Brookdale University Hospital and Medical Center

The optimal long-term antithrombotic strategy after apparently successful catheter ablation of atrial fibrillation (AF) remains uncertain, particularly in patients who meet conventional guideline thresholds for oral anticoagulation (OAC). To compare continuation versus cessation strategies of long-term OAC after successful AF ablation and to quantify net clinical benefit (NCB) integrating thromboembolic and bleeding outcomes. We searched PubMed, Cochrane CENTRAL, and Embase from inception through February 2026 for randomized and comparative observational studies evaluating long-term OAC continuation versus cessation (no OAC and/or switch to aspirin) after successful AF ablation. Risk of bias was assessed using RoB2 for randomized trials and a modified Newcastle-Ottawa Scale (NOS) for observational studies. Random-effects meta-analyses used a restricted maximum likelihood estimator with Hartung-Knapp adjustment. NCB was calculated as: thromboembolic event rate - (1.5 × major bleeding rate). Six studies met the inclusion criteria (four randomized trials and two observational cohorts). Stroke/transient ischemic attack (TIA) events were reported in six studies and were not significantly different between OAC continuation and cessation strategies (OR 0.69; 95% CI 0.24-1.99; p = 0.49). Systemic embolism (three studies) did not differ between groups (p = 0.12). Major bleeding (five studies) was numerically higher with continued OAC but not statistically significant (OR 2.07; 95% CI 0.88-4.86; p = 0.09). In NCB analysis, continued OAC yielded more negative or near-neutral NCB values, whereas, the cessation strategies were less negative or marginally positive; the fixed-effect risk difference in NCB (continued OAC vs cessation) was +0.00067 (95% CI -0.00279 to +0.00413). This meta-analysis suggests that after successful AF ablation, continuing OAC does not significantly reduce stroke risk compared to cessation or switching to aspirin, but it may increase major bleeding. While NCB trends favor cessation, the low absolute event rates and the risk of silent AF recurrence necessitate caution.

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant contributor to morbidity and mortality, linked to adverse cardiovascular outcomes. While extensive research highlights the cardiovascular burden in non-lean MASLD, lean MASLD remains comparatively understudied. To address this gap, our study evaluates cardiovascular outcomes in lean MASLD compared with non-lean MASLD. This is a retrospective cohort study of patients with MASLD identified in the multi-institutional database, TriNetX. Lean MASLD was defined as a body mass index <25 kg/m 2 . Leveraging 1:1 propensity score matching, we balanced baseline characteristics, including age, sex, comorbidities, laboratory values, and medication use. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular events, cerebrovascular outcomes, new-onset heart failure, and all-cause mortality over 1-, 3-, 5-, and 7-year follow-up. After matching, there were 67,519 patients in both groups. At 7-year follow-up, lean patients with MASLD demonstrated significantly higher rates of new onset heart failure compared with non-lean patients with MASLD (HR: 1.23, 95% CI: 1.16-1.31, P < 0.0001), composite cardiovascular events (HR: 1.21, 95% CI: 1.13-1.30, P < 0.0001), cerebrovascular events (HR: 1.33, 95% CI: 1.24-1.43, P < 0.0001), and all-cause mortality (HR: 1.48, 95% CI: 1.38-1.59, P < 0.0001). These increased risks were noted at 1-, 3-, and 5-year follow-up. Patients with lean MASLD are at significantly higher risks of cardiovascular events and all-cause mortality compared with non-lean patients with MASLD. Further research is needed to clarify the underlying pathophysiology and develop tailored interventions to improve outcomes for this growing population.

