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New Therapy Update Aprocitentan an Endothelin Receptor Antagonist for the Treatment of Drug-Resistant Systemic Hypertension
No full textResistant hypertension (RH) is the state of uncontrolled blood pressure in the face of ostensibly optimal pharmacological intervention. It accounts for roughly one in six cases of hypertension, and is associated with more severe morbidity and mortality outcomes than is non-RH. The prevalence of RH implies a currently unmanaged pathology, which may involve the potent vasoconstrictor endothelin. Several endothelin receptor antagonists are currently marketed for pulmonary arterial hypertension, but none so far has been marketed for RH. Aprocitentan is currently in development, an endothelin receptor antagonist that effectively produces clinically significant and sustained decreases in systolic and diastolic blood pressure in the setting of RH
Baxdrostat: An Aldosterone Synthase Inhibitor for the Treatment of Systemic Hypertension
No full textSystemic hypertension remains one of the leading cause of morbidity and mortality in the United States and throughout the world. Baxdrostat (CIN-107), a new drug developed by Roche is a selective aldosterone synthase inhibitor that is being evaluated as one of the potential treatments for hypertension, especially in patients with drug treatment-resistant hypertension. An increased level of aldosterone is associated with inflammation, systemic hypertension, and organ fibrosis, contributing to adverse cardiovascular events. A phase 2 trial, BrigHTN, showed promising results in demonstrating the efficacy of baxdrostat, where The HALO (efficacy and safety of baxdrostat in patients with uncontrolled hypertension) trial did not demonstrate any blood pressure-lowering benefit of baxdrostat when compared with the placebo. Several additional studies are now underway to evaluate the effectiveness of baxdrostat as an anti-hypertensive agent
Advances in the Management of Obstructive Hypertrophic Cardiomyopathy: The Role of Mavacamten
No full textIntroduction: Hypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disorder characterized by asymmetric left ventricular hypertrophy and increased risk of sudden cardiac death. While current treatments like beta-blockers, calcium channel blockers, and invasive procedures provide symptom relief, they do not prevent disease progression. Mavacamten, a first-in-class cardiac myosin inhibitor, offers a promising alternative by directly targeting the underlying cause of left ventricular outflow tract (LVOT) obstruction in obstructive HCM. This drug reduces myosin ATPase activity, decreasing myocardial contractility and alleviating symptoms such as shortness of breath, fatigue, and chest pain. Clinical trials, including EXPLORER-HCM and VALOR-HCM, have demonstrated significant improvements in LVOT obstruction, exercise capacity, and overall quality of life while reducing the need for invasive procedures. Areas covered: This review discusses mavacamten’s mechanism of action, pharmacokinetics, clinical efficacy, safety, and integration into clinical practice, highlighting its role as a key treatment for patients who do not respond to conventional therapies. Expert opinion: Mavacamten is generally well tolerated, although it requires careful monitoring of left ventricular ejection fraction (LVEF) and genetic factors such as CYP2C19 variations. The drug represents a significant advancement in the management of symptomatic obstructive HCM, offering a noninvasive, disease-modifying option
Digoxin Discontinuation in Patients With Hfref on Beta-Blockers: Implication for Future \u27Knock-Out Trials\u27 in Heart Failure
