RocScholar (Rochester Regional Health)
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Efficacy of nanoliposomal irinotecan in metastatic pancreatic ductal adenocarcinoma: A meta-analysis of NAPOLI randomized clinical trials
No full textEmerging Risk Factors for Invasive Pulmonary Aspergillosis: A Narrative Review
No full textAspergillus can cause a spectrum of diseases depending on the immune status and predisposing conditions. Invasive pulmonary aspergillosis (IPA) is classically seen in patients with severe immunocompromise, such as patients with hematologic malignancies, transplant recipients, and chronic corticosteroid use at high doses. Recently, IPA cases in patients without these classic risk factors, including those associated with severe respiratory viral infections, chronic obstructive pulmonary disease, liver failure, and critical illness, are being increasingly recognized. Delayed recognition and missed diagnoses contribute to increased mortality in these patient populations. Maintaining a high index of suspicion and implementation of systematic screening protocols in high-risk patients may help reduce missed or delayed diagnoses and improve patient outcomes. This review describes the pathophysiology, incidence, risk factors, outcomes, and diagnostic and treatment considerations in IPA in patients with emerging risk factors
Early U.S. Commercial Experience With a Novel Transcatheter Edge-to-Edge Repair System: Insights From Real-World Data
No full textBackground: The PASCAL Precision transcatheter valve repair system provides a new option for treating prohibitive surgical risk patients with significant, symptomatic degenerative mitral regurgitation (DMR).
Objectives: The authors report early U.S. commercial experience with the PASCAL Precision system.
Methods: Patients with DMR treated with the PASCAL Precision system in the United States were analyzed from the STS/ACC TVT Registry. Procedural, clinical, echocardiographic, functional, and quality-of-life outcomes to 30 days were assessed. All outcomes, including echocardiographic assessments, were site-assessed.
Results: In 1,995 DMR patients, the median age was 81.6 years, and 57.0% were male. Median STS-PROM for mitral valve repair was 3.6%, and 69.4% were in NYHA functional class III/IV. Mixed etiology (DMR + other etiology) was present in 11.4%, and 66.9% had complex anatomy (annular/leaflet calcification, mitral valve area \u3c 4 cm2, bileaflet flail/prolapse/tethering, or mitral stenosis). The device was successfully implanted in 97.7%. MR reduction was significant at 30 days with 94.2% achieving ≤ moderate MR and 72.6% ≤ mild MR (P \u3c 0.001 vs baseline). Patients experienced significant functional and quality-of-life improvements with a mean 21.0-point increase in Kansas City Cardiomyopathy Questionnaire score and 84.6% in NYHA functional class I/II (all P \u3c 0.001). Mitral valve reintervention and single-leaflet device attachment rates were 0.4% and 0.5%, respectively, and all-cause mortality, cardiovascular mortality, and heart failure readmission rates were 2.2%, 1.2%, and 2.6%, respectively, at 30 days.
Conclusions: Early U.S. STS/ACC TVT Registry commercial experience confirms the safety and effectiveness of the novel PASCAL Precision system in the treatment of a broad population of real-world DMR patients
MDS-1451: Evolving Mortality Trends in Myelodysplastic Syndromes Among Older US Adults: A 25-Year Nationwide Joinpoint Analysis
No full textCT-894: Incidence of Cytokine Release Syndrome-Associated Coagulopathy and Disseminated Intravascular Coagulation Following CAR-T Therapy: A Systematic Review and Meta-Analysis
No full textPOSTER: AML-941 Trends in Acute Myeloid Leukemia-Related Mortality Among Patients With Sepsis (1999–2023): A CDC WONDER Database Analysis
No full textCardiovascular complications during delivery hospitalizations in inflammatory bowel disease patients
No full textBACKGROUND: The relationship between inflammatory bowel disease (IBD) and cardiovascular outcomes among pregnant women has yet to be thoroughly investigated. Our aim is to assess the odds of cardiovascular disease and cardiac arrhythmias during hospital admissions for delivery and identify contributing factors associated with cardiovascular complications in pregnant women with IBD.
METHODS: We performed a retrospective analysis of data from the National Inpatient Sample, obtained from delivery admissions of pregnant women with and without IBD, identified via International Classification of Diseases codes, from 2009 to 2019. Using a regression model, we compared the odds of cardiovascular complications between these two groups, adjusting for traditional cardiovascular risk factors as confounding variables.
