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Exploring Factors Influencing US Medical Students’ Choice of Internal Medicine Residency
No full textSex Modifies the Severity and Outcome of Spontaneous Intracerebral Hemorrhage
No full textObjective: The limited existing evidence on sex differences in the clinical characteristics of patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH) comes from small, single-center studies. Here, we performed an individual patient data meta-analysis of 3 randomized clinical trials and 1 multi-ethnic observational study of ICH to investigate the impact of sex on ICH severity and outcome. Methods: Inclusion criteria in our study were a neuroimaging-confirmed ICH. We evaluated whether sex was associated with ICH severity (hematoma volume and expansion) and poor functional outcomes (modified Rankin Scale \u3e3) 3 or 6 months after the ICH. Results: A total of 4,812 ICH patients were evaluated (mean age 62, 40% female). Males with ICH were younger, more likely to be smokers and have diabetes, and less likely to be on anticoagulants (all p \u3c 0.05). In multivariable analyses, male sex was associated with non-lobar location (odds ratio [OR]: 1.63; 95% confidence interval [CI]: [1.39–1.92]; p \u3c 0.001), larger hemorrhages (beta: 0.16 [0.08–0.23]; p \u3c 0.001) and a higher risk of hematoma expansion (OR: 1.43 [1.20–1.71]; p \u3c 0.001). Despite the larger hemorrhage volume and higher risk of expansion, male sex was associated with a 24% lower risk of poor outcomes (OR: 0.76 [0.64–0.90]; p = 0.002). Interpretation: Compared to females, males with ICH have larger bleeds and higher risk of hematoma expansion. Despite the larger bleeds and higher risk of hematoma expansion, males with ICH have lower risk of poor outcomes. Our results suggest that the biology and clinical trajectory are different in females and males with ICH, supporting sex-specific research in this condition. ANN NEUROL 2025;97:232–241
Sarcomatoid Carcinoma of Small Intestine
No full textSarcomatoid carcinoma is a rare type of tumour consisting of neoplastic cells expressing both epithelial and mesenchymal cell markers. The small intestine is a rare site for sarcomatoid carcinoma and to date, a few cases have been reported. In this manuscript, a case of jejunal sarcomatoid carcinoma in a man in his 50s is reported. A review of the literature on sarcomatoid carcinomas of small bowel is presented
Role of Microrna in the Risk Stratification of Ischemic Strokes
No full textBackground: Ischemic stroke is a major cause of death and morbidity, and risk classification is essential for predicting therapeutic outcomes. MicroRNAs may be useful indicators for risk stratification, as they control gene expression and influence physiological and pathological processes. Methodology: A systematic strategy was developed to search relevant material using databases like PubMed, Scopus, and Web of Science. Selection criteria included human research, a certain date, or categories of studies. Data extraction, synthesis, and analysis were carried out to find trends, similarities, and differences among the chosen studies. The study’s design, sample size, methodology, statistical analysis, and any potential biases or restrictions from the selected reference papers were also taken into account. Results and findings: MicroRNA is an important biomarker for risk stratification in Ischemic Strokes. It can be used to identify Stroke-Specific microRNA Signatures, identify diagnostic and prognostic values, and regulate Vascular Inflammation, Endothelial Dysfunction, and Thrombus Formation and Resolution. It also has potential therapeutic applications. Conclusion: MicroRNAs have emerged as promising biomarkers for predicting stroke risk, severity of strokes, and clinical outcomes. They can be used to predict the severity of a stroke and aid clinicians in making treatment decisions
Protocol for the Catheter-Related Early Thromboprophylaxis With Enoxaparin (CRETE) Studies
No full textOBJECTIVES: In post hoc analyses of our previous phase 2b Bayesian randomized clinical trial (RCT), prophylaxis with enoxaparin reduced central venous catheter (CVC)-associated deep venous thrombosis (CADVT) in critically ill older children but not in infants. The goal of the Catheter-Related Early Thromboprophylaxis with Enoxaparin (CRETE) Studies is to investigate this newly identified age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against CADVT in critically ill children. DESIGN: Two parallel, multicenter Bayesian superiority explanatory RCTs, that is, phase 3 for older children and phase 2b for infants, and an exploratory mechanistic nested case-control study (Trial Registration ClinicalTrials.gov NCT04924322, June 7, 2021). SETTING: At least 15 PICUs across the United States. PATIENTS: Older children 1-17 years old (n = 90) and infants older than 36 weeks corrected gestational age younger than 1 year old (n = 168) admitted to the PICU with an untunneled CVC inserted in the prior 24 hours. Subjects with or at high risk of clinically relevant bleeding will be excluded. INTERVENTIONS: Prophylactic dose of enoxaparin starting at 0.5 mg/kg then adjusted to anti-Xa range of 0.2-0.5 international