Category: 8. Health

A 74-year-old female with a medical history of hypertension and type 2 diabetes mellitus was admitted to ICU following severe trauma from a road traffic accident. On admission, her home medications included empagliflozin, gliclazide, metformin, ramipril, amlodipine, and esomeprazole.

Initially, the patient presented with no hemorrhagic shock or organ failure. Her Glasgow Coma Scale (GCS) score was 14 upon arrival at the trauma center.

A computed tomography (CT) scan revealed:

• Mild traumatic brain injury with brain contusion hemorrhage and subarachnoid hemorrhage.

• Facial bone fractures.

• Thoracic trauma (Thoracic Trauma Score = 11) with a left-sided hemopneumothorax, which did not require drainage.

• American Association for the Surgery of Trauma (AAST) grade 3 traumatic splenic injury.

• Non hemorrhagic, non surgical pelvic trauma.

None of these injuries necessitated surgical intervention. An occipital scalp wound was debrided and sutured. Apart from esomeprazole, none of her long-term medications were resumed upon initial management. The patient’s initial medical course was favorable. Consequently, on Day 4, oral antidiabetic medications, including empagliflozin, were reintroduced.

From Day 5, the patient developed an unexplained fever without deterioration in her general condition.

By Day 7, while awaiting discharge from the ICU, her overall condition acutely deteriorated. She presented with a decreased level of consciousness (GCS 7/15), atrial fibrillation (heart rate 150–160 bpm), hemodynamic instability (90/54 mmHg), tachypnea (25–30 breaths per minute), hyperthermia (40 °C), and facial and left arm edema.

Arterial blood gas analysis revealed severe metabolic acidosis (pH 6.99, bicarbonate 6 mmol/L, pCO2 15 mmHg, pO2 105 mmHg, base excess − 23.4 mmol/L) with a lactate concentration of 1.8 mmol/L and a glucose concentration of 13.7 mmol/L.

Management initiated for septic shock included fluid resuscitation, vasopressor therapy, and broad-spectrum antibiotics. Subsequent cranial and thoraco-abdomino-pelvic CT scans revealed dermo-hypodermitis of the face, secondary to an occipital skin wound infection.

Further laboratory analysis showed a serum creatinine level of 55 µmol/L, discordant with her profound metabolic acidosis. This biochemical dissociation excluded acute kidney injury as the primary etiology, prompting evaluation for alternative causes such as diabetic ketoacidosis or toxic-mediated acidosis. In this context, a plasma ketone measurement was performed, revealing a level greater than 6 mmol/L. This strongly supported a diagnosis of EDKA associated with SGLT2i use.

All oral antidiabetic drugs, including empagliflozin, were discontinued. After achieving hemodynamic stability with aggressive crystalloid fluid resuscitation and correction of hypokalemia, a continuous intravenous insulin infusion was initiated, concurrently with a 10% dextrose infusion to prevent hypoglycemia.

Microbiological analysis confirmed methicillin-susceptible Staphylococcus aureus bacteremia, with positive blood cultures for nearly six days. Based on the antibiogram, antibiotic therapy was adjusted, and cloxacillin was subsequently introduced. A mitral valve endocarditis, characterized by a 12 mm mobile vegetation with renal and splenic emboli, developed as a secondary complication of the bacteremia. The patient was deemed unsuitable for surgical treatment due to her head trauma, which contraindicated extracorporeal circulation.

The shock resolved after 4 days, leading to the discontinuation of norepinephrine. After 5 days of insulin therapy, the patient’s acidosis resolved, and serum ketone bodies were negative. The continuous intravenous insulin infusion was then transitioned to a basal-bolus insulin regimen.

Ultimately, the clinical course of this infectious episode was favorable under well-managed antibiotic therapy for 6 weeks. The patient was transferred to a rehabilitation center after a 62-day ICU stay.

Artificial intelligence, touted for its potential to transform medicine, led to some doctors losing skills after just a few months in a new study.

AI helped health professionals to better detect pre-cancerous growths in the colon, but when the assistance was removed, their ability to find tumors dropped by about 20% compared with rates before the tool was ever introduced, according to findings published Wednesday.

Patients see doctors in a white coat as professional and trustworthy but often mistake a female medic wearing one for a nurse or medical assistant, a study has found.

Female physicians are “unfairly judged based on appearance and attire, which affected patients’ perceptions of professionalism and competency”, according to a global review of the evidence around patients’ impressions of what doctors wear.

“Female physicians are often judged more on appearance than their male counterparts,” it said.

“The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold.

