RocScholar (Rochester Regional Health)
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Teamwork to Trust
No full textTeamwork to Trust. Dr. Krishna Tangirala
Objectives: RRH focus on the patient experience Perception of staff working together: how that influences patient experience What is the importance of team building in patient care Implications of insurance expectations and changing team consistency Navigating the challenge
Community-Acquired Pneumonia Guidelines: Not CAPed yet?
No full textCommunity-Acquired Pneumonia Guidelines: Not CAPed yet? Dr. Maryrose Laguio-Vila, Infectious Disease Unit, Chair Medicine Service Line
Objectives: Outline the evolution of CAP guideline recommendations and highlight the major shifts in management Analyze the decision architecture, underlying values, and trade-offs shaping the 2025 CAP guideline update Critically appraise the evidence basis for the new CAP recommendations regarding: Adjunctive corticosteroid use in severe CAP; shorter antibiotic durations in specific populations; antibiotic decision-making in patients with CAP who test positive for a viru
Splanchnic Vein Thrombosis as the Initial Manifestation of Lambda Light Chain Multiple Myeloma
No full textWe present the case of a 67-year-old man who developed superior mesenteric vein thrombosis (SMVT) as the initial manifestation of IgD lambda and lambda light chain multiple myeloma (LCMM). He initially presented with abdominal pain and was found to have SMVT without identifiable thrombophilic risk factors. Persistent macrocytosis, unexplained renal dysfunction, and mild anemia prompted further evaluation, revealing markedly elevated serum free lambda light chains, suppressed immunoglobulins, and a bone marrow biopsy confirming LCMM. This case highlights the importance of considering plasma cell dyscrasias in patients with unprovoked thrombosis at atypical sites, particularly when accompanied by subtle hematologic or renal abnormalities. Early recognition of LCMM is essential given its aggressive nature and potential for diagnostic delay due to absent or minimal findings on standard serum protein electrophoresis
Impact of glucagon-like peptide-1 receptor agonists on cutaneous events: A systematic review and meta-analysis
No full textBackground: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for type 2 diabetes mellitus and obesity, but emerging reports suggest potential cutaneous adverse effects.
Objective: To evaluate the association between GLP-1RAs and cutaneous adverse events through a systematic review and meta-analysis of randomized controlled trials.
Methods: We searched 5 databases through October 2024 for placebo-controlled randomized controlled trials of GLP-1RAs in patients with type 2 diabetes mellitus or overweight/obesity. 2 independent reviewers screened studies, extracted cutaneous outcome data, and assessed risk of bias. Random-effects meta-analyses were performed.
Results: Of the 8867 articles screened, 34 randomized controlled trials (84,243 participants) were included. The incidence of alopecia was higher in GLP-1RA users than placebo (6.0 vs 0.8 per 1000 patient-years). GLP-1RA use was associated with an increased risk of alopecia (risk ratio 3.40; 95% CI 1.18–9.81; I2 = 67.77; P = .02), primarily driven by tirzepatide trials. No significant associations were observed for other cutaneous outcomes.
Limitations: Cutaneous adverse events were not pre-specified endpoints and may be under-reported.
Conclusion: GLP-1RA therapy is associated with an increased risk of alopecia but no other cutaneous events. Further studies are needed to understand underlying mechanisms and identify populations at risk of developing alopecia
Glucagon-Like Peptide-1 Receptor Agonists and Gastrointestinal Adverse Events: A Systematic Review and Meta-Analysis
No full textBACKGROUND & AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for glycemic control or weight management in patients with type 2 diabetes mellitus or overweight/obesity. However, there are concerns regarding their association with serious gastrointestinal adverse events, although findings have been inconsistent.
METHODS: We systematically searched 5 databases for placebo-controlled randomized controlled trials assessing GLP-1RAs in patients with type 2 diabetes mellitus, overweight/obesity, or metabolic dysfunction-associated steatohepatitis/metabolic dysfunction-associated steatotic liver disease. We included trials that reported cholecystitis, cholelithiasis, cholangitis, cholestasis, pancreatitis, gastroesophageal reflux disease (GERD), gastritis, esophagitis, gastrointestinal ischemia, gastrointestinal hemorrhage, intestinal obstruction, paralytic ileus, gastrointestinal ulceration, gastrointestinal perforation, or gastroparesis. Meta-analyses were performed using a random-effects model, with subgroup analyses evaluating risks based on patient population, GLP-1RA vs dual-agonist formulation, weight-loss profile, dosing, and duration of action.
