RocScholar (Rochester Regional Health)
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What Cardiologists Should Know About Amyloidosis
No full textBackground: Cardiac amyloidosis (CA) is an increasingly recognized but historically underdiagnosed cause of restrictive cardiomyopathy and heart failure with preserved ejection fraction (HFpEF). It results from the extracellular deposition of misfolded protein fibrils, most commonly transthyretin (ATTR) or immunoglobulin light chains (AL), leading to progressive myocardial dysfunction and multi-organ involvement.
Objective: This review provides a comprehensive, cardiology-centered overview of cardiac amyloidosis, with an emphasis on early recognition, diagnostic strategies, subtype differentiation, and the evolving therapies.
Content: We summarize the epidemiology, pathophysiology, and clinical manifestations of both ATTR and AL subtypes. Key diagnostic tools, including echocardiography, cardiac magnetic resonance imaging, bone scintigraphy, monoclonal protein screening, and endomyocardial biopsy, are reviewed in the context of a stepwise diagnostic approach. Special attention is given to clinical presentation, electrocardiographic and imaging red flags, and to differentiating CA from mimickers such as hypertrophic cardiomyopathy, hypertension-induced left ventricular hypertrophy, and aortic stenosis. Staging systems are detailed, highlighting the prognostic role of cardiac biomarkers. Therapeutic strategies are explored, including subtype-specific regimens (e.g., daratumumab-based therapy for AL; tafamidis and gene silencers for ATTR), the judicious use of conventional heart failure medications, and emerging therapies such as CRISPR-based gene editing.
Conclusions: Timely recognition and accurate diagnosis of cardiac amyloidosis are critical to improving outcomes. As diagnostic tools and disease-modifying therapies evolve rapidly, cardiologists must remain at the forefront of multidisciplinary care. A structured biomarker- and imaging-guided approach can enhance diagnostic yield, inform prognosis, and optimize patient-specific management
Efficacy of negative pressure wound therapy blowhole placement in alleviating severe subcutaneous emphysema and associated transient blindness following video-assisted thorascopic surgery: a case series
No full textVideo-assisted thorascopic surgery (VATS) lobectomy is widely used for treating lung cancer, but severe subcutaneous emphysema can be a rare complication, leading to distressing symptoms such as pain, temporary blindness, and voice changes. Traditional management strategies often require prolonged treatment, and blowhole incisions can result in infection and discomfort. This case series explores the use of negative pressure wound therapy (NPWT) applied via a unilateral blowhole incision to treat severe subcutaneous emphysema post-VATS lobectomy. In three cases, NPWT facilitated rapid resolution of pain, restored vision, and resolved voice changes within 8 h. No infection-related complications occurred. This approach not only accelerates recovery and alleviates patient discomfort but also reduces the burden on caregivers and healthcare teams. NPWT should be considered a valuable addition to the management of severe subcutaneous emphysema, improving patient outcomes and enhancing postoperative care
Listeria Bacteremia With Septic Brachial Artery Thrombosis and Pacemaker Infection in an Elderly Woman With a Prosthetic Aortic Valve and Recurrent Pacemaker Implantation
No full textA 77-year-old female with a history of coronary artery disease status post-coronary artery bypass grafting, aortic stenosis treated with transcatheter aortic valve replacement, and recent dual-chamber pacemaker implantation for high-grade atrioventricular block presented with recurrent syncope, right brachial artery thrombosis, and persistent bacteremia. Blood and thrombus cultures grew Listeria monocytogenes, leading to pacemaker extraction and a prolonged course of antibiotic therapy. This case illustrates the diagnostic challenges associated with systemic Listeria infections in patients with prosthetic devices and emphasizes the importance of early blood culture collection in patients with unexplained clinical symptoms
Anxiety: How Do I Get Through This Clinic Visit
No full textAnxiety: How Do I Get Through This Clinic Visit. Lorinda Parks, MD, Primary Care Regional Medical Director
Objectives:
Dr. Parks will discuss when patients come to clinic with a variety of forms of anxiety and how they often serve to derail the medical content of the visit, or risk quash any hope of the provider staying on schedule. There are tools and skills which can be deployed for anxiety similar to those used for HTN or DM but are not as widely taught. This presentation will strive to offer clinicians a usable skill set to educate patients about the message that anxiety is offering them, to remind patient and clinician that each of us can, in fact, manage the “season” of the life we are currently in and even find joy in the messages of anxiety. Participants should be able to utilize Emotional Tag Lines, THE WORK in 4 Questions and the Turnarounds in a formulaic way for anxiety; similar to the way pharmacologics are used in step wise approach to COPD or HTN. Select a tool which can generate understanding of anxiety and facilitate completion of the clinic visit while optimizing joy and connection
Infant and Toddler Peanut Oral Immunotherapy: Initiation Before Age 2 Increases Ad Libitum Peanut Consumption
No full textBackground: Peanut oral immunotherapy (POIT) has promising potential of disease modification, but there are no studies to date evaluating high-dose POIT, leading to ad libitum (ad lib) consumption of peanut products, especially in children 6 months to 4 years of age.
