McLaren Regional Medical Center

Tandem lesions (TLs) are a subtype of acute ischemic stroke, which involve an extracranial carotid lesion (ie, severe carotid stenosis ≥70%) with large vessel occlusion. While large vessel occlusion has a standard approach with mechanical thrombectomy (MT), the best practice for intervention of the carotid lesion is not well-established. Utilizing data from the ASSIST registry, we investigated the differences in clinical and procedural outcomes between acute versus nonacute stenting. The ASSIST registry (an international acute ischemic stroke MT prospective study) was utilized to identify the subgroup of patients with acute ischemic stroke secondary to TL who received MT. The TLs were grouped by MT+acute carotid stenting (CAS) versus MT+acute carotid nonstenting. The demographics and clinical outcomes (90-day modified Rankin Scale score) were compared between TL and non-TL groups, and between MT+CAS and MT+acute carotid nonstenting. Multivariable analyses were performed to determine independent predictors of clinical outcomes. A total of 183 of 1270 (14.4%) TLs were identified in the ASSIST registry. MT+CAS was performed in 83 of 183 (45.4%) subjects, and 100 of 183 (54.6%) received MT+acute carotid nonstenting. There are no significant differences at baseline between the 2 groups in the National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography Score, or target vessel. Achieving a modified Rankin Scale score of 0 to 2 at 90 days was 70.9% in the MT+CAS group versus 48.9% in the MT+acute carotid nonstenting group (P=0.001), with a modified Rankin Scale score of 0 to 2 being significantly associated with the MT+CAS group in multivariable analysis (odds ratio, 2.14 [95% CI, 1.01-4.51]). There was no significant difference in mortality or symptomatic intracerebral hemorrhage between the groups. In acute ischemic stroke, secondary to TLs treatment with thrombectomy and acute carotid stenting is associated with improved 90-day functional outcome without an increase in symptomatic intracerebral hemorrhage compared with no acute stenting approach. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03845491.

Frailty is an important geriatric syndrome that can adversely affects the quality of life of older adults. Lifestyle interventions, such as physical activity, healthy diet and medications optimization have strong evidence in prevention, treatment, and reversal of frailty. While physical activity is the most important, inactivity among older Americans remains high. We present a case in which successful approach to frailty prevention, through regular swimming, showed meaningful improvement. Collaboration between the patient, family and physician, was also important. Collectively, these efforts lead to improvement in patient's mood, quality of life, and medication use.

Disclosure: S. Keritum: None. J. kenmoe: None. A. Shrestha: None. H. Ghumman: None.Background: Paragangliomas are rare neuroendocrine tumors arising from the autonomic nervous system.Despite their low incidence, understanding their trends and potential disparities by sex is criticalfor clinical and public health strategies. This study investigates the incidence of paragangliomasin the United States, with a focus on sex-based disparities, using data from the Surveillance,Epidemiology, and End Results (SEER) database from 2000 to 2021. Methods: A retrospective analysis of paraganglioma incidence data was performed using SEER*Statsoftware. Cases diagnosed between 2000 and 2021 were included. Incidence rates werecalculated per 100,000 person-years and stratified by sex (male vs. female). Temporal trendswere analyzed using Joinpoint regression models to identify significant changes in incidenceover time. Results: The overall incidence of paragangliomas from 2000 to 2021 was stable at 0.05 per 100,000person-years for both males and females. From 2000 to 2019, no significant change in incidencewas observed. However, a sharp and statistically significant increase in incidence was notedfrom 2019 to 2021. This rise was consistent across both sexes, with no significant sex-baseddisparities identified over the study period. Conclusions: The incidence of paragangliomas remained stable from 2000 to 2019 but exhibited a markedincrease from 2019 to 2021. This trend underscores the need for further investigation intopotential factors driving this rise, including advances in diagnostic techniques and changes indisease awareness. Understanding these trends is crucial for guiding early detection andmanagement strategies. Figure 1: Incidence of Paragangliomas by Sex 2000-2021Presentation: Saturday, July 12, 2025

Objective: The purpose of the study was to assess the reliability of LLLT to accelerate dental implant osteointegration and healing process. Materials and Methods: The study sample included eight female patients according to the inclusion criteria with total twenty dental implant placed in healed sites (maxillary premolars) by using split mouth method. Group I was study group that receive LLLT, and group II was control group. Implant stability was assessed using ISQ scale in separate intervals at 6, 8 and 12 months postoperatively. Results: In Group I, the ISQ values at 3, 6, and 12 months after implant placement ranged from 60 to 74, 62 to 78, and 68 to 80, respectively, with statistically significant differences observed between 3 and 6 months, 3 and 12 months, and 6 and 12 months. In Group II, the ISQ values at 3, 6, and 12 months after implant placement ranged from 54 to 69, 56 to 70, and 60 to 72, respectively, with statistically significant differences observed between 3 and 6 months, 3 and 12 months, and 6 and 12 months. No mobility was observed in any implants in either group. Group I had significantly higher ISQ values at all follow-up intervals than Group II.).Conclusion: the LLLT has positive influence on increasing dental implant stability postoperatively.

Haemophilus influenzae (H. influenzae) is a common organism that causes noninvasive infections in the respiratory tract. Lately, there has been an increasing incidence of invasive diseases with nontypeable strains not covered by Hib vaccines. We discuss a case of a middle-aged male with sickle cell trait and gout who presented with altered mentation and polyarthralgia. On investigations, he had H. influenzae bacteremia on two sets of blood cultures with dissemination to meninges and joints, causing acute encephalopathy and polyarthralgia. The initial results of arthrocentesis and lumbar puncture were sterile. However, PCR analysis of the fluid revealed nontypeable H. influenzae. The patient required mechanical ventilation and vasopressor support given sepsis but recovered after extended antibiotics and multiple surgical debridements. Our case highlights the importance of maintaining a high suspicion of invasive disease in decompensated patients and the role of advanced diagnostics in treatment and outcome.