Metastatic Insulinoma Managed With Continuous Glucose Monitoring in a Young Female Patient.

Insulinomas are rare neuroendocrine neoplasms and causes of hypoglycemia. They present with neuroglycopenic symptoms, including confusion and seizures. Suspected diagnosis must be confirmed through bloodwork and imaging.

COVID-19-Associated Encephalopathy: A Case Series Demonstrating the Rapid Deterioration of Mental Status and a Review of the Literature.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is known for its severe inflammatory response, often leading to multi-organ dysfunction. Among the less-recognized complications is COVID-19-associated encephalopathy, particularly in the elderly, where it contributes significantly to morbidity and mortality. This report explores the rapid neurocognitive decline observed in six hospitalized patients with COVID-19, with or without pre-existing neurological conditions.

The DIMASHQ Procedure: AO Plug pseudoaneurys repair in cending aorta using uality intracardiac ecocardiography.

The transcatheter management of complex cardiovascular diseases has significantly evolved, offering less invasive alternatives to traditional surgical interventions. In this report we describe 2 cases of patients who developed ascending aortic pseudoaneurysms soon after coronary artery bypass grafting. With meticulous computed tomography angiography planning and with live intracardiac echography, these patients underwent successful transcatheter repair using a 6/4-mm Amplatzer Duct Occluder II (Abbott) vascular plug.

Embolic Stroke in a Patient With Left Atrial Myxoma.

We present a case of a patient with a left atrial myxoma who presented with an ischemic stroke. Her cardiac myxoma had an irregular contour and was highly mobile, both features that have been associated with a greater risk of thromboembolism. She was treated with prompt surgical resection.

Aspiration of Left Atrial Masses Using the Large-Bore Manual Aspiration System: The ASPIRATE LA Procedure.

Transcatheter mass extraction of left-sided cardiac masses has gained popularity in recent years, with scarce data on effectiveness, safety, and types of devices used. Mostly, left-sided aspirations use mechanical and continuous-flow-mediated devices (the AngioVac [AngioDynamics] and Penumbra systems [Penumbra]). To our knowledge, the use of manual aspiration devices has not been reported yet.

Comparing Patency of Pulmonary Stent Implantation and Balloon Angioplasty in Pulmonary Vein Stenosis: A Systematic Review and Meta-Analysis.

Pulmonary vein stenosis (PVS) is an insidious diagnosis associated with morbidity and mortality. Pharmacologic therapy may suffice initially, but advanced stages demand mechanical intervention. Pulmonary stent implantation (PSI) and pulmonary balloon angioplasty (PBA) are common strategies, both carrying restenosis risks.

Surgical Opioid Stewardship: From the Epidemic Through the Pandemic and Beyond.

Background: In response to the opioid epidemic, prescribing guidelines and statewide surgical opioid management programs were initiated in 2018-19. This analysis aims to document the sustainability of a regional opioid stewardship consortium through the pandemic and beyond.

Study Design: From September 2019 through August 2023, 15 NSQIP hospitals in two states gathered opioid-specific variables on patients undergoing 12 procedures.

Takotsubo Syndrome Following Catheter Ablation for Atrial Fibrillation: A Systematic Review and Metasummary of Case Reports/Series.

Atrial fibrillation (AF) catheter ablation is safe and effective, though rare cases of takotsubo syndrome (TTS) have been observed without proven causation. This review synthesizes TTS following AF ablation case reports and series. Until October 2024, PubMed/Medline, SCOPUS, and Google Scholar were searched for AF ablation and TTS case reports and series.

Left Bundle Branch Area Pacing Versus Right Ventricular Pacing in Patients With Atrioventricular Block: A Systematic Review and Meta-Analysis.

Background: Left bundle branch area pacing (LBBAP) is a new technique for patients with atrioventricular block (AVB) and preserved left ventricular ejection fraction (LVEF), potentially offering better cardiac function than right ventricular pacing (RVP).

Methods: We searched databases and registries for studies that compared LBBAP with RVP in patients with AVB and preserved LVEF. We extracted data on various outcomes and pooled the effect estimates using random-effects models.

Long-Term Follow-Up and Overall Survival in NRG258, a Randomized Phase III Trial of Chemoradiation Versus Chemotherapy for Locally Advanced Endometrial Carcinoma.

This randomized phase III trial aimed to determine whether treatment with cisplatin and volume-directed radiation followed by carboplatin and paclitaxel for four cycles (chemoradiotherapy [C-RT]) increased recurrence-free survival (RFS) and overall survival (OS) when compared with carboplatin and paclitaxel for six cycles (chemotherapy [CT]) in locally advanced endometrial cancer (UC). Previously reported results showed that C-RT did not improve RFS compared with CT. Here we report the final OS analysis.

Practice Advisory on the Implementation of Preoperative Anemia Management: The Society of Cardiovascular Anesthesiologists and the Society for the Advancement of Patient Blood Management.

