Unmasking Tuberculosis: A Case of Pericardial Effusion in a Young Adult With Recurrent Pneumonia.

This case presents a 25-year-old Indian male with no significant past medical history presenting to the emergency department (ED) due to two weeks of productive cough with pleuritic chest pain. The patient presented one week earlier to the ED; however, he left against medical advice and was given a 5-day course of Azithromycin 250 mg that minimally improved his symptoms. He returned to the ED shortly after completing the antibiotics and was admitted for further evaluation.

Age-specific outcomes after transcatheter left atrial appendage occlusion with the watchman device.

Background: Transcatheter left atrial appendage occlusion (LAAO) has become a suitable alternative to anticoagulation in patients with atrial fibrillation (AF). However, outcomes among patients age > 75 years undergoing LAAO are lacking.

Methods: We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.

Integrating breast cancer polygenic risk scores at scale in the WISDOM Study: a national randomized personalized screening trial.

Background: The Women Informed to Screen Depending On Measures of risk (WISDOM) Study is the first prospective, population-wide application of personalized breast cancer screening. We aim to demonstrate the feasibility of the study's novel use of polygenic risk scores (PRSs) to tailor screening, evaluate our strategy for adapting PRSs to diverse populations, and quantify the impact of incorporating PRS on the study's screening recommendations.

Methods: WISDOM is a randomized, preference-tolerant screening trial in the USA testing the safety and morbidity of risk-based versus annual screening in women aged 40-74 without a prior history of breast cancer.

Does First-Time Colon Cancer Screening Beyond Age 75 Reduce Cancer Risk Without Significant Complications? Insights From a Large US Retrospective Study.

Introduction: Colorectal cancer (CRC) is a leading cause of global cancer-related morbidity and mortality. This study examines the impact of first-time screening colonoscopy on CRC incidence in obese individuals aged 75 and older using a large US retrospective cohort.

Methods: Obese adults aged ≥ 75 were divided into two groups: those undergoing their first screening colonoscopy after 75 (Cases) and those without prior colonoscopy (Controls), using TrinetX database data.

Breast Cancer Immunotherapy: A Team Science Approach.

Immunotherapy has reshaped the treatment landscape of several malignancies, including breast cancer. While historically considered less immunogenic, breast cancer-particularly the triple-negative subtype (TNBC)-has demonstrated responsiveness to immune checkpoint inhibitors (ICIs). TNBC is characterized by higher tumor mutational burden, elevated PD-L1 expression, and increased tumor-infiltrating lymphocytes, making it a leading focus of immunotherapy development.

Exoscope-Assisted Spine Surgery: A Systematic Review From Basic to Complex Pathologies.

Operative neurosurgery has greatly benefited from technological advancements over the past several decades. However, challenges such as limited visualization, intraoperative navigation difficulties, and the complexity of spinal anatomy continue to pose significant hurdles for surgeons. The utilization of advanced technologies, such as exoscopes, navigation systems, and robotics, can help overcome some of these challenges, thereby enhancing surgical precision and accuracy.

Impact of Access Site in Percutaneous Coronary Intervention for Patients Complicated With Cardiogenic Shock: A Systematic Review and Meta-Analysis of 33,311 Individuals.

Background: Vascular access site selection remains critical in patients with cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI), with transradial access (TRA) increasingly favored for its potential safety benefits over transfemoral access (TFA).

Methods: A systematic search of PubMed, Cochrane Library, and Science Direct was conducted from inception to March 2025. Meta-analysis was performed using RevMan v5.

Beyond the break: development and validation of a new classification system for acute traumatic rib fractures.

Background: Despite the high incidence and significant injury burden of rib fractures, a universally agreed-upon taxonomy for acute traumatic rib fractures (TARF) has not been established. We propose a novel TARF with three components: (1) the rib that is fractured, (2) the anatomic sector of the fracture, and (3) the fracture severity. We hypothesized that each of these components can be interpreted on chest CT by radiologists and trauma surgeons with acceptable interobserver agreement (IOA), providing a consistent method for describing traumatic rib fractures.

Comparative Analysis Between Cortical Bone Trajectory (CBT) Screw Fixation and Traditional Pedicle Screw Fixation in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.

Cortical bone trajectory (CBT) screw fixation has been proposed as an alternative method to pedicle screw (PS) fixation for lumbar instrumented fusion. However, the benefits of this technique remain controversial. We searched PubMed, Scopus, Web of Science Advance, ScienceDirect, Embase (Ovid), and Cochrane databases from inception to July 22, 2023.

Prolonged Proton Pump Inhibitor Use and Electrolyte Abnormalities: A Case Presentation and Literature Review.

Proton pump inhibitors (PPIs) are utilized in the treatment of acid-related gastrointestinal diseases, such as gastroesophageal reflux disease (GERD) and peptic ulcers. Like any drug, they can cause side effects, some of which are observed during the clinical trial phase, while others become apparent during post-market surveillance. We present the case of a 68-year-old Caucasian female patient who had been taking a PPI (esomeprazole 40 mg twice daily) for over 10 years and presented to the Emergency Department (ED) with decreased magnesium levels (<0.