“Even when male and female physicians wore identical attire, female physicians were still more likely to be misidentified as nurses or medical assistants.”

The researchers found that “gender-related perceptions of physician attire” existed across the 13 countries studied, including the US, India, Japan, China and Germany.

The paper, published in the journal BMJ Open, is based on an analysis of 32 previously published studies on perceptions of doctors’ clothing.

“The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians,” the paper’s co-authors write.

Such behaviour is so widespread that hospitals and other healthcare providers should try to reduce bias among patients and “foster equitable perceptions” of male and female medics, they add.

The white coat has been a symbol of medical expertise for decades. Its association in patients’ minds with cleanliness and professionalism meant that “white medical coats became the standard attire for physicians worldwide in the 20th century”.

Until then, doctors had generally worn black clothing to reflect the seriousness of meetings with patients.

People receiving healthcare find the white coat reassuring, the study found.

“Regardless of gender, patients exhibited favourable attitudes towards physicians wearing white coats, perceiving the physicians as trustworthy, respectful, skilled, communicative and empathetic.”

The white coat is still widely used by doctors worldwide. However, it was banned in the UK in 2008, when the government decided that medics working in the NHS should follow a “bare below the elbows” approach to reduce their risk of spreading infections. The British Medical Association was unsure that evidence justified the change.

Despite patients’ preference for doctors wearing formal clothing, the Covid-19 pandemic made them more accepting of scrubs.

“Patients tended to feel more comfortable with physicians wearing scrubs after Covid-19 ceased. While the traditional white coat is seen as a symbol of professionalism and trust, patients have increasingly accepted scrubs, especially in emergency or high-risk settings,” the researchers found.

Globally, male doctors seem to enjoy another advantage in many patients’ minds as to what they wear.

“Patients’ perceptions of male physicians’ accessories have shown that details such as watches and glasses significantly impact professionalism and trustworthiness” and add to their perceived authority, the study found.

(NewsNation) — New research suggests popular weight loss drugs like Ozempic and Wegovy may affect more than just fat, raising questions about muscle strength and organ size after significant weight loss.

University of Utah scientists studied semaglutide, the active ingredient in weight loss medications, in mice.

In the study, published in the journal Cell Metabolism, researchers revealed “unexpected effects,” highlighting that lean mass, or body weight that isn’t fat, dropped about 10%. Most of the loss came from nonmuscle tissues, particularly the liver, which shrank by nearly half. Some skeletal muscles lost around 6% of their size, while others remained unchanged.

Despite relatively small changes in muscle size, certain muscles became weaker. Researchers said this could be especially concerning for adults over 60, who already face higher risks of muscle loss and reduced mobility.

“The loss of physical function is a strong predictor of not just quality of life but longevity,” said Katsu Funai, the senior author on the study. 

The findings challenge the assumption that lean mass loss comes mainly from skeletal muscle. Instead, they point to changes in metabolically active organs, such as the liver, which can shrink during healthy weight loss without harming function.

“It’s unlikely that the observed lean mass loss represents a serious adverse effect,” said Takuya Karasawa, co-first author on the study. 

Still, scientists emphasize that further human studies are necessary to determine whether similar effects occur in humans and whether they pose health risks.

“There remains a significant need for validation in humans, especially concerning muscle strength,” Karasawa said.

They also suggest that future clinical trials should track not only lean mass but also muscle strength and physical function, especially as more weight loss drugs enter the market.

“There are many additional weight loss drugs that are in clinical trials and coming out in the next three to five years,” Funai said. “But with all those clinical trials, if they’re interested in measuring lean mass loss, they need to consider physical function.” 

Those with hidradenitis suppurativa (HS) are more likely than those without the disease to develop depression or anxiety; however, patients treated with biologics appear to have a lower risk of depression, according to a study recently published in JAMA Dermatology.

HS is a chronic, inflammatory skin disorder that causes painful lesions, scarring and a foul-smelling discharge in areas where skin rubs together, such as the underarms and groin.

Affecting roughly 1% to 2% of the population, mostly women, HS usually begins in late adolescence or early adulthood. However, diagnosis is often delayed by an average of seven years, which can worsen symptoms and contribute to psychological distress.

Beyond the skin, HS is associated with conditions including cardiovascular disease, inflammatory bowel disease (IBD), metabolic syndrome and polycystic ovarian syndrome. These comorbidities are believed to stem from factors such as systemic inflammation, obesity, smoking and genetics.

HS also carries a significant mental health burden.

