Baylor University Medical Center Proceedings最新文献

Objectives: This study aimed to evaluate temporal trends in adult sickle cell disease (SCD) mortality in the United States from 1999 to 2020, stratified by age, sex, race, and geography, to identify disparities and guide targeted interventions.

Methods: A retrospective observational study was conducted using national mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database. The sample included adults aged ≥15 years who died from SCD between 1999 and 2020 (n = 17,443). Age-adjusted mortality rates (AAMRs) were calculated and stratified by demographic and geographic variables. Temporal trends were assessed using Mann-Kendall trend tests, and t-tests were applied to compare continuous variables across subgroups. Statistical significance was defined as P < 0.05.

Results: The AAMR for adult SCD increased by 132% over the study period (P = 0.014). The greatest rise in mortality was observed among adults aged ≥65 years (P = 0.008) and women (P = 0.015). Black individuals accounted for 97.5% of SCD-related deaths, underscoring severe racial disparities. Geographically, the Southern region exhibited the highest AAMR and was the only region with a statistically significant increase in mortality over time (P = 0.001).

Conclusions: Adult SCD mortality in the United States has risen significantly from 1999 to 2020, with disproportionate increases among older adults, women, and individuals in the Southern region. The findings highlight urgent needs for targeted national interventions, development of age-specific care models, and implementation of equity-focused health policies to address persistent racial and regional disparities in SCD outcomes.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder with systemic implications including dyslipidemia, hypertension, and chronic kidney disease. We explored the metabolic effects of leuprolide and spironolactone beyond their use for managing hyperandrogenic symptoms in PCOS.

Methods: We used the TriNetX Research Network to identify patients aged 18 to 50 years diagnosed with PCOS and stratified them by use of leuprolide or spironolactone. The cohorts were matched for demographics, comorbidities, and confounding medications and each had 2078 patients. Outcomes included rates of hypercholesterolemia, lipid profiles, lipid-lowering agent use, hypertension, antihypertensive medications, obesity, hyperglycemia, chronic kidney disease, and major adverse cardiovascular events.

Results: Over a 5-year examination period, leuprolide carried lower risks than spironolactone for hypercholesterolemia (risk ratio [RR] 0.46; 95% confidence interval [CI], 0.39-0.54), low high-density lipoprotein (RR 0.41; CI, 0.35-0.48), and elevated low-density lipoprotein (RR 0.39; CI, 0.26-0.58). Risks were also reduced for hypertension (RR 0.73; CI, 0.61-0.87), antihypertensive use (RR 0.86; CI, 0.75-0.99), and lipid-lowering therapy (RR 0.79; CI, 0.63-0.99). No significant differences appeared for chronic kidney disease, major adverse cardiovascular events, hyperglycemia, or obesity.

Conclusion: Leuprolide therapy was associated with improved lipid and hypertension outcomes compared to spironolactone. These findings support leuprolide's potential role in broader metabolic management of PCOS.

Background: Anal squamous cell carcinoma and its precursors, squamous intraepithelial lesions, arise in the anal transitional zone and pecten-a segment traversed during every colonoscopy. Whether conscious inspection of these areas during routine colonoscopy enhances detection of anal dysplasia has not been established.

Methods: An observational analysis (2011-2025) was conducted within a single academic health system, involving adult patients undergoing screening or diagnostic colonoscopy. Squamous anal dysplastic lesions seen in the anal transitional zone and pecten were photographed and biopsied. Specimens were classified as low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, or squamous cell carcinoma. Demographics, colonoscopy indications, and recognized risk factors were recorded.

Results: Incidental anal neoplasia was identified in 121 patients (71 female, 49 male, one transgender; median age 59 years [range 39-82]). Endoscopists detected 64 low-grade squamous intraepithelial lesions, 52 high-grade squamous intraepithelial lesions, and 5 squamous cell carcinomas, representing 52.9%, 43.0%, and 4.1% of lesions, respectively. Thirty-eight endoscopists made these findings during colonoscopies performed for colorectal cancer screening, polyp surveillance, or common gastrointestinal complaints. Conventional high-risk conditions, including human immunodeficiency virus infection, anogenital intraepithelial neoplasia, or organ transplantation, were present in 41 (33.9%) patients. Representative endoscopic images of anal dysplastic lesions are included.

Conclusions: A brief, deliberate inspection of the anal transitional zone and pecten during colonoscopy consistently reveals anal squamous intraepithelial lesions and squamous cell carcinoma. Incorporation of this maneuver into standard colonoscopy practice could extend early detection of anal dysplasia beyond presently targeted high-risk groups and thereby reduce the overall burden of anal cancer.

Background: Obesity remains a major public health issue in the USA, and West Texas lacks updated regional data, especially following the COVID-19 pandemic. This study compared the prevalence of obesity and its comorbidities in adults in West Texas from 2020 to 2022 to a previously published cohort from 2016 to 2018.

Methods: A retrospective cross-sectional study used deidentified patient data from Texas Tech University Health Sciences Center Internal Medicine Clinic. Adults aged 18 to 89 with at least two visits between 2020 and 2022 were included. Body mass index (BMI, kg/m²) categories were defined as normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Logistic regression evaluated associations between BMI and comorbid conditions, adjusted for age, sex, and race. Results were compared to the 2016 to 2018 cohort.