No full textBackground: National heart failure guidelines recommend quadruple therapy with renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF), most of whom also receive loop diuretics. However, the guidelines are less clear about the safe approaches to discontinuing older drugs whose decreasing or residual benefit is less well understood. The objective of this study was to examine whether digoxin can be safely discontinued in patients with HFrEF receiving beta-blockers. Methods: In OPTIMIZE-HF, of 2477 patients with HFrEF (EF ≤45%) receiving beta-blockers and digoxin, digoxin was discontinued in 450 patients. We assembled a propensity score-matched cohort of 433 pairs of patients in which digoxin continuation vs. discontinuation groups were balanced on 51 baseline characteristics. Using the same approach, from 992 patients not on beta-blockers, we assembled a matched cohort of 198 pairs of patients also balanced on 51 baseline characteristics. Hazard ratios (HRs) and 95% CIs for 1-year outcomes were estimated. Results: Among patients receiving beta-blockers, digoxin discontinuation had no association with the combined endpoint of heart failure readmission or death (HR, 1.01; 95% CI, 0.85-1.19), heart failure readmission (HR, 1.03; 95% CI, 0.85-1.25) or death (HR, 0.91; 95% CI, 0.72-1.14). Respective HRs (95% CIs) among patients not receiving beta-blockers were 1.60 (1.25-2.04), 1.62 (1.18-2.22) and 1.43 (1.08-1.89). Conclusions: Digoxin can be discontinued without increasing the risk of adverse outcomes in patients with HFrEF receiving beta-blockers. Future studies need to examine the residual benefit of older heart failure drugs to ensure their safe discontinuation in patients with HFrEF receiving newer guideline-directed medical therapy
A Survey of Sedation Practices for Adolescents and Young Adults With Acute Lymphoblastic Leukemia Undergoing Lumbar Puncture
No full textPurpose: Lumbar puncture is a frequently performed procedure for patients undergoing treatment for acute lymphoblastic leukemia. This brief procedure is frequently performed with sedation in young patients but with only local anesthesia in adults. Adolescent and young adult patients may be cared for by physicians with different training backgrounds and sedation preferences, making the utilization of sedation for lumbar punctures variable among providers. The benefits of sedation for young adults with leukemia undergoing lumbar puncture (analgesia, anxiolysis, safety) must be weighed against the obligate fasting interval, hospital cost, and resource allocation that is required. Methods: We conducted a survey of pediatric and medical oncologists who care for patients with acute lymphoblastic leukemia to assess their use of sedation for adolescents and young adults undergoing lumbar punctures as part of their cancer therapy. (see Supplemental Digital Content 1, http://links.lww.com/JPHO/A723). Results: Twenty-six percent of pediatric oncologists and 28% of medical oncologists completed the survey. Pediatric oncologists were more likely to perform lumbar punctures under sedation as compared with medical oncologists. This pattern remained consistent across all patient age ranges surveyed, despite no significant difference in the expected cumulative number of lumbar punctures that a patient was to undergo. Medical oncologists reported topicalization with local anesthetics before lumbar puncture more often than pediatric oncologists. Conclusion: Sedation practices for lumbar puncture during acute lymphoblastic leukemia treatment varies by specialty of treating oncologist
Disentangling the Impact of Adiposity From Insulin Resistance in Heart Failure With Preserved Ejection Fraction
No full textBackground: Obesity, insulin resistance (IR), and diabetes are common in heart failure with preserved ejection fraction (HFpEF) and are associated with worsening heart failure, but their independent contributions remain unknown. Objectives: In this study, we sought to determine the contribution of diabetes vs obesity to left heart abnormalities in HFpEF Methods: Indices of adiposity (body mass index [BMI], bioimpedance fat mass, waist circumference) and IR (homeostasis-model assessment [HOMA]) were measured among PVDOMICS study participants with HFpEF. Rest and exercise pulmonary capillary wedge pressure (PCWP) responses were compared, stratified by obesity (BMI ≥30 kg/m2), IR status (HOMA-IR ≥2.6), and diabetes diagnosis. Findings were also tested in an independent HFpEF cohort. Results: Of 276 patients with HFpEF, 246 (89%) had increased waist/height ratio, and 166 (60%) had BMI ≥30 kg/m2, with 114 (69%) of the latter having IR and 75 (45%) having diabetes. Of 110 (40%) with HFpEF and BMI \u3c30 kg/m2, 44 (40%) had IR and 27 (25%) had diabetes (both P \u3c 0.0001 vs obesity phenotype). The