RESULTS: Our study included 71,361 pregnancies with IBD and 41,117,443 pregnancies without this condition. The incidence of IBD in pregnancy rose near three-fold increase over the decade. In comparison to pregnancies without IBD, those involving pregnant patients with IBD exhibited an increased likelihood of encountering cardiovascular complications, with an adjusted odds ratio (AOR) of 1.37 (95% CI, 1.29-1.46). This heightened risk encompasses a range of conditions, including peripartum cardiomyopathy (AOR, 9.45; 95% CI, 3.86-23.15), cardiac arrhythmias (AOR, 2.03; 95% CI, 1.59-2.60), and hypertensive disorders of pregnancy (AOR, 1.51; 95% CI, 1.37-1.66), notably preeclampsia, eclampsia, and the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Pregnancies with IBD were also associated with three-fold higher odds of venous thromboembolism (AOR, 3.91; 95% CI, 1.45-10.48).
CONCLUSIONS: Pregnant patients with IBD had an increased odds of cardiovascular complications during delivery admissions, independent of traditional cardiovascular risk factors. Further research is needed to elucidate the underlying mechanisms and develop targeted prevention strategies for this high-risk population
Interdisciplinary Aspects of Workforce Wellness in Anaesthesiology
No full textA healthy anaesthesia workforce is pivotal to providing safe and efficient anaesthesia care globally. Workforce wellness underpins the risk of attrition, burnout, and physical and psychological illness. We review some models of workforce wellness in relation to anaesthesiology and approach them in an interdisciplinary context. The value of interprofessional collaboration with other healthcare disciplines to bring about the best patient-centric care is discussed. We then identify some challenges and opportunities for improvement by bridging the gaps in team collaboration
Persistent Hyperammonemia and Cerebral Edema Following Gastrostomy Tube Placement in a Post-bariatric Patient: A Diagnostic Dilemma
No full textA 45-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) and recent cholangitis presented with acute encephalopathy, seizures, and concern for anoxic brain injury. She was intubated for acute respiratory failure and found to have striking hyperammonemia with serum ammonia levels exceeding 300 µmol/L, in the absence of overt liver dysfunction. Her clinical course was complicated by septic shock, multifocal pneumonia, and gastrostomy tube (G-tube) malfunction. Despite aggressive medical management, including broad-spectrum antibiotics and lactulose, ammonia levels remained persistently elevated. CT and MRI of the brain revealed cerebral edema and diffuse cortical diffusion abnormalities concerning for metabolic encephalopathy or anoxic injury. Continuous renal replacement therapy (CRRT) was initiated due to worsening encephalopathy and acute kidney injury (AKI). Notably, imaging demonstrated malposition of the G-tube with distal placement in the excluded gastric remnant; an anatomic reservoir bypassed in Roux-en-Y that is not exposed to normal enteric flow. G-tube revision and eventual conversion to gastrojejunostomy tube (GJ-tube) led to a rapid decline in ammonia levels and improvement in neurologic status. We present a severe and unusual case of non-hepatic hyperammonemia, likely precipitated by altered post-bariatric anatomy and nitrogenous substrate accumulation in the excluded gastric remnant. While hyperammonemia is a well-described complication of liver failure and urea cycle disorders, it is rarely attributed to anatomical disruption in gastrointestinal transit. This report underscores the importance of considering altered post-surgical anatomy in the differential for unexplained metabolic encephalopathy and supports early imaging of enteral access in patients with Roux-en-Y anatomy and neurologic decline. Timely recognition and intervention may prevent irreversible neurologic injury and reduce the need for prolonged renal support
Supporting religion and spirituality at the bedside
No full textSpirituality is an integral part of patient-centered care: Inclusive nursing, which encompasses assessing and responding to patients\u27 spiritual needs, can improve patient outcomes. It is important to determine a patient\u27s religion and spirituality at the beginning of care because this may affect how a patient wishes to be treated. In support of patients\u27 spirituality, hospital chaplains are experts in providing spiritual care to patients, families, and staff. This article discusses the role of hospital chaplains and central aspects of different religious beliefs, with the aim of better equipping nurses to support patients\u27 spiritual needs across diverse backgrounds