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Association of Assisted Reproductive Technology and Stroke During Hospitalization for Delivery in the United States
No full textINTRODUCTION: Infertility treatment with assisted reproductive technologies (ARTs) has been associated with adverse vascular events in some but not all previous studies. Endothelial damage, prothrombotic factor release, and a higher prevalence of cardiovascular risk factors in those receiving ART have been invoked to explain this association. We sought to explore the relationship between ART and stroke risk using population-level data. METHODS: We conducted a retrospective cohort study using data from the National Inpatient Sample registry from 2015 to 2020, including all delivery hospitalizations for patients aged 15 to 55 years. The study exposure was use of ART. The primary end point was any stroke defined as ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, or cerebral venous thrombosis during index delivery hospitalization. Individual stroke subtypes (ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral venous thrombosis) were evaluated as secondary end points. Standard International Classification of Diseases, Tenth Revision, Clinical Modification algorithms were used to define study exposure, comorbidities, and prespecified end points. In addition to reporting population-level estimates, propensity score adjustment by inverse probability weighting was used to mimic the effects of randomization by balancing baseline clinical characteristics associated with stroke between ART and non-ART users. RESULTS: Among 19123125 delivery hospitalizations identified, patients with prior ART (n=202815, 1.1%) experienced significantly higher rates of any stroke (27.1/100000 versus 9.1/100000), ischemic stroke (9.9/100000 versus 3.3/100000), subarachnoid hemorrhage (7.4/100000 versus 1.6/100000), intracerebral hemorrhage (7.4/100000 versus 2.0/100000), and cerebral venous thrombosis (7.4/100000 versus 2.7/100000) in comparison to non-ART users (all P\u3c0.001 for all unadjusted comparisons). Following inverse probability weighting analysis, ART was associated with increased odds of any stroke (adjusted odds ratios, 2.14 (95% CI, 2.02-2.26); P\u3c0.001). CONCLUSIONS: Using population-level data among patients hospitalized for delivery in the United States, we found an association between ART and stroke after adjustment for measured confounders
Background Seropositivity to Jamestown Canyon Virus Can Lead to Diagnostic Confusion
No full textBackground seropositivity rates for specific antibodies to Jamestown Canyon Virus (JCV) can exceed 25 % in certain geographic areas in the United States. This can potentially lead to diagnostic confusion, as apparently illustrated by a patient from New Jersey with Powassan virus encephalitis, who also tested positive for antibodies to JCV
Return to Vocal Performance Following Microlaryngoscopy in Singers
No full textIntroduction: Although microlaryngoscopy has been recognized to be effective in addressing lesions in vocal performers, no detailed information regarding return to performance (RTP) following surgery exists. We describe our experience and offer proposals to establish standardized criteria for RTP among vocal performers. Methods: Records for adult vocalists who underwent microlaryngoscopy for benign vocal fold (VF) lesions and had a clearly documented RTP date between 2006 and 2022 were reviewed. Patient demographics, diagnoses, interventions, and postsurgical care before and after RTP were described. The need for medical and procedural interventions and rate of reinjury were used to determine the success of RTP. Results: Sixty-nine vocal performers (average age: 32.8 years, 41 [59.4%] female, 61 [88.4%] musical theater) underwent surgery for 37 (53.6%) pseudocysts, 25 (36.2%) polyps, 5 (7.2%) cysts, 1 (1.4%) varix, and 1 (1.4%) mucosal bridge. Fifty-seven (82.6%) underwent voice therapy. The average time to RTP was 65.0 ± 29.8 days. Prior to RTP, six (8.7%) experienced VF edema requiring oral steroids and one (1.4%) underwent a VF steroid injection. Within 6 months following RTP, eight (11.6%) received oral steroids for edema and three underwent procedural interventions (two steroid injections for edema/stiffness, one injection augmentation for paresis). One patient experienced pseudocyst recurrence. Conclusions: Return to vocal performance at an average of 2 months following microlaryngoscopy for benign lesions appears overwhelmingly successful, with low rates of need for additional intervention. There is a need for validated instruments to better measure performance fitness to refine and possibly accelerate RTP. Level of Evidence: 4 Laryngoscope, 134:329–334, 2024
Cardiac Myosin Activator Omecamtiv Mecarbil: Novel Treatment for Systolic Heart Failure
No full textSystolic Heart failure is a complex clinical syndrome characterized by a decrease in cardiac contractility and a reduction in organ perfusion. Current pharmacologic inotropes attempt to improve contractility via indirect mechanisms but are limited in terms of safety and effectiveness. Omecamtiv mecarbil is a novel agent in a new class of drugs known as cardiac myosin activators; their unique mechanism of action involves directly activating the enzymatic pathway in the cardiac myocyte as a way to improve ventricular contraction. Preclinical and clinical trials have found that omecamtiv mecarbil improves cardiac contractility without increasing the risk of any of the harmful effects that are associated with the currently available inotropic agents. Omecamtiv mecarbil is a worthwhile advance and patients with systolic heart failure would benefit from pharmacological use of this drug
Corrigendum to ‘Evolution of Twitter Use in Gynecology – a Quantitative Analysis Post Society of Gynecological Surgeons Ontology List Publication’
