Baylor University Medical Center Proceedings最新文献

Background: Anemia has been observed in up to 46% of individuals with acute brain injury. Blood transfusions are commonly performed to raise hemoglobin levels, so we aimed to compare the restrictive and liberal blood transfusion strategies in acute brain injury patients.

Methods: A systematic search was conducted on Web of Science, Embase, Scopus, Cochrane, and Medline/PubMed up to February 10, 2025. Continuous data were combined using mean differences (MD), and dichotomous outcomes were synthesized using risk ratios (RR); both were detailed with a 95% confidence interval (CI), applying R software (version 4.3). This study was registered and published with PROSPERO (ID CRD42025630392).

Results: The analysis incorporated six randomized controlled trials involving 2599 participants. There were no substantial variations between the liberal and restrictive transfusion groups in unfavorable neurological outcomes (RR: 0.90 [95% CI: 0.79-1.03]; P = 0.13), favorable neurological outcomes (RR: 1.16 [95% CI: 1.00-1.35]; P = 0.05), hospital length of stay (MD: -0.66 [95% CI: -2.48-1.16]; P = 0.48), or intensive care unit length of stay (MD: 0.15 [95% CI: -0.68-0.99]; P = 0.72). However, the liberal transfusion strategy was accompanied with an increased number of red cell units transfused (MD: 2.28, 95% CI: [1.75-2.80]; P < 0.01) and reduced sepsis or septic shock compared to the restrictive strategy (RR: 0.73 [95% CI: 0.56-0.96]; P = 0.02).

Conclusion: The liberal strategy of blood transfusion for patients with acute brain injury and anemia did not impact neurological outcomes. It reduced the incidence of sepsis or septic shock, but this came with an increase in the number of red blood cells transfused without affecting overall mortality or thrombotic events.

Background: Antibiotic resistance is a growing global health threat, driven in part by inappropriate use. This study assessed public knowledge, attitudes, and practices related to antibiotic use among adults in Jordan.

Methods: A national cross-sectional study was conducted among 1647 adults (≥18 years) via online surveys and phone interviews. The questionnaire, adapted from validated tools including the Eurobarometer, examined antibiotic use patterns, access sources, reasons for use, knowledge, and exposure to educational materials. An Antibiotic Knowledge Score based on four questions measured understanding of antibiotic effectiveness and risks of misuse.

Results: Most participants (61.6%) reported antibiotic use in the past year, with 25.9% obtaining them without a prescription. Only 6.4% achieved a perfect score, while 43.7% scored 75% or higher. Exposure to educational materials was associated with better knowledge. Higher education, healthcare employment, and urban residence predicted greater knowledge.

Conclusion: There are substantial knowledge gaps and misuse of antibiotics among Jordanian adults. Strengthening public education and enforcing prescription-only policies are critical to curbing misuse and addressing antibiotic resistance.

Background: In the last decade, the estimated prevalence of metabolic-associated fatty liver disease (MAFLD) in the Middle East and North African population has been gradually increasing and was recently found to exceed 40%, indicating an alarming trend. The morbidly and mortality attributed to digestive disease in Jordanian people has not been thoroughly investigated, and the relevant data are restricted to sporadic reports from cross-sectional studies, which are likely underestimated. This study aimed to identify the epidemiological trends and risk factors of digestive diseases in Jordan from 1990 to 2021.

Methods: The study utilized the 2019 Global Burden of Disease study dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs), years lived with short-term or long-term health loss, and years of life lost due to premature death for digestive disorders. Trends were analyzed using percentage change calculations.

Results: Between 1990 and 2021, the all-age prevalence, deaths, and burden of various digestive diseases have risen significantly. Among these, MAFLD, including cirrhosis, showed the most dramatic increases, with a 500% increase in prevalence, a 345% rise in all-age deaths, and a 438% increase in DALYs. Alcohol and tobacco emerged as the two primary risk factors for higher DALYs for digestive diseases. Alcohol was strongly associated with higher DALYs for cirrhosis, while tobacco was linked to increased DALYs for gallbladder and biliary diseases, upper digestive system diseases, and peptic ulcers.

