Evaluation of Change in Medication Regimen Complexity-ICU (MRC-ICU) Score Following Implementation of a Virtual Intensive Care Model in a Multisite, Rural Health-System.

Telehealth in the ICU (Tele-ICU) may improve patient outcomes and optimize utilization of high acuity intensive care unit (ICU) beds. However, the relationship between tele-ICU and medication regimen complexity-ICU (MRC-ICU) score is unexplored. To assess the effect of tele-ICU on MRC-ICU score and describe pharmacists' work.

Embolic stroke of undetermined source: A cardiovascular approach to diagnostic uncertainty.

Embolic stroke of undetermined source (ESUS) is a clinical event with an undelineated embolic etiology after the initial stroke workup. Once stroke specialists confirm ESUS, evaluation of rhythm disorders such as atrial fibrillation, specific cardiac pathologies (cardiomyopathy, left atrial cardiopathy, left-atrial septal pouch, aortic or mitral valve disease, cardiac neoplasm, right-to-left shunts, or device-related thrombus), and acquired hypercoagulable states, which may occasionally be related to malignancy, should be performed. While most ESUS patients require appropriate antiplatelet therapy, certain subsets may require oral anticoagulation.

Genetic and Molecular Determinants of Immunotherapy Response in Recurrent Ovarian Cancer.

Ovarian cancer remains a significant public health challenge. It originates in the ovaries and presents in various histological subtypes. Surgery and chemotherapy are the most suitable treatments to combat this disease.

Methods for Studying Bias in Graduate Medical Education.

Consistent with patterns seen in the larger population, bias in medical settings has been well established and negatively impacts outcomes, quality of care, and patient-clinician interactions. The purpose of this article is to provide a brief and introductory review of research methods for studying bias in graduate medical education, including (a) specific designs to consider and (b) considerations for overcoming barriers to implementation. While there are a variety of ways in which bias and inequity can be studied in medical settings, the unique limitations of graduate medical education may pose numerous challenges that researchers may need to overcome.

Impact of diabetes mellitus type-2 on the outcomes following mitral transcatheter edge-to-edge repair (TEER): A meta-analysis.

Background: Diabetes mellitus (DM) has been linked to unfavorable outcomes in patients undergoing Mitral Transcatheter Edge-to-Edge Repair (TEER). Nevertheless, the literature contains conflicting data. This meta-analysis aimed to assess the impact of DM on outcomes following Mitral TEER.

Baseline characteristics and in-hospital mortality predictors in female patients on venovenous extracorporeal membrane oxygenation: Impact of pregnancy.

Background: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is often used for lung rest in critically ill patients, including pregnant patients.

Objectives: We aimed to determine how pregnant and non-pregnant patients requiring VV-ECMO differed from each other and how pregnancy impacted in-hospital mortality.

Methods: We used the National Inpatient Sample to identify a cohort of female patients requiring VV-ECMO from 2016 to 2021, stratified by pregnancy status.

Efficacy of Drug-Coated Balloon versus Drug-Eluting Stent for Patients with De Novo Coronary Artery Disease: A Systematic Review and Meta-Analysis.

Objectives: This meta-analysis compared the efficacy and safety of drug-coated balloon (DCB) angioplasty with drug-eluting stent (DES) for the treatment of de novo coronary artery disease.

Methods: Following PRISMA guidelines, we conducted a systematic search of major databases, including Cochrane, Medline, Embase and ClinicalTrials.gov, to identify eligible randomized controlled trials (RCTs) comparing DCB and DES.

Anticoagulation in Patients with End-Stage Renal Disease: A Critical Review.

Background: Chronic kidney disease (CKD) and its advanced stage, end-stage renal disease (ESRD), affect millions worldwide and are associated with a paradoxical hemostatic imbalance-marked by both increased thrombotic and bleeding risks-which complicates anticoagulant use and demands clearer, evidence-based clinical guidance.

Design: This study is a critical review synthesizing the current literature on anticoagulant therapy in CKD and ESRD, with emphasis on altered pharmacokinetics, clinical complications, and therapeutic adjustments.

Data Sources: PubMed, Scopus, and Google Scholar were searched for articles discussing anticoagulation in CKD/ESRD, focusing on pharmacokinetics, clinical outcomes, and dosing recommendations.

Aseptic osteonecrosis of the jaw in a patient with HIV on tenofovir.

The introduction of antiretroviral therapy has improved survival of people with HIV (PWH). However, morbidities that accompany aging and the added burden of antiretroviral therapy on bone metabolism are growing concerns with treatment and improved survival. While a few studies have been done among PWH examining bone density and risk of fractures, the association with osteonecrosis is less studied.

Enhancing door-in-door-out time in a rural primary stroke centre using a large vessel occlusion alert: a quality improvement project.

Background: Thrombectomy is the primary treatment in the management of acute large vessel occlusions (LVO) strokes; however, many rural hospitals are not able to perform this procedure and must transfer patients to thrombectomy-capable centres expeditiously. This quality improvement initiative was aimed at optimising the door-in-door-out (DIDO) time for patients with stroke at a rural primary stroke centre in the USA, with a specific goal of DIDO time of <90 min, 50% of the time and <120 min, 75% of the time.

Methods: System inefficiencies in serial event processing, radiology interpretation, teleneurology application and activation of transferring emergency medical services were identified.

Green Endoscopy: A Review of Global Perspectives on Environmental Sustainability of Gastrointestinal Endoscopy.

Endoscopic procedures are the cornerstone of intervention in gastroenterology-from evaluating common illnesses to non-surgically managing complex diseases. Expectedly, these procedures are linked to greenhouse gas (GHG) emissions globally and contribute significantly to the global climate change crisis. Professional gastroenterology societies globally raise awareness of this evolving crisis and suggest specific measures to appropriately measure the burden contributed by endoscopy units and mitigate the environmental impact of this common clinical practice.

