Texas Tech University Health Sciences Center

A single course of antenatal corticosteroids is standard for women at risk of preterm birth, including those with ruptured membranes. The benefit of repeat courses in the setting of preterm premature rupture of membranes (PPROM) remains uncertain. This study aimed to assess the safety and effectiveness of repeat versus single course of corticosteroid in women with PPROM. We searched PubMed, Cochrane, and Embase databases from inception to September 17, 2025, with no language restrictions, using the terms related to PPROM and corticosteroids. Randomized and non-randomized clinical trials enrolling women with PPROM and comparing repeat with single course were included. Studies without PPROM or comparator group were excluded. Screening and quality assessment were performed by two authors, with a third author participation in case of disagreements. Statistical analysis used Review Manager 5.4 and R studio 4.5.0, with risk ratio (RR), random effects, Cochran Q test and I-squared statistics, and sensitivity analysis. This study was registered with PROSPERO (identifier: CRD420251069007). Six studies comprising 2,434 patients were included. Sensitivity analysis showed that repeat course of corticosteroids increased the risk of endometritis compared to a single course (RR = 1.63; 95% CI: 1.10 to 2.43). In the subgroup analysis the mixed hours corticosteroid favored the outcome of chorioamnionitis (RR = 1.62; 95% CI: 1.12 to 2.36; p = 0.001) with no overall subgroup difference. No difference was observed for the outcomes of respiratory distress syndrome, neonatal sepsis, necrotizing enterocolitis, and intraventricular hemorrhage. Repeat corticosteroid courses in PPROM may increase maternal infections morbidity without clear neonatal benefit. Further large, well-designed randomized trials are needed to clarify safety. · Repeat course of corticosteroid might increase maternal infections morbidity.. · A cautious approach due to potential increase in maternal morbidity related to repeat corticoid use.. · No significant neonatal benefit was observed with repeat courses of antenatal corticosteroids..

Purpose: Kidney cancer mortality in the United States exhibits persistent racial, ethnic, and geographic disparities, yet regional patterning of these disparities over time remains incompletely characterized. We conducted a retrospective analysis using national mortality data to examine differences in kidney cancer mortality between U.S. Mexico border and non-border regions from 2000 through 2020.Materials and Methods: Death records were obtained from CDC WONDER, and kidney cancer deaths were identified using ICD 10 code C64 as the underlying cause of death. We evaluated C64 to C65 in sensitivity analyses, including C65 separately. We compared demographics, age adjusted mortality rates, and temporal trends by border residence. Multivariable logistic regression assessed demographic patterning of deaths across regions, and Joinpoint regression evaluated changes in age adjusted mortality trends over time.Results: A total of 279,117 kidney cancer related deaths were recorded nationally. Hispanic decedents were disproportionately represented among border state deaths (22.9% vs 2.8% in non-border states). Border states accounted for 67.4% of Hispanic C64 deaths. Age distribution and racial composition of decedents differed between border and non-border regions (all p<0.001). In multivariable analyses, Hispanic ethnicity was strongly associated with border state residence among decedents, independent of age and race. Joinpoint regression identified multiple periods of change in mortality trends, with statistically significant increases in non-border regions and less precise segment estimates in border regions.Conclusion: Kidney cancer deaths among Hispanic decedents show substantial geographic concentration in U.S. Mexico border states. These findings support surveillance strategies and interventions that incorporate geographic context in efforts to reduce kidney cancer mortality disparities.

Semaglutide, a glucagon-like peptide-1 receptor agonist, and resmetirom, a thyroid hormone receptor-β agonist, are approved therapies for noncirrhotic metabolic dysfunction–associated steatohepatitis (MASH) with moderate to advanced fibrosis. Their comparative economic value has not been established. To evaluate the cost-effectiveness of semaglutide and resmetirom compared with standard of care (SOC) in patients with noncirrhotic MASH and F2–F3 fibrosis. A state-transition model simulated disease progression in a hypothetical cohort with F2–F3 fibrosis over 5- and 10-year horizons from a U.S. healthcare payer perspective. Clinical efficacy inputs were derived from phase 3 trials (ESSENCE and MAESTRO-NASH), with costs and utilities obtained from published sources. Scenario analyses incorporated semaglutide’s cardiovascular mortality benefit. Deterministic and probabilistic sensitivity analyses assessed uncertainty. Semaglutide was cost-effective versus SOC at 5 years (ICER, $42,200/QALY) and 10 years (ICER, $44,138/QALY). Resmetirom produced higher ICERs ($95,981/QALY at 5 years; $107,002/QALY at 10 years) but remained below a $150,000/QALY threshold. Inclusion of cardiovascular mortality benefits improved semaglutide’s ICER to $38,324/QALY. Probabilistic analyses showed semaglutide had the highest probability of cost-effectiveness across willingness-to-pay thresholds. Over a 10-year horizon, treatment of 100,000 patients with F2–F3 MASH was projected to prevent 270 cases of decompensated cirrhosis, 10 cases of hepatocellular carcinoma, and 1,040 liver-related deaths with semaglutide, compared with 310 cases of decompensated cirrhosis, 10 cases of hepatocellular carcinoma, and 1,180 liver-related deaths with Resmetirom. Semaglutide demonstrated superior cost-effectiveness compared with SOC and resmetirom, with cardiovascular benefits further strengthening its economic value. Not applicable.