Abnormalities in the synthesis or structure of globin chains are known as hemoglobinopathies, and they produce a wide range of clinical phenotypes. When both alleles of the same gene carry different hemoglobin variants, this results in compound heterozygosity. The condition described in this case report (hemoglobin C (HbC)/beta-zero (β⁰)-thalassemia) is one such example. On their own, neither HbC nor β⁰-thalassemia is typically associated with acute vaso-occlusive crises, and the combination of HbC/β⁰-thalassemia has not been well characterized. Limited reports indicate that this genotype is not known to cause pain episodes resembling those seen in HbSC disease. Here, we describe a 32-year-old woman with DNA-confirmed HbC/β⁰-thalassemia. She has chronic transfusion dependence, marrow expansion, and anemia, with a baseline hemoglobin of about 8 g/dL. Despite treatment with hydroxyurea and opioid therapy, she has persistent diffuse bone pain. During the current admission, she presented with worsening pain, nausea, and vomiting. Laboratory findings showed stable hemoglobin compared to her baseline, without leukocytosis or sickling, and imaging revealed no acute pathology. Her pain was managed with intravenous hydromorphone, with plans to transition to oral methadone and oxycodone as needed before discharge. This case illustrates the difficulty of managing severe pain in HbC/β⁰-thalassemia, particularly when symptoms occur with high intensity but without evidence of vaso-occlusion or acute hemolysis. While extramedullary hematopoiesis is a leading explanation for her pain, the degree of pain she experienced is unusual in the absence of acute sickling. Given the rarity of this genotype and the limited amount of published data, management remains challenging. Further research is needed to clarify the mechanisms of pain in HbC/β⁰-thalassemia and to distinguish organic causes from central sensitization in patients with chronic opioid use.

Heart transplantation remains the ultimate treatment option for patients with end stage heart disease, but donor supply remains insufficient, thereby complicating its allocation. Traditional scoring systems have demonstrated limited accuracy in predicting transplant outcomes, implying the need for more advanced approaches. Machine learning (ML) and artificial intelligence (AI) models show promising potential in predicting post-transplant prognosis, rejection risk and mortality by analyzing complex multidimensional variables beyond the capacity of conventional models. This meta analysis evaluates the application and performance of ML algorithms in image analysis and outcome prediction in patients undergoing cardiac transplantation. This meta analysis was conducted in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-analysis” (PRISMA) guidelines. An extensive search was conducted in all the major medical databases for relevant articles concerning machine learning algorithms and its application in cardiac transplantation. This was followed by an in-depth review of the included papers for relevant characteristics and outcomes. The statistical analysis was performed in R-Studio. Pooled area under the curve (AUC) was assessed using Ruttergatsonis model and the heterogeneity was assessed using the I^2 test. This review included a total of 17 papers with 512504 patients (prognostic elements) and 10 AI algorithms. Statistical analysis indicated pooled area under the curve(AUC) of 0.77[0.68;0.87,95%CI,p=0.9999]. A maximum AUC of 0.89 was observed with the RF algorithm by Miller et al and a minimum of 0.64 with the ANN algorithm by Lisboa et al and Nilsson et al. The papers were reviewed for relevant qualitativeas well as quantitative data pertaining to the performance of AI models. The capacity of AI algorithms in the domain of predicting cardiac transplant outcomes has been statistically established. The machine learning algorithms show promising clinical applications and utility in further enhancing the effectiveness of cardiac transplantation.

Amid the dismantling of state structures in Haiti, the first Black republic faces significant health disparities compared to its former colonial power, France. These disparities include lower life expectancy (64.8 vs. 82.3 years) and higher infant and maternal mortality rates. The situation is further exacerbated by widespread mental health issues, severe food insecurity (50% acute vs. 37% moderate), and elevated homicide rates (13.35 vs. 1.35 per 100,000 inhabitants). As calls grow for France to return the independence ransoms extracted from Haiti, there remains limited data on how reparations could impact the country’s public health, community well-being, or effective implementation of healing programs. Between Spring and Fall 2023, we conducted 4 focus groups: 1st with Haitian men and women residing in the United States, a 2nd-with men in Haiti, a 3rd with women in Cap-Haïtien and Les Cayes, and a 4th with women in Cité Soleil. We conducted focus groups structured interview protocol, comprised of open-ended questions categorized into 4 thematic sections. These questions provided insights into participants’ perceptions on mental health, the daily challenges and barriers to access care, and community-based healing. Participants emphasized need for policies that address the social determinants of health, ensure safety and justice, and promote healthier workplace environments. They also advocated for mental health education aimed at reducing stigma, cultivating trust, and strengthening community support systems; with an emphasis on developing professional training, ethics, and sustainable long-term mental health services accessible for individuals of all ages. Haitian participants underscore the critical need to restore security, address the social determinants of health, and implement community-based mental health initiatives. We propose a biopsychosocial-ecological approach to guide reparations efforts. A targeted investment of $30 billion could yield substantial improvements in healthcare, mental health services, and public safety—contributing to increased life expectancy, reduced mortality rates, and decreased violence.