Southern medical journal
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Southern medical journal · Jan 2025
ReviewThe Moreton Lecture Series: The Renin-Angiotensin-Aldosterone System-Physiology, Pathophysiology, and Pharmacological Inhibition.
The renin-angiotensin-aldosterone system (RAAS) is a complex regulator comprising hormones, proteins, and enzymes. The discovery of the RAAS and its pharmacological manipulation has been essential in the management of cardiovascular diseases, including hypertension. Beyond the benefits of hypertension, RAAS inhibition has implications for heart failure, atherosclerotic disease, and kidney disease. This review discusses the history and mechanism of RAAS inhibition, cardiovascular benefits, affordability, and potential future pharmacological therapies.
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Liver fibrosis represents a common sequela of nonalcoholic fatty liver disease (NAFLD) and other chronic liver diseases. Noninvasive liver fibrosis scores (LFSs) aim to evaluate the severity of liver fibrosis. Whether LFSs can predict the risk of future cardiovascular events (CVEs) remains unclear. This systematic review aimed to clarify the association between liver fibrosis and CVEs by studying the value of LFSs, namely the Fibrosis-4 (FIB-4) Index for Liver Fibrosis score and the NAFLD Fibrosis Score (NFS), for predicting CVEs. ⋯ The findings of this review suggest that liver fibrosis in patients with NAFLD is an independent predictor of future adverse CVEs, cardiovascular mortality, and all-cause mortality. Noninvasive and easy-to-perform LFSs, including FIB-4 score and the NFS, appear useful in predicting such events in patients with a spectrum of cardiovascular diseases and the general population without known cardiovascular disease.
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Southern medical journal · Jan 2025
Linkage to Treatment and Recovery Support Services for Patients with a Substance Use Disorder: A Survey of Kentucky Physicians.
The purpose of this study was to survey current physicians in Kentucky to evaluate their management of patients with substance use disorder (SUD), with a focus on the identification of their referral methods for linkage to SUD treatment and recovery support services. ⋯ There are gaps in screening and linkage to care, especially in internal medicine and family medicine physicians. Work is necessary to increase screening, build provider capacity to treat, and increase knowledge of SUD treatment and recovery resources in Kentucky.
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Southern medical journal · Jan 2025
Increased Prevalence of Skeletal Anomalies on Ultrasound Evaluation of Buprenorphine-Exposed Human Fetuses.
In this study, buprenorphine was the primary source of maternal opioid exposure at the time of initial prenatal evaluation. Current recommendations advise that level II ultrasounds be performed in patients with substance use disorders. For some patients, distance, transportation, and costs associated with obtaining ultrasounds from a specialist pose significant barriers. This study was thus undertaken to evaluate the value of level II ultrasounds in buprenorphine-exposed pregnancies. ⋯ This is the first report of skeletal anomalies in buprenorphine-exposed human fetuses. Causality is unproven, but this report is consistent with prior human and animal studies in which maternal opioid use has been linked to significant impairments in bone growth and development. Our findings suggest that anatomic surveys of fetuses exposed to buprenorphine should be performed by individuals with expertise in the detection of fetal skeletal anomalies.
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Southern medical journal · Jan 2025
Trends in Medical Students' Legal Concerns Regarding Abortion Care in the Wake of the 2022 Dobbs v Jackson Women's Health Organization Decision.
The 2022 Dobbs v Jackson Women's Health Organization US Supreme Court decision dramatically shifted the legal landscape in health care, leaving state legislatures to redefine the ethics of medical practice. As gold-standard medical procedures become banned and criminalized, physicians are facing heightened legal uncertainty and grappling with moral dilemmas of where and how to practice. This study aimed to quantitatively assess trends in legal concern among medical students and identify correlations with decision making regarding future medical training. ⋯ Individuals with heightened proximity to reproductive healthcare may face greater ethical and moral dilemmas as they seek future career opportunities in a post-Roe v Wade world. These data suggest that they seem highly responsive to moving out of abortion-restricted states, indicating that the Dobbs decision, and the legal landscape it has created, may further exacerbate disparities in reproductive health care.