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A rare case of in situ follicular B-cell neoplasm involving sebaceous lymphadenoma
No full textIn situ follicular neoplasia (ISFN) is characterized by a monoclonal proliferation of BCL2-positive B cells harboring the translocation t(14;18)(q32;q21). These cells are confined to follicle centers and are usually identified incidentally, with a very low risk of progression to follicular lymphoma. Sebaceous lymphadenoma is a rare, benign salivary gland tumor, most commonly arising in the parotid gland, and is histologically defined by solid epithelial nests and cysts with sebaceous differentiation in a hyperplastic lymphoid stroma. We report an unusual case of ISFN arising within a sebaceous lymphadenoma. To the best of our knowledge, this association has not previously been reported
Incidence and in-hospital mortality among women with acute myocardial infarction with or without SCAD
No full textBACKGROUND: Spontaneous coronary artery dissection (SCAD) has been increasingly recognized in the past decades. SCAD patients can present with acute myocardial infarction (AMI), particularly in young healthy women without conventional risk factors. However, data on the outcomes of SCAD patients presenting with AMI or benefit of PCI for SCAD in the setting of AMI is inconclusive.
METHODS: We evaluated the prevalence, recent trends, the incidence and in-hospital mortality among women with acute myocardial infarction (AMI) who presented with or without SCAD, and to evaluate the impact of PCI on in-hospital mortality from a population-based analysis, using the National Inpatient Sample (NIS) database between 2016 and 2019.
RESULTS: From 2016-2019, there were 1,527,555 cases of females presenting with AMI. Of that number, there were 12,125 cases of SCAD. Mortality trends in the SCAD and non-SCAD group were comparable. There was a gradual increase in incidence each year for SCAD-STEMI.
CONCLUSION: Mortality did not differ from 2016-2019 in patients with MI found to have SCAD or not. However, it seems that the SCAD-MI cases are gradually increasing each year. More research needs to be performed to better elucidate treatment outcomes in these patients
Step-by-Step ICE-Guided Aspiration Thrombectomy: Gastrointestinal Bleeding Patient With Device-Related Thrombus on Watchman FLX
No full textOBJECTIVES: Device-related thrombus (DRT) remains a significant complication in the field of left atrial appendage occlusion (LAAO). In patients who have difficulty tolerating long-term anticoagulation, treatment options are limited. We present a step-by-step intracardiac echocardiography (ICE)-guided AngioVac (AngioDynamics) challenging case in a 71-year-old woman with a gastrointestinal bleeding tendency and a highly mobile thrombus on a Watchman FLX device (Boston Scientific).
KEY STEPS: We obtained a 26-F DrySeal (Gore Medical) venous access, a 15-F extracorporeal membrane oxygenation cannula arterial access, and a 3-dimensional ICE access. We performed a challenging transseptal crossing using an Agilis medium curl catheter (Abbott) and an electrified Astato wire (Asahi Intecc Medical) as a result of a severely hypertrophic lipomatous septum. We snared the ICE catheter across the interatrial septum (IAS) with a 35-mm gooseneck snare in the inferior vena cava. We used a balloon-assisted technique to bring the F-18 AngioVac system across the IAS. The helicoptering technique with a J-wire assisted with suction of the DRT.
POTENTIAL PITFALLS: Currently, there are no data to support which post-LAAO antithrombotic regimen predicts DRT. For patients who are unable to tolerate long-term anticoagulation, treatment options are limited. To our knowledge, this is the first reported ICE-guided LAAO thrombus aspiration.
TAKE-HOME MESSAGES: ICE-guided aspiration thrombectomy of LAAO thrombus is feasible in high-risk patients who cannot tolerate long-term oral anticoagulation and to reduce the risk of clot embolization
Systematic Review and Meta-Analysis of the Super High-Pressure Balloon (SIS-OPN) for Percutaneous Coronary Intervention
No full textINTRODUCTION: The super high-pressure NC balloon (OPN NC; SIS Medical AG, Winterthur, Switzerland) is increasingly used in percutaneous coronary intervention (PCI). We performed a systematic review and meta-analysis of its efficacy and safety.
METHODS: A systematic review was conducted using PubMed and the Cochrane Library to identify studies using the OPN NC balloon in PCI. Procedural success, major adverse cardiac events (MACE), coronary perforation, and other complications were pooled using weighted means, confidence intervals (CI), and I² statistics for heterogeneity assessment.
RESULTS: Twenty-nine studies (5 prospective including 2 randomized-controlled trials, 12 retrospective, and 12 case reports) were included in the systematic review, of which 11 (3 prospective, 8 retrospective) were included in the meta-analysis. Of the 1015 meta-analysis patients, 50.7% presented with stable angina and 21.6% with an acute coronary syndrome. Mean lesion length was 22.8 ± 13.7 mm, the prevalence of moderate or severe calcification was 93.7%, and 40.4% of lesions were in-stent. Procedural success was 95.1% (95% CI 89.3%-98.8% with significant heterogeneity: I² = 84.9%). The incidence of periprocedural MACE was 1.9% (95% CI 1.1%-2.8%, I² 86.9%), and the incidence of coronary perforation was 0.6% (95% CI 0.3%-1.5%, I² 87.2%).
CONCLUSIONS: Use of the OPN NC balloon is associated with high success and acceptable complication rates. The heterogeneity of outcomes underscores the need for additional studies and standardized definitions
Maternal and fetal outcomes in those with autoimmune connective tissue disease.
No full textINTRODUCTION: Autoimmune CTDs like systematic lupus erythematosus (SLE), systemic sclerosis (SSc), and rheumatoid arthritis (RA)predominantly affect women during reproductive years and are linked to maternal and fetal complications.
