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The Importance of How and When in Measuring Epicardial Adipose Tissue
Full text linkEpicardial Adipose Tissue (EAT) is drawing increasing attention. As a quantifiable, modifiable, and potentially new cardiovascular therapeutic target, its accurate measurement is particularly relevant. In Cardiac Magnetic Resonance (CMR) different methods can be used to assess EAT burden. We take advantage of CMR-studies of EMPATROPISM trial to assess EAT through three different methods, evaluate the effect of Empagliflozin and look for significant difference in the ability to detect changes in serial measurements. In some settings such as treatment-induced changes or patient follow-up, multi-slice method of EAT evaluation provides higher accuracy to detect significant differences, otherwise unnoticed by single-slice approaches
Examining The Relationship Between Sleep Habits And Caffeine Consumption
Full text linkSleep is essential for cognitive function, mood regulation, immune defense, and metabolic health. Despite widespread caffeine use, its impact on sleep remains debated. It was initially hypothesized that higher caffeine consumption would correlate with greater sleep disturbances. This study explored the relationship between caffeine consumption and sleep habits in a general adult population using a Qualtrics-based self-report survey. Participants (n=93) reported average hours slept per night, time to fall asleep, and number of nighttime awakenings. Caffeine consumption was calculated based on reported intake and categorized into four dosage groups. Sleep outcomes were statistically compared using ANOVA, t-tests, and Pearson correlation.
Results revealed no statistically significant differences between caffeine intake and sleep duration (p=0.82), time to fall asleep (p=0.823), or frequency of nocturnal awakenings (p=0.49). Weak positive correlations were observed between higher caffeine intake and increased sleep latency (r=0.092) and number of awakenings (r=0.16), though neither reached statistical significance. While trends suggested greater caffeine consumption might be associated with poorer sleep quality, findings were inconclusive.
This pilot study suggests that caffeine consumption, as self-reported, does not significantly affect sleep metrics in a small, heterogeneous population. Larger sample sizes and future studies that control for confounders (e.g., other types of stimulant use, timing of intake, comorbidities) are needed to clarify the relationship
Ultrasonographic Appearance of Suspected Zinner Syndrome
Full text linkZinner syndrome (ZS) is a rare congenital condition characterized by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. ZS is suspected to be caused by the malformation of the mesonephric duct during embryogenesis. The incomplete migration of the ureteric bud results in ipsilateral renal agenesis and ejaculatory duct obstruction. The remaining gonad develops with inadequate seminal fluid drainage, leading to the formation of seminal vesicle cysts. ZS is often asymptomatic, leading to challenges in diagnosis, particularly in adolescents. Symptoms can include pain, dysuria, pollakisuria, perineal pain, epididymitis, and pain after ejaculation. Imaging plays a crucial role in the diagnosis of ZS. MRI is the preferred modality due to its ability to provide detailed anatomical and soft tissue information. Ultrasonography can be used for initial evaluation, especially in adolescents, and may reveal cystic masses in the retrovesical space and an absent kidney on the affected side. Differential diagnosis includes Mullerian duct cysts and utricular cysts, which can be distinguished based on their anatomical location. Surgical intervention is the mainstay of treatment for symptomatic patients, with the goal of relieving pain and preserving fertility. Various surgical approaches, including transurethral unroofing and open surgery, can be employed. Minimally invasive procedures, such as robotics, are gaining popularity. Surgical intervention for ejaculatory duct obstruction involves transurethral resection of the ejaculatory duct. Despite surgical interventions, azoospermia may persist due to contralateral spermiogenesis impairment. Early excision of the affected duct may help prevent negative effects on the contralateral genitourinary tract
Impact of ST-Elevation Myocardial Infarction (STEMI) On Patients With Celiac Disease
Full text linkBackground
Celiac Disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), sarcoidosis. The latter 3 have cardiovascular manifestations There are limited studies on the hospital outcomes of Celiacs with cardiac manifestations. The aim of this study was to evaluate the economic burden and hospital outcomes of Celiacs with concomitant ST elevation myocardial infarction (STEMI).
Methods
Patients aged 18 years and older with Celiac disease and STEMI versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized, multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, average length of hospital stay, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Weighted analysis utilizing Stata 17 MP was performed.
