Bridgeport Hospital

Semaglutide, a glucagon-like peptide-1 receptor agonist, and resmetirom, a thyroid hormone receptor-β agonist, are approved therapies for noncirrhotic metabolic dysfunction–associated steatohepatitis (MASH) with moderate to advanced fibrosis. Their comparative economic value has not been established. To evaluate the cost-effectiveness of semaglutide and resmetirom compared with standard of care (SOC) in patients with noncirrhotic MASH and F2–F3 fibrosis. A state-transition model simulated disease progression in a hypothetical cohort with F2–F3 fibrosis over 5- and 10-year horizons from a U.S. healthcare payer perspective. Clinical efficacy inputs were derived from phase 3 trials (ESSENCE and MAESTRO-NASH), with costs and utilities obtained from published sources. Scenario analyses incorporated semaglutide’s cardiovascular mortality benefit. Deterministic and probabilistic sensitivity analyses assessed uncertainty. Semaglutide was cost-effective versus SOC at 5 years (ICER, $42,200/QALY) and 10 years (ICER, $44,138/QALY). Resmetirom produced higher ICERs ($95,981/QALY at 5 years; $107,002/QALY at 10 years) but remained below a $150,000/QALY threshold. Inclusion of cardiovascular mortality benefits improved semaglutide’s ICER to $38,324/QALY. Probabilistic analyses showed semaglutide had the highest probability of cost-effectiveness across willingness-to-pay thresholds. Over a 10-year horizon, treatment of 100,000 patients with F2–F3 MASH was projected to prevent 270 cases of decompensated cirrhosis, 10 cases of hepatocellular carcinoma, and 1,040 liver-related deaths with semaglutide, compared with 310 cases of decompensated cirrhosis, 10 cases of hepatocellular carcinoma, and 1,180 liver-related deaths with Resmetirom. Semaglutide demonstrated superior cost-effectiveness compared with SOC and resmetirom, with cardiovascular benefits further strengthening its economic value. Not applicable.

Artificial sweeteners (AS) are widely used as sugar substitutes, particularly among individuals with metabolic disorders. Although AS are approved by regulatory authorities, concerns regarding their potential association with cancer risk persist due to inconsistent findings across studies. This umbrella review aimed to comprehensively synthesize evidence from published meta-analyses evaluating the association between AS consumption and cancer risk. A systematic search of PubMed, Web of Science, and Scopus was conducted to identify meta-analyses examining the association between AS consumption and cancer outcomes in human populations. Data synthesis was performed using random-effects models, and evidence certainty was evaluated using the GRADE framework. Sensitivity analyses, prediction intervals, and publication bias assessments were conducted when applicable. Overall AS consumption was not significantly associated with breast cancer (OR = 0.99, 95% CI 0.92–1.08, P = 0.99), colorectal cancer (CRC) (OR = 0.90, 95% CI 0.76–1.05, P = 0.18), pancreatic cancer (OR = 1.04, 95% CI 0.93–1.17, P = 0.44), gastric cancer (OR = 0.93, 95% CI 0.63–1.36, P = 0.71), or bladder cancer (OR = 1.19, 95% CI 0.75–1.88, P = 0.44). Dose-specific analyses showed no significant associations between AS consumption and breast cancer across low-dose (OR = 1.00, 95% CI 0.95–1.06, P = 0.83), moderate-dose (OR = 0.97, 95% CI 0.94–1.01, P = 0.21), or high-dose categories (OR = 0.88, 95% CI 0.73–1.06, P = 0.18). For CRC, low-dose AS consumption was associated with a reduced risk (OR = 0.87, 95% CI 0.76–0.99, P = 0.04; GRADE: low), whereas moderate-dose (OR = 1.11, 95% CI 0.92–1.33, P = 0.25) and high-dose AS consumption (OR = 0.89, 95% CI 0.79–1.00, P = 0.05) showed no significant associations with CRC risk. Based on the GRADE framework, the certainty of evidence was rated as low for breast cancer, CRC, and pancreatic cancer, very low for bladder cancer, and not assessable for gastric cancer due to the limited number of studies. Although no significant cancer risks were identified, the overall strength of the evidence was weak. More well-designed, high-quality studies are necessary to further explore and clarify the long-term impact of AS on cancer risk. Additionally, there is insufficient evidence available to assess the effects of AS on other cancer types, and further research is needed in this area.

