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TCT-709 Oral Anticoagulation Versus Left Atrial Appendage Closure in Active Cancer Patients With Atrial Fibrillation: A Comparative Analysis of Safety and Efficacy
No full textBackground: Atrial fibrillation (AFib) management in patients with active malignancy is challenging due to heightened thromboembolic and bleeding risks. Oral anticoagulation (OAC) remains standard, but left atrial appendage closure (LAAC) may provide a non-pharmacologic alternative. we wanted to compare clinical safety and efficacy outcomes of OAC versus LAAC in patients with active cancer and non-valvular AFib. Methods: A retrospective analysis of pooled data from multicenter observational cohorts including 1,432 patients (OAC: n = 932; LAAC: n = 500) with active cancer and AFib. Outcomes included stroke, major bleeding, and all-cause mortality at 12 months. Results: Stroke occurred in 2.3% of LAAC vs. 3.8% of OAC patients (p = 0.12). Major bleeding occurred in 4.4% of LAAC vs. 11.1% of OAC patients (p \u3c 0.001). All-cause mortality was lower in LAAC patients (14.6% vs. 20.3%, p = 0.01). Conclusion: In cancer patients with AFib, LAAC demonstrated similar stroke prevention but significantly lower bleeding and mortality rates compared to OAC, suggesting it may be a safer long-term option for select high-risk patients. Categories: STRUCTURAL: Left Atrial Appendage Exclusio
Plasma Adsorption with the MTx.100 Column in Critically Ill COVID-19 Patients: A Prospective Study and Propensity Score Analysis.
No full textBACKGROUND: Early in the COVID-19 pandemic, patients with severe disease admitted to the intensive care unit (ICU) had a high incidence of mortality. We aimed to investigate whether plasma adsorption with the MTx.100 Column could improve survival.
METHODS: We performed a prospective, single-arm, multicenter, Emergency Use Authorization (EUA) trial in patients admitted to the ICU with severe COVID-19 who were worsening despite standard therapy. The primary outcome was all-cause mortality on day 28. Outcomes were analyzed using both a pre-specified performance goal (PG), and a propensity score-matched (PSM) analysis from the highest enrolling center, in which patients treated with the standard of care (SOC) plus the MTx.100 Column (n = 70) were compared to a contemporaneous cohort treated at the same center with SOC only (n = 244).
FINDINGS: Between May 21, 2020, and November 2, 2021, 107 patients with severe COVID-19 (mean age 58.1) at 7 US centers were enrolled and had at least one plasma adsorption treatment initiated. All-cause mortality on day 28 was 37.4% (40/107), an improvement over the prespecified PG (88.1%, p \u3c 0.0001). There were no serious adverse events attributable to the MTx.100 Column or plasmapheresis. Improvements in most metabolic and inflammatory markers were also noted. The PSM analysis showed that survival odds were three times higher for MTx.100 Column-treated patients (95% CI: 1.56-5.88) than for those treated with SOC only.
INTERPRETATION: The MTx.100 Column treatment in severe COVID-19 resulted in a lower mortality than SOC by both pre-specified PG and PSM analysis.
TRIAL REGISTRATION: clinicaltrials.gov (NCT04358003)
Dobutamine-Masked Myxedema Coma Mimicking Acute Coronary Syndrome: A Rare Case of Cardiogenic Shock and Diagnostic Challenges
No full textDescription: Case Report: A 55-year-old woman with hypothyroidism presented with a 1-week history of dyspnea and limb swelling. Initial evaluation revealed bradycardia with first-degree atrioventricular block, elevated troponins, and brain natriuretic peptide. She was treated for non-ST-elevation myocardial infarction with heparin while continuing levothyroxine. Later, she developed cardiogenic shock. Random cortisol levels were normal. Dobutamine drip was started, and cardiac catheterization revealed no coronary artery disease. Laboratory tests showed a thyroid-stimulating hormone (TSH) of 40.6 mIU/mL (0.465-4.680) and a free T4 of 0.4 ng/dL (0.8-1.9). Echocardiography demonstrated global hypokinesis with an ejection fraction of 30%. Myxedema coma was identified as the underlying cause, with TSH levels inappropriately elevated in relation to the severity of hypothyroidism. Discussion: The interpretation of thyroid function tests in critical illness is challenging due to the effects of drugs like dobutamine. Although dopamine’s effect on TSH suppression is well established, the impact of dobutamine, commonly used in critical care, is less well understood. Dobutamine suppresses TSH secretion by acting on thyrotroph cells, which can mask severe hypothyroidism and delay diagnosis, as seen in this case. Conclusion: Myxedema coma can precipitate severe cardiac dysfunction, including cardiogenic shock, and may mimic acute coronary syndromes. Dobutamine therapy, while supportive, can suppress TSH levels, potentially obscuring the diagnosis of hypothyroidism. Early recognition and appropriate management of myxedema coma are crucial to improving outcomes
