Al‐Khazraji, Ahmed

ABSTRACT Background and Aims Alpha‐gal syndrome (AGS) is an IgE‐mediated hypersensitivity to galactose‐α‐1,3‐galactose, triggered by tick bites. It typically presents with delayed onset allergic or gastrointestinal symptoms after red meat consumption. This study aims to evaluate the prevalence of clinical symptoms and outcomes in AGS patients. Methods A systematic search of PubMed, Embase, and Cochrane Central was conducted to identify studies with at least five AGS patients that utilized alpha‐gal IgE for diagnosis and reported symptomatology. A random‐effects model calculated pooled prevalence and 95% confidence intervals (CIs) for clinical characteristics of AGS. Results Of the 739 studies screened, 15 met the inclusion criteria, comprising 1162 AGS patients (57% female). Urticaria was identified as the most prevalent symptom (63.8%, CI: 34.5–88.3, I 2 = 98.8%). At least one gastrointestinal symptom was reported in 69.2% of patients (CI: 49.3–85.9, I 2 = 97.5%), including abdominal pain (58.3%, CI: 36.0–78.9, I 2 = 96.0%), diarrhea (41.7%, CI: 22.3–62.5, I 2 = 93.4%), nausea (39.1%, CI: 29.2–49.6, I 2 = 79.1%), and vomiting (31.1%, CI: 21.9–41.2, I 2 = 70.4%). Tick bite history was recalled by 78.7% (CI: 46.4–98.1; I 2 = 99.1%), and 91.8% (CI: 84.6–96.8; I 2 = 70.3%) had symptom onset ≥ 1 h post red meat intake. Symptomatic improvement was observed in 86.5% (CI: 73.9–95.4, I 2 = 80.9%) of patients, with complete resolution in 42.7% (CI: 26.4–59.8, I 2 = 73.8%). Conclusion AGS typically presents with delayed onset allergic and GI symptoms after red meat intake, often with tick bite history. Majority of patients report symptomatic improvement on follow‐up.

Infective endocarditis (IE) is a severe illness associated with significant morbidity and mortality. The primary purpose of this study was to evaluate morbidity and mortality of IE in a hospital serving the most diverse area in New York City. An analysis of 209 patients admitted to the hospital from 2000 to 2012 who were found to have IE based on modified Duke criteria. Among the 209 patients with IE, 188 (88.8%) had native heart valves and 21 (11.2%) had prosthetic valves. Of the patients with native heart valves, 3.7% had coronary artery bypass graft, 4.3% were active drug users, 6.3% had permanent pacemakers, 12.2% had a history of IE, 25.7% were diabetic, 17% had end-stage renal disease (ESRD), 9% had congestive heart failure, 8% had abnormal heart valves, and 13.8% had an unknown etiology. Mortality rates of the patients with prosthetic heart valves were 27.7% compared to 8.11% in patients with native heart valves (OR 3, p<0.0001). Since we identified diabetes mellitus and ESRD to be significant risk factors in our population, we isolated and compared characteristics of patients with and without IE. IE among patients with diabetes mellitus was 23% compared with 13.8% in the control group (p=0.016). Cases of IE in patients with ESRD were 15.3%, compared with 4% in the control group (p<0.0001). We identified an overall mortality rate of 20.1% in patients with IE, a readmission rate within 30 days of discharge of 21.5%, and an average age of 59 years. Among 209 patients, 107 were males and 102 females. The most common organisms identified were Staphylococcus aureus (43.7%), viridans streptococci (17%) followed by Enterococcus (14.7%). Despite appropriate treatment, high rates of morbidity and mortality remained, with a higher impact in patients greater than 50 years of age. Such discoveries raise the importance of controlling and monitoring risk factors for IE.