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Cardiometabolic risk and therapeutic outcomes in mild autonomous cortisol secretion
No full textPURPOSE OF REVIEW: Adrenal tumors are increasingly detected due to widespread use of cross-sectional imaging, with mild autonomous cortisol secretion (MACS) present in up to 50% of cases. This review summarizes the current evidence linking MACS to cardiometabolic comorbidities and outcomes, and evaluates the impact of adrenalectomy and emerging medical therapies.
RECENT FINDINGS: MACS is consistently associated with higher prevalence of hypertension, impaired glucose metabolism, dyslipidemia, obesity, and cardiovascular events compared to nonfunctioning adrenal tumors (NFATs). Several observational studies and randomized controlled trials have shown that adrenalectomy can improve blood pressure and glycemic control, although evidence regarding lipid metabolism and obesity is mixed. Despite growing evidence, gaps remain in predicting which patients will benefit most from surgical or medical therapy.
SUMMARY: MACS is clinically relevant entity with substantial cardiometabolic burden. While adrenalectomy may confer benefits in selected patients, individualized risk stratification remains a key challenge. Future research should focus on identifying predictive biomarkers, clarifying therapeutic thresholds and conducting large-scale prospective trials to inform clinical decision-making
Adverse events of cold snare compared to hot snare and ablation endoscopic mucosal resection for large colorectal polyps
No full textBackground and Study Aims: Endoscopic mucosal resection (EMR) techniques for large (≥ 20 mm) non-pedunculated colorectal polyps (LNPCPs) have expanded with the introduction of ablation and cold EMR (cEMR). This study assessed adverse events for newer EMR techniques including cEMR compared to hot EMR.
Patients and Methods: We conducted a secondary analysis of four prospective multicenter studies of consecutive patients with LNPCPs undergoing EMR from 2019-2024. Primary outcome was serious adverse events (SAEs) with cEMR and hot EMR. Secondary outcomes included SAEs with hot EMR subgroups (no ablation [hEMR], margin ablation [hEMR-m], margin and base ablation [hEMR-mb]).
Results: 1762 patients (mean age 65.8y, 1890 LNPCPs) were included: 522 cEMRs and 1368 hot EMRs (368 hEMR, 770 hEMR-m, 230 hEMR-mb). SAEs were higher with hot EMR (4.7%, 3.6-5.9) compared to cEMR (1.9%, 0.9-3.5), including in subgroups of hEMR (6.0%, 3.8-8.9), hEMR-m (3.9%, 2.6-5.5) and hEMR-mb (5.2%, 2.7-8.9). Serious post-endoscopic bleeding (PEB) was numerically higher with hot EMR (2.3%, 1.6-3.3) compared to cEMR (1.3%, 0.5-2.7), including in subgroups of hEMR (3.0%, 1.5-5.3), hEMR-m (1.9%, 1.1-3.2) and hEMR-mb (2.6%, 1.0-5.6). Perforation, intraprocedural and postprocedural, was numerically higher with hot EMR (1.2%, 0.7-2.0) compared to cEMR (0.2%, 0.0-1.1). hEMR-m and hEMR-mb with clipping had lower serious and overall PEB than without clipping.
Conclusions: Cold EMR demonstrated lower rates of SAEs, serious PEB and perforation compared to hot EMR. Perforation and mortality occurred almost exclusively after hot EMR. Hot EMR with margin ± base ablation did not increase SAEs compared to hot EMR without ablation
World health Organization\u27s guidance for tracking non-communicable diseases towards sustainable development goals 3.4: an initiative for facility-based monitoring
No full textBACKGROUND: Non-communicable diseases (NCDs) account for over 60% of annual global deaths, disproportionately affecting low- and middle-income countries. This trend undermines progress toward Sustainable Development Goal (SDG) 3.4, which seeks to reduce premature mortality from NCDs by one-third by 2030. Despite the availability of effective and relatively affordable interventions, addressing NCDs requires sustained, coordinated efforts and robust monitoring systems. Facility-based monitoring offers a dynamic alternative to static surveys, enabling continuous assessment of healthcare quality and utilization.
METHODS: This study followed a systematic approach to develop standardized global and national NCD monitoring indicators, using the Donabedian model as a conceptual framework. It focused on four major NCD categories: hypertension and cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases, and cancers. The methodology included systematic scoping reviews from inception up to November 2021 and a multi-round Delphi process involving global experts to assess the validity and feasibility of proposed indicators. This study was funded internally by WHO. There were no payments to participants.
FINDINGS: The final output consisted of 81 validated indicators-22 core and 59 optional. These indicators demonstrated high feasibility and relevance for facility-based monitoring of NCD service delivery. They provide actionable metrics for assessing and improving the quality of care across diverse health system settings.
