with high morbidity and mortality. Traditional surgical management is increasingly being supplemented by minimally invasive approaches, including…
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Hyponatremia-Induced Rhabdomyolysis in a Patient with Psychogenic Polydipsia: A Case Report
Hyponatremia is a common electrolyte abnormality that can lead to various complications, including rhabdomyolysis. Observational studies have identified a correlation between hyponatremia and the occurrence of rhabdomyolysis in hospitalized patients. We report a 45-year-old male…
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Thyroid Hormone Resistance Syndrome: A Case Report with Literature Review
Resistance to thyroid hormone receptor beta (THRβ) is a rare condition causing abnormal thyroid function tests (TFTs) characterized by elevated thyroid hormone levels with unsuppressed Thyroid Stimulating Hormone (TSH). Thyroid hormone action involves multiple steps, and…
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A Hidden Cause of Bone Fragility: Late Diagnosis of Hypophosphatasia in a 40-Year-Old Female
Hypophosphatasia (HPP) is a rare inherited metabolic disorder caused by loss-of-function mutations in the ALPL gene, leading to deficient activity of tissue-nonspecific alkaline phosphatase (TNSALP). This results in impaired bone and dental mineralization, causing a wide range…
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Epiploic Appendagitis Following Blunt Abdominal Trauma: A Case Report with Literature Review
Epiploic appendagitis (EA) is a rare and self-limiting cause of acute abdominal pain resulting from ischemia due to torsion or venous thrombosis of epiploic appendages. It often mimics more common conditions, such as diverticulitis or appendicitis, leading to misdiagnosis and…
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Probiotics: A Promising Ally in Burn Treatment
This review explores the potential therapeutic benefits of probiotics in the treatment of burn injuries, with the aim of addressing the limitations of traditional therapeutic approaches. It offers a comprehensive analysis of burn pathophysiology, including a wide range of burn…
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Acute Myeloid Leukemia Presenting as Bilateral Proptosis: A Case Report with Literature Review
Introduction: Acute myeloid leukemia (AML), constituting 30% of pediatric malignancies, is the most common childhood cancer. This paper explores the rare presentation of AML with extramedullary involvement, specifically bilateral proptosis, in a 15-year-old boy. Case report: The…
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Challenges and Infectious Complications in Living Donor Liver Transplantation in Egypt: A Comprehensive Review
Background: Living donor liver transplantation (LDLT) is a crucial therapeutic option for patients with end-stage liver disease in Egypt, where deceased donor grafts are scarce. This study aims to investigate the challenges and infectious complications associated with LDLT in…
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Efficacy and Safety of Penehyclidine Hydrochloride in Postoperative Nausea and Vomiting Prevention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Introduction: Postoperative nausea and vomiting (PONV) is a common complication following anesthesia. Penehyclidine hydrochloride (PHC), an anticholinergic medication, selectively inhibits the M1 Muscarinic and M3 Muscarinic receptors involved in the nausea and vomiting…
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Impact of Serum Adiponectin Level on Insulin and hs-CRP in Patients with Type 2 Diabetes: A Case-Control Study
Introduction: Type 2 diabetes mellitus (T2DM) is marked by insulin resistance, hyperglycemia, and systemic inflammation. Adiponectin—a hormone produced mainly by adipose tissue—enhances insulin sensitivity and exhibits anti‐inflammatory properties. This study evaluated serum…
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TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research
Introduction: The increasing utilization of real-world data platforms in medical research necessitates a comprehensive understanding of their methodological strengths and limitations. TriNetX has emerged as a significant platform for exploring large healthcare datasets. This…
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Investigating the Impact of Primary Education on Birth Control Practices in Bangladesh: A Primary Study
Introduction: Bangladesh faces significant challenges due to overpopulation, impacting essential resources such as healthcare, employment, and education. This study investigates the role of primary education in influencing contraceptive adoption and examines the socio-economic…
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Noonan Syndrome and Osteoporosis: A Comprehensive Case Study and Literature Review
Noonan syndrome (NS) is a genetic disorder caused by mutations in the RAS/MAPK signaling pathway, typically characterized by unique physical features, congenital heart defects, and short stature. Osteoporosis (OP), although uncommon in NS, can significantly impact patients'…
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Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A United States-Based Study From 1990 to 2024
Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United…
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Real-World Epidemiological Analysis of Gastrointestinal Neuroendocrine Carcinomas: A TriNetX-Based Study
Introduction: Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a diverse group of aggressive tumors with variable clinical outcomes. Although progress has been made in classifying and treating these cancers, detailed real-world data on their anatomical distribution and…
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Investigating Racial Disparities in Insulin Pump Use Among People with Type 1 Diabetes Across the United States: A Retrospective Multicenter Study
Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database…
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Safety and Efficacy of Metformin for Idiopathic Intracranial Hypertension: A U.S.-Based Real-World Data Retrospective Multicenter Cohort Study
Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety. Methods: We performed a retrospective cohort…
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The Impact of Idiopathic Intracranial Hypertension on Cardiovascular Disease Risk Among UK Women: An Obesity-Adjusted Analysis
Introduction: Idiopathic intracranial hypertension (IIH) is associated with increased cardiovascular disease (CVD) risk, but the relative contributions of obesity versus IIH-specific factors remain unclear. This study aims to disentangle the effects of obesity and IIH on stroke…