RESULTS: We included 55 randomized controlled trials involving 106,395 participants. GLP-1RAs increased the risk of cholelithiasis (risk ratio [RR], 1.46; 95% CI, 1.09-1.97; 2 more cases per 1000) and probably increased the risk of GERD (RR, 2.19; 95% CI, 1.48-3.25; 4 more cases per 1000) compared with placebo. GLP-1RAs probably have little or no effect on the risk of other gastrointestinal or biliary events. Subgroup analyses showed that the increased risks of cholelithiasis and GERD were more pronounced in trials including individuals with overweight/obesity or metabolic dysfunction-associated steatohepatitis/metabolic dysfunction-associated steatotic liver disease, weight-loss-inducing GLP-1RAs, or high-dose formulations, although these subgroup effects were not statistically significant.
CONCLUSIONS: GLP-1RAs are associated with an increased risk of cholelithiasis and GERD, but do not appear to increase the risk of other gastrointestinal or biliary adverse events
Vonoprazan Improves Efficacy of Bismuth Quadruple Therapy for Helicobacter pylori Rescue Treatment: A Multicenter Randomized Controlled Trial
No full textBackground: Rescue treatment for non-naive patients with persistent Helicobacter pylori (H. pylori) infection is lacking, especially in areas where tetracycline is unavailable. This trial aimed to evaluate the efficacy and safety of replacing proton pump inhibitor (PPI) with potassium-competitive acid blocker (P-CAB) in bismuth quadruple therapy (BQT) containing amoxicillin and furazolidone as rescue therapy.
Materials and methods: We conducted a prospective, open-label, noninferiority randomized controlled trial at six institutions in eastern China. A total of 444 patients with a history of H. pylori treatment failure were enrolled and randomly assigned in a 1:1 ratio to either the 14-day P-CAB-BQT group (vonoprazan 20 mg, colloidal bismuth 200 mg, amoxicillin 1000 mg and furazolidone 100 mg, all given twice daily) or the 14-day PPI-BQT group (rabeprazole 10 mg given twice daily, and the same dose of three other drugs as the 14-day P-CAB-BQT group). The primary endpoint was the eradication rate assessed by 13C urea breath test. The secondary endpoints were adverse events and compliance.
Results: H. pylori eradication rates of PPI-BQT versus P-CAB-BQT group were 83.8% versus 91.9% in the intention-to-treat (ITT) analysis (treatment difference: 8.1%; 95% CI: 2.1%-14.1%; non-inferiority p \u3c 0.001, p-value for difference = 0.008); 86.1% versus 95.8% in the modified ITT (MITT) analysis (treatment difference: 9.7%; 95% CI: 4.4%-15.0%; non-inferiority p \u3c 0.001, p-value for difference \u3c 0.001); and 86.3% versus 95.6% in the per-protocol (PP) analysis (treatment difference: 9.3%; 95% CI: 3.8%-14.8%; non-inferiority p \u3c 0.001, p-value for difference \u3c 0.001). The P-CAB-BQT regimen was shown to be non-inferior to the PPI-BQT regimen and yielded higher eradication rates across all analysis populations (ITT, MITT, and PP). The overall frequency of adverse events (27.9% and 34.2%, p = 0.151) and compliance (93.7% and 94.6%, p = 0.686) were similar between PPI and P-CAB groups. Among the patients suspected of drug-induced fever (8.6% and 7.2%, p = 0.597), 82.9% experienced fever after administration of furazolidone for \u3e 10 days. The eradication rates were not affected by prior choice of antibiotics and the number of treatment attempts.
Conclusions: The 14-day P-CAB-BQT therapy containing amoxicillin and furazolidone provided a satisfactory eradication rate and a good safety profile as rescue treatment for H. pylori eradication, regardless of prior choice of antibiotics and the number of treatment attempts. Shortening the treatment course to 10-11 days could prevent the majority of drug-induced fevers
Glucagon-Like Peptide-1 Receptor Agonists and Respiratory Diseases: A Systematic Review and Meta-Analysis
No full textComparison Between GIP/GLP-1 Co-agonists and GLP-1 Agonists on Pulmonary Outcomes in COPD Patients
No full textCrazy Paving Pattern in Setting of Massive Hemoptysis From Negative Pressure Pulmonary Edema
No full textRadiologic Evaluation and Management of Metastatic Renal Cell Carcinoma with Tumor Thrombus Extension into Right Atrium
Full text linkThis case report discusses the radiologic evaluation, histopathology, and management of a 67-year-old female with metastatic renal cell carcinoma (RCC) extending as a tumor thrombus into the right atrium. The patient had newly developed hematuria that was not followed up with the recommended imaging modality. Months later, the patient presented to the emergency department with progressive hematuria in addition to symptoms of dyspnea and significant weight loss. Initial CT imaging revealed a large renal mass with metastasis to the liver and lungs, along with tumor thrombus invading the inferior vena cava and right atrium. Histopathologic evaluation confirmed metastatic RCC and utilized in conjunction with the imaging studies to verify cancer staging. Combination immunotherapy with pembrolizumab and lenvatinib was initiated by the oncologist. This case emphasizes the importance of a comprehensive radiologic and clinical evaluation of hematuria as well as adequate workup to verify and stage RCC