INTERPRETATION: This study highlights the urgent need for comprehensive, context-sensitive NCD monitoring frameworks. The proposed set of indicators offers a validated foundation for improving NCD care delivery and aligns with efforts to achieve SDG target 3.4. Ongoing updates and local adaptations will be essential to ensure continued relevance and effectiveness.
FUNDING: This study was funded internally by WHO
Hemophagocytic Lymphohistiocytosis After Treatment With Checkpoint Inhibitor Therapy
No full textHemophagocytic lymphohistiocytosis (HLH) is a rare hematological syndrome presenting with massive, dysregulated cytokine release that can result in multiple organ failure and is associated with a high risk of mortality. Based on the recent North American consortium recommendations, it has been suggested to categorize HLH into two entities, HLH syndrome and HLH disease. HLH disease encompasses multiple subgroups, including familial HLH (F-HLH), HLH-associated immune compromise (IC-HLH) and HLH observed after immune activating therapies. The diagnosis can be quite challenging, and the pathophysiology leading to HLH disease has yet to be fully elucidated. Much less is known about HLH that occurs due to treatment with immunotherapy such as immune checkpoint inhibitors (ICIs). Herein, the authors report a case of a 71-year-old man who was treated with a combination of nivolumab and ipilimumab for bladder cancer. He later presented with mental status changes and pancytopenia, ultimately meeting the diagnostic criteria for HLH syndrome
Erythema Ab Igne: Toasted Skin Syndrome as a Cutaneous Marker of Chronic Pain
No full textErythema ab igne (EAI) is a rare skin reaction caused by prolonged exposure to low-level heat, resulting in a reticular pattern of localized erythema and hyperpigmentation. This condition carries a potential risk of transformation into cutaneous malignancy. We present the case of a 38-year-old woman who developed a reticular-patterned rash on her abdomen. She had been using hot water bags to alleviate severe abdominal pain associated with chronic cholecystitis, which led to the development of hyperpigmented, mottled, erythematous skin changes across her entire abdomen. After discontinuing heat application, her hyperpigmentation significantly decreased, although the skin changes persisted years later
Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus
No full textBACKGROUND: Adults hospitalized with acute respiratory infections, including respiratory syncytial virus (RSV), often have multiple underlying conditions. Few data are available on the combined effect of conditions on risk of severe outcomes from RSV disease.
METHODS: We enrolled adults hospitalized with RSV at 26 hospitals in 20 US states admitted January 2022-July 2024. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤ 1%) or high pairwise correlation (≥ 0.7). We applied Bayesian profile regression to identify profiles of conditions associated with increased risk of RSV severe outcomes, stratifying among adults aged 18-59 and ≥ 60 years.
RESULTS: We analyzed data from 1111 adults hospitalized with RSV (median age [IQR] = 66 [53-75]). Among 397 adults aged 18-59 years, two profiles were identified: (1) minimal prevalence with fewer underlying conditions and a posterior median ICU admission risk of 21% (95% credible interval = [16‒25]); (2) cardiorenal/diabetes with frequent heart failure, chronic kidney disease, diabetes, and increased ICU admission risk (37% [27‒48]). Among 714 adults aged ≥60 years, four profiles were identified: (1) minimal prevalence (ICU admission risk = 22% [18‒26]), (2) cardiorenal/diabetes (27% [21‒34]), (3) hematologic malignancy and transplant receipt (12% [6‒21]), and (4) chronic pulmonary disease with home oxygen dependence (44% [25‒66]).
CONCLUSION: Distinct underlying condition profiles with varying risks of critical illness were observed among inpatients with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest the role of multimorbidity in severe RSV disease risk warrants further attention
Hepatotoxicity induced by MK-677
No full textMK-677, a growth hormone secretagogue, is gaining popularity among performance-enhancing supplements. While its side effects include oedema, increased appetite and muscle pain, reports of hepatotoxicity are scarce. Here we present the case of an otherwise healthy man in his early 30s, who developed transaminitis after consuming MK-677 for 2 months before presentation. Liver function tests eventually returned to normal limits after stopping the supplement
Assessing the effectiveness of texture and color enhancement imaging versus white-light endoscopy in detecting gastrointestinal lesions: A systematic review and meta-analysis
No full textINTRODUCTION: Gastrointestinal cancers account for 26% of cancer incidence and 35% of cancer-related deaths globally. Early detection is crucial but often limited by white light endoscopy (WLE), which misses subtle lesions. Texture and color enhancement imaging (TXI), introduced in 2020, enhances texture, brightness, and color, addressing WLE\u27s limitations. This meta-analysis evaluates TXI\u27s effectiveness compared to WLE in gastrointestinal lesion lesion detection.