BackgroundThe rapid integration of telemedicine into cardiovascular care requires a comprehensive understanding of patient satisfaction to maintain service quality and equity. Although telemedicine adoption is increasing in Saudi Arabia, patient-centered evaluations, particularly for specialized services such as cardiology in non-urban regions, are lacking. This study assessed patient satisfaction and identified its key predictors within a cardiac telemedicine service in Najran, Saudi Arabia.Patients and methodsA prospective cross-sectional study was conducted among 109 consecutive patients attending the Najran Cardiac Virtual Clinic between June and August 2024. Participants completed a validated electronic survey that collected sociodemographic data, clinical history, and satisfaction levels across 12 domains of telemedicine care, rated on a four-point Likert scale from Poor to Excellent. High overall satisfaction was defined as a composite score at or above the 75th percentile of the sample distribution. Predictors of satisfaction were identified using univariate and multivariable logistic regression models.ResultsThe mean age of participants was 47.1±17.2 years, and 60 (55.0%) were female. Overall satisfaction was very high, with 104 patients (95.4%) rating their experience as "Good" or "Excellent." The highest-rated domains were confidentiality and privacy (104/109, 95.4% Good/Excellent) and ease of use (104/109, 95.4%). Multivariable analysis identified two independent predictors of high satisfaction: higher educational attainment (associated with 3.1 times higher odds of high satisfaction; adjusted odds ratio (aOR): 3.1, 95% CI: 1.2-8.0; p=0.019) and a lower count of comorbidities (fewer than three versus three or more comorbidities; aOR: 2.8, 95% CI: 1.1-7.3; p=0.034).ConclusionCardiac telemedicine services in Najran achieved high patient satisfaction and demonstrated broad acceptability across age, gender, and residential settings. This study provides one of the first patient-centered evaluations of a dedicated cardiac telemedicine service in a non-urban region of Saudi Arabia. However, significantly lower satisfaction was reported by patients with lower educational attainment and those with multiple comorbidities. To ensure equitable delivery, these groups require prioritized interventions such as tailored digital literacy support, simplified interfaces, and integrated care pathways.

Background: Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy with transient left ventricular dysfunction, often triggered by acute illness. Coronavirus disease 2019 (COVID-19) has been implicated as a precipitant, but comparative outcome data for COVID-19-related versus non-COVID-19 TCM remain largely limited to the early pandemic, when few effective treatments existed.Methods: We conducted a retrospective cohort study using the TriNetX database, identifying US adults hospitalized between March 2020 and March 2025 with TCM and created two cohorts: patients with TCM and laboratory-confirmed COVID-19 and patients with TCM without COVID-19, both diagnosed within 14 days of admission. The primary outcome was 30-day all-cause mortality, with secondary 30-day outcomes and one-year mortality also assessed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated.Results: Of 16,649 patients (6,367 COVID-19 TCM and 10,282 non-COVID-19 TCM), 5,955 per group remained after propensity score matching. Baseline demographics and comorbidities were well balanced (mean age 66.8 years; 76.8% female). Thirty-day mortality did not differ significantly between COVID-19 and non-COVID-19 TCM (12.0% vs. 11.1%; HR 1.07, 95% CI 0.97-1.19). However, COVID-19 TCM was associated with higher risks of heart failure with reduced ejection fraction (HFrEF) (HR 1.18, 95% CI 1.10-1.26), cardiogenic shock (HR 1.25, 95% CI 1.08-1.46), and ventricular arrhythmias (HR 1.37, 95% CI 1.14-1.64). One-year mortality was significantly higher in the COVID-19 cohort (22.0% vs. 18.3%; HR 1.19, 95% CI 1.10-1.29).Conclusion: COVID-19-associated TCM is not linked to excess short-term mortality but carries higher risks of acute complications and significantly worse one-year survival, highlighting the persistent effects of COVID-19 after an acute infection.

Once considered a concern solely for the gut, gluten is now recognized as an important factor in the pathogenesis of metabolic dysfunction-associated steatotic liver disease. Studies estimate that 18%-40% of individuals with gluten-related diseases have elevated liver enzyme levels, with 9% of patients with unexplained hypertransaminasemia ultimately diagnosed with gluten sensitivity. Hepatic manifestations of gluten sensitivity range from mild transaminase elevations to autoimmune liver diseases, metabolic dysfunction-associated steatotic liver disease, and even cirrhosis. Up to 50% of untreated cases of gluten-induced liver dysfunction show significant hepatic injury, which can lead to liver failure in severe cases. The pathophysiology is multifaceted and involves increased intestinal permeability, immune dysregulation, and shared genetic risk factors. A gluten-free diet leads to normalized liver enzymes in 75%-90% of cases within 1 year. Long-term gluten-free diet adherence has been paradoxically linked to higher body mass index, insulin resistance and increased hepatic steatosis risk, which raise concerns about its metabolic impact. Our review dissects the gluten-liver axis, emphasizing a need for early recognition, targeted screening, and personalized dietary interventions. Ultimately, given the increasing global burden of metabolic and autoimmune liver diseases, understanding gluten’s role is essential for optimizing liver health and preventing progressive hepatic injury.