METHODS: We conducted a population-based, retrospective cohort study using the national inpatient data sample to compare maternal and fetal outcomes in patients with and without CTD delivering between October 2015 and December 2020. Regression analysis was performed and adjusted for multiple patient characteristics to compare outcomes.
RESULTS: Our study comprised of 18,866,050 deliveries, of which 50,450 (0.02%) had autoimmune CTD, including 25,340 with SLE, 23,945 with RA, and 1,165 with SSc. Patients with CTDs had significantly higher odds of maternal death (aOR 3.898; 95% CI: 1.462-10.389, p = 0.007), hypertensive disorders (aOR 1.554; 95% CI: 1.456-1.659, p \u3c 0.001), acute kidney injury (aOR 4.886; 95% CI: 3.934-6.069, p \u3c 0.001), blood transfusions (aOR 1.853; 95% CI: 1.628-2.109, p \u3c 0.001), peripartum cardiomyopathy (aOR 2.709; 95% CI: 1.492-4.917, p = 0.001), sepsis (aOR 2.112; 95% CI: 1.430-3.119, p \u3c 0.001), and ARDS (aOR 1.623; 95% CI: 1.076-2.449, p = 0.021). Fetal outcomes were also worse, with higher odds of small for gestational age fetuses (aOR 1.926; 95% CI: 1.779-2.086, p \u3c 0.001), stillbirth (aOR 1.644; 95% CI: 1.352-2.000, p \u3c 0.001), and preterm labor (aOR 1.702; 95% CI: 1.574-1.841, p \u3c 0.001). Patients with RA, SS, and SLE experience varying degrees of complications.
CONCLUSION: Our study shows that pregnant patients with autoimmune CTDs have worse maternal and fetal outcomes compared to those without CTDs. The rates of adverse outcomes varies among CTD subtypes. Comprehensive preconception counseling and tailored management strategies are essential for optimizing outcomes in these patients.
Key Points:
• Increased Maternal Complications: Patients with autoimmune CTDs had significantly higher odds of maternal death, hypertensive disorders, acute kidney injury, blood transfusions, peripartum cardiomyopathy, sepsis, and ARDS.
• Adverse Fetal Outcomes: Higher odds of small for gestational age fetuses, stillbirth, and preterm labor were observed in patients with CTDs compared to those without.
• CTD Subtype Variations: Complication rates varied among CTD subtypes, with SLE, RA, and SSc each presenting varying risks and outcomes
Predictors of treatment attrition among individuals in substance use disorder treatment: A machine learning approach
No full textBACKGROUND: Early treatment discontinuation in substance use disorder treatment settings is common and often difficult to predict. We leveraged a machine learning approach (i.e., random forest) to identify individuals at risk for treatment attrition, and specific factors associated with treatment discontinuation.
METHOD: Participants (N = 29,809) were individuals ≥ 18 years who attended substance use disorder treatment facilities in the United States. Using random forest, we aimed to predict three outcomes (1) leaving against medical advice (AMA), (2) discharging involuntarily, and (3) discharging early for any reason. Predictors included participant demographics, substance use the month before and at intake, indices of mental and physical health, as well as treatment center and program type.
FINDINGS: We observed low to moderate area under the curve (range = 0.631-0.671), high negative predictive values (range = 0.853-0.965), and low positive predictive values (0.088-0.336) across the three treatment attrition outcomes. The most robust predictors of the three outcomes included treatment center, treatment type, and participant age. Additional predictors of the three outcomes included employment status; reason for treatment; primary drug at intake and frequency of use; prescription opioid, benzodiazepine, or heroin use at intake; living status at intake; and driving under the influence prior to treatment.
CONCLUSIONS: Our models were able to accurately identify individuals who remained in treatment, but not those who left treatment prematurely. The most robust predictors of treatment discontinuation were treatment center and program type, suggesting that targeting treatment facility features may have a significant impact on reducing treatment attrition and improving long-term recovery
Social support among women with infertility: Associations with psychiatric symptoms, disordered eating, and substance use
No full textThough social support in the broader population is related to better psychosocial outcomes, little work has examined the relationship between social support and patient-reported outcomes among women with infertility. The purpose of this study was to investigate whether perceived social support was associated with psychiatric symptoms, disordered eating, and substance use among women with an infertility diagnosis. Individuals who received a diagnosis of female-factor infertility (N = 188) completed measures of perceived social support, psychiatric symptoms, disordered eating, and substance use. Approximately two-thirds of participants endorsed having high levels of perceived social support (63.3%) with smaller proportions indicating moderate (28.2%) or low levels (8.5%). Compared to those with high levels of support, participants with low/moderate levels were more likely to report greater symptoms of anxiety (p \u3c 0.001), greater symptoms of depression (p \u3c 0.001), and hazardous cannabis use (p = 0.03). Clinicians could consider screening women with infertility for level of social support
Demographic and Clinical Characteristics of Mental Health Crisis Line Callers Who Were Transferred to 911
No full textOBJECTIVE: This study aimed to describe the characteristics of callers to a statewide mental health crisis line who were transferred to 911 (active rescue).
METHODS: This retrospective cohort study examined mental health crisis line calls transferred to active rescue (N=3,538 calls; N=3,132 unique callers) from the Georgia Crisis and Access Line (2016-2018). Chi-square analyses and t tests were used to examine descriptive differences between caller characteristics and call features.
RESULTS: Of crisis line callers with a contact that resulted in active rescue, 53% were male, and 53% were Black. Youth callers represented 11% of all rescue calls; 74% of these callers had Medicaid. Active rescue most frequently occurred because of a danger to oneself (58%). Reasons for active rescue differed by race (p\u3c0.001).
CONCLUSIONS: Most crisis calls resulting in active rescue occurred because of concern about self-harm. Demographic differences by reason for active rescue reveal gaps in the understanding of crisis care delivery
