Jersey Shore University Medical Center

In the United States, colorectal cancer is the third most prevalent non-skin cancer, causing 8% of cancer-related deaths. The most effective way to decrease cancer morbidity and mortality is cancer screening. However, individuals who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) are less likely to utilize cancer screening services compared to the general population. To understand the barriers to effective colorectal cancer screening in the LGBTQ+ population and recommend solutions, we conducted a critical review of the literature using multiple databases until March 2024 using search strings like "colorectal cancer", "screening", "LGBTQ+", "healthcare equity" and "barriers". We addressed the barriers at various levels, including patient, provider, institution, health insurance, healthcare policies, and data and population surveys. Our analysis indicates that the key contributing factors are social stigma, lack of provider awareness, and insufficient culturally competent care. We also recommend potential solutions such as provider training, increasing awareness and accessibility of screening services, and incorporating patient-centered care models. To achieve equitable access to colorectal cancer screening for the LGBTQ+ population, a holistic strategy involving healthcare professionals, lawmakers, and researchers is required. By identifying the challenges and solutions, this minireview aims to promote healthcare equity and better health outcomes for the LGBTQ+ population. Recommendations for future studies are also given to improve healthcare provision for the LGBTQ+ community.

Abstract Background: Anemia is a common comorbidity in patients with heart failure and is strongly associated with adverse clinical outcomes. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, specifically dapagliflozin, may improve anemia-related biomarkers. However, findings from individual trials have been inconsistent, leaving the magnitude and consistency of these effects unclear. Objective: Our study aims to clarify the effects of dapagliflozin on anemia in patients with heart failure. Methods: We conducted a systematic search of PubMed, Embase, Cochrane CENTRAL, and trial registries for randomized and non-randomized clinical trials. Outcomes included changes in hemoglobin, ferritin, transferrin saturation (TSAT), and serum iron. Mean differences (MD) and 95% confidence intervals (CIs) were pooled using random-effects models. We performed sensitivity analyses by sequentially excluding studies and assessed bias using Cochrane tools and ROBINS-I, grading evidence via GRADE. Results: Six studies (n=5,075) were included. Dapagliflozin significantly increased hemoglobin (MD 1.05; 95% CI 0.75–1.35; P < 0.00001). Ferritin was significantly reduced (MD –14.50; 95% CI –22.13 to –6.86; P = 0.0002); sensitivity analyses excluding Bhaganagarapu et al. amplified this reduction (MD –23.37; 95% CI –34.57 to –12.17; P < 0.00001). While TSAT changes were non-significant overall (MD 0.37), sensitivity analysis demonstrated a significant reduction (MD –1.36; 95% CI –2.37 to –0.35). Serum iron remained unchanged (MD –0.09). Evidence certainty was moderate-to-high for hemoglobin and ferritin but low for TSAT and serum iron. Conclusion: In heart failure patients, dapagliflozin reliably increases hemoglobin and decreases ferritin. While the primary analyses for transferrin saturation were non-significant, sensitivity testing revealed significant changes. These findings suggest that dapagliflozin may beneficially influence iron metabolism. However, further large-scale, dedicated trials are warranted to confirm these mechanisms.

Basaloid squamous cell carcinoma (BSCC) of the rectum is an exceptionally rare malignancy, distinct from other more common gastrointestinal cancers. Although human papillomavirus infection is strongly associated with squamous cell carcinomas at other anogenital sites, its role in rectal BSCC remains unclear. We report a 66-year-old woman who presented with fatigue and intermittent hematochezia. Colonoscopy revealed a distal rectal mass, and biopsy confirmed poorly differentiated BSCC. Immunohistochemistry was negative for human papillomavirus. Molecular profiling demonstrated high tumor mutational burden and elevated PD-L1 expression. This case underscores the extreme rarity of rectal BSCC and the diagnostic and therapeutic challenges it poses.

