Baylor University Medical Center Proceedings最新文献

Background: West Nile virus is a single-stranded RNA arbovirus with variable clinical presentation.

Methods: To better understand the clinical characteristics, diagnostic evaluation, and outcomes, we performed a retrospective analysis of the Baylor Scott & White Health medical records for hospitalized adult patients with West Nile virus from January 1, 2015, to September 1, 2024.

Results: A total of 79 patients were included. Most were male (55.7%) with a mean age of 64.15 years. The highest concentration of cases was reported in Dallas County (34.2%) and Tarrant County (22.8%). Seventy-three patients (92.4%) had neuroinvasive disease, while 6 patients (7.8%) had nonneuroinvasive disease. Presenting symptoms included fever (73.43%), confusion (49.59%), and weakness (40.51%). Six patients (7.6%) were found to have acute ischemic stroke during their admission. Fifteen patients (18.99%) died. Cerebrospinal fluid analysis generally showed elevated protein (mean value 104.7 mg/dL) with either neutrophilic (mean 32%) or lymphocytic pleocytosis (mean 51.6%). None of the treatments analyzed (intravenous immunoglobulin, plasma exchange, and steroids) was found to have any significant effect on morbidity and mortality.

Conclusion: West Nile virus is a common recurring disease across Texas. While some cases progress to neuroinvasive disease, there appears to be no meaningful way to predict these cases based on clinical and demographic data.

Background: Venous thromboembolism (VTE) poses a significant clinical burden, ranking as the third primary contributor to cardiovascular-related mortality. While extended anticoagulation reduces recurrence, it raises bleeding risks. Reduced-dose direct oral anticoagulants (DOACs) may offer an optimal balance by preventing VTE recurrence while minimizing hemorrhage. This meta-analysis evaluated the efficacy and safety of reduced-dose DOACs for secondary VTE prevention.

Methods: We established a thorough systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches through March 20, 2025. Dichotomous data were pooled utilizing risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), implemented with R version 4.3.

Results: Our analysis included three randomized controlled trials encompassing 8615 patients. Reduced-dose anticoagulation was associated with a statistically significant decrease in the incidence of major bleeding (RR: 0.49 [95% CI: 0.29-0.81]; P < 0.01), clinically relevant nonmajor bleeding (RR: 0.72 [95% CI: 0.58-0.89]; P < 0.01), and all-cause mortality (RR: 0.66 [95% CI: 0.46- 0.97]; P = 0.03). However, there were no significant differences between the two groups in the incidence of recurrent VTE (RR: 0.98 [95% CI: 0.66-1.48]; P = 0.94), recurrence of nonfatal pulmonary embolism (RR: 1.09 [95% CI: 0.59-2.03]; P = 0.78), fatal pulmonary embolism recurrence (RR: 0.66 [95% CI: 0.19-2.34]; P = 0.52), and deep vein thrombosis recurrence (RR: 1.14 [95% CI: 0.62-2.09]; P = 0.68). Similarly, there were no significant differences in the incidence of any adverse events (RR: 1.01 [95% CI: 0.98- 1.05]; P = 0.51) and serious adverse events (RR: 0.92 [95% CI: 0.83-1.02]; P = 0.11).

Conclusion: This meta-analysis demonstrated that reduced-dose DOACs offer an effective approach for extended VTE prophylaxis, significantly reducing major bleeding risks without compromising protection against recurrent thrombosis. Notably, the data indicate a potential mortality benefit, solidifying their role in long-term management. These findings advocate for individualized therapy tailored to patient risk profiles, prioritizing an optimal efficacy-safety balance. Further large-scale randomized controlled trials are needed to validate long-term outcomes, refine dosing strategies, and define patient subgroups that derive the maximal benefit.

Heterotaxy syndrome, or situs ambiguus, is a rare congenital condition characterized by abnormal left-right positioning of thoracoabdominal organs. It often includes splenic anomalies such as polysplenia and vascular malformations like interruption of the inferior vena cava (IVC) with azygos continuation. These anatomical variants can impair venous return, increasing the risk of venous thromboembolism, particularly in young patients. We present the case of an 18-year-old woman with obesity and long-term estrogen-containing oral contraceptive use who presented with acute bilateral pulmonary emboli. Initial imaging noted polysplenia, but the diagnosis of heterotaxy syndrome with IVC interruption and azygos continuation was not made until 5 months later during evaluation for recurrent chest pain. Hypercoagulable workup was negative, and anticoagulation was continued due to ongoing thrombotic risk. This case highlights heterotaxy syndrome as an underrecognized contributor to venous thromboembolism in young individuals and underscores the importance of considering anatomical risk factors in cases of unprovoked thromboembolism.

Background: Asthma and cardiovascular disease (CVD) are major health burdens with potential interconnections. This study analyzed mortality trends and demographic and regional disparities in US adults with coexisting asthma and CVD from 1999 to 2020.

