Baylor University Medical Center Proceedings最新文献

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects a significant proportion of the global population. Lean MASLD, characterized by normal body mass index but the presence of metabolic dysfunction, presents a unique clinical challenge. This study explored the role of diet quality, measured by the Healthy Eating Index (HEI), in the development of lean MASLD.

Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES, 2017-2020). Participants were adults classified as lean (body mass index <23 kg/m² for non-Hispanic and Asian, <25 kg/m² for others) with metabolic dysfunction. MASLD was diagnosed based on hepatic steatosis and at least one cardiometabolic risk factor. We assessed diet quality using HEI-2015 and employed survey-weighted logistic regression to evaluate the association between HEI scores and lean MASLD, adjusting for potential confounders.

Results: Among 1707 participants, higher HEI scores were associated with a reduced likelihood of lean MASLD. Specifically, individuals in HEI quartile 4 had 66% lower odds of developing MASLD compared to those in quartile 1 (odds ratio = 0.34, 95% confidence interval = 0.12-0.96, P = 0.04). Higher protein intake and refined grain consumption were positively associated with MASLD, while oil intake showed a protective effect.

Conclusions: A higher-quality diet, as indicated by a better HEI score, is associated with a lower risk of lean MASLD. This study underscores the importance of diet quality in MASLD prevention and highlights the need for further research into specific dietary components that impact liver health in lean individuals.

Neonates are at an increased risk of seizures due to their immature brains and high risk of injury. Most neonatal seizures are provoked seizures (triggered by an acute illness or brain injury). Etiologies include hypoxic-ischemic encephalopathy, stroke, hemorrhage, infections, cortical malformations, metabolic diseases, and genetic disorders. With increasing use of bedside electroencephalographic monitoring, electrographic seizures without clinical correlation are being diagnosed more frequently. In the 2021 updated classification of the International League Against Epilepsy, abnormal clinical movements require electrographic activity for the diagnosis of a seizure. In neonates, seizures have a focal onset and are further classified according to their dominant clinical feature. Seizures can be motor, nonmotor, or sequential. All neonatal units should use evidence-based protocols to expedite the evaluation and treatment of neonatal seizures. Electroencephalograms should confirm seizure control. In neonates who do not respond to conventional antiseizure treatment, pyridoxine-dependent seizures should be ruled out.

Background: Colonoscopy is a vital procedure for colorectal cancer screening and intervention; however, it can be uncomfortable for patients, particularly older people and those with diverticular disease. In our systematic review and meta-analysis, we aimed to evaluate the impact of abdominal compression devices (ACDs) on patient comfort and procedural efficiency during colonoscopy.

Methods: A literature search was performed in PubMed, Web of Science, Scopus, Cochrane Central, and Embase from inception to April 2025. A risk of bias assessment was performed by using the Cochrane tool for assessing risk of bias in randomized trials, version 2 (ROB2). Data analysis was conducted using R version 4.2.2 and RStudio version 2022.07.2.

Results: Our comprehensive search across multiple databases yielded 16 randomized controlled trials involving 3098 participants. Our analysis revealed that ACDs significantly reduced cecal intubation time (mean difference: -2.20, 95% confidence interval [CI]: -3.50 to -0.90; P = 0.009), manual pressure application (risk ratio [RR]: 0.54, 95% CI: 0.39 to 0.76; P = 0.003), and the need for patient repositioning (RR: 0.55, 95% CI: 0.48 to 0.64; P > 0.001). Additionally, ACDs were associated with lower visual analog scale pain scores, indicating enhanced patient satisfaction. However, no significant differences in complete colonoscopy rates or cecal intubation lengths were found.

Conclusion: Our findings suggest that ACDs can optimize colonoscopy procedures, improve patient comfort, and reduce staff workload, warranting their integration into routine practice. Future studies should focus on standardizing ACD applications and exploring long-term outcomes to further enhance the benefits of this approach in clinical settings.

Background: Use of specialized devices such as a continuous glucose monitor (CGM) for patients with diabetes are most beneficial if patients attend their follow-up appointment. We evaluated the use of a social media reminder system for patient attendance to a CGM follow-up appointment.