Amyloidosis is increasingly recognized as a contributor to heart failure, particularly among older adults and patients with heart failure with preserved ejection fraction (HFpEF). Despite advances in diagnostic imaging and disease-modifying therapies, amyloidosis remains underdiagnosed in many settings, and population-level data examining its co-occurrence with cardiovascular disease on death certificates are limited. This study examined two decades of national mortality data to evaluate deaths co-coded with amyloidosis and cardiovascular disease (CVD) in the United States and to assess temporal trends and demographic disparities in age-adjusted mortality rates. A retrospective analysis was conducted using mortality data from the CDC WONDER database spanning 1999-2020. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) using Joinpoint 5.0.2. Between 1999 and 2020, 26,391 amyloidosis and CVD-related deaths occurred among adults aged 25 years and older in the United States. The overall AAMR for deaths co-coded with amyloidosis and CVD increased from 4.40 in 1999 to 9.31 in 2020, with an AAPC of 3.49 (p < 0.001). The most pronounced increase occurred between 2018 and 2020 (APC: 13.60). Rates were higher among men than women, with both sexes showing a marked increase in the last decade. African American or Black individuals had the highest rates (11.40), followed by White (5.11) and Hispanic (3.86) individuals. Rates were highest in the Northeast region (6.71). Metropolitan areas had higher rates than non-metropolitan areas (5.73 vs. 4.76), with a more pronounced increase in metropolitan regions. Age-adjusted mortality rates for deaths co-coded with amyloidosis and cardiovascular disease have increased over time, likely reflecting improved recognition and documentation. Higher rates of co-coded deaths were noted among men, African Americans, and individuals in the Northeast region, highlighting potential disparities in diagnostic access and recognition.

The ZAP-X (ZAP Surgical Systems, Inc., San Carlos, CA) is the newest dedicated cranial stereotactic radiosurgery (SRS) platform. A prospective study was conducted between October 2023 and January 2025 involving 200 patients with 374 intracranial targets treated using ZAP-X. The study aimed to assess the feasibility of the ZAP-X workflow, as well as its safety, clinical and dosimetric performance, and patient satisfaction. The study cohort included various central nervous system pathologies, including 106 brain metastases (BM), 42 meningiomas (MA), 18 trigeminal neuralgias (TN), 11 acoustic neuromas (AN), nine recurrent glioblastomas (RGBM), seven pituitary adenomas (PA), three spinal tumors (ST), three arteriovenous malformations (AVM), and one cavernous hemangioma of the pons (HM).The average number of patients treated per month was 13 ± 2, and the average number of treatments per month was 35 ± 9. The maximum number of patients treated in a day was five. The average gamma passing rate was 98.5 ± 1.7% (91.2 - 100%) at a 10% low-dose threshold, 2% dose difference, and 1 mm distance-to-agreement. The average conformity index (CI), Paddick conformity index (PCI), gradient index (GI), homogeneity Index (HI), and gradient measure across all patients were 1.3 ± 0.3, 0.77 ± 0.11, 3.3 ± 0.8, 1.5 ± 0.3, and 0.38 ± 0.16 cm, respectively. The largest tumor volume treated was 29.29 cm3, and the highest number of targets treated in a single course was 10. Average treatment time was 50 ± 20 minutes, with setup time being the most significant predictor (adjusted r² = 0.972). The Efficast head and shoulder mask significantly improved patient comfort and reduced alignment errors compared to head-only masks. Patient satisfaction was high across all measured domains, with average scores ranging from 4.7 to 5.0 on a 5-point scale. The most common treatment side effects were fatigue and headache.This initial experience represents the largest single institution series to date and supports the ZAP-X as a promising alternative to conventional SRS platforms such as Gamma Knife (GK) and CyberKnife (CK). Continued research and multi-institutional studies are warranted to further validate these findings and assess long-term outcomes.

Obstructive jaundice is a potentially life-threatening condition with multiple etiologies. Lemmel syndrome is a rare and intriguing cause of obstructive jaundice, most commonly associated with a periampullary duodenal diverticulum. This syndrome presents a diagnostic challenge because its features are often subtle and can mimic more common causes of biliary obstruction. We report a case of a 68-year-old patient who presented with acute abdominal pain, had a broad differential, and was ultimately diagnosed with Lemmel syndrome. This case emphasizes the importance of recognizing the syndrome, as its presentation can overlap with several other conditions.

Current ESC/EACTS guidelines recommend standard-duration dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). However, the subsequent transition to either extended DAPT or single antiplatelet therapy (SAPT) remains debated due to limited comparative outcome data. This Bayesian meta-analysis and meta-regression evaluate the clinical safety of DAPT versus SAPT, and the impact of potential confounders on all-cause mortality. Following PRISMA guidelines, a systematic search of PubMed, Embase, Cochrane Library, ScienceDirect, and Scopus was conducted till April 2025 to identify randomized clinical trials (RCTs) and cohort studies. Primary outcomes were all-cause mortality and bleeding events. Bayesian random-effects meta-analysis was performed using the brms package in R with Markov Chain Monte Carlo sampling and weakly informative priors. Bayesian meta-regression of log-transformed odds ratios (OR) assessed associations with relevant covariates. Fourteen studies (9 RCTs and 5 cohort studies) comprising 56,572 patients were included. Compared with SAPT, DAPT was associated with increased all-cause mortality (OR 1.25; 95% credible interval [CrI], 1.04-1.51; posterior probability of harm, Pr[OR > 1] = 84%). DAPT also increased the risk of net adverse clinical events [NACE] (OR, 1.29; 95% CrI, 1.08-1.53), minor bleeding (OR, 1.60; 95% CrI, 1.10-2.33), major bleeding (OR, 1.70; 95% CrI, 1.30-2.23), and BARC 2-5 bleeding (OR, 1.78; 95% CrI, 1.40-2.26) with Pr [OR > 1] >90% for all outcomes. No significant differences were observed in cardiac death, cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), stent thrombosis, or stroke. Meta-regression revealed that higher baseline odds of dyslipidemia (-0.89), hypertension (-1.19), prior MI (-0.94), and previous revascularization (-0.30) were associated with greater mortality benefit from DAPT. However, in the DAPT cohort, increased odds of adverse events, including cardiac death (0.41), MACCE (0.55), stroke (0.60), MI (0.29), and NACE (0.98), were significantly associated with higher all-cause mortality. Extended DAPT is associated with a higher all-cause mortality, bleeding events, and NACE. While DAPT may benefit high-risk populations, the increased odds of adverse events are significantly associated with mortality, warranting that it be carefully considered and monitored in post-PCI patients.