presence of IR was not associated with worse left heart remodeling or PCWP. In contrast, obesity (regardless of IR status) was associated with greater biventricular enlargement, worse exercise performance, poorer quality of life, and higher rest and exercise PCWP (P \u3c 0.01 for all). Obesity was associated with higher rest and dynamic PCWP responses (+4.4 mm Hg; 95% CI: +2.5 to +6.4 mm Hg; P \u3c 0.0001), even after adjustment for HOMA-IR (+4.7 mm Hg; 95% CI: +2.7 to +6.7 mm Hg; P \u3c 0.0001). Greater fat mass, BMI, and waist circumference were associated with higher PCWP at rest and exercise (P \u3c 0.0009 for all), but HOMA-IR was not (+0.01 mm Hg; 95% CI: −0.13 to +0.16 mm Hg; P = 0.84). Findings were similar evaluating diabetes in place of IR, and were replicated in the independent HFpEF cohort (n = 254), where BMI remained independently associated with higher rest and exercise PCWP (+0.19 mm Hg [95% CI: +0.11 to +0.27 mm Hg] per kg/m2; P \u3c 0.0001), but diabetes was not. Conclusions: Excess adiposity is present in most patients with HFpEF, even among those not considered obese according to BMI, calling for further study of cardiometabolic therapies among patients with HFpEF and excess adiposity with BMI \u3c30 kg/m2. Although excess body fat is associated with IR and diabetes, cardiac remodeling, hemodynamics, and functional impairment are independently correlated with body fat, but not IR. These findings suggest that diabetes is primarily a marker of greater adiposity in HFpEF, with less direct impact on heart failure severity. (Pulmonary Vascular Disease Phenomics Program [PVDOMICS]; NCT02980887
Extracorporeal Membrane Oxygenation Is Associated With Decreased Mortality in Non-Acute Respiratory Distress Syndrome Patients Following Severe Blunt Thoracic Trauma
No full textBACKGROUND Extracorporeal membrane oxygenation (ECMO) has emerged as a critical intervention in the management of patients with trauma-induced cardiorespiratory failure. This study aims to compare outcomes in patients with severe thoracic injuries with and without venovenous extracorporeal membrane oxygenation (VV-ECMO). METHODS We performed a retrospective cohort study on Trauma Quality Improvement Program (2017-2021) and included all patients with isolated blunt thoracic injuries with Abbreviated Injury Scale score of ≥4 who required intubation. Patients were divided into two groups based on VV-ECMO and were compared using propensity score matching with the primary outcome of mortality. RESULTS A total of 14,106 patients with severe thoracic injuries were identified. Propensity score matching resulted in two groups of 812 VV-ECMO and 812 non-VV-ECMO groups. Venovenous ECMO group had significantly lower in-hospital mortality rates (22.3% vs. 37.3%, p \u3c 0.001). However, VV-ECMO group had significantly higher rates of complications including cardiac arrest (27.7% vs. 10.6%), pulmonary embolism (7.6% vs. 2.1%), ventilator-associated pneumonia (16.7% vs. 4.2%), unplanned intubation (11.9% vs. 8.5%), unplanned intensive care unit (ICU) admission (8.4% vs. 4.9%), and unplanned return to operation room (10.1% vs. 2.6%) (p \u3c 0.001, for all). Patients in VV-ECMO group had significantly higher hospital (29.46 ± 26.37 vs. 13.59 ± 13.3 days) and ICU (22.96 ± 19.38 vs. 9.38 ± 9.05 days) length of stay (p \u3c 0.001, for both). In VV-ECMO group, the mean ± SD time to perform VV-ECMO was 5.54 ± 5.91 days. Each day earlier initiation of VV-ECMO resulted in decreased hospital and ICU length of stay by 67.1% and 59.9%, respectively (p \u3c 0.001 for both). Among patients without acute respiratory distress syndrome (n = 435 in each group after repeated PS matching), we observed significantly lower mortality rates in VV-ECMO group (26.9% vs. 40%, p \u3c 0.001). CONCLUSION While VV-ECMO in isolated blunt thoracic trauma patients is associated with higher survival rates even in non-acute respiratory distress syndrome cases, it is associated with higher incidence of complications. These findings emphasize earlier consideration of VV-ECMO in severe blunt thoracic trauma
InTouch Week of September 8, 2025
