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TRANSCATHETER REPAIR OF PERIVALVULAR LEAK WITH A VENTRICULAR SEPTAL DEFECT OCCLUDER IN A PROSTHETIC MITRAL VALVE: A CASE REPORT OF RECURRENCE AND CHALLENGES
Get PDFEnhancing Continuity and Communication on the Psychiatry Consult-Liaison Service Through a Standardized Handoff Process - A Quality Improvement Initiative
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A Novel Biomarker To Predict The Risk Of Contrast-induced Nephropathy In Patients Undergoing Coronary Angiography: Total Bilirubin Phosphorus Ratio
No full textEmbracing Imperfection: Medical Students’ Perspectives on Pass/Fail Curricula in Medical Education
Get PDFImpact of Pre-Existing Mental Health Disorders on Post-Transplant Mental Health and Substance Use Outcomes
No full textBackground: Mental health disorders (MHD), such as depression and anxiety, are prevalent among organ transplant recipients, with rates significantly exceeding those in the general population. These conditions are associated with poorer outcomes, yet the relationship between pre-existing MHD and post-transplant mental health and substance use outcomes remains underexplored. This study investigates whether pre-existing MHD impacts these outcomes to inform interventions that improve long-term health for transplant recipients. Methods: A retrospective cohort analysis was conducted using the TriNetX Database, encompassing data from 485,536 organ transplant recipients from 69 U.S.-based healthcare organizations (2014–2024). Patients were stratified into two cohorts based on the presence (Cohort 1) or absence (Cohort 2) of pre-transplant MHD, defined as diagnoses of sleep disorders, major depressive disorder, or anxiety. Propensity score matching was applied to balance demographic variables. Outcomes included post-transplant mental health conditions and substance use disorders, assessed through ICD-10 codes. Logistic regression and Kaplan-Meier survival analysis were used to estimate odds ratios (ORs) and hazard ratios (HRs), respectively. Results: After matching, each cohort included 141,683 patients. Cohort 1 demonstrated significantly higher risks for post-transplant mental health conditions, including dysthymic disorder (OR: 9.911; HR: 8.60) and PTSD (OR: 14.794; HR: 12.82). Substance use disorders, such as alcohol-related disorders (OR: 2.15; HR: 2.15), were also more prevalent in Cohort 1. While odds ratios for mental health conditions were notably high, substance use disorders exhibited more moderate increases. Conclusions: Pre-existing MHD significantly elevates the risk of adverse mental health and substance use outcomes post-transplant. These findings underscore the necessity for comprehensive mental health assessments and interventions as standard components of pre- and post-transplant care. Addressing these risks through targeted strategies can enhance the quality of life and long-term outcomes for transplant recipients
Aesthetic Surgery Journal
No full textBackground Although COVID-19 infection rates have declined from pandemic peaks, recent infection may pose a potential concern in aesthetic surgery. Of note, the surgical risks associated with recent infection are not well defined. Previous studies, constrained by small cohorts and early-pandemic data, have not conclusively established whether recent COVID-19 infection continues to influence surgical outcomes. Objectives The authors sought to determine whether COVID-19 infection within 30 days before body-contouring procedures is associated with increased postoperative complications. Methods Adult patients who underwent body-contouring surgery between August 2020 and March 2025 were identified from the US Collaborative Network on TriNetX (TRINETX, LLC, Cambridge, MA). Patients were categorized based on documented COVID-19 infection within 30 days preoperatively. Propensity score matching (1:1) was performed to balance demographics and comorbidities. Thirty-day postoperative complications were compared using risk ratios (RRs), with statistical significance defined as P \u3c .05. Results A total of 3941 patients were matched in each of the COVID-19 and non-COVID-19 groups. Patients in the matched COVID-19 group had a significantly increased risk of surgical-site infection (RR 1.56, P = .010), wound disruption (RR 1.69, P = .003), postoperative pain (RR 1.66, P = .002), anticoagulant use (RR 1.77, P \u3c .0001), and emergency department visits (RR 1.50, P = .010). Conclusions Despite reduced overall prevalence, recent COVID-19 infection remains associated with increased risk of postoperative complications following body-contouring surgery. Delaying elective aesthetic procedures by at least 30 days following recent infection appears prudent to enhance patient safety and minimize complications
TCT-1023 Comparative Effectiveness of DES, DCB, and BMS for the Treatment of In-Stent Restenosis in Carotid Artery Stents: A Systematic Review and Meta-Analysis
No full textBackground: In-stent restenosis (ISR) following carotid artery stenting is a challenging complication associated with an increased risk of cerebrovascular events. Various endovascular approaches—including drug-eluting stents (DES), drug-coated balloons (DCB), and bare-metal stents (BMS)—are employed for ISR treatment. This study compares the clinical outcomes of these treatment modalities. Methods: A systematic review and meta-analysis of studies from 2005–2024 was conducted. Outcomes included restenosis rate, stroke, target lesion revascularization (TLR), and mortality. Subgroup analyses by patient comorbidities and lesion characteristics were also performed. Results: A total of 12 studies comprising 1,284 patients were included (DES: 478; DCB: 412; BMS: 394). DES had the lowest rate of recurrent ISR (7.2%), followed by DCB (12.8%) and BMS (22.4%). TLR was lowest in the DES group (5.1%) compared to DCB (10.6%) and BMS (17.3%). Stroke and mortality rates were similar across groups. Conclusion: DES appears to offer superior efficacy in preventing recurrent carotid ISR and reducing the need for revascularization. DCBs are a viable alternative in high-risk patients where stenting is undesirable. BMS should be reserved for select cases given higher restenosis and TLR rates. Categories: ENDOVASCULAR: Stroke, Stroke Prevention, Carotid Interventio
TCT-494 Cost-Effectiveness of SGLT2 Inhibitors, Statins, and GLP-1 Receptor Agonists for Cardiovascular Secondary Prevention: A Comparative Analysis
No full textBackground: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Several pharmacologic therapies including sodium-glucose co-transporter 2 (SGLT2) inhibitors, statins, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated cardiovascular benefit in high-risk populations. This study evaluates and compares the cost-effectiveness of these agents in secondary prevention of cardiovascular events. Methods: A systematic review and comparative cost-effectiveness analysis were performed based on studies published between 2015 and 2025. We included randomized controlled trials and model-based economic evaluations reporting incremental cost-effectiveness ratios (ICERs) in patients with established cardiovascular disease. Outcomes included cost per quality-adjusted life year (QALY) gained, major adverse cardiovascular events (MACE) reduction, and treatment-specific adverse events. Results: Statins demonstrated the highest cost-effectiveness, with ICERs ranging from 10,000 per QALY gained. SGLT2 inhibitors had moderate ICERs between 50,000 per QALY, particularly cost-effective in patients with heart failure or chronic kidney disease. GLP-1 RAs had higher ICERs, ranging from 120,000 per QALY gained, primarily due to higher drug costs. All three drug classes showed significant MACE reduction compared to placebo, with the greatest relative risk reduction seen in statins (RR 0.78), followed by SGLT2i (RR 0.85) and GLP-1 RAs (RR 0.88). Conclusion: Statins remain the most cost-effective agent for cardiovascular secondary prevention. SGLT2 inhibitors offer favorable cost-effectiveness in specific subgroups, particularly patients with heart failure or diabetes. GLP-1 RAs, while effective, may require price reductions to achieve cost-effectiveness thresholds in most health systems. Categories: CORONARY: Pharmacology/Pharmacotherap