Erie County Medical Center

ObjectivesChronic heart failure (CHF) restricts daily functioning and quality of life. Anaemia is frequent in CHF and can impair functional outcomes. This research evaluated the effectiveness of anaemia on functional status among Pakistani CHF patients.Materials and MethodsThis cross-sectional study comprised 310 patients aged 18 years and above who attended outpatient clinics and community health centres in Islamabad and Rawalpindi. The structured questionnaire was used to gather data on demographics, self-reported anaemia, and medical history. Functional status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Descriptive statistics, chi-square, t-tests, correlation, two-way ANOVA, and multiple regression were analysed.Results239 respondents (77%) were anaemic. The KCCQ-12 scores (30.9 ± 3.9) were lower in anaemic patients (34.1 ± 3.2), and there was an inverse relationship between functional status and anaemia (r = -0.338, p < 0.001). There were significant effects of anaemia (p < 0.001), age (p < 0.001), and both (p < 0.001) in two-way ANOVA, with older anaemic patients more impaired. Regression revealed that anaemia (B = -2.10), age (B = -1.25), female gender (B = -0.95), comorbidities (B = -0.48), and smoking (B = -0.65) were the predictors of poor functional status (p = 0.05).ConclusionsAnaemia is ubiquitous among CHF patients in Pakistan and closely associated with diminished functional capacity, especially in the elderly. Anaemia screening and treatment should be part of CHF management to enhance the quality of life.

Patients seeking information about maxillofacial prosthodontic care increasingly turn to artificial intelligence (AI)-driven chatbots for guidance. However, the readability, accuracy, and clarity of these AI-generated responses have not been adequately evaluated within the context of maxillofacial prosthodontics. The purpose of this study was to assess and compare the readability and performance of chatbot-generated responses to frequently asked questions about intraoral and extraoral maxillofacial prosthodontics. A total of 20 frequently asked intraoral and extraoral questions were collected from 7 maxillofacial prosthodontists. These questions were submitted to 4 AI chatbots: ChatGPT, Gemini, Copilot, and DeepSeek. A total of 80 responses were evaluated. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL). Seven maxillofacial prosthodontists were calibrated to score the chatbot responses on 5 domains, relevance, clarity, depth, focus, and coherence, using a 5-point scale. The obtained data were analyzed using 2-way ANOVA with post hoc Tukey tests, Pearson correlation analyses, and intraclass correlation coefficients (ICCs) (α=.05). FKGL scores differed significantly among chatbots (P=.002). DeepSeek had the lowest FKGL, indicating better readability, while ChatGPT had the highest. Word counts, relevance, clarity, content depth, focus, and coherence varied significantly among platforms (P<.005). ChatGPT, Gemini, and DeepSeek consistently scored higher, while Copilot had the lowest scores across all domains. For questions on intraoral prostheses, FKGL scores negatively correlated with word count (P=.013). For questions on extraoral prostheses, word count positively correlated with all qualitative metrics except for FKGL (P<.005). Significant differences were found in both readability and response quality among commonly used AI chatbots. Although the DeepSeek and ChatGPT platforms produced higher-quality content, none consistently met health literacy guidelines. Clinician oversight is essential when using AI-generated materials to answer frequently asked questions by patients requiring maxillofacial prosthodontic care.

BACKGROUNDStable angina pectoris, a clinical manifestation of coronary artery disease (CAD), is commonly evaluated using non-invasive diagnostic tools. Traditionally, stress testing modalities such as exercise electrocardiography (ECG), myocardial perfusion imaging (MPI), and stress echocardiography have been the first-line strategies. However, coronary computed tomography angiography (CCTA), an anatomic imaging modality, is increasingly used for its ability to directly visualize coronary artery stenoses and plaque burden. Despite growing adoption, the comparative effectiveness of CCTA and stress testing in terms of diagnostic accuracy, prognostic value, and clinical outcomes in stable angina remains an area of active debate.AIMTo compare the diagnostic and prognostic performance of CCTA with various forms of stress testing in adult patients presenting with suspected or confirmed stable angina.METHODSA comprehensive literature search was performed across PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials in accordance with the PRISMA guidelines. Only randomized controlled trials (RCT) published in English within the last 15 years were included. Studies involving adult patients (≥ 18 years) with stable angina or low-risk chest pain were selected. The intervention was CCTA, and the comparators included ECG, MPI, and stress echocardiography. Data were extracted using a standardized process, and study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Due to heterogeneity in outcome measures and modalities, narrative synthesis was employed.RESULTSFive high-quality RCTs encompassing a total of 5551 patients were included. CCTA demonstrated superior diagnostic accuracy and prognostic capability across multiple studies. It was more effective in predicting major adverse cardiac events, including myocardial infarction and cardiac death, and was associated with fewer unnecessary invasive coronary angiographies and better event-free survival. Studies also reported improved revascularization rates in patients evaluated with CCTA, particularly within tiered diagnostic protocols. Stress testing, while useful, showed limitations in sensitivity and downstream clinical decision-making.CONCLUSIONCCTA offers a diagnostically superior and clinically impactful strategy for the initial evaluation of patients with stable angina, especially those with intermediate pretest probability of CAD. Compared to conventional stress testing, it enhances risk stratification, reduces unnecessary procedures, and may improve long-term outcomes. These findings support its broader integration into diagnostic pathways for stable angina.

