ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Bridging the Gap between Evidence and Practice: Nationwide Retrospective Analysis of Lipid-Modifying Therapy Prescription Patterns in 5 Million Patients with Type 2 Diabetes Mellitus
Get PDFIntroduction: Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia and significantly increased cardiovascular risk, making lipid-modifying therapy a crucial preventive intervention in these patients. Despite clear guidelines recommending statin therapy for both primary and secondary prevention, real-world prescription routines and practices show gaps in clinical care. We aimed to evaluate the rates and patterns of lipid-modifying therapy under prescription among T2DM patients across U.S. healthcare facilities.
Methods: We conducted a retrospective observational analysis using the TriNetX US Collaborative Network database, including data from 69 healthcare organizations throughout the United States. Patients with T2DM patients aged 40-75 years were included in our cohort. Under-prescription rates were calculated and analyzed across demographic subgroups using standardized protocols within the TriNetX platform.
Results: Among 5,007,910 T2DM patients, we observed significant statin under-prescription rates. Our analysis showed a prescription rate of 55.1% for statins in eligible patients with T2DM.
Conclusions: Our findings revealed a significant under-prescription of lipid-modifying therapy in T2DM patients. The universal nature of under-prescription suggests barriers to guideline implementation. These results underscore the urgent need for systematic interventions, including automated identification systems, standardized protocols, and optimized provider education to improve cardiovascular risk management in patients with T2DM
Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Case Report With Vertigo, Dysmetria, And Impaired Tandem Gait
Get PDFSMART syndrome is a rare, delayed complication of brain radiation. The acronym SMART stands for stroke-like migraine attacks following radiation therapy. This case is one of the first to describe episodic vertigo, dysmetria, and impaired tandem gait following proton beam radiotherapy for a craniopharyngioma.
An 18-year-old male presented with migraine headaches, upper and lower limb weakness, episodic vertigo, and dysmetria with impaired tandem gait. This occurred following proton-beam radiotherapy, which was completed at around 11 years of age for recurrent craniopharyngioma. Magnetic resonance imaging (MRI) of the brain demonstrated a T1 hyperintense signal in the cortex of the right parietal and temporal lobes consistent with SMART syndrome. In addition, a subcortical hyperintense signal was seen in the right parietal, temporal, and frontal lobes.
Atypical presentations of SMART syndrome are out there, and it is essential to recognize them in patients presenting with neurological symptoms following radiation therapy so that diagnosis and treatment can be done
Multiple Myeloma and Chronic Kidney Disease–Related Mortality, 1999–2023: A Population-Based Time-Trend Analysis
Get PDFBackground: Multiple Myeloma (MM) is the second most common hematological cancer, with chronic kidney disease (CKD) representing a major complication. This study aims to analyze national mortality trends, demographic differences, and geographic variation related to MM and CKD.
Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥45 with MM (C90.0) and CKD (N18); Deaths recorded anywhere on the death certificate (multiple-cause). Age-adjusted mortality rates (AAMRs) per 100,000 populations were calculated for variables. Joinpoint regression analysis was utilized to evaluate annual percent changes (APCs).
Results: From 1999 to 2023, a total of 24,606 deaths occurred among adults with MM and CKD in the U.S. The overall AAMR increased from (0.65) in 1999 to (0.86) in 2023 (AAPC: 1.22; 95% CI: 0.54 to 2.00; p<0.001). Males had a higher overall AAMR (1.09) and a more rapid increase (AAPC: 1.40; p<0.001) compared to females (AAMR: 0.60; AAPC: 0.71; p=0.027). Racially, NH Blacks had the highest AAMR (2.14). Regionally, the highest AAMRs were in the South (0.83). Metropolitan areas had a higher overall AAMR 0.81 than Non-metropolitan areas 0.77 (available 1999–2020 only). Most deaths occurred in inpatient medical facilities (46.27%). Among adults aged ≥65 years, overall CMR was 1.80 per 100,000.
Conclusion: Mortality from MM and CKD is increasing in the U.S from 1999 to 2023. NH Blacks, males, urban areas and the South region face high burden of death, underscoring the need for targeted strategies to reduce these substantial disparities
Comparative Outcomes of Esophageal Stent Placement in Esophageal Cancer Patients: A Prospective Study of 183 Cases
Get PDFIntroduction: Esophageal stent placement is a vital, minimally invasive procedure for alleviating dysphagia and enabling smoother food passage. It offers immediate relief, reduces hospital stays, and enhances quality of life for high-risk patients. Effective for both malignant and benign conditions, stenting is cost-efficient and requires skilled professionals for optimal outcomes. This study examines outcomes of various stent types in esophageal cancer patients, evaluating efficacy, safety, and quality-of-life impacts.