Preoperative anemia is common and associated with worse outcomes in cardiac surgery including acute kidney injury, red blood cell transfusion, cardiovascular complications, stroke, infection, and death. Patient blood management programs, which include dedicated clinical programs to diagnose and treat anemia in advance of surgery (ie, preoperative anemia programs), have been highlighted as a means to optimize the blood health of each patient, thereby decreasing risk for allogeneic transfusion and improving clinical outcomes. However, there remain implementation challenges for preoperative anemia programs, including difficulties with education of patients and staff, short lead times to address anemia, infrastructure and staffing limitations, lack of clear leadership or ownership of preoperative anemia, the need to develop treatment algorithms and ensure appropriate infusion therapy support, lack of capital support, and insurance/reimbursement concerns, amongst others.

Self-Expandable Versus Balloon-Expandable Transcatheter Aortic Valve Replacement for Treatment of Patients With Small Aortic Annulus: An Updated Meta-Analysis of Reconstructed Individual Patient Data.

Transcatheter aortic valve replacement has emerged as an effective alternative to surgery in selected patients with aortic stenosis. It needs to be made clear which type of valve has better results in patients with small aortic annulus. We searched PubMed, Scopus, Embase, Cochrane Library, and Web of Science, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Successful Transcatheter Mitral Valve Mass Extraction With Complete Resolution of the Severe Mitral Regurgitation.

Interest has arisen in exploring the off-label application of left-sided percutaneous mechanical aspiration, where conventional management strategies may not suffice. Percutaneous mechanical aspiration has been shown to be effective as a diagnostic and therapeutic intervention in select patients with infective endocarditis. This paper hereby reports the first case of a successful transeptal large bore manual aspiration device (AlphaVac; Angiodynamics) for nonbacterial thrombotic endocarditis with total resolution of associated severe mitral valve regurgitation.

Apparent Diffusion Coefficient of the Optic Nerve Head in Idiopathic Intracranial Hypertension.

Idiopathic Intracranial Hypertension (IIH) is a condition in which patients have elevated intracranial pressure which does not have an apparent cause. To diagnose IIH, evaluation excluding other causes of elevated pressure must be performed. This typically includes magnetic resonance imaging (MRI) of the brain and venous sinuses.

Andexanet Alfa-Associated Heparin Resistance in Cardiac Surgery: Mechanism and In Vitro Perspectives.

Background: Andexanet alfa (andexanet) is the only Food and Drug Administration-approved antidote for direct FXa (factor Xa) inhibitors but has been reported to cause resistance to unfractionated heparin (UFH). This has delayed anticoagulation for procedures requiring cardiopulmonary bypass. The mechanism, andexanet and UFH dose dependence, and thrombotic risk of andexanet-associated heparin resistance are unknown.

Efficacy and safety of dostarlimab in combination with chemotherapy in patients with dMMR/MSI-H primary advanced or recurrent endometrial cancer in a phase 3, randomized, placebo-controlled trial (ENGOT-EN6-NSGO/GOG-3031/RUBY).

Objectives: Part 1 of the RUBY trial (NCT03981796) demonstrated improved survival in patients with primary advanced or recurrent endometrial cancer (EC) treated with dostarlimab plus carboplatin-paclitaxel versus placebo plus carboplatin-paclitaxel. Here, we examine additional efficacy and safety data from patients with mismatch repair deficient/microsatellite instability-high (dMMR/MSI-H) EC in the RUBY trial.

Methods: Patients were randomized 1:1 to dostarlimab 500 mg or placebo plus carboplatin-paclitaxel every 3 weeks for 6 cycles followed by dostarlimab or placebo every 6 weeks for up to 3 years.

Multimedia-Based Education Led to Improvement in Disease Knowledge Among Patients with Cirrhosis.

Background: Current evidence shows limited patient understanding of liver disease, coupled with no standard guidelines or methods to offer patient education in a busy clinical environment. We developed multimedia-based education (MBE) for those with cirrhosis & tested its effectiveness in improving patient knowledge from baseline to 1 month.

Methods: This prospective study enrolled cirrhotic patients who had a scheduled visit with a hepatologist at an ambulatory academic practice or were admitted to the liver inpatient service.

From books to the bedside: post-graduation impact of 'Week On the Wards' on medical education.

Background: The transition between preclinical and clinical years during medical school has been shown to be challenging. Cooper Medical School of Rowan University (CMSRU) implements one required two-week-long shadowing program for first and one one-week-long shadowing program for second-year medical students called Week On the Wards (WOW). The goal of this study is to ascertain whether students who completed the WOW curriculum found it beneficial over the long-term.

High-Sensitivity Cardiac Troponin [hs-cTn] as a Valuable Biomarker for Pulmonary Hypertension Risk Stratification: A Contemporary Review of the Literature.

Pulmonary hypertension (PH) can lead to cardiac failure, thereby significantly affecting life expectancy and quality of life. Due to inadequate disease surveillance and risk assessment, clinical challenges persist despite advances in diagnosis and treatment. We aimed to review the potential of high-sensitivity cardiac troponin (hs-cTn) as a biomarker for predicting outcomes in PH patients.

Survival and Recovery From Postmyocardial Infarction Apical Wall Rupture With a Complex Course.

Ventricular wall rupture is associated with poor outcomes subsequent to an acute myocardial infarction. We describe a case of postmyocardial infarction apical wall rupture following percutaneous coronary intervention. Our case emphasizes the importance of swift evaluation, diagnosis, and management to enhance survival in individuals confronting this critical condition.