Interstitial lung disease (ILD) is not classically considered an extra-articular manifestation of psoriatic arthritis (PsA). However, emerging evidence suggests that pulmonary involvement may be more common than previously recognized. The prevalence of ILD in PsA remains poorly defined. To estimate the pooled prevalence of ILD among patients with PsA and to evaluate associated risk factors and comparative risk with other populations. We conducted a systematic review and meta-analysis registered in PROSPERO. MEDLINE (PubMed), EMBASE (Scopus), and the Cochrane Library were searched from inception to January 2026. Observational studies reporting ILD prevalence in PsA were included. Random-effects models with logit-transformed proportions were used to pool prevalence estimates. Subgroup analyses were performed based on ILD diagnostic method. Six studies comprising 14,272 patients with PsA were included. The pooled prevalence of ILD was 3% (95% confidence interval [CI]: 1%-7%; I2 = 96.6%). Prevalence was significantly higher in studies using imaging-based diagnosis with computed tomography or high-resolution computed tomography (6%, 95% CI: 4%-10%; I2 = 55%) compared with studies relying on non-imaging identification (1%, 95% CI: 1%-11%; I2 = 0). The difference between subgroups was statistically significant (p < 0.0001). Smoking was associated with a significantly increased risk of ILD in PsA (pooled odds ratio 2.94, 95% CI: 1.22-7.12; I2 = 1.8%). Interstitial lung disease affects a meaningful proportion of patients with psoriatic arthritis, particularly when imaging-based diagnostic methods are used. ILD may be underrecognized in routine clinical practice. Increased awareness, standardized diagnostic approaches, and prospective studies are needed to define optimal screening and management strategies for ILD in PsA. PROSPERO registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278657 Key Points •Interstitial lung disease may be an underrecognized comorbidity in psoriatic arthritis. •The prevalence appears higher when imaging-based diagnostic methods are used.

Introduction: Novel influenza viruses (NIV) are a specific type of influenza A virus that differs from the seasonal flu viruses currently circulating among humans. These viruses often originate in animals, such as birds or pigs, and can infect humans. Public health officials are particularly concerned about novel viruses. The goal of this study is to determine whether individuals infected with NIV have a higher risk of hospitalization and mortality. Methods: We used deidentified and publicly available data for a population-based cohort study of adults admitted to intensive care units of acute care hospitals in Texas from Q1 2016 through Q2 2024 with a principal diagnosis of influenza. Hospitalizations transferred to or from another hospital, nonemergency admissions, and hospitalizations discharged against medical advice were excluded. The target population was identified using International Classification of Diseases. Tenth Revisions, Clinical Modification (ICD-10-CM) codes selected from Clinical Classification Software Refined Category10 RSP003: Influenza. The primary outcome was short-term mortality. Overlap propensity score weighting was applied with results expressed as adjusted risk ratio and 95% confidence interval (aRR [95% CI]). Results: Of the 15,301 hospitalizations included in the study, 790 (5%) had novel influenza A virus, 1,983 (13%) had unidentified influenza A virus, and 12,258 (82%) had identified influenza A virus. The distributions of age and sex were not statistically different between the groups with most other covariates showing either insignificant or only small differences between the groups. Short-term mortality was similar between the groups 3.8% for both novel and unidentified influenza A virus vs 4.4% for identified influenza A virus. On adjusted analyses, virus classification was not associated with either in hospital or short-term mortality; aRR 1.0 [95% CI 0.7 to 1.5] for novel vs identified and aRR 1.2 [95% CI 0.7 to 2.0] for novel vs unidentified. Conclusions: Although a presumption could be that there is no developed immunity to NIV, over the last 9 years, it has had no impact on either the frequency of hospitalization or short-term mortality. It is possible that traditional flu vaccination can reduce the risk of hospitalization and death from either of the flu viruses.