Whispers of Resilience: Navigating Primary Ovarian Insufficiency in the Shadows of Metabolic Disorder
No full textDescription: Classic galactosemia (CG) is linked to primary ovarian insufficiency (POI), even with early dietary management. Many affected females develop secondary amenorrhea and subfertility despite normal pubertal development. Early recognition and monitoring of ovarian function are essential. Current fertility options are limited, and emerging therapies lack strong evidence. More longitudinal studies are needed to guide management and improve outcomes. Case Report: A 26-year-old female with CG on a galactose-restricted diet since infancy presented with 6 months of oligo-amenorrhea. She achieved menarche at 15 with previously regular periods. Lab results showed elevated follicular stimulating hormone (FSH) (79.1 mIU/mL, normal: 3.9-8.8), luteinizing hormone (32.7 mIU/mL, normal: 2.1-10.9), and low estradiol (\u3c 15 pg/mL, normal: 25-115), progesterone (0.35 ng/mL, normal: 0.31-1.52), and anti-mullerian hormone (0 ng/mL, normal: 0.69-13.39), indicating poor ovarian reserve. Pelvic ultrasound revealed small ovaries, and elevated galactose metabolites confirmed CG-related complications. Hormone replacement therapy was initiated to address deficiencies. Despite stable FSH/luteinizing hormone levels, fertility assessment for oocyte cryopreservation suggested a limited response due to persistently low anti-mullerian hormone and poor estrogen response to exogenous FSH. Discussion: Secondary amenorrhea and subfertility in patients with CG and otherwise normal growth and puberty warrant suspicion of POI. Prompt recognition and diagnostic evaluation can alleviate the psychological burden associated with this diagnosis. Dietary galactose restriction, calcium supplementation, and comprehensive monitoring of biochemical, neurodevelopmental, and endocrinological parameters are paramount. Early management of POI, inclusive of a nutritious diet and vigilant ovarian function monitoring, are crucial. However, even with strict dietary galactose restriction, ovarian complications may still occur. Conclusion: CG can present with diverse clinical manifestations, but its diagnosis should alert clinicians to the early prediction and detection of secondary amenorrhea due to POI to address subfertility risks in young females. The lack of randomized controlled trials highlights the need for longitudinal studies and registry integration to clarify the impact of hormone replacement therapy on clinical outcomes and inform evidence-based guidelines. Emerging reproductive interventions, such as mesenchymal stem cell transplantation and in vitro activation of dormant follicles, show promise but are supported mainly by case reports and small series. Rigorous randomized trials are essential to validate these techniques for fertility restoration in CG-related POI
Thyrotoxic Periodic Paralysis: Acute Paralysis as the Initial Presentation of Graves’ Disease
No full textDescription: Thyrotoxic periodic paralysis (TPP) is a form of hypokalemic paralysis marked by transient muscle weakness. Often triggered by exertion or high-carbohydrate meals, it primarily affects East Asian and middle-aged men and may be the first sign of hyperthyroidism despite the absence of classic symptoms. Case Report: A 35-year-old Haitian man presented with sudden bilateral lower limb weakness preceded by thigh cramps for 3 days. He had no thyroid-related symptoms. Employed in a warehouse, recent staffing shortages led to more exertion. On examination, he was afebrile, hemodynamically stable, with thyromegaly, reduced hip strength, and diminished reflexes. Laboratory tests showed hypokalemia (2.1 mmol/L), elevated creatine kinase, low thyroid-stimulating hormone, high T4/T3, and positive thyroid antibodies. Electrocardiogram showed U waves, and ultrasound confirmed hypervascular thyroid parenchyma. Diagnosed with hypokalemic TPP, he was treated with methimazole and potassium replacement. His potassium normalized, and his symptoms improved. Discussion: TPP, often linked to Graves’ disease, results when excess thyroid hormone overactivates the sodium-potassium ATPase pump in muscle cells, shifting potassium intracellularly and causing paralysis. Epinephrine and insulin exacerbate this shift, explaining why TPP episodes often follow exertion or high-carbohydrate intake. It is more common in men and shows seasonal variation, possibly due to potassium loss in humid climates. The usual lack of hyperthyroid symptoms complicates TPP diagnosis. Patients often show hypokalemia and respective electrocardiogram changes. Management involves cautious potassium replacement to avoid rebound hyperkalemia, while treatment targets the underlying hyperthyroidism. Conclusion: This case underscores the importance of recognizing TPP as a rare but reversible cause of acute paralysis, even in non-Asian populations and those without overt hyperthyroid symptoms. Early diagnosis and treatment are crucial to preventing complications and ensuring patient recovery. Targeting the underlying hyperthyroidism remains essential for long-term management and recurrence prevention