Studies have found higher rates of depression and anxiety among those with HS compared with the general population, especially among women, smokers and those with alcohol use disorders. Potential drivers include chronic pain, impaired body image, sexual dysfunction and social or economic challenges such as unemployment.

A recent review found that HS patients face elevated risks not only of depression and anxiety, but also of bipolar disorder, psychotic disorders, substance abuse and suicide. Another study reported that those with HS, especially severe cases, often experience poorer sleep, mood and overall quality of life.

While these associations are documented, few studies have examined whether disease severity influences mental health outcomes, or whether HS increases the likelihood of recurrent depression and anxiety in those with a prior history.

To look into this association, researchers conducted the nationwide cohort study that used Danish health registries to track all residents of Denmark from January 1, 1997, to December 31, 2022. Data on demographics, education, income, medical conditions, hospital visits and prescriptions were linked using personal identification numbers. HS cases were identified from hospital diagnoses, and participants were considered unexposed until their first HS diagnosis. Controls from the general population were matched 4:1 by age and sex.

The main outcomes were new cases of depression or anxiety, based on hospital records or prescriptions for antidepressants or anxiety medicines. Other factors included income level, lifestyle habits and other health conditions.

HS severity was estimated by treatment type (topical, systemic nonbiologic, or biologic) and the number of HS-related surgeries. Participants were followed from their start date until the first mental health outcome, death, migration or study end. To ensure only new cases were captured, those with depression or anxiety in the three years prior to the index date were excluded.

The analysis included 10,206 patients with HS and 40,125 matched controls. The mean age in both groups was about 38 years, and 69.9% were female. Compared with controls, HS patients had higher rates of alcohol use disorder (5.8% vs 2.6%), smoking (14.0% vs 3.8%), drug use disorder (5.1% vs 0.8%), diabetes, hypertension and IBD. They were also less likely to be in the highest income or education brackets.

It was also found that about 55.5% of patients received systemic nonbiologic drugs, while 6.5% received biologics. Those treated with biologics had the highest prevalence of substance use disorders and IBD.

During follow-up, HS patients had a higher incidence of new-onset depression or anxiety than controls. had a 52% higher overall risk of developing depression or anxiety, with depression risk (HR 1.69) higher than anxiety risk (HR 1.48). The higher risk showed up in all treatment groups, but for those using biologics, depression risk was not significantly different from people without HS. Having more hospital stays for HS-related surgery was linked to higher risk, but researchers did not find a clear pattern of risk increasing with more surgeries.

At the start of the study, people with HS were more likely to have had depression or anxiety in the past, but during follow-up, their chances of it coming back were about the same as those without HS.

This study had several strengths, including a large number of participants, long follow-up and detailed registry data that made it possible to account for other health conditions and factors. It also looked at both depression and anxiety in the same group of patients and broke down the results by signs of disease severity.

The study had several limitations. Because the registry data were not collected for research, some patients may have been misclassified or had undiagnosed HS. Depression and anxiety were defined broadly, from mild to severe, making it difficult to measure the effect of illness severity.

Disease severity was based on treatments received, which may not match a patient’s actual condition and can be affected by doctor or patient choices. In addition, medication adherence wasn’t measured. HS cases treated only in primary care were also excluded, and the mostly White Danish population means the results may not apply to other groups.

The authors of this study stressed that clinicians should screen for depression and anxiety in all HS patients, regardless of disease severity, given the significant risk identified. They urged for further research to uncover other factors that may contribute to mental health challenges in this population.

Authorship, funding, disclosures

Additional authors included co-lead author Lauren E. Milling, Priyamvada Prathima, Vivian Li, Ashlyn M. Lemmen, Ivy S.L. Streeter, Paul K.S. Heisig, Nicole M. Derosia, Elizabeth Riffo, Haonan Xu, Thao H. Nguyen, Aashiya Kolengaden, Samuel C. Markson, and John G. Doench.

This work was supported by the National Institutes of Health (National Institute of Allergy and Infectious Diseases grant U19AI133524 and National Cancer Institute award 1K99CA290077-01A1), a Cancer Research Institute Immuno-Informatics Postdoctoral Fellowship (CRI5009), and the American Association of Immunologists Intersect Fellowship Program for Computational Scientists and Immunologists. LaFleur and Sharpe also received funding for this work from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ; the Blavatnik Biomedical Accelerator at Harvard University; the Quadrangle Fund for Advancing and Seeding Translational Research (Q-FASTR) at Harvard Medical School; and Calico Life Sciences LLC.

