Piedmont Athens Regional

Introduction: Stress ulcers are superficial lesions that commonly develop in the fundus and body of the stomach, often as a result of physiological stress associated with hospitalization. Patients in the intensive care unit (ICU) are particularly susceptible to these ulcers, prompting routine initiation of stress ulcer prophylaxis (SUP). However, SUP is often not discontinued once the patient’s risk factors subside. This study aimed to reduce the inappropriate continuation of SUP during inpatient care and at discharge at Piedmont Athens Regional by implementing a pharmacist-led guidance document to support appropriate discontinuation practices. Methods: This single-center, pre-post interventional study evaluated patients admitted to the medical or cardiac ICU who were initiated on SUP. A pharmacist-driven guidance document outlining criteria for SUP discontinuation was implemented. The pre-intervention group consisted of 50 randomly selected patients admitted between November 2023 and January 2024, while the post-intervention group included 50 patients admitted between November 2024 and January 2025. Eligible patients were aged ≥ 18 years, admitted to the medical or cardiac ICU for more than 24 hours, and receiving either a proton pump inhibitor (PPI) or a histamine-2-receptor antagonist (H2RA). The primary outcome was the number of days patients remained on inappropriate SUP. The secondary outcomes were the number of patients discharged on inappropriate SUP at both ICU and hospital discharge. Continuous and categorical variables were analyzed using the Mann-Whitney U test and Chi-Square test, respectively. Statistical significance was assessed with a significance level of 0.05. Results: The post-intervention group had fewer total days on SUP (4.1 vs 5.7 days, p = 0.03) and fewer days of inappropriate SUP use (0.2 vs 1.1 days, p = 0.04) compared to the pre-intervention group. ICU discharge on SUP decreased (54% vs 76%, p = 0.021), while hospital discharge on SUP also declined (14% vs 20%), though not significantly (p = 0.424). Conclusions: This study highlights the positive impact of pharmacist-led interventions in reducing overall and inappropriate SUP use. Findings support the benefit of a standardized approach to regularly reassess SUP appropriateness.

Abstract Background Host-directed therapies (HDTs) are emerging as promising adjuncts to anti-tuberculosis treatment (ATT), aiming to improve early bacteriological clearance and reduce treatment failures. This network meta-analysis (NMA) evaluated the efficacy of various HDTs in achieving negative sputum conversion at 4 and 8 weeks, using standard ATT (isoniazid, rifampin, ethambutol, pyrazinamide) as the referenceGraphical AbstractGraphical abstract showing key findings.Risk of bias analysisRisk of bias Methods A systematic review identified randomized controlled trials (RCTs) comparing HDTs—Interleukin-2 (IL-2), Immunoxel, Metformin, Mycobacterium vaccae, Statins, V5 Immunitor, and Vitamin D—plus ATT versus ATT alone. A Bayesian random-effects NMA using a binomial likelihood with logit link estimated odds ratios (ORs) and 95% credible intervals (CrIs). A frequentist NMA was conducted for comparison. Outcomes were sputum conversion at 4 and 8 weeksCumulative rankogram of host directed therapies in TuberculosisRadiogram showing pictorial representation of various treatment armsGraph showing SUCRA scores of Host directed therapies in Tuberculosis managementGraph showing sucre scores of the various HDTs used in the studies analyzed. Results Twenty-eight RCTs (4,260 patients) were included. At 4 weeks, V5 Immunitor (OR 30.7; CrI 11.0–102), Immunoxel (OR 5.68; CrI 1.82–17.4), and Mycobacterium vaccae (OR 2.05; CrI 0.996–4.94) ranked highest. IL-2, Vitamin D, and Statins showed modest, non-significant effects; Metformin had lower efficacy (OR 0.716; CrI 0.137–3.69). At 8 weeks, V5 Immunitor remained top (OR 35.4; CrI 8.89–201), followed by Vitamin D and M. vaccae. Frequentist models confirmed large effects for V5 Immunitor and Immunoxel for sputum conversion to negative at 4 weeks. Heterogeneity was moderate. Conclusion V5 Immunitor and Immunoxel significantly improved early sputum conversion when added to ATT. Findings were consistent across Bayesian and frequentist models, supporting potential inclussion of HDTs in tuberculosis therapy. Disclosures All Authors: No reported disclosures

BackgroundAcute myocardial infarction (AMI) remains a leading cause of mortality in the African American population, warranting an examination of regional and demographic trends to inform health policies.MethodsUtilizing the Centers for Disease Control and Prevention’s WONDER death certificate database, we conducted a comprehensive analysis of AMI mortality from 1999 to 2020 in African Americans and overall adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, race, and geographic region. Joinpoint regression facilitated the assessment of mortality trends, revealing average annual percentage changes (AAPCs) with 95% confidence intervals (CIs).ResultsOver the study period (1999 - 2020), there were 3,015,339 total deaths due to AMI in adults aged 25 and older. African Americans had the highest AAMR, at 71.5, followed by Whites, at 63.5, and the lowest among Asians, at 32.6. Overall, AAMR decreased in the African American population from 128.5 in 1999 to 48.5 in 2020, with an AAPC of -5.29 (95% CI: -5.69 to -4.9). AAMR decreased from 109 in 1999 to 37.6 in 2020 in African American females. African American males experienced a decline from 157.8 to 63.4 in AAMR. African American males had a higher overall AAMR (88.6) than females (59.3). Regionally, AAMR was highest in the South (77.6) and lowest in the Northeast (57.6) among African Americans.ConclusionsWhile AMI mortality has declined, persistent differences persist in the African American community. African American males experience a higher mortality rate as compared to females. Regional variations, notably the higher AAMR in the Southern region, emphasize the need for targeted health policies to mitigate disparities and enhance healthcare access. These measures may include expanding insurance coverage and improving access to healthcare, education, food, and employment for African Americans.

