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Higher mortality following SARS-CoV-2 infection in rural versus urban dwellers persists for two years post-infection
No full textPrevious studies demonstrated higher short-term mortality among rural compared with urban residents infected with SARS-CoV-2. However, whether this difference persists remains uncertain. This retrospective cohort study analyzed two-year post-COVID-19 mortality by rurality using the National Clinical Cohort Collaborative COVID-19 Enclave, a United States-based longitudinal electronic health record repository. We analyzed mortality among patients infected with SARS-CoV-2 between April 2020 and December 2022, with follow-up until December 2024. Patients were categorized into urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR) groups based on residential ZIP Code. Mortality differences were assessed using Kaplan-Meier analysis and weighted multivariable Cox regression, with weights derived from demographic factors and models adjusted for background clinical risk and social vulnerability. Among 3,082,978 SARS-CoV-2-infected patients, we found a significant association between rurality and increased two-year all-cause mortality post-infection. Adjusted hazards for two-year mortality for UAR and NAR were 1.19 (95% CI 1.18-1.21) and 1.26 (1.22-1.29). A reference cohort of 4,153,216 COVID-19-negative patients showed a modest yet consistent rural mortality penalty, with a similar relative hazard across cohorts, an observed rurality-COVID-19 interaction, and a greater absolute number of deaths following SARS-CoV-2 infection. Our findings emphasize ongoing rural mortality disparities and the importance of public health efforts in rural communities
Permanent visual impairment following a Behçet’s disease flare while on calcitonin gene-related peptide receptor antagonist therapy: a case report
No full textBackground: Behçet’s disease (BD) is a chronic, relapsing, systemic vasculitis that can involve both arteries and veins. Ocular involvement, including non-granulomatous panuveitis and occlusive retinal vasculitis, is common and a significant cause of morbidity. Erenumab is a monoclonal antibody targeting the calcitonin gene-related peptide (CGRP) receptor approved for migraine prevention Although it is generally well tolerated, recent concerns have emerged regarding its vasoconstrictive potential in patients with underlying vascular disorders. Case presentation: We report a case of a 44-year-old woman with a history of BD, well-managed with azathioprine and methotrexate, who developed painless, bilateral subacute visual loss eleven days after receiving her second monthly dose of erenumab. This occurred during a BD flare marked by oral ulcers and severe migraine. Despite corticosteroid treatment, visual acuity did not improve. Erenumab was discontinued, but at her following visit four weeks later, vision remained impaired and visual fields showed blind spot enlargement and nonspecific defects. Conclusion: We hypothesize that the patient’s visual loss was due to secondary ischemia from BD–associated small-vessel vasculitis, potentially exacerbated by CGRP receptor blockade from erenumab, which may have impaired compensatory vasodilation in the optic nerve or retinal circulation. This case represents the first report of permanent bilateral visual impairment associated with CGRP antagonist use in a patient with BD. Recent FDA labeling updates for CGRP-targeting agents now caution against use in patients with preexisting vascular disease, including risk of hypertension and Raynaud’s phenomenon. This case underscores the need for heightened caution when prescribing CGRP inhibitors to patients with systemic vasculitic disorders and highlights the importance of further investigation to better define the safety profile of these agents in individuals with underlying vascular disease
Machine Learning-Based Behavioral Profiling of Resilience and Susceptibility in Social Stress-Exposed Mice
No full textNeurocognitive and Neuroinflammation Gene Expression Changes in Pediatric Cancer Patients Treated with Methotrexate
No full textIntegrating Bulk with Single Cell RNA-Seq Data for the Discovery of Clinically Actionable Biomarkers and Therapeutic Targets in Triple Negative Breast Cancer.
No full textTrail, Mervin Lee
No full textPlaque adjacent to the photgraph reads:
Mervin Lee Trail, M.D.
December 2, 1933 – January 3, 2001
One of Louisiana’s foremost head and neck surgeons. Dr. Merv Trail was appointed Chancellor of the LSU Health Sciences Center on December 9, 1994. Six months after he assumed duties as the Acting Chancellor. Dr. Trail was named Senior Vice President and CEO of the LSU Health Sciences Center August 18, 2000.
Born in Cumberland, Maryland, Dr. Trail earned his medical degree from the University of Maryland School of Medicine and completed a residency in Otolaryngology-Head and Neck Surgery at John Hopkins. A board certified ear, nose and throat specialist, Dr. Trail was recruited by the LSU School of Medicine in 1968 where he initiated an educational process for the residency program in his specialty. Dr. Trail devoted his professional life to the LSU Health Sciences Center where he headed various academic and clinical programs including the Department of Otolaryngology—Head and Neck Surgery. He founded the Stanley S. Scott Cancer Center and was its first director.
