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Safety of Vancomycin Use Through Midline Catheters for Outpatient Parenteral Antimicrobial Therapy
No full textThis cohort study examines the association between vancomycin use through midline catheters and device-related complications among patients receiving outpatient parenteral antimicrobial therapy
An Atypical Case of Infectious Myositis in a Young Woman on Immunosuppressive Therapy
No full textInfectious myositis is a rare but serious condition typically caused by bacterial pathogens. In immunocompromised patients, including those on long-term immunosuppressive therapy, clinical signs of myositis can be subtle or delayed. We present the case of a 21-year-old woman with systemic lupus erythematosus (SLE) on immunosuppressive therapy who presented with pain, fever, tachycardia, and swelling of the right lower leg. Initial evaluation revealed no skin defects or rash and normal creatine phosphokinase (CPK) levels. A non-contrast computed tomography (CT) scan of her leg showed some soft tissue changes, but it was only after a week of worsening symptoms that contrast-enhanced CT imaging revealed a multiloculated, large abscess, measuring 23.7 cm in length, in the anterior compartment of the leg. The abscess was drained surgically, and intraoperative cultures grew methicillin-resistant Staphylococcus aureus. The absence of early definitive findings, including a normal CPK level, may have contributed to the delay in diagnosis. This case highlights the diagnostic challenges of infectious myositis in immunosuppressed patients, where early imaging and laboratory findings can be misleading, underscoring the importance of repeated clinical assessment and timely advanced imaging to ensure early detection and appropriate treatment
Obesity as a risk factor for early-onset colorectal cancer: Evidence from a nationally representative database
No full textBACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide with an alarming rise in early-onset CRC (eoCRC) over the past several decades. Unlike late-onset CRC, the drivers behind eoCRC remain less clear. While certain risk factors such as obesity and smoking have demonstrated a relatively strong association with eoCRC in the literature, some studies have challenged these associations, emphasizing the need for additional studies.
AIM: To investigate the impact of various risk factors on eoCRC with a special focus on obesity.
METHODS: This cross-sectional study used de-identified data from the National Health and Nutrition Examination Survey (1999-2023), including 30321 United States adults aged 18 to 49 years. Participants with missing key variables were excluded. Standardized protocols were used to collect demographic, lifestyle, anthropometric [body mass index (BMI), body roundness index (BRI), waist circumference (WC)], and self-reported CRC data. Logistic regression and propensity score matching assessed associations between obesity-related parameters and eoCRC. Statistical analyses were performed in R and Stata, with P \u3c 0.05 defined as significant.
RESULTS: Of 30321 participants, 48 received a diagnosis of eoCRC. Patients with eoCRC were older (mean age 39.96 years vs 34.36 years; P \u3c 0.001) and had higher WC and BRI. None of the eoCRC patients were heavy drinkers (P = 0.006). Unadjusted models demonstrated significant associations of eoCRC with BRI quartiles, as well as BMI-defined obesity, WC, and smoking. In unadjusted models, BRI remained the strongest independent predictor; those in the highest BRI quartiles had over 10-fold greater odds of eoCRC. In fully adjusted models, BRI remained significant, but BMI- and waist-based obesity were not.
CONCLUSION: BRI is a stronger predictor of eoCRC risk compared to other obesity indices and is a superior tool for identifying young individuals at higher risk of CRC
Insights from 300 Periprosthetic Tibial Fractures: Where Do We Go from Here?: Commentary on an article by Evan M. Dugdale, MD, et al.: Three Hundred Periprosthetic Tibial Fractures Around a Total Knee Replacement. Classification and Outcomes from a Single Institution
No full textNavigating the Alphabet Soup of Interstitial Lung Diseases (ILD): The Role of Pharmacists
