Faculty Bibliography
Searched for:
school:LISOM
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13021
Serum bicarbonate concentration is inversely associated with bone density in adults with type 2 diabetes mellitus: African American-Diabetes Heart Study
BACKGROUND:Osteoporosis is a significant cause of morbidity and mortality in the aging population. Individuals with type 2 diabetes mellitus (T2D) typically have higher bone density yet also a higher rate of fractures. Blacks, meanwhile, have a lower incidence of osteoporosis compared to European Americans. Serum bicarbonate may be a risk factor for bone loss, but studies are conflicting, and little is known about this relationship in T2D or Blacks. METHODS:We examined the longitudinal relationship between serum bicarbonate and change in bone density in 300 participants with T2D in the African American-Diabetes Heart Study (AA-DHS). Serum bicarbonate was measured at baseline, and bone density was assessed using CT volumetric bone mineral density (vBMD) scans of the thoracic and lumbar vertebrae at baseline and after five years of follow-up. Multivariate linear regression models assessed associations between baseline serum bicarbonate and longitudinal change in vBMD, adjusted for multiple confounders. RESULTS:, p < 0.001), without a clear threshold effect or differences by sex. CONCLUSIONS:In this cohort of Blacks with T2D, higher baseline serum bicarbonate levels were associated with improved changes in bone density over time. Further studies are needed to determine if alkali supplementation would ameliorate loss of bone density in this population.
PMID: 40157565
ISSN: 1873-2763
CID: 5818022
Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection
BACKGROUND/UNASSIGNED:Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals. METHODS/UNASSIGNED:This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression. RESULTS/UNASSIGNED:=0.01). CONCLUSIONS/UNASSIGNED:In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.
PMID: 40143807
ISSN: 1524-4628
CID: 5816392
Utility of 4-dimensional computed tomography in predicting single-gland parathyroid disease-Can we abandon intraoperative parathyroid monitoring?
BACKGROUND:Four-dimensional computed tomography is routinely used to localize parathyroid disease, with consistently excellent parathyroid gland localization rates reported. This study evaluated whether pairing 4-dimensional computed tomography results with preoperative clinical variables can accurately predict single-gland disease in primary hyperparathyroidism. METHODS:Patients with primary hyperparathyroidism who underwent both 4-dimensional computed tomography imaging and parathyroidectomy between January 2019 and September 2021 at a large academic health system were included. Patient demographics, preoperative characteristics, and peri- and postoperative data were collected. The accuracy of 4-dimensional computed tomography in correctly identifying patients with single-gland disease with and without preoperative calcium and parathyroid hormone levels was calculated. Single-gland disease was defined by intraoperative parathyroid hormone decrease >50% and a hypercellular gland on pathology. RESULTS:One hundred seventy-five patients had 4-dimensional computed tomography results suggestive of single gland disease. One hundred fifty-two patients (87%) were predicted correctly to have single-gland disease. The predictive accuracy increased when stratifying by preoperative calcium (≥10.5 mg/dL, ≥11 mg/dL, and ≥12 mg/dL) and parathyroid hormone levels (≥65 pg/mL, ≥100 pg/mL, and ≥200 pg/dL). The accuracy further increased when stratifying by age (≤50 years). Accuracy for single gland disease was 100% when combined with any of the following: (1) calcium ≥12 mg/dL, (2) parathyroid hormone ≥200 pg/dL, or (3) calcium ≥11 mg/dL in patients ≤50 years. CONCLUSION/CONCLUSIONS:Four-dimensional computed tomography alone accurately predicted single gland disease in 87% of patients with primary hyperparathyroidism. When combined with preoperative calcium, parathyroid hormone and age thresholds, predictive accuracy for single-gland disease approached 100%. Given the high likelihood of single-gland disease in these scenarios, clinicians may consider offering focused unilateral parathyroidectomy without intraoperative parathyroid hormone monitoring in selected patients.
PMID: 40138877
ISSN: 1532-7361
CID: 5815992
Effects of B Vitamins on Homocysteine Lowering and Thrombotic Risk Reduction-A Review of Randomized Controlled Trials Published Since January 1996
Homocysteine is an amino acid derived from methionine which is metabolized via vitamin B6 (pyridoxine)- and vitamin B12 (cobalamin)-dependent pathways. Supplementation of B vitamins has been shown to effectively reduce plasma homocysteine levels. Previous research has also demonstrated an association between lower plasma homocysteine levels and decreased risk of myocardial infarction, stroke, and venous thromboembolism. However, whether supplementation of B vitamins is associated with risk reduction in thromboembolic events and confers clinical benefits remains inconclusive. This review examines clinical trials published over the past 29 years to assess the effects of B vitamin supplementation on thrombotic risk reduction and homocysteine metabolism. The findings from these studies are inconsistent, and the impact of B vitamins on thrombosis prevention remains uncertain. Given the conflicting evidence, further clinical and translational research is necessary to clarify the role of B vitamin supplementation in thrombosis risk reduction.
