Temporal and regional trends in adults with diabetics kidney disease in the US from 1999 to 2020.

AIMS: We aim to analyze trends in mortality rates among adults with diabetic kidney disease (DKD) in the US from 1999 to 2020. METHODS: We queried the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database for mortality statistics from 1999 to 2020 associated with DKD in adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) were calculated and trends were analyzed using the Joinpoint Regression Program. RESULTS: From 1999 to 2020, a total of 528,430 deaths were reported among adults with DKD. The mortality rates increased over time with males consistently exhibiting higher AAMR than females. NH American Indian or Alaska Native individuals had the highest AAMR, followed by NH Blacks, Hispanics, NH Whites, and NH Asians. The West region had the highest AAMR, followed by the Midwest, South, and Northeast. Rural regions had higher AAMR than urban areas, and mortality rates increased with age. CONCLUSIONS: This study reveals notable disparities in DKD mortality rates across demographic groups and geographic regions. NH American Indians or Alaska Natives, males, elderly individuals, rural residents, and those in the West region were disproportionately affected. Understanding these trends is crucial for developing targeted interventions to reduce DKD-related mortality and address healthcare disparities.

Two decades of influenza and pneumonia mortality trends: Demographics, regional shifts and disparities in the United States: 1999 to 2020.

BACKGROUND: In the 20th century, influenza and pneumonia constituted the largest proportion of infectious disease deaths in the United States. Despite progress in management, US mortality trends for these diseases have not been thoroughly investigated. OBJECTIVES: We aim to examine the patterns of influenza and pneumonia-related deaths among US residents. METHODS: Crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using influenza and pneumonia mortality data (International Classification of Diseases, 10th revision codes: J09-J18) from the CDC WONDER database. Annual percentage changes with a 95% confidence interval were determined using joinpoint regression analysis. Average annual percentage changes were computed as the weighted average of annual percentage changes. RESULTS: From 1999 to 2020, US influenza and pneumonia deaths totaled 1,257,088 (AAMR: 17.09), with a significantly decreasing AAMR (-2.94). Males had a higher AAMR (20.13) than females (15.02). Non-Hispanic American Indians had the highest AAMR (20.44), while Hispanics had the lowest AAMR (13.91). The Northeast had the highest AAMR (18.02). All other regions had similar AAMRs. Rural regions had a consistently higher AAMR (19.80) than urban regions (AAMR: 16.51). CONCLUSION: Tailoring interventions toward high-risk groups can enhance the effectiveness of preventive measures, vaccination, and health care access.

Mortality patterns in older adults with infective endocarditis in the US: A retrospective analysis.

BACKGROUND: Infective Endocarditis (IE) has become a significant cause of morbidity and mortality over the last two decades. Despite management advancements, mortality trends in the USA's geriatric population are unexplored. The aim of this study was to assess the trends and regional differences in IE related mortality among geriatric patients in the USA. METHODS: We analyzed death certificates sourced from the CDC WONDER database spanning 1999 to 2020. The research targeted individuals aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC), along with 95% CI, were calculated through joinpoint regression analysis. RESULTS: From 1999 to 2020, infective endocarditis caused 222,573 deaths, showing a declining trend (APC: -0.8361). Males had higher AAMR (26.8) than females (22.2). NH White had the highest AAMR (25.8), followed by NH American Indians or Alaska Natives (19.6). Geographically, the Midwest had the highest AAMR (27.4), followed by the Northeast (25.8). Rural areas consistently had higher AAMRs (26.6) than urban areas (23.6), while 80.16% of deaths occurring in urban settings. North Dakota, Nebraska, and Montana had the highest state AAMRs, approximately double than the states with the lowest mortality rates: Mississippi, Hawaii, California, and Massachusetts. Those aged 85 and above accounted for 42.9% of deaths. CONCLUSION: IE mortality exhibited a clear pattern: rising till 2004, declining from 2004 to 2018, and increasing again till 2020. Key risk factors were male gender, Midwest residence, NH White ethnicity, and age ≥85.Targeted interventions are essential to reduce IE mortality, especially among vulnerable older populations.