Methods: Between January and December 2022, 183 patients with esophageal cancer were enrolled from three tertiary healthcare facilities. Patients were divided into three groups based on the esophageal stent used: self-expanding metallic stents (SEMS, n = 84), self-expanding plastic stents (SEPS, n = 61), and fully covered self-expanding metallic stents (FCSEMS, n = 38). All stent placements were performed under endoscopic guidance, with follow-up assessments at 1 week, 1 month, 3 months, and 6 months to evaluate stent patency, dysphagia relief, and complications.
Results: Technical success rates were high: SEMS 96.4%, SEPS 95.1%, and FCSEMS 97.4%. Immediate dysphagia relief occurred in 87.4% of patients. FCSEMS had a significantly longer median patency duration (8.0 months) compared to SEMS (6.3 months) and SEPS (5.6 months). Additionally, SEPS exhibited a higher migration rate (13.1%), while overall complications were noted in 18.0% of patients.
Conclusions: Esophageal stent placement effectively palliates dysphagia in cancer patients. FCSEMS shows advantages with prolonged patency, yet careful stent selection is essential to optimize patient outcomes. These findings underscore the importance of individualized treatment planning and regular monitoring to achieve optimal outcomes
VACTERL Associated with Lung Hypoplasia and Urinary Anomalies in a 20-Month-Old Boy: A Case Report
Get PDFThe VACTERL association is a rare group of birth defects, including vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb defects, with an incidence of 1 in 10,000 to 40,000 live births. Infants with lung hypoplasia and urinary malformations face significant challenges. VACTERL requires three or more defects for diagnosis, with unclear causes possibly linked to genetic and environmental factors, including consanguinity. While pulmonary and genitourinary anomalies are not typical, they can coexist. This case is unique due to epispadias and bladder inversion, differing from typical urinary anomalies. We present a 20-month-old infant diagnosed with VACTERL along with left lung hypoplasia, bladder inversion, and epispadias. This rare case is the first documented in Syria, emphasizing the importance of recognizing VACTERL variations. Identifying such cases aids in understanding the condition’s complexity and guiding better management strategies
Portal Venous Gas Following Laparoscopic Rectal Surgery: A Case Report of Internal Herniation without Bowel Necrosis
Get PDFThe presence of free air (pneumatosis) in the main and intrahepatic portal veins generally indicates acute mesenteric ischaemia, often accompanied by bowel necrosis. Internal herniation (IH) is a rare but serious complication of laparoscopic rectal surgery, where the mesenteric window is deliberately left open. IH, followed by mechanical intestinal obstruction, can cause intestinal damage, ischaemia, and necrosis, which may manifest as hepatic portal venous gas (HPVG) on imaging. In cases linked to IH, mesenteric ischaemia often results in a severe and potentially fatal clinical course. Here, despite computerised tomography findings suggestive of advanced ischaemia, a young patient underwent successful surgical intervention for IH. Rapid diagnosis and prompt emergency surgery enabled the reduction of the herniation without bowel resection, preventing progression to irreversible complications. Although leaving mesenteric windows open maintains anastomotic perfusion, this practice may carry a risk of IH in selected patients. Importantly, no bowel resection was needed, illustrating the importance of early detection. Further comprehensive studies are recommended to explore this issue
A Hidden Carcinoma with Mixed Squamous and Neuroendocrine Differentiation Revealed Through Paraneoplastic Hypercalcemia: A Case Report
Get PDFHypercalcemia of malignancy is most associated with squamous cell carcinomas, but can also be observed in many advanced cancers. It is usually mediated through parathyroid hormone-related protein and is known as humoral hypercalcemia of malignancy. We present a rare case of humoral hypercalcemia of malignancy associated with a poorly differentiated carcinoma exhibiting both neuroendocrine and epithelial differentiation.
A 67-year-old man was found to have elevated serum calcium on presentation to the emergency department for shortness of breath and abdominal pain. Further investigation revealed low serum parathyroid hormone (indicating a non-parathyroid etiology of hypercalcemia) and elevated serum parathyroid hormone-related protein (supporting a diagnosis of humoral hypercalcemia of malignancy). Imaging revealed numerous disseminated subcutaneous nodules, peritoneal carcinomatosis with liver, cecal, lymph nodes, and bone metastases. Histopathology and immunohistochemistry revealed a poorly differentiated carcinoma exhibiting features of both squamous and neuroendocrine differentiation, along with a high level of cell proliferation. The patient was treated with intravenous fluids and intravenous bisphosphonates as per hypercalcemia management guidelines, with only minimal improvement in his serum calcium level. Our patient succumbed to the metabolic complications within a few days of presentation before the primary site could be identified or definitive treatment could be initiated.
Hypercalcemia of malignancy is a common presentation of advanced cancer and is associated with poor prognosis. We describe a case of hypercalcemia of malignancy in a patient with a poorly differentiated carcinoma of unknown primary origin with neuroendocrine and squamous differentiation, which is a rare phenomenon
Improving Compliance with the National Early Warning Score 2 (NEWS2) in an Egyptian Central Hospital Emergency Department: A Two-Cycle Clinical Audit
Get PDFBackground: NEWS2 is a standardized assessment tool used to determine illness severity and identify patients at risk of deterioration. However, its effectiveness is limited by systemic barriers. This audit primarily aims to evaluate NEWS2 compliance in an emergency department and implement targeted interventions to address recognized gaps.