Conclusion: Digestive diseases are increasingly prevalent in Jordan, with MAFLD leading the rise, reflecting better management and prevention. These contrasting trends highlight the need for optimized public health strategies to reduce morbidity and mortality, alongside further research to address the unique challenges posed by modern lifestyles and shifting dynamics in this region.

Background: The use of mechanical circulatory support (MCS) devices with transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (mTEER) is occasionally required; however, outcomes data are lacking.

Methods: We utilized the Nationwide Inpatient Sample database to identify hospital admissions of adults treated with TAVR and mTEER, with or without MCS, between 2018 and 2021.

Results: We identified 330,055 patients undergoing TAVR and mTEER, with 3240 in the MCS group and 326,815 in the non-MCS group. From 2018 to 2021, there was a steady increase in procedural volume (P for trend <0.001). Utilization of MCS remained stable (P for trend: total 0.096). The use of any MCS modality was associated with a >26-fold increase in mortality (1.01% vs 26.82%, P < 0.001). Mortality remained steadily high with MCS use (P for trend = 0.08). Length of stay and cost of hospitalization were higher in the MCS group (P < 0.05 for both).

Conclusion: The use of MCS in patients undergoing TAVR or mTEER was associated with higher mortality, morbidity, and healthcare utilization; however, causation cannot be determined given the inherent limitations of the dataset.

Background: Psoriatic arthritis (PsA) is a rapidly progressive arthritis that is difficult to prevent and treat. The comparative risk of PsA development in psoriasis patients prescribed PsA-approved immunomodulators is unknown. Methods: We assessed the 3-year risk of PsA in psoriasis patients on immunomodulators of IL-12, 17, 23, tumor necrosis factor alpha, JAK1, and JAK3. Using the TriNetX Research Network, we identified patients with psoriasis and the use of an immunomodulatory agent. The immunomodulatory agents assessed included adalimumab, infliximab, ixekizumab, secukinumab, tildrakizumab, certolizumab pegol, risankizumab, etanercept, guselkumab, and ustekinumab. Results: Overall, IL-23 inhibitors risankizumab, guselkumab, and ustekinumab had the greatest decreased risk of PsA. Conclusion: Physicians can consider risankizumab, guselkumab, and ustekinumab as treatment options for psoriasis patients with PsA risk factors to mitigate disease progression and improve patients' quality of life.

Background: Robotic platforms are increasingly utilized in bariatric surgery to overcome technical limitations of traditional laparoscopy. However, the impact of robotics on postoperative pain control is not fully understood. This study aimed to compare pain control outcomes following primary bariatric surgery performed via robot-assisted approaches versus conventional laparoscopy.

Methods: This retrospective investigation involved all adults who underwent primary bariatric surgeries at a single institution from August 2016 to January 2019. Multivariable generalized linear and ordinal logistic regression models were fitted to test predictive associations of the robotic vs laparoscopic surgical technique with postoperative in-hospital opioid consumption and pain intensity ratings, independent of covarying risk factors.

Results: A total of 340 patients (201 in the robotic group and 139 in the laparoscopic group) were included in the study. Baseline preoperative characteristics were similar between comparison groups, except mean body mass index was significantly higher among robotic surgery recipients (47.7 vs 44.0 kg/m²; P < 0.001). Postoperative in-hospital opioid consumption did not significantly differ among recipients of robotic versus laparoscopic bariatric surgery. No difference was detected between comparison cohorts in total inpatient opioid use (P = 0.30), opioid use in the postanesthesia care unit (P = 0.98), or average opioid use per inpatient day (P = 0.18). Similarly, in multivariable ordinal logistic regression models of postoperative day 0 and postoperative day 1 pain ratings, perceived pain intensity was not significantly higher following robotic versus laparoscopic primary bariatric surgeries, after accounting for other risk factors.

Conclusion: Compared to conventional laparoscopy, robotic primary bariatric procedures did not independently decrease postoperative in-hospital opioid utilization or pain intensity.

Background: Multidisciplinary heart team (MHT) evaluation is a class I recommendation for coronary and structural heart disease, yet limited outcomes data exist for high-risk and complex valvular heart disease (VHD) patients referred for surgery.