Real-time Patient Experience Surveys Lead to Better Scores.

Introduction: The patient satisfaction survey is a controversial fixture of modern emergency care. Patients who are satisfied are more likely to adhere to the treatment plan and less likely to pursue legal action. However, the current surveys are susceptible to recall bias.

Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematoma: Impact of Surgical Approach.

Background And Objectives: Single-session middle meningeal artery embolization (MMAE) combined with surgical evacuation is a rapidly emerging strategy in the treatment of chronic subdural hematoma (cSDH). However, the effect of different evacuation techniques within this approach remains unclear.

Methods: We conducted a retrospective multicenter cohort study across 8 US institutions of patients with cSDH who underwent single-session MMAE with concomitant surgical evacuation between 2018 and 2024.

Impact of Medication Dose Optimization on Heart Failure Outcomes in African-American Female Patients: A Safety-Net Hospital Experience.

Heart failure among African-American female patients represents a significant public health challenge, with hospitalization rates being much higher than those of White female patients. The high prevalence of comorbidities in this population often necessitates the selective implementation of guideline-directed medical therapy (GDMT). This study examines which medication classes should be prioritized to improve outcomes in this vulnerable population.

Association Between Long-Term Aircraft Noise Exposure and Cardiovascular Disease: A Meta-Analysis with Focused Subgroup Analyses.

Background: Aircraft noise is a growing public health concern, particularly for those living near airports. Our study aimed to evaluate the long-term impact of aircraft noise exposure on cardiovascular health outcomes.

Methods: We conducted a comprehensive search of multiple databases up to December 2024.

Influenza-Associated Acute Necrotizing Encephalopathy in US Children.

Importance: Acute necrotizing encephalopathy (ANE) is a rare, but severe, neurologic condition for which epidemiologic and management data remain limited. During the 2024-2025 US influenza season, clinicians at large pediatric centers anecdotally reported an increased number of children with influenza-associated ANE, prompting this national investigation.

Objective: To understand the clinical presentation, interventions, and outcomes among US children diagnosed with influenza-associated ANE.

Preventing Oxygen Therapy Related Fires and Burn Injuries: A Comprehensive National Strategic Approach.

Fires and burn injuries incurred from home oxygen therapy continue to pose a significant and escalating public health risk, particularly as the population of older adults ≥65 years exponentially grows over the next decades. In these oxygen-rich environments, common household ignition sources can trigger spontaneous fires that burn hotter and spread more rapidly. This endangers the patient, family members, neighbors, home healthcare workers, and first responders, potentially leading to property loss, injury, and/or death.

Efficacy and Safety of Ustekinumab and Vedolizumab for Crohn's Disease of the Pouch.

Background And Aims: Medically refractory ulcerative colitis may require colectomy with ileal pouch-anal anastomosis. Complications of the J-pouch include pouchitis, occurring in 50%-80% of patients, and Crohn's disease (CD) of the pouch, occurring in 3%-17%. Our aim was to evaluate the efficacy and safety of ustekinumab (UST) and vedolizumab (VDZ) in patients with CD of the pouch.

Comparing maternal postpartum hemorrhage outcomes with uterine balloon tamponade versus vacuum-induced hemorrhage devices: a retrospective cohort study.

Objective: To compare maternal postpartum hemorrhage outcomes between uterine balloon tamponade (UBT) and vacuum-induced hemorrhage control devices (VHD).

Methods: We conducted a retrospective cohort study of 184 deliveries using UBT with the Bakri Postpartum Balloon or VHD with the JADA System at an urban safety-net hospital in the United States between January 2018 and December 2023. The primary outcome was massive transfusion (≥4 units packed red blood cells [pRBCs]).

Effect of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors on Lipid Profile and Cardiovascular Events in High-Risk Diabetic Patients.

Background Type 2 diabetes mellitus (T2DM) significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD), and optimal lipid control is essential for reducing major adverse cardiovascular events (MACE). However, despite the widespread use of statins, many high-risk diabetic patients fail to reach target low-density lipoprotein cholesterol (LDL-C) levels. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as effective adjunctive agents for lipid lowering.

Electrocardiogram essentials: Bradycardia.

Introduction: Bradycardia is a common finding in the emergency department (ED) and presents along a clinical spectrum, ranging from asymptomatic to hemodynamic compromise and cardiac arrest.

Objective: This manuscript evaluates the management of bradycardia through a discussion of several cases.

Discussion: Bradycardia may result in severe hemodynamic compromise and is defined as a heart rate less than 60 beats per minute (bpm).

Heart's Hidden Signal: A Rare Case of Alternating Bundle Branch Block and Atrioventricular Block.

Introduction: Alternating bundle branch block (ABBB) is a rare cardiac rhythm disorder characterized by alternating occurrence of right BBB and left BBB patterns in consecutive beats. The presence of ABBB in conjunction with atrioventricular block is even more rare.

Case Presentation: A 69-year-old man with no significant medical history presented to the emergency department with dyspnea on exertion, lightheadedness, and dizziness for 3 weeks.