units (IU)/mL for older children and therapeutic dose of enoxaparin starting at 1.5 mg/kg then adjusted to anti-Xa range of greater than 0.5-1.0 IU/mL or 0.2-0.5 IU/mL for infants while CVC is in situ. MEASUREMENTS AND MAIN RESULTS: Randomization is 2:1 to enoxaparin or usual care (no enoxaparin) for older children and 1:1:1 to either of 2 anti-Xa ranges of enoxaparin or usual care for infants. Ultrasonography will be performed after removal of CVC to assess for CADVT. Subjects will be monitored for bleeding. Platelet poor plasma will be analyzed for markers of thrombin generation. Samples from subjects with CADVT will be counter-matched 1:1 to subjects without CADVT from the opposite trial arm. Institutional Review Board approved the CRETE Studies on July 1, 2021. Enrollment is ongoing with planned completion in July 2025 for older children and July 2026 for infants
Timing of Excisional Debridement and Its Effects on Outcomes in Geriatric Burn Patients: A Retrospective Analysis
No full textIntroduction: Optimal timing for excisional debridement in geriatric burns remains unclear. We hypothesized that early debridement (ED: ≤72 h) is associated with improved outcomes. Methods: A 6-year (2017–2022) analysis of the TQIP database was done to isolate geriatric (≥65 years) burn patients (2nd or 3rd degree with TBSA ≥10 %) undergoing excisional debridement. Propensity score matching (1:1) adjusted for demographics, injury severity, and frailty. Outcomes were mortality, complications, length of stay (LOS), and discharge disposition. Results: After matching 882 patients, ED (n = 294) was associated with lower rates of sepsis (2.4 % vs. 7.1 %) and deep vein thrombosis (2.0 % vs. 6.1 %) (p \u3c 0.05). There was no difference in mortality. ED had shorter hospital (12 vs. 23 days, p \u3c 0.001) and ICU LOS (9 vs. 16 days, p \u3c 0.001). ED had higher routine discharge (25.9 % vs. 16.3 %, p = 0.039). Conclusion: Early excisional debridement within 72 h is associated with reduced complications and shorter hospitalization in geriatric burn patients. Level of evidence: Level III retrospective study
Dair to Be Different: Successful Use of Dair Regimen, a Novel Treatment Combination for Ebv-Induced Hlh
No full textHemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome caused by uncontrolled immune activation and hemophagocytosis. In adults, Epstein-Barr virus (EBV) infection is a known trigger. This report describes a novel approach to treating EBV-induced HLH in a 29-year-old female, avoiding the potential toxicities of chemotherapy-based regimens, such as infertility. The patient presented febrile, tachycardic, and hypotensive following a week of high fever, bilious emesis, and diarrhea. Laboratory results showed elevated AST and ALT, hyperbilirubinemia, leukopenia, thrombocytopenia, and hyperferritinemia. Imaging revealed splenomegaly, and a positive mononucleosis rapid test confirmed EBV infection. Based on her clinical presentation, laboratory findings, and a bone marrow biopsy showing phagocytic histiocytes, she was diagnosed with EBV-induced HLH, fulfilling 7 of the 8 diagnostic criteria (5 required). The patient was started on the DAIR regimen two days after transfer. DAIR combines dexamethasone for its potent anti-inflammatory properties (used in HLH-94/HLH-2004), anakinra to control the cytokine storm, IVIG for passive immune support and antiviral action, and rituximab to target EBV-infected B cells. The patient responded well to treatment. EBV became undetectable within three weeks, and by seven weeks, blood counts, liver function, ferritin, triglycerides, and fibrinogen levels had normalized. Ten weeks after symptom onset, she returned to work and is now pregnant, with no signs of relapse. This case demonstrates the effectiveness of DAIR as a chemotherapy-free alternative for EBV-induced HLH, offering a targeted approach to the syndrome’s complex pathogenesis while achieving sustained remission
Thrombotic and Vascular Complications of Oral Contraceptives
No full textThe oral contraceptive pill is the most commonly used form of reversible contraception, as it has significantly grown in popularity in recent years. The 2 types of oral contraceptive pills are combination oral contraceptives, which contain estrogen and progesterone, and progestin-only pills. Both have failure rates of approximately 7.2–9% with typical use and are safe for most patients. However, several thrombotic and vascular complications have been found to be associated with the usage of oral contraceptive pills, most notably being an increase in blood pressure and thrombosis. Although these complications do not typically affect young, healthy females, they merit concern for patients with a history of hypertension or thrombosis or patients with preexisting risk factors for these conditions. Overall, progestin-only pills are the safer option regarding these complications. Additionally, a complete summary of the medical eligibility criteria for contraceptive use has been created and is regularly updated by the Centers for Disease Control and Prevention. This chart summarizes the recommendations for contraception use by patients with a variety of preexisting conditions or risk factors