Methods: From June 2021 to August 2022, our institutional MHT-comprising cardiac surgeons, interventional cardiologists, heart failure specialists, advanced imaging specialists, intensivists, and palliative care specialists-evaluated the highest-risk or complex VHD patients. Patient demographics, Society of Thoracic Surgeons Predicted Risk of Mortality scores, initial treatment plans, final team recommendations, and outcomes, including adherence to recommendations, 30-day readmission, and mortality at 30 days, 1 year, and 2 years were analyzed.

Results: Among 121 patients, the MHT recommended surgery for 67%, transcatheter intervention for 14%, a hybrid approach for 3%, and medical management (MM) for 17%. Overall adherence to MHT recommendations was 89%. Thirty-day mortality was 7/81 (9%) for surgical patients, 3/17 (18%) for transcatheter, 0/3 for hybrid, and 4/20 (20%) for MM. By 2 years, mortality rose to 17/81 (21%) for surgery, 9/17 (53%) for transcatheter, 1/3 (33%) for hybrid, and 11/20 (55%) for MM.

Conclusion: MHT evaluation facilitates individualized treatment strategies by distinguishing patients who may benefit from intervention despite high procedural risk, while sparing those unlikely to benefit.

Objectives: To investigate the relationship between juvenile idiopathic arthritis (JIA) and pregnancy outcomes.

Methods: A comprehensive literature review was conducted by searching for published articles indexed in Pubmed, Embase, Scopus, and Web of Science databases from inception through January 2025. All observational studies that compared the risk of any pregnancy outcomes of women with and without JIA were identified. Pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using the random-effect, generic inverse variance method of DerSimonian and Laird.

Results: A total of 196 articles were identified, and 11 studies fulfilled the inclusion criteria and were included in the meta-analysis. For maternal outcomes and delivery outcomes of pregnant JIA women, there was an increased risk of developing preeclampsia/eclampsia (RR 1.54, 95% CI 1.07-2.22; I² 72.68%), undergoing cesarean section (RR 1.50, 95% CI 1.23-1.83; I² 88.47%), and postpartum hemorrhage (RR 2.12, 95% CI 1.08-4.16; I² 88.77%). For neonatal outcomes, there was an increased risk of preterm birth (RR 1.74, 95% CI 1.33-2.26; I² 84.23%) and being small for gestational age (RR 1.20, 95% CI 1.08-1.33; I² 84.23%). No significant increase was detected in the risk of pregnancy-induced hypertension (RR 1.74, 95% CI 0.93-3.26; I² 86.58%), gestational diabetes (RR 0.96, 95% CI 0.65-1.44; I² 52.41%), and stillbirth (RR 1.38, 95% CI 0.78-2.44; I² 0.00%).

Conclusion: JIA is associated with higher risks of preeclampsia, undergoing cesarean section, postpartum hemorrhage, small-for-gestational-age infants, and preterm birth.

Background: Acute respiratory distress syndrome (ARDS) is a significant cause of morbidity and mortality, particularly among critically ill patients with limited treatment options. This study analyzed long-term trends in ARDS mortality in the US, focusing on racial disparities. By examining mortality rates across racial, regional, and gender groups, the study identified demographic and geographic inequalities to inform targeted interventions.

Methods: ARDS mortality data from 1999 to 2022 was obtained from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were stratified by sex, race, and US census region. Joinpoint regression was used to calculate annual percentage changes (APCs) and average annual percent change (AAPC).

Results: The overall AAMR increased from 7.40 (1999) to a peak of 21.72 (2021) before declining to 8.49 (2022, AAPC: 2.92). American Indians had the highest AAMR, increasing from 13.8 (1999) to 18.89 (2022, AAPC: 4.37). Asians had the lowest AAMR, declining from 7.4 (1999) to 6.17 (2022). AAMRs declined from 1999 to 2017, surged from 2017 to 2020, and dropped after 2022. Regional disparities were notable among the Northeast and Midwest, with Black populations having higher mortality.

Conclusion: ARDS mortality trends worsened during the COVID-19 pandemic, disproportionately affecting American Indian and Black populations. Addressing these disparities requires equitable healthcare policies and further research into social determinants of health.