Background: Drug-coated balloon angioplasty is an established treatment strategy for coronary in-stent restenosis (ISR). While paclitaxel-coated balloons (PCB) have been studied most extensively, limus-coated balloons—including sirolimus- (SCB) and biolimus-coated balloons (BCB)—offer potential advantages due to their antiproliferative effects and pharmacokinetic profiles. However, direct comparisons remain limited. Objectives: To compare the efficacy of SCB, BCB, and PCB for the treatment of coronary ISR using a pairwise and network meta-analysis of randomized controlled trials (RCTs). Methods: A systematic search of PubMed, Scopus, and Cochrane was performed to identify RCTs comparing any combination of SCB, BCB and PCB angioplasty for ISR lesions. Outcomes of interest include target lesion failure (TLF), a composite of cardiac death, target-vessel myocardial infarction (TV-MI), and target lesion revascularization (TLR), as well as these individual outcomes. A pairwise and frequentist network meta-analysis with random-effects models was used to estimate risk ratios (RR) and 95% confidence intervals (CIs) for each comparison. Treatments were ranked with P-scores. Results: Five RCTs with 977 patients with ISR were included in the analysis (SCB 25.8%; BCB 27.6%; PCB 46.6%). In pairwise comparisons, limus-coated balloons demonstrated similar efficacy to PCB across all endpoints. Network meta-analysis revealed no significant differences among SCB, BCB, and PCB in the risk of TLF, TV-MI, cardiac death, or TLR (Figure 1) . P-score rankings indicated that PCB was most favorable for reducing TLF and TLR, while SCB and BCB ranked highest for reducing cardiac death and TV-MI, respectively. Conclusions: In this network meta-analysis of RCTs, limus-coated balloons and PCB demonstrated comparable efficacy profiles for the treatment of coronary ISR. P-score rankings suggest potential outcome-specific differences that warrant further investigation in adequately powered head-to-head trials.

This retrospective cohort study utilized the TriNetX Research Network, comprising real-time electronic medical records from over 100 healthcare organizations. Adults (≥18 years) treated between 2021 and 2024 were included if they underwent bariatric surgery or received a GLP/GIP agonist (tirzepatide, semaglutide, liraglutide, or dulaglutide). Patients exposed to both interventions were excluded. Propensity score matching (1:1, greedy nearest neighbor) was used to balance covariates between groups. The analytic window spanned from 90 to 1,095 days post-index. Patients with a prior history of each outcome were excluded. Primary outcomes included mortality, atrial fibrillation (Afib), myocardial infarction (MI), heart failure (HF), and stroke. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were calculated for each endpoint. Results: The final matched cohorts included 135,863 bariatric patients and 2,070,839 GLP/GIP-treated patients. Bariatric surgery was associated with significantly lower risk of mortality (RR 0.561, 95% CI: 0.524–0.600, p < 0.001), Afib (RR 0.892, 95% CI: 0.828–0.960, p = 0.002), MI (RR 0.605, 95% CI: 0.536–0.684, p < 0.001), and HF (RR 0.578, 95% CI: 0.531–0.630, p < 0.001). Stroke risk was also significantly lower (RR 0.863, 95% CI: 0.801–0.930, p < 0.001). Kaplan-Meier survival analyses confirmed improved event-free survival in the bariatric cohort across all outcomes. Notably, hazard ratios mirrored these findings, with mortality HR 0.365 ( p < 0.001), HF HR 0.440 ( p < 0.001), and MI HR 0.553 ( p < 0.001). Conclusion: In this large real-world analysis, bariatric surgery was associated with significantly lower risks of death, arrhythmias, myocardial infarction, heart failure, and stroke compared to GLP/GIP therapy. These results reinforce the profound cardiometabolic benefits of bariatric surgery and highlight its value as a preferred intervention in eligible patients at high cardiovascular risk.

BackgroundMyocardial perfusion imaging (MPI) stress testing using technetium sestamibi is a non-invasive tool for diagnosing and risk-stratifying patients with coronary artery disease. Despite its utility, MPI stress testing exhibits various limitations.Case summaryAn 80-year-old male presented with severe non-radiating exertional epigastric pain. Four months earlier, an MPI test was low risk with no significant perfusion defect. High-sensitivity cardiac troponins peaked at 97 ng/L with a delta value of 25. Left cardiac catheterization revealed a 99% calcified stenosis in the left main coronary artery. The patient underwent emergent coronary artery bypass grafting for refractory angina.DiscussionA critical left main coronary artery stenosis occurred despite a recent negative stress MPI. False-negative MPI can occur with balanced ischaemia in multi-vessel and left main coronary artery disease. This case underscores the importance of cautiously interpreting MPI results in intermediate/high-risk patients to identify balanced ischaemia.