Perioperative outcomes of atrial fibrillation in patients undergoing transcatheter aortic valve replacement: a national inpatient sample study.

Background: Transcatheter aortic valve replacement (TAVR) has transformed the management of patients with severe symptomatic aortic stenosis who are unfit for surgical aortic valve replacement. Atrial fibrillation is one of the most common arrhythmias observed in patients with aortic stenosis undergoing TAVR. Our study explores the impact of Afib on perioperative outcomes in patients undergoing TAVR.

Young Adults Undergoing Percutaneous Coronary Intervention for Myocardial Infarction in the United States, 2011 to 2023.

The prognostic impact of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in young adults undergoing percutaneous coronary intervention (PCI) remains under explored. We compared the long-term outcomes of young adults undergoing PCI for STEMI and NSTEMI. We used the United States (US) TriNetX database (2011 to 2023), encompassing young adults aged 18 to 50 years hospitalized for myocardial infarction (MI), who received PCI within 24 hours of presentation.

Survival Outcomes in Stage IV Small Bowel Neuroendocrine Tumor Patients Undergoing Loco-Regional Surgery: An Experience From a Pakistani Cancer Center.

Background: Small bowel neuroendocrine tumors (SB-NETs) are rare malignancies often diagnosed at an advanced stage due to their nonspecific symptoms. The role of loco-regional surgery in stage IV SB-NETs remains debated, particularly in lower-middle-income countries, where healthcare resources and treatment accessibility differ from high-income settings.

Methods: This retrospective study analyzed survival outcomes in stage IV SB-NET patients who underwent loco-regional resection at Shaukat Khanum Memorial Cancer Hospital & Research Centre between 2014 and 2023.

The impact of surgical timing in ankle fracture on postoperative wound complications: a critical 24-hour cutoff point through systematic review and meta-analysis.

Background: Ankle fractures are among the most prevalent injuries in the general population, and the timing of surgical fixation may influence postoperative wound complications. This systematic review and meta-analysis investigated the impact of surgical timing on postoperative wound complications, specifically investigating the significance of a 24-hour cutoff point.

Materials And Methods: The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases.

Biomarkers for the detection of circulating tumor cells.

Circulating tumor cells (CTCs) have emerged as a key biomarker in cancer detection and prognosis, and their molecular profiling is gaining importance in precision oncology. Liquid biopsies, which allow the extraction of CTCs, circulating tumor DNA (ctDNA) or cell-free DNA (cfDNA), have measurable advantages over traditional tissue biopsies, especially when molecular material is difficult to obtain. However, this method is not without limitations.

Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty for Cement Allergy.

Despite the success of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), complications leading to loosening and eventual failure can arise. While infection, instability, and aseptic loosening are some of most common causes of UKA and TKA failure, one of the less common reasons is delayed hypersensitivity reactions. While most allergic reactions are hypersensitivity reactions to metal, hypersensitivity reactions to other materials used in the procedure, such as polymethylmethacrylate bone cement, have begun to gain more attention in recent years.

Platelet levels before and after iron replacement therapy in patients with iron deficiency anemia.

Background: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. Patients with IDA often present thrombocytosis, but little is known about its degree and prevalence, and its response to iron replacement.

Methods: We conducted a retrospective review of 76 consecutive patients with anemia secondary only to iron deficiency.

Reducing Postoperative Opioids in Pediatric Laparoscopic Cholecystectomy: A Retrospective, Single-Center Cohort Study.

Introduction: Overprescribing of opioid pain medications can lead to adverse outcomes and contributes to the opioid crisis. We previously reported eliminating opioids in select patients. This retrospective study aimed to compare outcomes in pediatric patients undergoing laparoscopic cholecystectomy (LC) who were and were not prescribed opioid pain medications.

Right Ventricular Myocardial Infarction: Pathophysiology, Diagnosis, and Therapeutic Approaches.

Right ventricular myocardial infarction (RVMI) is a significant and distinct form of acute myocardial infarction associated with considerable morbidity and mortality. It occurs most commonly due to proximal right coronary artery obstruction, often in conjunction with inferior myocardial infarction. RVMI poses unique diagnostic and therapeutic challenges due to the anatomical and functional differences between the right and left ventricles.

Incidentally discovered inflammatory pseudotumour of the spleen: understanding clinical manifestations and diagnosis.

A splenic inflammatory pseudotumour (IPT) is a rare condition in which inflammatory cells and non-cancerous specialised cells known as myofibroblasts abnormally replicate in the spleen. Patients with IPT may experience symptoms like abdominal pain, fever and weight loss, making it difficult to distinguish from processes like cancer. As a result, diagnosing IPT often requires imaging studies and microscopic examination.

Therapeutic Levels of Acetaminophen Causing AKI: A Case Report and Literature Review.

Our case highlights the importance of being aware of the potential renal complications that can occur with acetaminophen, even when used at dosages slightly above the recommended therapeutic dose.

Robotic assisted TKA may allow for smaller polyethylene liner sizes compared to manual TKA with simultaneous removal of Hardware.

Total knee arthroplasty (TKA) with hardware around the knee is a challenge to preserve bone while boney landmarks are distorted. Robotic assisted (RA) TKA may assist in simultaneous hardware removal and TKA due to preoperative planning and retention of bone. The aim of this study is to identify if there are differences in component fixation, component constraint and functional outcomes dependent during simultaneous removal of hardware (ROH) around the knee and TKA comparing RA-TKA to manual.