No full textInterstitial lung disease (ILD) is a group of heterogeneous disorders that carries a poor prognosis and is characterized by lung parenchyma inflammation and/or fibrosis. It is further categorized into specific subtypes of ILD, which drive treatment approaches. Diagnosis is elusive with non-specific respiratory symptoms, and dyspnea is the most common symptom experienced by patients. A multidisciplinary approach is recommended to collaboratively diagnose ILD and direct treatment. Historically, treatment of most ILDs has focused on the use of immunosuppressive agents and targeted pharmacotherapies for select ILD subtypes, increasing over the past decade. In select subtypes of ILD, antifibrotics have slowed the progression of loss of lung function, especially forced vital capacity. Adverse events can be significant and lead to the discontinuation of disease-modifying therapies. These agents can be used as monotherapy or combined in select scenarios, highlighting the importance of evaluating the risk–benefit profile. Pharmacist involvement in the care of this population has been shown to improve access to medications and prevent the discontinuation of evidence-based therapeutics due to adverse event mitigation approaches. This review summarizes the current understanding and management of ILDs and highlights the pharmacist role in disease state optimization
Genetic contributions to epigenetic-defined endotypes of allergic phenotypes in children
No full textAsthma is a common respiratory disease, with contributions from both genes and the environment and significant heterogeneity in underlying endotypes; yet, little is known about the relative contributions of each to these endotypes. To address this gap, we used nasal mucosal cell DNA methylation (DNAm) and gene expression and genotypes for 284 children in the Urban Environment and Childhood Asthma (URECA) birth cohort. Using an unbiased data-reduction approach and 37,256 CpGs on a custom-content Asthma&Allergy array, empirical Bayesian factorization was implemented to identify three DNAm signatures that were associated with phenotypes reflecting allergic diseases (allergic asthma and allergic rhinitis), allergic sensitization (atopy) (specific and total immunoglobulin E), and/or type 2 inflammation (eosinophil count and fractional exhaled nitric oxide [FeNO]). These associations were replicated in the Infant Susceptibility to Pulmonary Infections and Asthma (INSPIRE) and the Children\u27s Respiratory Environment Workgroup (CREW) cohorts. The genes that were correlated with each signature in URECA reflected three cardinal endotypes of asthma: inhibited immune response to microbes, impaired epithelial barrier integrity, and activated type 2 immune pathways. To estimate the genetic contributions to these signatures, we used a common set of genotypes available in the three cohorts. The joint SNP heritability of each signature was 0.21 (p = 0.037), 0.26 (p = 1.7 × 10(-8)), and 0.17 (p = 7.7 × 10(-6)), respectively. The heritabilities of the DNAm signatures suggest that genetic variation contributes significantly to epigenetic signatures of allergic phenotypes and that susceptibility to the development of specific endotypes of asthma is present at birth and is poised to mediate individual epigenetic responses to early-life environments
Sex-specific associations between hypertensive disorders in pregnancy and fetal and placental weight
No full textImportance: Hypertensive disorders in pregnancy (HDPs) are common and increase the risk of maternal and fetal morbidity and mortality. HDPs may impact fetal growth; however, sex-specific effects have been understudied.
Objective: To examine whether sex-specific differences exist in the association between HDPs and birthweight and placental weight.
Methods: A birth cohort based in Detroit, Michigan, was utilized (n = 1258). HDPs and birthweight were abstracted from medical records; placental weight was obtained from placental pathology reports. Linear regression was used to model sex-specific associations, after multiple imputation, confounder adjustment, and inverse probability weighting to account for selection bias.
Results: The primary analysis included all pregnancies (n = 853), while the secondary analysis included those sent for placental pathology, reflective of complicated pregnancies (n = 165). In the primary analysis subset, males of mothers with gestational hypertension had birthweight Z-scores that were on average 0.90 standard deviations higher, but this association was not found among females (interaction P = 0.019; male β [95% confidence interval {CI}]: 0.90 [0.28, 1.52]; female β [95% CI]: −0.12 [−0.65, 0.41]). However, in the subset of complicated pregnancies, female mothers with gestational hypertension also had reduced birthweight (interaction P = 0.013; male β [95% CI]: 1.50 [0.15, 2.86]; female β [95% CI]: −1.14 [−2.13, −0.16]). For fetoplacental weight ratio, any HDP was associated with a lower ratio among females only (interaction P = 0.028; male β [95% CI]: −0.04 [−0.71, 0.64]; female β [95% CI]: −0.95 [−1.57, −0.33]).