Results
This study identified approximately 82304 patients with Celiac Disease from the years 2019 to 2020. Of these patients, 1505 had a concomitant diagnosis of a STEMI. Mean age of patients with Celiac Disease and STEMI was 68.21 while Celiac alone was 56.27. The analysis revealed that mortality (OR 2.38, pand total hospital charges (THC) were increased ($36197, pThe length of stay between patients with Celiac disease and Celiac Disease who suffer from a STEMI were not significant at 4.5 and 5 days respectively (p\u3c 0.1333).
Discussion
Celiac disease is a systemic immune-mediated disorder that is triggered by an abnormal immune response to gliadin, a component of gluten1. Hallmark inflammatory response to gluten could further augment atherosclerosis, a major contributor to cardiovascular diseases1,2. Research shows a significant molecular link between Celiac disease and cardiovascular disease which involves common inflammatory pathways, endothelial dysfunction, and genetic predisposition2. Further research in this area could yield better patient outcomes.
Conclusion
Our study revealed that patients with Celiac Disease who have a STEMI had higher mortality, and total hospital charges compared to patients with only Celiac Disease. Common and overlapping inflammatory pathways contribute to both Celiac Disease and STEMI which likely increases the risk for complications and mortality for these patients which was demonstrated by our study. A multi-disciplinary approach should be utilized on treating patients with Celiac Disease and STEMI due to the significant morbidity and mortality. Further studies are needed to further evaluate the impact of STEMI on Celiac Disease
Evaluation of Human Mesenchymal Stromal Cells (MSC) as an Adjuvant Therapeutic for Chronic Lyme Disease
Full text linkBackground: Lyme disease, caused by the spirochetal bacterium Borrelia burgdorferi, is the most prevalent vector-borne illness in the Northern Hemisphere. If undiagnosed or untreated, the disease progresses through multiple stages of increasing clinical severity. While antibiotics such as doxycycline and ceftriaxone are the current standard of care, patients with chronic or late-stage Lyme disease may require additional therapeutic interventions.
Rationale: Human mesenchymal stem cells (MSCs) are of growing clinical interest due to their immunomodulatory properties, low immunogenicity, and potential to promote tissue repair. These characteristics position MSCs as promising adjuvant therapies for chronic Lyme disease, with the potential to reduce reliance on more invasive or symptomatic treatments.
Conclusion: Although definitive clinical data is lacking, early evidence and mechanistic rationale suggest that MSC-based therapies may mitigate the physiological consequences of persistent Lyme disease. Further investigation, including well-designed, large-scale clinical studies, is essential to evaluate the safety, efficacy, and therapeutic viability of MSCs in this context
Engaging Ukrainian TF-CBT Therapists in a PRACTICE Skills Course to Support Their Wellbeing
Full text linkBackground: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.
Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of war in Ukraine. Specifically, this study examined if course participation was associated with increased PRACTICE coping skills usage, decreased burnout and STS, increased feelings of TF-CBT competency/confidence, and increased empathy for clients\u27 experiences when implementing the skills.
Method: The eight-session virtual course included cultural adaptations to increase its compatibility with Ukrainian culture. Thirteen matched pre-post course surveys were analysed to provide preliminary data on the course\u27s effect on PRACTICE coping skills usage, burnout, and STS. The course\u27s impact on therapist coping/wellbeing, TF-CBT competency/confidence, and empathy for clients was also examined qualitatively.
Results: PRACTICE coping skills were utilized significantly more frequently at post-course compared to pre-course (p = .010). Therapists also reported lower average scores for burnout and STS after course completion, though these changes were not statistically significant. Most participants (92.3%) reported professional benefits from course participation including increased competency/confidence and empathy for clients. All therapists (100%) reported personal benefits from course participation including increased use of coping skills.