The Role of ChatGPT in Medical Research: Progress and Limitations.

Advancements in AI have resulted in the development of sophisticated language models like ChatGPT, which can generate human-like text. While ChatGPT is useful for clarifying concepts and providing basic guidance, it has limitations. It lacks the ability to provide the latest scientific information and access original medical databases. Studies have shown that ChatGPT's text can be robotic, shallow, and lacking a human touch. It has also been found to provide misleading or inaccurate information. Researchers and medical professionals should be aware of these limitations and not solely rely on ChatGPT for complex tasks. The human element and real-world experiences are indispensable in science, and consulting experts is advisable for reliable insights.

Gender and racial disparities in obesity-related cardiovascular-induced mortality in the USA, 1999-2020.

Obesity is closely linked to various cardiovascular diseases, leading to increased mortality rates. This study examines the trends in cardiovascular-induced obesity associated mortality among individuals aged 15 years and older in the United States. Data were sourced from the CDC WONDER for the years 1999-2020, encompassing fatalities where cardiovascular disease was the underlying cause of death and obesity was a contributing factor. The dataset was analyzed, considering annual patterns, gender, and ethnic origins. A total of 280,992 deaths were reported, with 56.35 % attributed to males and 43.64 % to females. The age-adjusted mortality rate was 5.8 for males and 4 for females. Non-Hispanic white individuals accounted for 71.049 % of total deaths, while non-Hispanic Black individuals contributed 19.510 %. The highest mortality rate was observed among non-Hispanic Black individuals, with non-Hispanic American Indian or Alaska Native individuals following. Non-Hispanic Asian or Pacific Islander individuals had the lowest mortality rate. The average annual percentage change (AAPC) was 6.1 for males and 4.4 for females. A significant increase in the overall mortality rate was observed from 2018 to 2020, with Hispanics/Latinos exhibiting the highest increase. The elevated AAMR among males as compared to females may be attributed to the cardio-protective properties of estrogen in women. Furthermore, the COVID-19 pandemic introduced unfavorable lifestyle changes, including weight gain and reduced exercise, potentially exacerbating CVD mortality trends after 2019. Further timely and targeted efforts are needed to control obesity and cardiovascular-related mortality in the USA.

Lysozyme-induced nephropathy due to systemic granulomatous disease.

Lysozyme-induced nephropathy is a rare form of acute tubular injury that has almost exclusively been reported in patients with monocytic malignancies. Typically, patients will present in acute renal failure A renal biopsy is necessary to confirm the diagnosis and will demonstrate proximal tubular cells with hypereosinophilic granules, which are periodic acid-Schiff and Jones methenamine silver-positive. Immunohistochemical staining for lysozyme will also be present. The following rare case will describe a case of lysozyme nephropathy in a patient without any underlying hematological malignancy, but instead with systemic granulomatous disease.

Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis.

PURPOSE: Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. METHODS: A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. RESULTS: Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller's myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. CONCLUSION: In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success.

Antibody-Drug Conjugates: A Review of Approved Drugs and Their Clinical Level of Evidence.

Antibody-drug conjugates (ADCs) are an innovative family of agents assembled through linking cytotoxic drugs (payloads) covalently to monoclonal antibodies (mAbs) to be delivered to tumor tissue that express their particular antigen, with the theoretical advantage of an augmented therapeutic ratio. As of June 2023, eleven ADCs have been approved by the Food and Drug Administration (FDA) and are on the market. These drugs have been added to the therapeutic armamentarium of acute myeloblastic and lymphoblastic leukemias, various types of lymphoma, breast, gastric or gastroesophageal junction, lung, urothelial, cervical, and ovarian cancers. They have proven to deliver more potent and effective anti-tumor activities than standard practice in a wide variety of indications. In addition to targeting antigen-expressing tumor cells, bystander effects have been engineered to extend cytotoxic killing to low-antigen-expressing or negative tumor cells in the heterogenous tumor milieu. Inevitably, myelosuppression is a common side effect with most of the ADCs due to the effects of the cytotoxic payload. Also, other unique side effects are specific to the tissue antigen that is targeted for, such as the cardiac toxicity with Her-2 targeting ADCs, and the hemorrhagic side effects with the tissue factor (TF) targeting Tisotumab vedotin. Further exciting developments are centered in the strategies to improve the tolerability and efficacy of the ADCs to improve the therapeutic window; as well as the development of novel payloads including (1) peptide-drug conjugates (PDCs), with the peptide replacing the monoclonal antibody, rendering greater tumor penetration; (2) immune-stimulating antibody conjugates (ISACs), which upon conjugation of the antigen, cause an influx of pro-inflammatory cytokines to activate dendritic cells and harness an anti-tumor T-cell response; and (3) the use of radioactive isotopes as a payload to enhance cytotoxic activity.