Interpretation: Male fetuses may prioritize growth, whereas females may prioritize placental development when exposed to HDPs
On the persistence of racial health inequities: Maternal exposure to geospatial racism is transmitted to infant
No full textStructural racism (SR) refers to the discriminatory beliefs, methods and strategies that are systemically embedded in the policies and practices of the US. Racial residential segregation, termed “a fundamental cause of health inequities”, is central to SR in the US because it impacts economic stability, education, healthcare, neighborhood and built environment, and social and community context for residents. Segregation systematically injects chronic stress in the lives of residents through a variety of mechanisms including polluting industries and liquor stores in Black communities, chronic unemployment fueled by job loss and decentralization, aggressive policing, increased incarceration rates for Black residents, and under-resourced schools. Spatial manifestations of SR have been linked to stress responses, immune dysregulation, and heightened chronic inflammation among US Black individuals consistent with accumulation of tissue damage or allostatic load which refers to the “cumulative burden of chronic stress and life events”. This chronic stress has been termed “weathering”, a concept which posits that the stress of racial discrimination, including residential segregation, has biological effects that are pro-inflammatory, and predictive of chronic conditions, such as heart disease, diabetes, and cancer. Maternal exposure to chronic stress, resulting in weathering, can create an inflammatory fetal environment that is transferable to the infant. We hypothesize that a heightened propensity in mothers toward chronic inflammation due to mother’s exposure to structural racism can be transferred to her offspring in utero, creating an intergenerational cycle of disadvantage and poor health. Recent and emerging research have introduced methods of objectively measuring exposure to SR as well as measuring the outcome of maternal transfer of the effects of exposure to SR to offspring. Given the evidence that chronic racial stress could lead to inflammation, the observation of elevated levels of inflammatory markers in neonatal dried blood spots (DBS) in relation to maternal exposure to SR, could provide evidence of maternal transfer. Infant blood spots are routinely collected and stored and can be analyzed using untargeted metabolomics to measure metabolite features representing biologically relevant pathways, including biomarkers of inflammation, lipid mediators, and exogenous exposures. Empirical evidence of how SR can initiate processes in early life that manifest in adult disease can corroborate existing theories and generate a paradigm shift that informs interventional research as well as policy
Using night shift worker and employee health stakeholder perspectives to inform the development of Arcashift(tm), a digital precision circadian medicine intervention for shift work disorder
No full textBACKGROUND: More than a quarter of night shift workers (NSWs) have symptoms severe enough to meet diagnostic criteria for Shift Work Disorder (SWD). This study sought to understand the experiences of both NSWs and employee health stakeholders (EHSs) to inform the design of an effective digital precision circadian medicine intervention for NSWs experiencing SWD.
METHODS: NSWs (N = 20) participated in virtual focus groups (N = 5) and were asked about their experiences with night shift work, desired components of a digital intervention for SWD, and feedback on a potential digital precision circadian medicine intervention (i.e., Arcashift™) for SWD. Eligibility criteria: fixed night schedule for 6 + months, diagnosed with SWD, and aged 18-50 years. EHSs (N = 5) participated in virtual 1-on1 interviews, where they were asked about what motivations, goals, and return-on-investments (ROIs) mattered with regards to investing in a digital intervention for NSWs. Focus groups and interviews were digitally recorded and transcribed. Combined transcript reflexive thematic analysis was conducted to identify themes.
RESULTS: The reflexive thematic analysis produced three themes. The first theme, the trials and tribulations of night shift work, related to the physical, mental, and emotional tolls related to working the night shift and resulted from problem-focused discussions with NSWs about what it is like to work the night shift. Subthemes included: physically and mentally draining, the world runs on daytime hours, and lack of respect and consideration. The remaining two themes, thrown to the wolves and shifting towards an app, were the result of shifting focus group conversations with NSWs and interviews with EHSs towards solution-focused thinking by presenting a digital precision circadian medicine intervention (i.e., Arcashift™) through which NSWs\u27 SWD could be improved.
CONCLUSION: This study represents a strong preliminary step toward the development of an app for the intervention of SWD. There is a critical need for a real-world intervention for SWD, and stakeholders were optimistic about the potential of an app to help address SWD. Future work is needed to assess the extent to which the proposed app, informed by these stakeholder insights, is able to improve outcomes for employees and ROIs for EHSs.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s44247-025-00167-3
Multimedia Approach to Living Donation Education for Transplant Professionals: Building a Professional Society Multimedia Work Group
No full textPURPOSE OF REVIEW: Currently, there are number of initiatives underway across the world to remove barriers and increase education about living donation and living donor transplantation, including among professionals. Widespread use of the internet and social media (SoMe) started a new era of online information sharing. Extensive studies have highlighted the significant role of visual abstracts (VAs) and infographics in disseminating medical information including related to donation and transplantation. SoMe can foster networking and collaboration between transplant professionals across the globe.
RECENT FINDINGS: The American Society of Transplantation Living Donor Community of Practice (LDCOP) Multimedia Workgroup (MMWG) was established to support the LDCOP\u27s professional education mission by providing audiovisual support for various initiatives using visual abstracts, infographics, and professional community engagement. The MMWG employs rigorous multi-layered vetting by professionals with academic expertise to ensure the reliability and accuracy of the content, pioneering a model for creating visual educational content, collaborative learning and skill-building across experience levels.
SUMMARY: In this perspective review, we summarize the history of a professional society multimedia work group and our experience building a multimedia approach to living donation education for transplant professionals