Sharpe has patents/pending royalties on the PD-1 pathway from Roche and Novartis.
LaFleur, Milling, Streeter, Lemmen, Hesing, Derosia, and Sharpe have a patent on methods for modulating STUB1 for the treatment of cancer. Sharpe is on advisory boards for Elpiscience, Monopteros Therapeutics, Corner Therapeutics, BioEntre, Alixia, GlaxoSmithKline, Janssen, Amgen, AltruBio, ImmVue, and MabQuest. Sharpe receives research funding from Calico Life Sciences LLC and Taiwan Bio. Doench consults for Microsoft Research, Abata Therapeutics, Servier, Maze Therapeutics, BioNTech, Sangamo, and Pfizer. Doench consults for and has equity in Tango Therapeutics. Doench serves as a paid scientific advisor to the Laboratory for Genomics Research, funded in part by GlaxoSmithKline. Doench receives funding support from the Functional Genomics Consortium: AbbVie; Bristol Myers Squibb; Janssen; and Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ. Doench’s interests were reviewed and are managed by the Broad Institute in accordance with its conflict-of-interest policies.

The chest wall perforator flap technique is becoming more common for breast cancer reconstruction surgeries, and new findings established higher patient satisfaction with the technique within a 21-month follow-up compared with other methods, according to a recent study published in Surgery reported^.1

Breast reconstruction usually occurs after an individual has undergone a mastectomy, where the entire breast is removed, or a lumpectomy, where only the cancer cells and a small piece of healthy breast tissue are removed. There are 2 main types of breast reconstruction: implant reconstruction and tissue (flap) reconstruction, which are sometimes used in conjunction to rebuild a woman’s breast entirely. Reconstruction can take place directly after a mastectomy or lumpectomy, or it can happen months or even years later to one or both breasts.² The study aimed to assess the safety and complication profile of different standard breast reconstruction techniques.¹

Breast-conserving surgeries and techniques provide psychological and aesthetic benefits for patients, thus translating to improved quality of life, making them the most preferred choice of treatment for individuals with breast cancer.¹

The retrospective comparative observational study included 346 female participants who underwent breast cancer surgery between December 2020 and September 2024. The average age was 59.58 years, and the mean body mass index ranged from 20 to 36.7. Amongst the subtypes of breast cancer present in participants, the most common was invasive ductal carcinoma (IDC, 75%), followed by ductal carcinoma in situ (DCIS, 19.4%) and invasive lobular carcinoma (ILC, 8.3%).

Patients were then divided into variants depending on the type of breast cancer surgery they underwent and whether or not they opted for immediate reconstruction or no reconstruction at all. Of them, 36 underwent chest wall perforator flap reconstruction, which moves a patient’s skin and fat, but not muscle, from the chest area to reconstruct the breast using a perforator (blood vessels) for blood supply. The remaining groups included those who received a lumpectomy without reshaping (n = 161), a lumpectomy with oncoplastic mammoplasty (breast conservation with plastic surgery techniques; n = 69), and a mastectomy with or without immediate reconstruction (n = 80).

In addition to the complication rates of each operation, including re-excision (a follow-up procedure to remove additional tissue), local recurrence of cancer cells, and patient satisfaction, measured using the BREAST-Q assessment. The complication rate in patients who underwent the chest wall perforator flap was 11.1%, similar to that of the lumpectomy (11.8%) and the oncoplastic mammoplasty (11.6%), which is significantly lower when compared with mastectomy with reconstruction (23.1%). The re-excision rate in the chest wall with perforator flap (13.9%) was also significantly lower compared with the lumpectomy (19.3%) and the oncoplastic cases (17.4%). Furthermore, there were no local or distant recurrences observed with the chest wall perforator flap in patients with an average follow-up of 21.4 months; patient satisfaction was also high with this procedure, with 86.1% reporting favorable outcomes.

Researchers concluded, “In cases involving the removal of more than 20% of the breast volume, tumors located in areas of the breast with less tissue, which are more difficult to remodel, or in patients who do not accept contralateral breast symmetrization, volume replacement techniques with chest wall perforator flaps (CWPFs) have been postulated as an interesting option to preserve the breast while achieving a good cosmetic result.”

References

1. Acera M, García EC, Román CFS, et al. Breast reconstruction techniques with perforator flaps vs other surgical techniques in breast cancer. Surgery. Published online August 6, 2025. doi:10.1016/j.surg.2025.109586

2. Breast reconstruction: What is it, types, procedure & recovery. Cleveland Clinic. June 30, 2025. Accessed August 8, 2025. https://my.clevelandclinic.org/health/treatments/16809-breast-reconstruction.