Objective: To report real-world outcomes of high-dose POIT in children 6 months to 4 years of age, including adverse events, achievement of ad lib consumption, and the impact of age on these outcome measures.
Methods: Patients 6 months to 4 years of age with a diagnosis of peanut allergy were enrolled in a POIT protocol with a goal dose of 3000 mg. Demographics along with POIT and clinical outcomes 6 months after POIT are reported.
Results: Sixty children, with a median age of 16 months, started POIT. Three (5%) were lost to follow-up, and 6 (10%) discontinued POIT because of recurrent adverse events or the inability to consume daily peanut protein. Fifty-one (85%) children completed POIT in a median of 7 months and were consuming ad lib peanut products for a duration of 6 months after completion of the POIT protocol. Sixteen (26.7%) children experienced a total of 22 adverse reactions during POIT. Initiating POIT before 24 months of age increased the likelihood of ad lib peanut consumption by an odds ratio of 11.69 (1.19-114.31, P = .035).
Conclusions: Our study demonstrates that high-dose POIT in infants and toddlers is well tolerated and can lead to ad lib introduction of dietary peanut products into the diet, especially if initiated before 2 years of age
Can Anemia Be a Prognostic Indicator to Scope for Gastroesophageal Junction Adenocarcinoma?
Get PDFGastroesophageal junction adenocarcinoma is a rapidly progressive disease that has a poor prognosis with a 5-year survival rate of 20%. It commonly presents with major symptoms of dysphagia and weight loss in addition to a long-standing history of reflux. As of now, screening for esophageal adenocarcinoma (EAC) is dependent on identifying risk factors which include a family history of Barrett’s esophagus and esophageal adenocarcinoma or patients with gastroesophageal reflux disease and at least one other risk factory for EAC such as age greater than 50 years, obesity or central adiposity, history of smoking, or male gender. Here, we present a case of an individual who presented with rapidly worsening dysphagia which was preceded by early anemia. We hope this case presents anemia as a crucial factor that would warrant screening patients with early complaints of dysphagia or weight loss for esophageal adenocarcinoma
B-59 Malnutrition Drastically Worsens Outcomes of Mitra Clip Implantation; Insights from Real World Data
No full textComparison of Streptococcus pneumoniae nasopharyngeal colonization, serotype-specific and protein-specific antibody and cytokine levels in young children prior to, during and post COVID-19 pandemic
No full textBACKGROUND: We studied changes in pneumococcal epidemiology and immunology in young children at pre-COVID, during-COVID and post-COVID time-frames.
METHODS: Pneumococci were cultured from nasopharynx and density semi-quantified at six healthy child visits, age 6-36 months, and during acute otitis media (AOM). Serum antibody levels were measured by ELISA. Nasopharyngeal cytokine/chemokine levels were measured by rt-PCR. Differences between pre-COVID (2017 Mar-2019 July), during-COVID (2020 March-2022 March) and post-COVID (2022 April-2023 July) were analyzed.
RESULTS: At healthy visits, pneumococcal detection was significantly lower during-COVID (21 %) vs. pre-COVID (28 %) and returned to 27 % post-COVID. Nasopharyngeal pneumococcal detection during AOM was not different during the three time frames (47-49 %), and density was consistently higher during AOM compared to healthy visits. Multiple vaccine and non- vaccine serotypes were detected during all time-frames. During-COVID, antibody levels to serotype 6A were lower than pre or post-COVID when measured at 24 months old. Increasing antibody levels occurred across the three time-frames for serotypes 22F and 33F. Pneumococcal- specific protein IgG levels did not differ across the three time-frames. Nasopharyngeal cytokine/chemokine levels during-COVID were lower.
CONCLUSIONS: During the COVID-19 pandemic pneumococcal nasopharyngeal colonization, antibody and cytokine levels in young children differed compared to before and after the pandemic