This systematic review evaluated the role of human albumin infusion in patients with decompensated cirrhosis, refractory ascites, acute-on-chronic liver failure (ACLF), and hepatorenal syndrome type 1 (HRS-1). A total of 398 studies were screened, with 125 excluded for not meeting eligibility criteria, and the final selection comprised randomized controlled trials and clinically relevant post hoc analyses published between 2016 and 2024. The findings suggest that albumin infusion confers significant benefits in reducing the incidence of post-paracentesis circulatory dysfunction (PICD), acute kidney injury (AKI), and hyponatremia, while also improving survival in selected patient populations. Comparative trials demonstrated that albumin may outperform standard care and support vasoconstrictor-based regimens, though cost-effectiveness concerns remain when compared to alternatives such as midodrine. The evidence base is strengthened by large multicenter trials with objective outcomes, though limitations include small pilot studies, post hoc subgroup analyses, and heterogeneity in dosing strategies. Overall, albumin infusion appears to be a clinically valuable intervention in the management of advanced cirrhosis, but further trials are warranted to clarify its long-term effects, particularly on hepatocellular carcinoma progression and optimal treatment regimens.

This systematic review evaluated randomized controlled trials examining the effects of glucagon-like peptide-1 (GLP-1) receptor agonists on microvascular outcomes in type 2 diabetes, focusing on diabetic retinopathy and nephropathy. Four eligible RCTs, enrolling over 27,000 patients with follow-up periods ranging from 32 weeks to 5.4 years, were included. GLP-1 receptor agonists consistently demonstrated renal protective effects, primarily driven by reductions in new or worsening nephropathy and macroalbuminuria, with more modest and inconsistent effects on estimated glomerular filtration rate (eGFR) decline. In contrast, their impact on retinopathy remained inconclusive. A transient signal of worsening retinopathy has been reported in the context of rapid glycemic improvement; however, across large outcome trials, effects on retinopathy have been inconsistent and remain inconclusive. Overall, the evidence for retinopathy risk is limited by small event numbers, heterogeneity in assessments, and exploratory analyses. The certainty of renal benefit was strengthened by rigorous trial designs and low risk of bias, whereas retinopathy outcomes were generally secondary and less robust. These findings suggest that GLP-1 receptor agonists can be prioritized for patients at high renal risk, but careful monitoring of individuals with pre-existing retinopathy remains warranted.

This systematic review evaluates the effect of rapid diagnostic tests (RDTs) on clinical outcomes in patients with bloodstream infections (BSIs), with particular emphasis on their integration into antimicrobial stewardship programs (ASPs). A comprehensive literature search across PubMed, Scopus, Embase, and the Cochrane Central Register of Controlled Trials identified randomized controlled trials (RCTs) and post-hoc analyses that compared RDTs, including multiplex polymerase chain reaction (PCR), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and rapid phenotypic antimicrobial susceptibility testing (AST), with conventional microbiological workflows. Studies were assessed for methodological quality using the Cochrane risk of bias tool. Outcomes of interest included time to effective therapy, antimicrobial optimization, mortality, and hospital length of stay. The included RCTs consistently demonstrated that RDTs, particularly when paired with ASP interventions, accelerated therapeutic decisions and improved antibiotic targeting compared with conventional methods. Importantly, this review is novel in restricting inclusion to RCT evidence and in examining individual diagnostic modalities, offering more granular insights than prior reviews that pooled heterogeneous study types. However, variability in study design, population characteristics, and outcome definitions highlights the need for standardized research approaches and consistent integration with stewardship frameworks. Overall, the findings support the clinical value of RDTs in enhancing BSI management and optimizing antimicrobial therapy, while underscoring that their impact is maximized when embedded within structured ASPs. These results carry important implications for both high-income and resource-limited healthcare settings, reinforcing the role of diagnostic stewardship in translating rapid results into improved patient outcomes.

This letter, signed by over 50 academic chairs of emergency medicine, urges the ACGME to reconsider a proposed mandate requiring all emergency medicine residency programs to adopt a four-year training model. The authors argue that current three-year programs are supported by data demonstrating equivalent educational and clinical outcomes compared to four-year formats. They criticize the flawed survey methodology underpinning the proposal, note the loss of milestone-based training flexibility, and highlight the lack of added scholarly or clinical value in the fourth year. The letter also outlines negative consequences for fellowship participation, workforce development, trainee debt, and diversity. The signatories advocate for maintaining the current flexible training model to preserve excellence, equity, and innovation in emergency medicine education.

BackgroundMedical students face increased threats to their sleep quality and lifestyle health because academic stress and unpredictable class hours create these challenges. Medical students commonly use too much caffeine as a stress management tool, but research lacks data about how caffeine affects both sleep quality and restless legs syndrome (RLS) symptoms. MethodsThe study utilized a research design combining cross-sectional analysis and correlation assessment with a participant group of 300 medical students ranging from 18 to 30 years old. Data was collected from January to March 2025. The Caffeine Consumption Questionnaire, combined with the Pittsburgh Sleep Quality Index (PSQI) and Restless Legs Syndrome Symptom Severity Scale, enabled researchers to collect necessary data. IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY) served as the platform to perform all statistical assessments through descriptive statistics, ANOVA tests, chi-square tests, correlation analysis, and multiple regression procedures.ResultsThe medical students among the surveyed sample of 300 showed 237 participants (79%) caffeine consumption, while 78 participants (26%) consumed it nightly. Studies revealed that RLS symptoms affected 34 participants (11.2%) of participants as increased caffeine consumption resulted in milder RLS (r = -0.383, p < 0.01) yet negatively impacted sleep quality (r = 0.197, p < 0.01). The students who consumed caffeine in the morning experienced the highest sleep quality and the lowest severity of RLS symptoms (r = -0.266, p < 0.01). Additionally, poor sleep deteriorated RLS symptoms.ConclusionHigher caffeine use minimizes the reported intensity of RLS symptoms but leads to diminished sleep quality, particularly when coffee is taken late in the day. The combination of poor sleep and RLS symptoms creates a continuous worsening effect that persists across the cycle. Medical students' overall health and academic performance depend on specific intervention methods that teach proper sleep habits and caffeine consumption.