Citations

Increases in aortic wave reflection and aortic pulsatile load are known contributors to hypertension, cardiovascular risk, and pulsatile stress to end organs. To our knowledge, this is the first study to demonstrate that evening binge alcohol consumption increases heart rate, aortic pulsatile load, and aortic augmentation index the following morning when compared with fluid control. These findings highlight the deleterious overnight cardiovascular effects of binge alcohol consumption in young adults.

ABSTRACT Drug-induced autoimmune-like hepatitis represents a distinct phenotype of drug-induced liver injury characterized by clinical, biochemical, and/or histological features resembling autoimmune hepatitis. We present a case of severe Isoniazid (INH) -induced drug-induced autoimmune-like hepatitis in a 62-year-old man with a dramatic response to corticosteroid therapy after INH discontinuation alone proved insufficient. Initial laboratory tests showed markedly elevated transaminases and profound hyperbilirubinemia. Despite INH discontinuation, his clinical condition did not improve. Liver biopsy revealed severe acute hepatitis with interface hepatitis, lymphoplasmacytic infiltration, and multiple foci of lobular confluent necrosis. Prednisone therapy led to rapid clinical improvement and normalization of liver biochemistries over 3 months.

ABSTRACT Histoplasmosis has a wide spectrum of presentations ranging from mild pulmonary disease to a more widespread infection leading to disseminated histoplasmosis. Gastrointestinal histoplasmosis is a rare form of disseminated histoplasmosis that most commonly causes nonspecific symptoms and rarely presents with serious symptoms. Duodenal involvement is further rare but can cause ulcerated lesions leading to upper gastrointestinal bleed. The potential for a nonspecific initial presentation quickly progressing to a fatal upper gastrointestinal bleed makes it important to keep Gastrointestinal histoplasmosis in our list of differentials, as timely initiation of appropriate antifungal therapy can significantly reduce the risk of severe complications and mortality.

Background: Lymphaticovenous anastomosis (LVA) is an effective surgical treatment for extremity lymphedema. Indocyanine green (ICG) fluorescent lymphography, the traditional standard for imaging lymphatic vessels, has limitations, including difficulty depicting deeper or congested lymphatics and contraindication in iodine hypersensitivity. This study evaluated contrast-enhanced ultrasound (CEUS) with microbubbles for identifying lymphatic vessels for LVA and compared it with ICG lymphography. Methods: In this single-center retrospective review, intraoperative CEUS with intradermal injection of microbubble suspension (Lumason, Bracco Diagnostics, Inc.) was used in patients before LVA surgery between October 2019 and February 2023. Pre- or intraoperative ICG lymphography was also used to identify target lymphatic vessels. All patients diagnosed with primary or secondary extremity lymphedema who underwent LVA were included. Technical success rate was defined as lymphatic vessels identified by CEUS that led to successful LVAs. Descriptive statistics were used. Results: Thirty-two patients underwent LVA surgery, with a mean age of 58.5 ± 13.9 years. CEUS identified lymphatic vessels in all 32 patients, including 7 in whom ICG failed. Two patients with ICG allergy underwent CEUS only. CEUS identified more candidate lymphatics per patient (5.3 ± 4.2) compared with ICG (2.5 ± 2.7). Of the 182 anastomoses, 96 (52.8%) were identified by both CEUS and ICG, 75 (41.2%) by CEUS only, and 11 (6%) by ICG only. Conclusions: CEUS is a promising tool for identifying lymphatic vessels in patients with lymphedema undergoing LVA, particularly when ICG lymphography is inadequate or contraindicated.

Abstract There is an urgent need to improve dementia ascertainment robustness in real-world studies assessing drug effects on dementia risk. We developed algorithms to dementia identification algorithms using Medicare claims (inpatient/outpatient/prescription) from 3318 Visit 5 (2011-2013) and 1828 Visit 6 (2016-2017) participants of the Atherosclerosis Risk in Communities (ARIC) Study, validated against ARIC's rigorous syndromic dementia classification. Algorithm performance was compared to existing algorithms (Jain, Bynum, Lee). We further evaluated algorithms effectiveness in a 20% random Medicare sample aged ≥70 years who initiating liraglutide or dipeptidyl peptidase 4 inhibitors (DPP4i) to assess 3-year adjusted risk difference (aRD) for dementia. Our incident dementia algorithm required two dementia diagnostic codes within 1-year, or one dementia code plus a new dementia prescription within 90 days. It achieved a positive predictive value (PPV) of 69.2%, specificity of 99.0%, and sensitivity of 34.6% (population prevalence: 8.8%), comparable to extant algorithms (PPV, 58.7–68.6%; sensitivity 25.5–40.4%). Prevalent dementia algorithm (without requiring incident diagnoses/prescriptions) demonstrated similar performance. In the Medicare sample, dementia risk ranged from 3.0% to 12.5%, aRD comparing liraglutide to DPP4i varied −1.2% to −3.6%, with our algorithm closely matching the Bynum algorithm. Algorithm selection significantly impacts treatment effect estimates, highlighting its importance in in pharmacoepidemiologic research.