Results: Of the 3595 patients included, 51% were obese, 30% were overweight, and 19% had normal BMI. Compared to 2016 to 2018, obesity prevalence increased (51% vs 46.6%). The prevalence of hypertension and obstructive sleep apnea increased across all BMI groups. Diabetes prevalence decreased in the obese group (51.2% to 47%) and remained stable in others. Hyperlipidemia decreased in the obese category (60.3% to 48%) but increased in the normal BMI category. Coronary artery disease prevalence decreased in overweight and obese groups. COVID-19 was significantly more prevalent among overweight and obese patients.

Conclusions: Obesity prevalence and several key comorbidities, including hypertension, obstructive sleep apnea, and COVID-19, increased in West Texas during the 2020 to 2022 period. Although diabetes and hyperlipidemia declined among individuals with obesity, the overall burden of obesity remains substantial. These findings highlight the need for continued monitoring and targeted strategies to address chronic disease risk in this population.

Depression and anxiety affect more than half a billion people worldwide, yet access to mental health care remains severely limited due to stigma, cost, geography, and workforce shortages. Internet-based cognitive behavioral therapy (iCBT) and, more recently, artificial intelligence (AI)-driven chatbots have emerged to bridge this gap. AI chatbots deliver 24/7 support through natural language processing and machine learning, simulating human-like conversations grounded in cognitive behavioral therapy principles. Evidence suggests that chatbot use improves engagement and reduces attrition compared with iCBT alone, with randomized trials and recent meta-analyses demonstrating short-term reductions in depressive and anxiety symptoms. Chatbots such as Woebot, Wysa, and Tess integrate mood tracking, automated check-ins, and structured therapeutic activities that enhance self-efficacy and emotional regulation. Despite these benefits, limitations remain, including the inability to replicate genuine empathy, risk of misinterpretation during crises, reliance on short-term evidence, and lack of standardized evaluation frameworks. Privacy and data security also represent significant ethical concerns. Future research should prioritize long-term, diverse studies, transparent reporting of therapeutic principles, and development of universal guidelines for safety and implementation. While AI chatbots cannot replace professional care, they represent an innovative and cost-effective complement to overburdened systems, particularly in resource-limited settings.

Background: American Board of Internal Medicine (ABIM) certifying exam pass rates are crucial metrics for internal medicine residency programs, as lower pass rates influence accreditation. Additionally, higher scores correlate with lower hospitalist-specific mortality and readmission rates. Prior research identified associations between pass rates and factors such as US Medical Licensing Examination scores and in-training examination performance. However, little is known about how residency training factors such as hospital patient complexity, academic affiliation, region, and program size affect ABIM pass rates. This study aimed to identify determinants of ABIM pass rates to serve as a reference for residency applicants and residency program leaders.

Methods: Data from 550 US internal medicine residency programs were analyzed, incorporating publicly available ABIM pass rates (2022-2024), hospital case mix index (CMI) as a surrogate for patient acuity, academic affiliation, geographic region, and program size. Descriptive and inferential statistics were performed using JASP software.

Results: The average ABIM exam pass rate for first-time test takers was 86% (standard deviation 11.7). University-based programs had significantly higher pass rates than community-based and community-based university-affiliated programs (F(2542) = 52.70; P < 0.001). Pass rates correlated positively with hospital CMI (r = 0.34, P < 0.001) and program size (r = 0.272, P < 0.001), but not geographic region (P = 0.21). A regression model showed CMI, program size, and academic affiliation as significant determinants, explaining 22.5% of pass rate variance.

Conclusion: Higher patient acuity, university-based affiliation, and larger residency programs significantly correlate with higher ABIM pass rates. These findings provide insights for residency applicants upon selecting training programs. Further research is needed to evaluate these factors in relation to clinical competence.

Background: Rural communities face challenges of insufficient healthcare professionals. Studies show that rural populations experience disparities in skin cancer care and delayed diagnoses.

Methods: Data describing Texas dermatologist locations from 2015 to 2022 were obtained from the Texas Department of Health Services. County-level data, including estimated population, rural-urban continuum codes, public health regions, and poverty percent, were collected from the Texas Department of Health Services, the Economic Research Service at the US Department of Agriculture, and the US Census Bureau.

Results: Only 2 public health regions met the recommended ratio of 4 dermatologists per 100,000 people in 2022. While dermatologist density has increased with a compound annual growth rate of 2.47%, rural areas with <5000 people showed a negative compound annual growth rate of -9.12%. Dermatologist density in public health regions surrounding the largest cities in Texas-San Antonio, Houston, Austin, and Dallas-was 4.01 per 100,000 dermatologists in 2022, which was significantly higher than the rest of Texas at 1.86 (P < 0.05).

Conclusions: These findings highlight insufficient access to Texas dermatologists and describe disparities linked to population, poverty, and urban proximity. Efforts are needed to address these inequalities and their consequences on dermatologic outcomes in rural communities.

PEComa, or perivascular epithelioid cell tumor, is a distinctive mesenchymal neoplasm arising from perivascular epithelioid cells (PECs) that classically demonstrates a myomelanocytic immunophenotype. PEComas predominantly affect adults, with female predilection, and can occur at various anatomical sites, including the retroperitoneum, uterus, kidney, liver, and soft tissues. Most PEComas are considered benign and have an overall good prognosis. However, malignant PEComas are generally uncommon and tend to behave aggressively. In this clinical vignette, we present a 65-year-old woman with a malignant PEComa arising in the retroperitoneum with the development of metastatic disease, illustrating the importance of accurate diagnosis and potential treatment implications.