No full textRibbon-Cutting Marks Official Opening of Converted Instrument Shop Classroom NYMC Goes Gold for Childhood Cancer Awareness Month Great Things are Happening on Campus Dana Mordue, Ph.D., Leads Future Scientists in the Fight Against Tick-Borne Diseases CDM Designated as NYS CTLE Sponsor for Educator Training Accelerated iBMS Program Paves the Way to Medicine NYMC Alpha Omega Alpha Chapter Receives Grant to Combat Food Insecurity NYMC Club Fair 2025 Ignites Campus with Community Spirit TCDM Educates on Oral Health Care at Tarrytown Back to School Bash In the Community-NYMC Students Create No-Sew Blankets for Ronald McDonald Househttps://touroscholar.touro.edu/in_touch/1373/thumbnail.jp
Developing a Murine Model to Investigate the Mechanisms of Peanut, Cashew, Shrimp Multifood Allergy
No full textApproximately 32 million people in the United States have food allergies, which is approximately 10 percent of the population. Food allergies can be mild, moderate, or even severe, resulting in anaphylaxis. The most predominant food groups that trigger food allergies include peanuts, tree nuts, fish, and shellfish. Peanuts and tree nuts have some similarities in protein structure. Shellfish is not associated with the protein properties of peanuts or tree nuts, it is the leading cause of adult anaphylaxis and often co-exist with peanut and tree nut allergies Currently, there are few studies that have established a murine model for allergy development or measure of anaphylaxis. This problem renders significant data and gaps in knowledge regarding a suitable treatment approach, much less an understanding of how allergies develop. Though the knowledge of food allergies themselves is well established, there are few studies that examine their mechanisms.
In this study, C3H/HeJ mice were sensitized intraperitoneally weekly for three weeks using 500 µg protein of peanut, cashew, and shrimp, with 2 mg Alum with control mice being naïve to the tested allergens. During weeks 4 and 5, the sensitized mice received intragastrical challenges with 200 mg/mouse with the following foods: peanut on week one, cashew during week two, and shrimp on during the third week. Anaphylactic symptoms and rectal temperatures were measured during the challenges, while serum IgE levels were measured following the oral challenges. Results showed significant elevation of peanut, cashew, and shrimp-specific IgE levels in the allergen-sensitized mice. Across all allergens, mice experienced some level of symptoms of anaphylaxis. This was shown to be in juxtaposition with decreased rectal temperatures. When the naïve mice were tested with the allergens, they experienced no elevation expression of IgE in their serum. Further, the naïve mice showed no expression of anaphylaxis symptoms or decrease in temperature when intragastric challenges were performed thus showing IgE is a necessary mediator of anaphylaxis, and the symptoms associated with it through the
detection methods used, throughout this study
Engage & Empower: Foundations of Social Work Practice
No full text2025
Engage & Empower: Foundations of Social Work Practice is an open educational resource for social work students in “foundations of social work practice” courses. It begins by explaining Open Educational Resources and their benefits. Students then explore social work fundamentals, including the diverse roles of social workers.
With this foundation, students engage with the NASW Code of Ethics’ key terms, and principles. This ethical grounding prepares them for the “growth work” needed to develop cultural competence and cross-cultural awareness. They then learn to apply various Generalist Practice skills across different-sized systems to empower client populations.
Next, the book explores the complexities of mental health and substance abuse, highlighting the clinical challenges of these fields. Finally, it examines the personal characteristics and professional skills essential for effective social work.
Assessments such as multiple-choice quizzes, essay and thought questions are provided after each chapter.
By integrating these foundational concepts and assessments, this book equips students with the knowledge, skills, and ethical framework needed to navigate the foundations of social work practice with confidence, competence, and a commitment to social justice.https://touroscholar.touro.edu/opentextbooks/1013/thumbnail.jp