Gray zone lymphoma: A case report and comprehensive review of literature.

Gray zone lymphoma is a very rare liquid malignancy that possesses intersecting features between primary mediastinal B-cell lymphoma and classic Hodgkin Lymphoma. In the case presented and accompanying literature review, we will discuss a patient with a chief complaint of shortness of breath and was found to have a mediastinal mass with biopsy consistent with mediastinal gray zone lymphoma. Herein, we explore the historical and recently updated diagnostic criteria of gray zone lymphoma from 2022 as well as the pathophysiology as it pertains to gene expression, while also reviewing the histological findings, epidemiology and treatment modalities.

Pembrolizumab induced pericardial tamponade: A case report.

Key Clinical Message: The occurrence of a large pericardial effusion is not a commonly noted adverse event associated with pembrolizumab and our report demonstrates that a rapid development can be diagnosed with close monitoring and triage to acute medical settings. Abstract: Pembrolizumab is an immune checkpoint inhibitor used in various types of cancers. Pericardial tamponade is a rare side effect reported in only very few case reports. Early recognition and therapeutic intervention is vital in all cases. We report a case of a 54-year-old male with Stage 3 lung adenocarcinoma who developed cardiac tamponade secondary to pembrolizumab and subsequently required pericardial window.

Efficacy of patient-sided breath shields for slit-lamp examination.

OBJECTIVE: To evaluate the efficacy of patient-sided breath shields in preventing oronasal droplet transmission during slit-lamp examination. DESIGN: Experimental study testing the efficacy of patient-sided breath shields on a slit lamp. METHODS: Two commercially available patient-sided breath shields and a 3-dimensional (3D)-printed shield designed by the authors were attached to a slit-lamp chin rest for testing. Each shield was exposed to 3 standardized sprays of coloured dye from a spray gun with its nozzle adjusted to simulate the angular dispersion of a human sneeze. Any overspray not blocked by the shields was recorded and compared with spray with no shield (control). Image-processing software was used to ascertain the surface area of overspray not blocked by the tested shield compared with the control of no shield. RESULTS: With typical use, both commercially available patient-sided shields and the 3D-printed shield blocked 100% of forward-travelling measurable droplets from a simulated sneeze spray. Even when set to the furthest distance setting to simulate the worst-case scenario, shield 1 and the 3D-printed shield blocked 99.96% and 99.65% of overspray, respectively. However, slow-motion footage did reveal that a considerable amount of spray rebounded off the shields and extended peripherally past its borders. CONCLUSIONS: With typical use, all tested shields prevented 100% of oronasal transmission. To encourage accessibility, the authors offer a free 3D model and instructions for creating the tested patient-sided breath shield. Patient-sided shields should be combined with other infection-control measures to minimize transmission.

Optimal Timing of Perioperative Chemical Thromboprophylaxis in Elective Major Abdominal Surgery: A Systematic Review and Meta-analysis.