Dr. Trail was the Chief Executive Officer of a statewide comprehensive public health care education and delivery system—arguably the largest academic health center in the U.S.—comprising six professional schools and ten hospitals. With approximately 3,000 students and more than a thousand residents and fellows enrolled in its programs, Dr. Trail governed a system that educates about 70% of the health professionals practicing in Louisiana. Under his leadership, the Center grew into the one of the states most powerful economic engines. Generating nearly 25,000 jobs and an annual economic impact of about $3 billion.
Dr. Trail’s talents were also in great demand by civic and community groups. No one individual contributed more to the prosperity of New Orleans through sports, special events and the building of the Ernest N. Morial Convention Center. Although repeatedly honored by National, local and regional professional and civic organizations, Dr. Trail’s greatest pride was in his students and faculty and their accomplishments.https://digitalscholar.lsuhsc.edu/cac/1101/thumbnail.jp
Charity Hospital of Louisiana at New Orleans, 1930s
No full textArchitectural drawings of the 1930s era Charity Hospital by Weiss, Dreyfous and Seiferthhttps://digitalscholar.lsuhsc.edu/cac/1098/thumbnail.jp
Bayesian Mediation Analysis for Time-to-Event Outcome: Investigating Racial Disparity in Breast Cancer Survival
No full textMediation analysis is conducted to make inferences on effects of mediators that intervene the relationship between an exposure variable and an outcome. Bayesian mediation analysis (BMA) naturally considers the hierarchical structure of the effects from the exposure variable to mediators and then to the outcome. We propose three BMA methods on survival outcomes, where mediation effects are measured in terms of hazard rate, survival time, or log of survival time respectively. In addition, we allow setting a limited survival time in the time-to-event analysis. The methods are validated by comparing the estimation precision at different scenarios through simulations. The three methods all give effective estimates. Finally, the methods are applied to the Surveillance, Epidemiology, and End Results Program (SEER) supported special studies to explore the racial disparity in breast cancer survivals. The included variable completely explained the observed racial disparities. We provide visual aids to help with the result interpretations
Lack of Follow-Up in a Food-Insecure Population
No full textLiterature regarding attendance in elective health programs, like the Geaux Get Healthy Clinical Program at Our Lady of the Lake (OLOL), is scarce. This study aimed to investigate reasons for the non-enrollment of eligible, food-insecure individuals from Baton Rouge in the Geaux Get Healthy Clinical Program at Our Lady of the Lake (OLOL), which is a clinic-based community program addressing food insecurity. A prospective qualitative study was conducted using semi-structured phone interviews with 19 participants screened for food insecurity within the Franciscan Missionaries of Our Lady Health System (FMOLHS) but who did not enroll in the program. Interviews were recorded, transcribed, and analyzed thematically. Demographic data were extracted from the Epic database and statistically analyzed. The participants, primarily African-American females, cited a lack of awareness as the main reason for non-enrollment. Other barriers included embarrassment, transportation difficulties, and competing priorities. This study highlights the importance of addressing barriers to participation in community health programs like Geaux Get Healthy. Enhancing awareness and mitigating obstacles can improve program enrollment and ensure better use of resources to positively impact the health outcomes of food-insecure populations
Routine Overnight Assessments in Stable Pediatric Surgery Patients: A Critical Reconsideration
Get PDFBackground: Hospitalized patients are subject to overnight vital sign (OVS) monitoring which leads to subsequent sleep disturbance and contributes to adverse outcomes and negative hospital experiences. Studies in pediatric populations have shown that routine OVS checks infrequently detect significant events. We hypothesized that OVS monitoring in pediatric surgery patients rarely detects abnormalities resulting in meaningful interventions. Materials and methods: We performed a retrospective chart review of patients ≥ 5 years old admitted to the pediatric surgery service at a stand-alone Children\u27s Hospital from 2019 to 2021. ICU patients were excluded from analysis. Overnight vital signs were defined as those recorded every 4 h between 10:00 PM and 6:00 AM. Abnormal OVS and subsequent interventions were recorded. Results: Analysis included 354 patients aged 5-19 years old. At least one OVS was abnormal in 62% of patients. Abnormal blood pressure was the most commonly flagged OVS (80%). The rate of intervention for flagged OVS was 58%. Medication administration was the most common intervention (54%). Unplanned operative intervention and transfer to the ICU were uncommon but did occur in this cohort (0.9% and 1.4%, respectively). Conclusion: The majority of pediatric surgery patients had at least one flagged OVS and, while rare, some serious complications were detected. While minimizing sleep disturbance and maximizing patient satisfaction is valuable, these results support prioritizing patient safety with routine vital sign assessments until we can determine if there are sub-populations that can be safely managed without sleep disruptions. Level of evidence: Level 4. Study type: Retrospective chart review