The Efficacy and Safety of Seladelpar for Primary Biliary Cholangitis: A Systematic Review and Meta-Analysis
No full textBackground and Objective: Seladelpar is an oral, once-daily medication that improves cholestasis through its selective peroxisome proliferator-activated receptor (PPAR-δ) agonism. It shows promising efficacy in treating primary biliary cholangitis (PBC) patients. Methods: A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Cochrane, Scopus, and WOS until July 19th, 2025. Dichotomous outcomes were reported using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). Results: Three RCTs with 499 patients were included. Seladelpar was significantly associated with an increased ALP normalization (RR: 21.12 with 95% CI [4.14, 107.58], p \u3c 0.01), biochemical response (RR: 3.06 with 95% CI [2.00, 4.70], p \u3c 0.01), and decreased pruritus NRS score change (MD: −1.47 with 95% CI [−2.73, −0.21], p = 0.02). Seladelpar was also significantly associated with a decreased incidence of pruritus (RR: 0.54 with 95% CI [0.31, 0.94], p = 0.03) but with an increased incidence of headache (RR: 3.37 with 95% CI [1.11, 10.23], p = 0.03). However, there was no significant difference between seladelpar and placebo regarding the incidence of any adverse events (RR: 0.96 with 95% CI [0.87, 1.06], p = 0.43). Conclusion: Seladelpar improved liver biomarkers of cholestasis and reduced pruritus in patients with PBC without significantly increasing the adverse effects. This makes seladelpar a promising addition to the treatments available for PBC. Trial Registration: PROSPERO: CRD42024521208
A Delayed Adverse Reaction: Hydralazine-Induced Lupus After Years of Use.
No full textDrug-induced lupus (DIL) is a rare autoimmune condition triggered by certain medications, most commonly hydralazine and procainamide. DIL can manifest after a few weeks or even after several years of drug exposure. We present a case of a 61-year-old female with hypertension and type 2 diabetes mellitus who developed progressive polyarthritis, myalgia, and fatigue that developed over a year after three years of hydralazine use. Laboratory findings revealed anemia, leukopenia, elevated inflammatory markers, an anti-nuclear antibody (ANA) titer of 1:2560, and anti-histone antibodies of 4.9 units. A false-positive immunoglobulin M (IgM) Lyme antibody complicated the diagnostic workup. Discontinuation of hydralazine and initiation of corticosteroid and methotrexate resulted in resolution after six weeks, confirming the diagnosis of hydralazine-induced lupus
Successful Management of High-Risk Gestational Choriocarcinoma with Choriocarcinoma Syndrome: A Case Report
Get PDFIntroduction: Choriocarcinoma is a rare and highly malignant gestational trophoblastic neoplasia that is treatable with timely and appropriate intervention. However, choriocarcinoma may lead to life-threatening complications, such as choriocarcinoma syndrome (CCS), a rare type of tumor lysis manifesting as hemorrhage at metastatic sites of advanced tumors.
Case Description: This case involves a 30-year-old woman, gravida 3 para 0, with high-risk choriocarcinoma and a WHO score of 11, indicating high risk. Initial management comprised Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine (EMA/CO) chemotherapy until multisystem complications arose, including the development of CCS which resulted in an abdominal compartment syndrome. An exploratory laparotomy led to a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Subsequent treatment involved Etoposide/Cisplatin (EP) chemotherapy to minimize toxicity before re-initiating EMA/CO, ultimately completing a total of 14 EMA/CO cycles.
Discussion: To our knowledge, this is only the second case reported of CCS in a female patient, as most reported cases discuss testicular choriocarcinoma complicated by CCS in male patients. The patient\u27s survival underscores the success of combining risk-based chemotherapy, surgery, and supportive care to achieve favorable outcomes in high-risk choriocarcinoma cases with rare, life-threatening complications in female patients. Furthermore, 2024 National Comprehensive Cancer Network guidelines suggest considering induction therapy with EP in tumors with WHO scores of greater than or equal to 12, but this case suggests that induction chemotherapy with EP may be a viable option for treating high-risk choriocarcinomas with WHO scores of less than 12 that are at risk for developing CCS