Conclusions: Results indicate that participants experienced professional and personal benefits from course completion. This study provides helpful preliminary evidence of a positive impact, however, given the small sample size, larger scale implementation is needed
THE USE OF N-(4-AMINOPHENYL)PIPERIDINE DERIVATIZATION TO IMPROVE ORGANIC ACID DETECTION AND SEPARATION BY SUPERCRITICAL FLUID CHROMATOGRAPHY-MASS SPECTROMETRY
No full textOrganic acid analysis in complex mixtures by LC-MS has been difficult, due in large part to the poor sensitivity of the negative ionization mode needed to detect these native (i.e., underivatized or untagged) compounds. Similar negative ionization-based restrictions have also made it challenging to quantify such compounds using supercritical fluid chromatography (SFC)-MS, a technique that has become more important for metabolomic analysis. In this study, the use of a high proton affinity N-(4-aminophenyl)piperidine derivatization tag was investigated to enhance four organic acids’ (lactic, succinic, malic, and citric acids) detection with varying numbers of carboxylate groups. Upon derivatization with N-(4-aminophenyl)piperidine, detection limits were achieved down to 0.5 ppb, with overall improvements in detection limit ranging from 25- to 2100-fold. The impact of derivatization towards sensitivity, which increased by 200-fold for compounds that were detectable in their native forms, and mass spectrometric detection were also discussed. Preliminary column comparison and modifier effects were further investigated to identify the stationary phase and modifier most suitable for the separation of these four derivatized compounds by SFC. Thus, these results effectively demonstrate the capability of the derivatization technique in improving analysis of organic acids by SFC-MS, particularly for those that are undetectable in their native forms
Radiofrequency Ablation versus Naproxen for the Management of Ankylosing Spondylitis: A Comparative Analysis
Full text linkAnkylosing spondylitis (AS) is a chronic inflammatory disease characterized by inflammation primarily affecting the spinal vertebrae and sacroiliac joints, leading to pain, stiffness, and progressive loss of spinal mobility.
Management typically focuses on alleviating symptoms and controlling inflammation to improve patient quality of life. In this study, we compared the efficacy of two common treatment modalities: radiofrequency ablation (RFA) and naproxen. RFA is a minimally invasive procedure that targets specific nerve endings to interrupt pain signals, whereas naproxen is a non-steroidal anti-inflammatory drug (NSAID) used to reduce inflammation and provide symptomatic relief. Our systematic review involved a cohort of AS patients treated with either RFA or naproxen over a six-month period. Clinical outcomes were evaluated based on pain relief, functional improvement, and overall quality of life. Results demonstrated that RFA reported substantial reductions in pain intensity and improved functional outcomes compared to those treated with naproxen. These improvements in pain management were sustained for the duration of the study period.
Furthermore, while naproxen effectively managed symptoms in the short term, its efficacy diminished over time, highlighting limitations in long-term pain control. In contrast, RFA offered prolonged relief, making it a viable option for sustained management of AS symptoms.
The findings suggest that RFA should be considered a preferred treatment for AS patients seeking long-term pain relief and enhanced quality of life. This study contributes to the growing body of evidence supporting the use of RFA in the management of inflammatory spinal conditions
Case Report: Ruptured Infrarenal Abdominal Aortic Aneurysm
Full text linkA ruptured abdominal aortic aneurysm (AAA) is a life-threatening vascular emergency with high mortality rates. We report a case of a 79-year-old male with no reported past medical history but a significant lifelong smoking history who presented to the emergency department with generalized weakness, lower abdominal pain, hypotension, tachycardia, and a reported syncopal episode. Emergency medical services (EMS) found the patient at home during a welfare check, appearing pale and weak. Upon movement from his bed to a stretcher, he experienced a syncopal episode, became tachycardic, and was transiently hypoxic. Initial laboratory studies revealed a hemoglobin of 13 g/dL, hematocrit of 40.6%, and lactate of 7.3 mmol/L. Computed tomography angiography (CTA) of the abdomen and pelvis demonstrated a ruptured infrarenal AAA measuring 12.5 x 11.1 x 13.5 cm, with a large surrounding retroperitoneal hematoma and hemoperitoneum. This case highlights the importance of early recognition and emergent management of ruptured AAA, which requires prompt surgical intervention to improve survival outcomes
Barriers to Care for Neonatal Abstinence Syndrome in Southern New Jersey
Full text linkNeonatal Abstinence Syndrome (NAS) is a spectrum of clinical manifestations seen in newborns due to withdrawal secondary to intrauterine illicit and/or prescription drug exposure. Newborns with NAS present with common signs of withdrawal such as poor feeding, irritability, seizures, hypertonicity, low birth weight, loose stool, and premature birth. Maternal opioid use is the most common cause of NAS and with the increase in opioid use in the past decade the cases of NAS have also increased. This study examines the prevalence and challenges associated with NAS in Southern New Jersey. Our analysis reveals that Atlantic and Gloucester counties reported the highest rates of NAS in 2022, with these areas also demonstrating high opioid-related death ratesin adults. Our proposed intervention includes creating a facilitation guide and teaching class to pregnant mothers on the effects of opioid use on a developing fetus and provide mental health and OBGYN resources