Relative carcinogenicity of tacrolimus mycophenolate after solid organ transplantation and its implications for liver transplant care.

Background: malignancy is a leading cause of late morbidity and mortality in liver transplant recipients. Cumulative immunosuppression has been shown to contribute to post-transplant malignancy (PTM) risk. There is emerging evidence on the differential carcinogenic risk profile of individual immunosuppressive drugs, independent of the net effect of immunosuppression.

Non-Traumatic Hepatobiliary Emergencies.

Hepatobiliary emergencies typically present with a constellation of different symptoms including abdominal pain, fevers, nausea, vomiting, jaundice, coagulopathy, and in some instances, encephalopathy. The differential can be broad and may include infectious, inflammatory, and even iatrogenic etiologies. Workup with appropriate lab and imaging studies can help discern between different pathologies and thus guide their management.

Introduction to Point-of-Care Ultrasonography.

Medical ultrasonography was first used as a diagnostic tool in 1942 by Theodore Karl Dussik to visualize brain structures. Use of ultrasonography broadened to the field of obstetrics in the 1950s and has since expanded to many other medical special-ties owing to ease of use, reproducibility, low cost, and lack of radiation. Advancements in ultrasonography technology have allowed clinicians to perform procedures with greater accuracy and to characterize tissue better than ever before.

Testosterone is lower in men with non-alcoholic fatty liver disease and alcohol-related cirrhosis and is associated with adverse clinical outcomes.

Background/aims: Low serum testosterone is common in cirrhotic men, but the impact of disease aetiology remains uncertain. This study compares serum total testosterone (TT) levels by disease aetiology and assesses its prognostic value.

Methods: Single-centre retrospective study of cirrhotic men who had TT levels measured between 2002 and 2020.

Administration of intravenous iron through a home-based infusion strategy is safe and has high patient acceptance.

Background And Aims: To evaluate the safety and patient experience of a hospital-initiated home-based iron infusion service in patients with iron deficiency with or without anaemia.

Methods: Retrospective cohort study, including adult patients who received intravenous iron through a Hospital in The Home service in a single tertiary centre between August 2020 and 2021. A chart review was conducted for documented adverse events (AEs).

Emergent laparoscopic surgical intervention for perforated hemorrhagic cholecystitis with hemodynamic instability.

Hemorrhagic cholecystitis is a rare diagnosis that closely mimics acute cholecystitis. Physical examination, laboratory studies and, in particular, computed tomography imaging allow for rapid diagnosis, stabilization and emergent surgical intervention. We describe our experience with three patients requiring emergent surgical intervention for hemorrhagic cholecystitis with unique clinical features including decreased platelet function due to liver cirrhosis, dual antiplatelet therapy and intraoperative finding of cholecystohepatic communication.

Cardiac Risk Stratification in Liver Transplantation: Results of a Tiered Assessment Protocol Based on Traditional Cardiovascular Risk Factors.

Coronary artery disease (CAD) confers increased perioperative risk in patients undergoing liver transplantation (LT). Although routine screening for CAD is recommended, there are limited data on the effectiveness of screening strategies. We evaluated the safety and efficacy of a 3-tiered cardiac risk-assessment protocol that stratifies patients based on age and traditional cardiac risk factors.

Sodium Intake, Circulating Microvesicles and Cardiovascular Outcomes in Type 2 Diabetes.

There is ongoing debate surrounding the complex relationship between dietary sodium intake and cardiovascular morbidity and mortality. The existing literature consists largely of observational studies that have demonstrated positive, negative, U-/J-shaped or unclear associations between sodium intake and cardiovascular outcomes. Our group and others have previously demonstrated an inverse relationship between dietary sodium intake and cardiovascular outcomes in people with type 2 diabetes.

The relationship between habitual dietary sodium intake and RAAS blockade on circulating microparticle levels in type two diabetes.

Objective: Low sodium intake is paradoxically associated with adverse cardiovascular outcomes in individuals with type 2 diabetes mellitus (T2D), possibly from renin-angiotensin-aldosterone system (RAAS) activation, leading to endothelial dysfunction. In the present study, we investigated the associations between habitual sodium intake and RAAS blockade on endothelial function by measuring circulating microparticles (MPs) in individuals with T2D.

Methods: We conducted a prospective, cross-sectional study in 74 individuals with T2D.

Strategies for enumeration of circulating microvesicles on a conventional flow cytometer: Counting beads and scatter parameters.

Enumeration of circulating microvesicles (MVs) by conventional flow cytometry is accomplished by the addition of a known amount of counting beads and calculated from the formula: MV/μl = (MV count/bead count) × final bead concentration. We sought to optimize each variable in the equation by determining the best parameters for detecting 'MV count' and examining the effects of different bead preparations and concentrations on the final calculation. Three commercially available bead preparations (TruCount, Flow-Count and CountBright) were tested, and MV detection on a BD FACSCanto was optimized for gating by either forward scatter (FSC) or side scatter (SSC); the results were compared by calculating different subsets of MV on a series of 74 typical patient plasma samples.

Pulmonary Hypertension in a Patient with Hereditary Hemorrhagic Telangiectasia.

t Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu Disease, is an autosomal dominant genetic disorder that is characterized by the abnormal development of blood vessels. While the pathophysiology underlying the development of pulmonary hypertension (PH) in patients with HHT is not fully understood, it is believed to occur by one of two mechanisms: increases in pulmonary vascular resistance or cardiac output. In the following report, we describe an interesting case of a 26-year-old woman with HHT whose right heart catheterization initially demonstrated PH with elements of both pre- and post-capillary PH.

Bowel perforation complicating an ACTH-secreting phaeochromocytoma.

Unlabelled: ACTH-secreting phaeochromocytoma (ASP) is a rare cause of ACTH-dependent Cushing's syndrome (CS). We report the case of a 63-year-old female presenting with CS secondary to an ASP complicated by bowel perforation. This case report highlights ASP as an uncommon but important cause of ectopic ACTH secretion (EAS).

Medical students help bridge the gap in sexual health education among middle school youth.

Background: School-based programs are important in addressing risky teenage sexual behavior. We implemented a sex education program using trained medical student volunteers.

Methods: Medical students (n=30) implemented a seven-session curriculum, designed by medical students and faculty, to 7th and 8th grade students (n=310) at a local school.

Influence of Medical Student Debt on the Decision to Pursue Careers in Primary Care.

Purpose: To determine if medical student debt has an effect on medical student specialty choice.

Methods: A cross-sectional survey was distributed to students at 12 medical schools across the United States to assess the effect of debt on specialty choice.

Results: In total, 415 students responded to the survey; 98 medical students reported that they were pursuing a primary care residency (PCR) and 250 reported that they were pursing a non-primary care residency (NPCR).

Post-training excitotoxic lesions of the dorsal hippocampus attenuate generalization in auditory delay fear conditioning.

An abundance of evidence indicates a role for the dorsal hippocampus (DH) in learning and memory. Pavlovian fear conditioning provides a useful model system in which to investigate DH function because conditioning to polymodal contextual cues, but generally not to discrete unimodal cues, depends upon the integrity of the DH. There is some suggestion that the hippocampus may be involved in generalization to discrete auditory stimuli following conditioning, but the available literature offers conflicting results regarding the nature of hippocampus involvement.