Methods: A two-cycle clinical audit was conducted at ShubraKhit Central Hospital\u27s ED over a period of three weeks. Cycle 1 (August 18–25, 2025) established a baseline by assessing vital sign documentation, NEWS2 calculation, and escalation practices in 50 patients. The analysis of the root causes successfully identified the key barriers. Targeted interventions were implemented. Cycle 2 (September 1–8, 2025) re-audited the other 50 patients to evaluate the impact of the intervention. Data were analyzed using chi-square or Fisher’s exact tests as appropriate, with effect sizes and 95% CIs.
Results: Cycle 1 showed serious and critical drawbacks, with only 2% of patients having a complete set of vital signs documented, and NEWS2 calculated in only 2% of cases. The primary barriers were a lack of equipment (96%) and a 100% lack of awareness of the escalation protocol. Following the suitable intervention, Cycle 2 demonstrated a significant improvement, with 100% of patients having all vital signs documented, and NEWS2 calculated in 96% of cases.
Conclusions: A targeted intervention focuses on addressing specific root causes, leading to compliance with the NEWS2 scoring system. This ensures that evidence-based quality improvement can bridge the gap between clinical guidelines and practice
Antibiotic Knowledge, Perception, and Practice of Intern Doctors in Turkey: A Survey Study
Get PDFBackground: This study aimed to measure intern doctors\u27 knowledge, attitudes, and perceptions about antibiotic treatment and determine the situation on the subject.
Methods: A 34-question questionnaire was prepared for the study, and volunteers were administered the questionnaire face-to-face or via a Google form on a mobile WhatsApp application. Prospectively, 221 volunteer physicians participated in the survey, which was conducted between March 15-22, 2024 in Turkey.
Results: Of the participants, 118 (53.4%) were male and 103 (46.6%) were female. The mean age (mean ± SD) was 24 years (24.46±1.83). Many participants had good antibiotic knowledge but a poor antibiotic use percentage. The knowledge that misuse of antibiotics causes resistance was quite high, and there were deficiencies in the mechanisms of resistance. The misconceptions identified were stopping treatment when the clinical condition improved, regardless of the duration, or giving treatment every time the fever was high. There was a significant and positive correlation between age level-antibiotic knowledge and age-level-resistance awareness (rs=0.190, p=0.002 and rs=0.152, p=0.007, respectively). A significant difference was also found between gender-attitude scores (p=0.004). There was a significant (rs=0.247, p=0.003) and positive correlation between antibiotic knowledge and resistance awareness, and a significant (rs=0.610, p<0.001) and positive correlation between antibiotic knowledge and attitude and perception scores.
Conclusion: In order to increase the resistance awareness of the intern doctors and to decrease the wrong attitudes and perceptions, there is a need to develop social programs, practical applications, and patient-oriented practices together with some educational program curriculum changes
Insights into the Epidemiology and Determinants of Helicobacter Pylori Negative Gastritis: A Retrospective Study
Get PDFIntroduction: The prevalence of Helicobacter pylori (HP)-negative gastritis is rising in the United States, yet its origins and risk factors remain largely unexplored. This study aims to assess the prevalence of HP-negative gastritis and explore the demographic, clinical, and risk factor profiles that differentiate HP-negative from HP-positive subjects with histological evidence of gastritis.
Methods: We conducted a retrospective analysis of 241 patients who underwent Esophagogastroduodenoscopy (EGD) for upper gastrointestinal symptoms at a tertiary care center between July 2020 and July 2021. Symptoms prompting referral included dysphagia, abdominal pain, nausea, and others. Gastric biopsies were collected from the antrum and body, and clinical, demographic, and laboratory data were analyzed to compare HP-negative and HP-positive gastritis cases.
Results: Of the patients biopsied, 38.2% (n=92) showed histological evidence of gastritis, with 78% of these being HP-negative and 22% HP-positive. HP-negative cases were predominantly chronic chemical gastritis (61.5%), while all HP-positive cases were active chronic gastritis. Significant ethnic disparities were noted; 61.5% of HP-negative patients were Caucasian, and 72.7% of HP-positive patients were African American. Medical comorbidities, particularly gastroesophageal reflux disease (GERD), were more associated with HP-negative gastritis. The antrum was more frequently affected in HP-negative cases compared to HP-positive cases.
Conclusion: HP-negative gastritis is significantly linked with Caucasian ethnicity and existing medical comorbidities but shows no strong associations with the analyzed lifestyle or medication factors. These findings highlight the need for further large-scale prospective studies to better understand the etiology, risk factors, and clinical implications of HP-negative gastritis