Abstract INTRODUCTION CDKN2A/B homozygous deletion is associated with poor prognosis and aggressive tumor behavior. It is a marker of high proliferative potential, which may facilitate invasion beyond the primary tumor site, including the leptomeninges. The incidence and clinical behavior of leptomeningeal disease (LMD) in these patients is not well defined. METHODS In this retrospective single-institution review, we analyzed deceased adult patients with glioblastoma IDH-wildtype (GBM) and IDH-mutant astrocytoma grade 4 (AIDHm) harboring CDKN2A/B homozygous deletion who were evaluated at Jersey Shore University Medical Center from January 2022 through April 2025. All deletions were identified through next-generation sequencing in all patients at diagnosis. RESULTS We identified 28 patients harboring CDKN2A/B homozygous deletion (26 GBM patients and 2 AIDHm patients). Median age was 67 (28-83); 21 were male. Radiographically LMD was diagnosed in 8/28 (28%): 7/26 (27%) GBM patients and 1/2 (50%) AIDHm patients. 3/8 patient with LMD underwent lumbar puncture; all had negative cytology. Mean overall survival (OS) for the GBM cohort was 12.2 months (2–25). Mean OS for GBM with LMD was 9.2 months (3–15). Mean time from diagnosis to LMD was 6.9 months (1–14), with mean OS of 2.4 months (0.4–9) after LMD diagnosis. Out of the 2 AIDHm patients, 1 developed LMD 15 months from diagnosis and died 7 months later, and 1 developed extracranial osseous metastasis 11 months from diagnosis and died one month later. 9/28 (32%) patients developed multifocal dissemination at progression and 8/28 (28%) presented with multifocal disease. CONCLUSION Leptomeningeal disease occurred in 28% of glioma patients harboring CDKN2A/B homozygous deletion and multifocal disease occurred in 60% of the patients either at diagnosis or progression. These findings suggest CDKN2A/B homozygous deletion may contribute to aggressive dissemination and poor survival. These results underscore the need for early surveillance strategies and further research into dissemination mechanisms.

Abstract BACKGROUND : The presence of cardiovascular disease (CVD) in patients with leukemia leads to worse clinical outcomes, but the disparities in this issue are still not fully examined. This research investigates differences in the CVD burden related to leukemia deaths across various demographic and geographic contexts using CDC WONDER data from 1999 to 2020. METHODOLOGY : A disproportionality analysis was conducted to calculate reporting odds ratio (ROR) of CVD burden in leukemia patients compared to all-cause deaths across age groups 15–85 years. A ROR greater than 1 indicated a higher burden of CVD in cancer patients. Average Annual Percentage Changes (AAPCs) were calculated to evaluate trends, with p-values determining significance. RESULTS : The highest ROR was found in the 15–24 age cohort (2.565), decreasing with age but rising slightly in older adults (85+: 0.56). The 55–64 age group experienced the most significant annual increase (AAPC: 2.02). Males consistently showed higher RORs compared to females, however, the most notable rise was in middle-aged females (AAPC: 1.51). Among racial groups, young Hispanics had the highest ROR (2.637), whereas NH Whites (55–64 AG) experienced the largest AAPC (1.43). Midwest had the lowest ROR but also exhibited the steepest regional increase (45–54: 1.78). Urban regions reported higher RORs than rural areas, with medical facilities displaying the highest RORs. CONCLUSION : These results highlight the importance of developing focused cardiovascular care strategies, especially for high-risk groups such as younger individuals, males, Hispanics, and those residing in urban areas. Public health initiatives should target these disparities to enhance outcomes for patients with leukemia.