Methods: Using CDC WONDER data, we examined death certificates for individuals aged ≥25 years who died from 1999 to 2020 with both CVD (ICD I00-I99) and asthma (ICD J45-46). Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity, region, and urbanization.

Results: There were 145,404 deaths involving both asthma and CVD. AAMR rose from 3.5 to 4.6 per 100,000, with a sharp increase from 2018 to 2020 (APC: 28.5; 95% CI: 17.34-35.05). Older adults had the highest AAMR (10.2). Women had higher rates than men (3.5 vs 2.4). Non-Hispanic (NH) Blacks had the highest AAMR (6.1), followed by NH American Indian/Alaska Natives (3.8), NH Asian/Pacific Islanders (3.5), Hispanics (3.0), and NH Whites (2.7). The Western region had the highest AAMR (3.7). Rates were similar across urban and rural areas.

Conclusions: Mortality from coexisting asthma and CVD increased, especially among older adults, women, and NH Black individuals. Targeted public health strategies are needed to address these disparities.

Carney-Stratakis syndrome (CSS) is a rare hereditary disorder involving gastrointestinal stromal tumors (GISTs) and paraganglioma/pheochromocytoma, typically linked to mutations in the SDHB, SDHC, and SDHD genes. The unique mechanism of tumorigenesis, including pseudohypoxia and hypermethylation caused by succinate dehydrogenase deficiency, renders target therapy with tyrosine kinase inhibitors ineffective; therefore, complete surgical resection is the optimal treatment in the absence of tumor metastases. Herein, we report the case of a 74-year-old woman with gastric GIST and urinary bladder paraganglioma. Molecular testing on the gastric GIST revealed a cKIT exon 11 mutation, and germline testing showed a variant of uncertain significance in the DIS3L2 gene. The patient has been on imatinib since July 2023 with controlled disease. To the best of our knowledge, this is the first reported case of CSS with a DIS3L2 variant. Further reports and studies are needed to establish a definitive association between this gene and CSS.

We report a case of a previously healthy 4-year-old girl who presented with two recurrent episodes of complicated pneumonia and Haemophilus influenzae bacteremia. Immunologic evaluation revealed hypogammaglobulinemia, as immunoglobulins (IgG, IgA, IgM, IgE) were below detectable levels and genetic testing identified a pathogenic TCF3 variant, confirming a diagnosis of TCF3 (transcription factor 3) deficiency. TCF3 is a key transcription factor in B- and T-cell development, and its deficiency results in impaired antibody production and increased susceptibility to infections. This case highlights the rarity of TCF3 mutations in pediatric patients, the importance of early recognition, and the critical role of immunoglobulin replacement therapy as the current mainstay of treatment.

BRAF inhibitors are a class of targeted therapies used in the treatment of malignant melanoma. They are the standard of care in the treatment of advanced BRAF-mutated malignant melanoma and are generally well tolerated. However, in rare cases, an adverse effect involving granulomatous lymphadenopathy may occur. This case report discusses a patient receiving BRAF inhibitor therapy who developed mediastinal lymphadenopathy with necrotizing granulomatous disease found on intranodal forceps biopsy.

Neonatal cholestasis is a pathological condition characterized by impaired bile flow in infants, typically presenting within the first 3 months of life. While common etiologies include biliary atresia, metabolic disorders, and infections, rare causes such as congenital portosystemic shunts must also be considered in the differential diagnosis. We present the case of a term infant with a congenital portosystemic shunt who presented with cholestasis and hyperammonemia. Bilirubin and liver function enzymes gradually decreased after initiation of ursodeoxycholic acid therapy. In newborns presenting with hypoglycemia, cholestasis, and thrombocytopenia, initial investigations are usually performed for metabolic diseases, congenital infections (toxoplasmosis, cytomegalovirus, rubella, herpes simplex virus), and genetic causes. As these tests may take time to return, early radiological imaging should be pursued to evaluate for anatomical abnormalities.

Background: The superiority of incision type in liver transplant has yet to be clearly established.

Methods: In this study, we reviewed all liver-only transplant recipients at the Simmons Transplant Institute from 2012 to 2018 and divided them based on two incision types: Mercedes (M) and hockey stick (HS).

Results: A total of 765 patients met inclusion criteria: 278 had an M incision (36%) and 487 had an HS incision (64%). There was no difference between groups based on sex, age, body mass index, presence of ascites pretransplant, and prior open abdominal surgeries. After transplant, the incidence of fascial dehiscence and subsequent incisional hernia repairs between groups was the same. However, patients with an M incision had more wound infections (4.3% vs 1.2%, P = 0.007), required more wound vacuum-assisted closure device placements (25% vs 13%, P < 0.001), and had higher rates of washouts (25% vs 14%, P < 0.001). There was no difference in wound complications between the use of polydioxanone or polypropylene (Prolene) as the fascial closing suture of choice. Significant risk factors for the development of an incisional hernia included sex, age, and body mass index.

Conclusion: Our results indicate that M incisions require greater postoperative wound care.