OBJECTIVE: To investigate the effect of the timing of chemoprophylaxis on venous thromboembolisms (VTEs) and bleeding rates in patients undergoing major abdominal surgery. BACKGROUND: Postoperative bleeding and VTE incur significant morbidity, mortality, and health care costs. Chemoprophylaxis is used routinely to prevent VTEs but increases bleeding risk. The perioperative timing of chemoprophylaxis initiation may influence both VTE and bleeding risks. The optimal window for commencing chemoprophylaxis in the perioperative period is unclear. METHODS: MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched using PRISMA guidelines. Randomized trials and cohort studies published between January 1, 2000 to May 10, 2022, which reported on chemoprophylaxis timing as well as the incidence of VTE and bleeding after elective abdominal surgery were meta-analyzed. RESULTS: From 6175 studies, 14 (24,922 patients) were meta-analyzed. Bariatric (4 studies), antireflux (1 study), hepato-pancreatic-biliary (5 studies), colorectal (1 study), ventral hernia (1 study), and major intra-abdominal surgeries (2 studies) were included. Chemoprophylaxis was initiated before skin closure in 10,403 patients, and postoperatively in 14,519 patients. Both symptomatic [risk ratios (RR), 0.81; 95% CI, 0.45-1.43; P =0.460] and overall (RR, 0.74; 95% CI, 0.45-1.24; P =0.250) VTE rates were comparable between study groups. Compared with postoperative chemoprophylaxis, early usage increased the risk of all bleeding (RR, 1.56; 95% CI, 1.13-2.15; P =0.007), major bleeding (RR, 1.63; 95% CI, 1.16-2.28; P =0.005), blood transfusion (RR, 1.48; 95% CI, 1.24-1.76; P <0.001), and reintervention (RR, 1.94; 95% CI, 1.19-3.18; P =0.008). CONCLUSIONS: Our findings advocate for initiating chemoprophylaxis postoperatively in elective abdominal surgery to minimize bleeding risk without compromising VTE protection.

Post Operative Complications Of Open Partial Nephrectomy With Respect To Tumour Location.

BACKGROUND: Partial Nephrectomy has been the go-to approach for the treatment of small sized renal tumours for years now. Like any other surgical procedure, it is associated with post-operative complications. The study was aimed at determining the post-operative complications of open partial nephrectomy concerning tumour location. METHODS: This descriptive cross-sectional study was done on 45 patients as per inclusion criteria. The patients were managed as per department protocols and were observed for the development of immediate post-operative complications during hospital stays. RESULTS: Post-operative complications were observed in 4 (8.9%) patients and included haemorrhage (n=1; 2.2%) and urine leak (n=3; 6.7%). There was a statistically significant association between post-operative complications of partial nephrectomy and central tumour location (p=0.008, OR=14.52 and LR=5.70) and increased age (p=0.04, LR=5.40 and OR=8.90). Discussion: Increased age and tumour location may play a significant role in determining the likelihood of post-operative complications in patients who have undergone surgery for renal tumours.

The New Gold Standard In Laparoscopic Imaging: 3d Vs 4k Laparoscopic Nephrectomy- A Single Centered Randomized Controlled Trial.

BACKGROUND: Thanks to progressive technology and modern innovations, laparoscopic procedures, being minimally invasive, have now supervened upon most open surgical procedures. Laparoscopic procedures have proven advantages over open procedures. The study was designed to compare the outcomes of laparoscopic nephrectomy between 3D and 4K camera resolutions. METHODS: This randomized control trial carried out at Tabba Kidney institute, Karachi, Pakistan from July 2020 to April 2021, to our knowledge was the first of its kind comparative study in Pakistan and internationally. All patients diagnosed to have symptomatic non-functioning kidney on the basis of both renal scintigraphy and CT- KUB were divided through blocked randomization in to two different camera resolution groups, i.e., 3D vs 4K and outcomes in terms of operative time, haemoglobin fall, post procedure complications and in patient stay were recorded. RESULTS: It was observed that the 3D group had a significantly shorter mean total operative time 172.1±36.9 vs 272.5±14.1 respectively (p<0.005). A significant difference was also observed in mean operative time for task 2 was 53.1±21.1 & 101±30.9 mins (p<0.005), and for task 3 was 67.18±18.3 & 112.5±37 mins (p=0.005) for 3D and 4K groups respectively. The mean haemoglobin drops in 3D and 4K groups was 0.51±1.6 & 0.73±1.1 respectively (p=0.7). Moreover, the mean hospital stay was 2.5±0.6 for 3D group & 2.7±0.9 for 4K group (p-value 0.8). Post-operative wound infection was observed in one patient in each group. No case had to be converted to surgery by an open approach. CONCLUSIONS: We concluded that despite being the latest technological advancement with a greater zooming capability, when used for performing laparoscopic nephrectomy, 4K imaging system couldn't show any superiority over 3D imaging system, in different operative tasks and in terms of total operative time.