Introduction: Encephalitis, acute inflammation of the brain, correlates with systemic complications, prolonged ICU stays, and high mortality. Cerebrovascular disease (CVD) involves reduced blood flow to the brain. The impact of CVD on outcomes of critically-ill encephalitis patients has not been well characterized. We hypothesized that compromised cerebrovascular integrity in CVD exacerbates the impact of cerebral inflammation and critical illness. Methods: We used publicly available data to conduct a population-based cohort study of adults admitted to intensive care units of acute care hospitals in Texas from 2016 through 2022 with encephalitis. Transfers, elective admissions, and discharges against medical advice were excluded. The population was identified using International Classification of Diseases, Tenth Revisions, Clinical Modification (ICD-10-CM) codes selected from Clinical Classification Software Refined Category NVS002: Encephalitis. CVD was identified using ICD-10-CM codes G45x, G46x, I60x-I69X, and H340x. The outcome was short-term mortality. Overlap propensity score weighting was applied with results expressed as adjusted risk ratio and 95% confidence interval (aRR [95% CI]). Results: Of 6,576 hospitalizations included in the study, 1,496 (23%) had CVD. Hospitalizations with CVD were older (48% vs 38% aged ≥ 65 years), had higher Deyo comorbidity index (mean[SD] 2.3 [2.2] vs 2.1 [2.4]), and more often required invasive mechanical ventilation (38% vs 28%). Patients with CVD had a higher rate of short-term mortality (28% vs 17%). Hospital length of stay was longer for CVD patients (mean[SD] 19[19] days vs 16[19] days). All covariates balanced exactly after overlap weighting. Within the overlap population, CVD remained associated with mortality (26% vs 22%) and (aRR 1.2 [95% CI 1.1 to 1.3]). Similar results were observed on sensitivity analyses for older patients, patients using invasive mechanical ventilation, and those more severely ill. Conclusions: Although CVD patients were older, had higher burden of comorbidities, and were at greater risk of death, after risk adjustment, preexisting CVD was still found to significantly and independently increase the risk of death in critically ill patients with encephalitis. These findings can help with early risk stratification.

Introduction: Death certificates are the primary source for estimating the population-level burden of sepsis mortality, while ICD codes are often used to identify sepsis deaths in hospital claims data. Based on ICD codes, sepsis is present in up to 1 in 2 hospital decedents in the United States. A prior study comparing the number of sepsis decedents in hospital claims data and death certificates showed markedly lower figures among the latter, but the findings are dated and different ICD coding approaches were used for claims and death certificate data. We evaluated the contemporary concordance of similarly coded sepsis diagnosis between population-level hospital claims data and death certificates. Methods: We used a statewide dataset to identify all in-hospital decedents aged ≥18 years in Texas and the corresponding aggregate inpatient death certificate data from CDC WONDER during 2020-2023. An identical, previously reported ICD-10 code-based taxonomy was used to identify sepsis in claims data and death certificates. Normal approximation was used to estimate the rate difference [RD] and rate ratio [RR] in the frequency of sepsis diagnosis overall and in demographic and COVID-19 diagnosis strata, and for their comparisons across categories within examined strata. Results: There were 282,958 decedents in claims data and 321,660 in death certificates, with 136,886 (48.4%) and 67,212 (20.9%) reporting sepsis, respectively (RD 27.5% [95% CI 27.2-27.8]; RR 2.32 [95% CI 2.30-2.33]). RD in the frequency of sepsis diagnosis between claims data and death certificates ranged from 23.0% (non-COVID-19) to 41.6% (COVID-19), with corresponding RR 2.04 and 3.49, respectively. RD in the frequency of sepsis diagnosis between claims data and death certificates and their RR varied across the examined strata categories, being highest among decedents aged 18-44 years (vs ≥65 years), males (vs females), Hispanics (vs Whites), and those with COVID-19 (vs non-COVID-19). Conclusions: Death certificates substantially underestimated the burden of sepsis-associated mortality among hospital decedents, when compared to hospital claims data in Texas, with the use of an identical ICD code-based algorithm. The gaps in the frequency of sepsis diagnosis were greater among younger decedents, males, Hispanics, and those with COVID-19.