No full textThe authors regret the authorship affiliations are incorrect on the originally published abstract. The correct authorship and affiliations are: E.S. Chorna1; R. Abramov1; C.L. Grimes1,2; E.D. Drugge1 1New York Medical College, Valhalla, NY 2Westchester Medical Center, Valhalla, NY The authors would like to apologise for any inconvenience caused
Berberine Inhibits the Inflammatory Response Induced by Staphylococcus Aureus Isolated From Atopic Eczema Patients via the TNF-Α/Inflammation/RAGE Pathways
No full textAtopic eczema patients exhibit high levels of Staphylococcus aureus (S. aureus) skin colonization. S. aureus can stimulate macrophages and the expression of proinflammatory cytokines. Berberine (BBR), an alkaloid, attenuates S. aureus toxin production. This study investigated if BBR suppressed bacterial growth and inflammatory response induced by eczema-patient-derived S. aureus using murine macrophage (RAW 264.7) and human monocyte cell lines (U937). RAW 264.7 and U937 were treated with BBR at different concentrations and stimulated with heat-killed S. aureus (ATCC #33591) or S. aureus derived from severe eczema patients (EC01–EC10), who were undergoing topical steroid withdrawal, for 24 h. TNF-α protein levels were determined by ELISA, gene expression by qRT-PCR, cell cytotoxicity by trypan blue excursion, and reactive oxygen species (ROS) levels by fluorometric assay. BBR showed a bacteriostatic effect in S. aureus (ATCC strain #33591 and clinical isolates (EC01–EC10) and suppressed TNF-α production in RAW 264.7 and U937 cells exposed to heat-killed S. aureus (ATCC and clinical isolates) dose-dependently without any cell cytotoxicity. BBR (20 µg/mL) suppressed \u3e90% of TNF-α production (p \u3c 0.001), downregulated genes involved in inflammatory pathways, and inhibited S. aureus ROS production in U937 and RAW 264.7 cells (p \u3c 0.01). BBR suppresses S. aureus-induced inflammation via inhibition of TNF-α release, ROS production, and expression of key genes involved in the inflammatory pathway
Unveiling the Impact of Seizures While Driving: A Retrospective Cohort Study on Type, Frequency, and Consequences in People With Epilepsy Prior to Diagnosis
No full textImpact of Seizures While Driving Prior to Diagnosis in People With Focal Epilepsy: Motor Vehicle Accidents and Time to Diagnosis Bases B, Barnard S, French JA, Pellinen J. Neurology. 2023;101(13):e1370-e1375. doi:10.1212/WNL.0000000000207464. PMID: 37286361 Objective: To identify the type, frequency, and consequences of seizures while driving (SzWD) in people with epilepsy prior to diagnosis. Methods: We performed a retrospective cohort study using the Human Epilepsy Project (HEP) to identify pre-diagnostic SzWD. Clinical descriptions from seizure diaries and medical records were used to classify seizure types and frequencies, time-to-diagnosis, and SzWD outcomes. Data was modeled using multiple logistic regression to assess for factors independently associated with SzWD. Results: 32 pre-diagnostic SzWD were reported among 23/447 (5.1%) participants. Of these, seven (30.4%) had more than one. Six participants (26.1%) experienced a SzWD as their first-lifetime seizure. Most SzWD were focal with impaired awareness (n = 27, 84.4%). Of participants who had MVAs, six (42.9%) had no recollection. SzWD led to hospitalization in 11 people. Median time from first seizure to first SzWD was 304 days (IQR = 0-4056 days). Median time between first SzWD to diagnosis was 64 days (IQR = 10-176.5 days). Employment was associated with a 3.95-fold increased risk of SzWD (95% CI: 1.2-13.2, p = 0.03), and non-motor seizures were associated with a 4.79-fold increased risk (95% CI: 1.3-17.6, p = 0.02). Significance and discussion: This study identifies the consequences of seizure-related MVAs and hospitalizations people experience prior to epilepsy diagnosis. This highlights the need for further research aimed at improving seizure awareness and improving time to diagnosis
Antimicrobial Resistance and Novel Alternative Approaches to Conventional Antibiotics
No full textAntimicrobial resistance is a significant public health issue. The unprecedented spread of antimicrobial-resistant organisms has been identified by the World Health Organization as one of the leading healthcare threats. Projections for annual worldwide deaths attributed to antimicrobial resistance approach 10 million by 2050, with an associated economic burden of USD 100 trillion. This paper reviews the mechanisms known to contribute to antimicrobial resistance and provides insight into potential available alternatives to conventional antibiotics. Antimicrobial approaches addressed include dual antibiotic therapy, antimicrobial peptides, monoclonal antibodies, bacteriophages, probiotics, nanomaterials, and cannabinoids. Key pathogens in need of antimicrobials referred to as the ESKAPE pathogens are discussed
Knowledge Graphs in Pharmacovigilance: A Scoping Review
No full textPurpose: To critically assess the role and added value of knowledge graphs in pharmacovigilance, focusing on their ability to predict adverse drug reactions. Methods: A systematic scoping review was conducted in which detailed information, including objectives, technology, data sources, methodology, and performance metrics, were extracted from a set of peer-reviewed publications reporting the use of knowledge graphs to support pharmacovigilance signal detection. Findings: The review, which included 47 peer-reviewed articles, found knowledge graphs were utilized for detecting/predicting single-drug adverse reactions and drug-drug interactions, with variable reported performance and sparse comparisons to legacy methods. Implications: Research to date suggests that knowledge graphs have the potential to augment predictive signal detection in pharmacovigilance, but further research using more reliable reference sets of adverse drug reactions and comparison with legacy pharmacovigilance methods are needed to more clearly define best practices and to establish their place in holistic pharmacovigilance systems