Floseal-induced small bowel obstruction.

Floseal is a haemostatic agent designed to augment the body's natural clotting cascade response. We describe the first case in over a decade, and the first case with intra-operative images of early post-operative small bowel obstruction (SBO) associated with Floseal use in general surgery. A previously well man in his 30s underwent laparoscopic appendicectomy for clinical acute appendicitis. Floseal was applied to the right lateral abdominal wall for haemostasis. He developed a mechanical SBO, with diagnostic laparoscopy confirming a transition point between the caecum and terminal ileum, adherent to the area of the previously applied Floseal. He underwent adhesiolysis and uneventful recovery. We propose Floseal may exacerbate early post-operative inflammation and provide a nidus for early adhesion formation. We recommend removing excess Floseal not incorporated in the haemostatic clot and to consider Floseal as a differential in early post-operative SBO.

Exploring Data and Literature Currently Available on the COVID-19 Vaccines.

The COVID-19 pandemic has been labeled one of the most lethal pandemics in human history. As a result, there has been a high level of urgency throughout the world to establish successful vaccinations to subdue the effects of the virus and return to a level of normalcy. This study aims to investigate the different COVID-19 vaccines available both in the United States and across the globe. Through exploration of how the vaccines were developed, how they elicit immunity, their efficacy, and their safety profiles, this review has the goal of increasing the amount of knowledge regarding the vaccines available to combat SARS-CoV-2, while also providing an epidemiological and biostatistical approach to interpreting acquired data available on the vaccines.

A Clinical Overview of Acute and Chronic Pancreatitis: The Medical and Surgical Management.

An inflammatory process involving the pancreas, known as pancreatitis, can be categorized as either acute or chronic and may present in one of many ways. The clinical manifestations of acute pancreatitis are generally limited to epigastric or right upper quadrant pain, while manifestations of chronic pancreatitis are broader and may include abdominal pain in tandem with signs and symptoms of pancreatic endocrine and exocrine insufficiency. An understanding of the initial insult, proper classification, and prognosis are all factors that are of paramount importance as it pertains to managing patients who are afflicted with this disease. Our review delves into the depths of pancreatitis by exploring the embryology and anatomy of the pancreas, the pathophysiology and etiology of acute and chronic pancreatitis, and the medical and surgical management of acute and chronic pancreatitis.

Postpartum Respiratory Distress Due to Hypertension-Related Pulmonary Edema.

We present the case of a 35-year-old female who presented to the emergency department (ED) shortly after undergoing a cesarean section with dyspnea. Her vitals on admission revealed hypertension, tachypnea, bradycardia, and suboptimal oxygen saturation. Physical examination was remarkable for crackles in the lower lung fields. Laboratory results revealed elevated lactate dehydrogenase (LDH), pro-B-type natriuretic peptide (pro-BNP), and D-dimer levels. A CT angiogram showed no pulmonary emboli, and an echocardiogram revealed a normal ejection fraction and no diastolic dysfunction. A chest X-ray was significant for pulmonary edema and vascular congestion. The patient was diagnosed with respiratory distress due to pulmonary edema that was secondary to hypertension. This unusual case report seeks to highlight the idea that elevated blood pressure in postpartum women should warrant careful monitoring, as its consequential manifestations may be lethal. Additionally, pulmonary edema secondary to hypertension should be considered as a differential in either postpartum or peripartum women who present with respiratory symptoms and elevated blood pressure.