METHODS: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of CENTRAL, PubMed, Embase, and Web of Science identified randomized controlled trials and observational studies comparing TXI with WLE. Outcomes included lesion detection rates, color differentiation, and visibility scores. The risk of bias was assessed using the Cochrane ROB 2.0 tool and Newcastle-Ottawa tools, and evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS: Seventeen studies with 16,634 participants were included. TXI significantly improved color differentiation (mean difference: 3.31, 95% confidence interval [CI]: 2.49-4.13), visibility scores (mean difference: 0.50, 95% CI: 0.36-0.64), and lesion detection rates (odds ratio [OR]: 1.84, 95% CI: 1.52-2.22) compared to WLE. Subgroup analyses confirmed TXI\u27s advantages across pharyngeal, esophageal, gastric, and colorectal lesions. TXI also enhanced adenoma detection rates (OR: 1.66, 95% CI: 1.31-2.12) and mean adenoma detection per procedure (mean difference: 0.48, 95% CI: 0.25-0.70).
CONCLUSION: TXI improves gastriontestinal lesion lesion detection by enhancing visualization and color differentiation, addressing key limitations of WLE. These findings support its integration into routine endoscopy, with further research needed to compare TXI with other modalities and explore its potential in real-time lesion detection
A Qualitative exploration of the impact of abortion restrictions on people with high risk pregnancies in Georgia
No full textOBJECTIVES: This study aimed to understand the barriers people with high risk pregnancies living in a restrictive US state face while attempting to access abortion care.
STUDY DESIGN: We conducted a qualitative study using semistructured virtual interviews with Georgia residents experiencing a high risk pregnancy and attempting to access abortion care. We recruited using flyers distributed at multiple health care facilities in Atlanta, Georgia, as well as an out-of-state clinic. The interviews focused on the participant\u27s pregnancy experience, abortion-seeking journey, and impact of Georgia\u27s restrictive laws. We transcribed, coded, and analyzed the interviews and present a subset of themes.
RESULTS: We interviewed 19 people from January 2023 to February 2024. Participants described their pregnancies as high risk for a wide range of reasons and often described a lack of understanding of how HB481 would impact their ability to access abortion care in Georgia. They discussed ways in which they felt their specific abortion was necessary and should qualify for care. As participants attempted to access abortion care post-HB481, many described feeling betrayed and abandoned by the government, health care system, their individual support networks, and even God and/or the universe. Participants also shared how HB481 exacerbated their suffering as they attempted to navigate the best of multiple bad options available to them.
CONCLUSIONS: Our results indicate that, even when abortion bans include exceptions, people who see their pregnancies as high risk face barriers that ignore their medical circumstances, have adverse impacts even when care is received, leave patients feeling alone, and exacerbate suffering during already challenging times.
IMPLICATIONS: Our study furthers the understanding of how abortion bans affect people who see their pregnancies as high risk and highlights gaps in public knowledge about the impact of Georgia\u27s law. These results can be used to demonstrate the impact of abortion restrictions on people with a variety of high risk pregnancies and counter common political and public narratives that legal exceptions allow people to access needed care
Long Head of the Triceps Transfer to the Proximal Ulna for Active Elbow Flexion in Arthrogryposis
No full textUNLABELLED: Children with amyoplastic arthrogryposis may have absent myotomes (e.g., biceps brachii, brachialis), leading to a lack of active elbow flexion and/or elbow extension contractures. In these cases, the long head of the triceps can be transferred through an extensile approach to the proximal volar ulna, improving both active and passive elbow flexion. Key technical considerations include patient selection, preservation of the long head\u27s neurovascular pedicle, precise dissection of the radial and ulnar nerves, and safe tendon rerouting. This paper highlights technical details with a representative case example and an accompanying technique video. A 6-year-old patient with amyoplasia and absent active flexion underwent a long head of the triceps transfer. The procedure was documented with surgeon point-of-view high-definition footage to emphasize crucial technical steps. Passive and active elbow flexion improved at short-term follow-up and was sustained at 2 years.
KEY CONCEPTS: (1)Elbow flexion can be improved through long head of triceps transfer in children with amyoplastic type of arthrogryposis.(2)Use of one head of the triceps adds elbow flexion and does not sacrifice elbow extension function as the medial and lateral heads of the triceps are preserved as elbow extensors.(3)Most children with arthrogryposis have demonstrated clinically that they can achieve selective control of the long head of the triceps to flex the elbow post-operatively, while relaxing the medial and lateral heads of the triceps for elbow extension.(4)The long head of the triceps originates from the scapula and has separate radial nerve branch proximal innervation allowing dissection away from the other two heads of the triceps.(5)Careful dissection and understanding of the anatomy of the three heads of the triceps is needed for successful surgical transfer of the long head of the triceps