PMCID:11990291
PMID: 40218880
ISSN: 2072-6643
CID: 5824432
Pregnancy outcomes are compromised in obese women with PCOS after transfer of a single frozen-thawed euploid embryo
PMID: 40127713
ISSN: 1556-5653
CID: 5814792
Diabetes Management Through Remote Patient Monitoring: A Mixed-Methods Evaluation of Program Enrollment and Attrition
PMID: 40217996
ISSN: 2227-9032
CID: 5824412
A Life Dedicated to Surgical Innovation: Harvey Cushing (1869-1939)
PMID: 40110981
ISSN: 1538-4683
CID: 5813552
Female gender and racial minority status is associated with Poor clinical outcomes and higher healthcare resource utilization in necrotizing fasciitis: Analysis of a Nationwide database in the United States
INTRODUCTION/BACKGROUND:Necrotizing fasciitis is a rapidly progressive infection associated with high mortality and complications. It mainly involves subcutaneous tissue and fascia. More quality data on disparities in clinical outcomes of necrotizing fasciitis must be provided. Our study aims to identify gender and racial disparities in necrotizing fasciitis outcomes. METHODS:We used data from the Nationwide Inpatient Sample database from 2016 to 2020. As appropriate, the Chi-square and t-test were used to test for associations between categorical and continuous variables. Multivariate logistic regression models, adjusted for key confounders, were used to obtain odds ratios for in-hospital mortality and various complications. Similarly, multivariate linear regression models were created for continuous outcome variables. RESULTS:Among 118,775 patients with necrotizing fasciitis, women (adjusted odds ratio [aOR] 1.18, 95 % confidence interval [CI]: 1.07-1.30, p = 0.001), Asian (aOR 1.49 (95 % CI: 1.10-2.02, p = 0.01), and Hispanic (aOR: 1.16; 95 % CI: 1.0-1.35; p = 0.045) patients had significantly higher in-hospital mortality than White patients. In comparison with men, women were more likely to require invasive mechanical ventilation and blood transfusions and develop ARDS. They are less likely to develop AKI, acute myocardial infarction, or venous thromboembolism and require non-invasive mechanical ventilation (p < 0.05 for all comparisons). Similarly, certain racial minority groups were also at a heightened risk for complications, such as AKI requiring hemodialysis, ARDS, venous thromboembolism, sudden cardiac arrest, and need for blood transfusion, among others (p < 0.05 for all comparisons). As compared to white patients, African American (1.7 days longer, p < 0.001), Asian (4.3 days longer, p < 0.001), and Hispanic (0.6 days longer, p = 0.048) patients had a significantly longer length of hospital stay. Asian, African American, and Hispanic patients also had substantially higher hospitalization costs, amounting to an additional $17,596.07 (p < 0.001), $5899.60 (p < 0.001), and $4356.55 (p < 0.01), respectively, versus White patients. Native American patients did not have any significant difference in the cost of hospitalization as compared to White patients. CONCLUSION/CONCLUSIONS:Females and racial minorities are at increased risk of mortality and higher healthcare resource utilization in necrotizing fasciitis. There is a need to develop equitable management strategies and health policy interventions to address these disparities effectively.
PMID: 40147168
ISSN: 1879-1883
CID: 5816872
25 years of palivizumab: a global historic review of its impact on the burden of respiratory syncytial virus disease in children
INTRODUCTION/UNASSIGNED:Respiratory syncytial virus (RSV) causes significant morbidity and mortality in young children. For 25 years, palivizumab has been the only effective pharmaceutical RSV preventive. AREAS COVERED/UNASSIGNED:We summarize the development and a quarter-century of real-world evidence with palivizumab. We highlight its positive impact on the burden of RSV in high-risk children. Based on lessons learnt from its implementation, we suggest strategies for effective and equitable deployment of newer RSV preventives. EXPERT OPINION/UNASSIGNED:Following failure of the formalin-inactivated RSV vaccine in 1967, RSV intravenous immunoglobulin was approved in 1996 after three decades' research. Subsequently, palivizumab emerged as the most effective and safe RSV preventive, demonstrated by the IMpact trial, and was licensed in 1998 in the United States. Over the last 25 years, the benefits of palivizumab have been firmly established through a wealth of evidence, predominantly from high-income countries (HICs). To achieve a global impact with the newer RSV preventives, evidenced-based universal guidelines must be developed and endorsed by regulatory authorities and relevant scientific societies. Independent economic evaluations should incorporate all RSV-associated healthcare costs, reduction of long-term respiratory sequelae, and standardized outcomes. Most importantly, equity in product availability and implementation, particularly in low- and middle-income countries (LMICs) is essential.
PMID: 40111069
ISSN: 1744-8336
CID: 5813572
Novel C1A Domain Variant in Protein Kinase Cγ in Spinocerebellar Ataxia Type 14 Decreases Autoinhibition [Case Report]
Spinocerebellar ataxia type 14 (SCA14) is an autosomal dominant neurodegenerative disorder characterized by adult-onset cerebellar ataxia, and occasionally pyramidal signs, cognitive changes, sensory changes, myoclonus, and tremor. SCA14 results from heterozygous gain-of-function pathogenic variants in PRKCG, which encodes protein kinase Cγ. The aim was to elucidate the molecular mechanism of disease in a 60-year-old man with SCA14 due to a novel heterozygous variant in PRKCG c.154T > C p.(C52R). Next-generation sequencing was completed in the proband, targeted variant analysis was conducted in his family, and biochemical functional assays were performed. The C52R variant segregated with disease. Like other C1A domain variants, it had increased basal activity yet was unresponsive to agonist stimulation and was relatively resistant to down-regulation. This expands the genetic landscape of SCA14 and supports the condition as a gain-of-function disease, with variants in the C1A domain having leaky activity yet unresponsiveness to agonist stimulation.
PMID: 40100287
ISSN: 1473-4230
CID: 5813262