Methods: A retrospective analysis compared use of social media appointment reminders to paper-based reminders among 171 patients with diabetes receiving a CGM at a public hospital in suburban New York City. The multivariate logistic regression analysis for the outcome of attendance at an outpatient follow-up visit adjusted for demographic and health variables.

Results: The social media reminder group (88.2%, n = 60/68) had a significantly (P < 0.001) greater percentage of attendance at the follow-up appointment than the traditional reminder group (60.2%, n = 62/103). Almost all from the social media reminder group used WhatsApp (98.5%, n = 67). Multivariate logistic regression analysis showed increased odds of social media appointment reminders for attendance (odds ratio = 4.35; 95% confidence interval, 1.70, 11.16; P = 0.002).

Conclusion: Social media reminders were associated with increased outpatient appointment attendance for patients with diabetes using CGMs. We recommend wider use of social media platforms, especially WhatsApp, by health care facilities for their reminder systems to improve outpatient appointment attendance among patients with diabetes.

Background: Strongyloides stercoralis is a parasitic nematode that chronically infects an estimated 30 to 100 million individuals worldwide. In solid organ transplant recipients, Strongyloides can cause disseminated disease or hyperinfection, both with a high mortality rate. The American Society of Transplantation recommends serologic screening for all potential transplant donors and recipients with risk factors.

Methods: This single-center, retrospective chart review involved patients aged 18 or older who underwent evaluation for cardiac transplant and serologic Strongyloides screening at Baylor Scott & White Medical Center in Temple, Texas, between March 2019 and March 2024. A total of 259 patients underwent screening for Strongyloides as part of a broader evaluation for cardiac transplant candidacy. Data were collected and managed using REDCap hosted at our institution. Bivariate analyses were completed to test the association between the Strongyloides seropositive and seronegative groups. All statistical analyses were performed in SAS 9.4.

Results: Of 259 patients, 11.58% tested positive or equivocal for Strongyloides. All seropositive or serology equivocal patients received appropriate treatment.

Conclusion: Based on our results, targeted screening may miss many seropositive patients. Given the lack of epidemiological risk factors within our seropositive population, we recommend consideration of universal screening for solid organ transplants for Strongyloides.

Lectures are here to stay in medicine and medical education; the goal is to improve them so that the audience engages with and retains the information. Successful presenters are generally overprepared, designing the lecture with the learning objectives in mind and clearly stating them. They consider incorporating activities, audiovisuals, anecdotes, questions, and the "cultivation of confusion" to elicit critical thinking. Beyond creating slides with minimal text but clear conceptual designs and including notes for themselves, effective presenters utilize body language and voice inflection and tone. It is reported that when presenters demonstrate interest and energy, they can engage audience members who bring a variety of learning styles.

Background: Breast cancer is the most common cancer and the second leading cause of female cancer-related death in the US. Time to treatment initiation is often critical for improving cancer outcomes. Socioeconomic status (SES) is increasingly recognized as influential in cancer treatment efficacy.

Methods: This retrospective cohort study investigated associations between SES and delayed breast cancer treatment initiation across treatment modalities in Southeast Texas. Logistic regression models assessed the associations between delays and socioeconomic or clinical characteristics among 609 patients.

Results: Regarding overall treatment, males, unmarried patients, younger patients, and Medicaid users experienced increased delay odds, while females, widows, and Medicare users experienced decreased odds. For chemotherapy, Tricare coverage was associated with excessive delay odds. Regarding surgical intervention, African Americans, unmarried patients, younger patients, and Medicaid users experienced increased delay odds, while Caucasians, older patients, and Medicare users experienced decreased odds. For radiation therapy, divorcees and those with Medicare and Medicaid eligibility experienced increased delay odds. Regarding hormone therapy, younger patients and Medicaid users experienced increased delay odds, while older patients and Medicare users experienced decreased odds. For immunotherapy, unmarried patients experienced increased delay odds, while being married conferred lower odds.

Conclusion: These results indicate that certain SES factors significantly predict treatment delays in breast cancer care.