University Physicians

Introduction: Phenobarbital (PHB) may present advantages over benzodiazepines (BZD) for alcohol withdrawal syndrome (AWS), but the optimal dosing strategy of PHB in early management of AWS is unknown. This study compared the impact early low-dose PHB versus high-dose PHB on clinical outcomes in patients with AWS. Methods: This multi-center, retrospective cohort study evaluated adults with AWS treated with intravenous PHB in the emergency department and medical intensive care unit (ICU) between July 2020 and January 2025. Outcomes of patients who received low-dose PHB (≤ 5 mg/kg) were compared to those who received high-dose (>5 mg/kg) over 24 hours. The primary outcome was ICU length of stay (LOS). Secondary outcomes included hospital LOS, mechanical ventilation, adjunctive therapy use, and patient disposition. Results: The final analysis included 40 low-dose and 45 high-dose PHB patients. Median 24-hour cumulative PHB dose was 130 mg in the low-dose group and 585 mg in the high-dose (p < 0.05). Patients in the low-dose group had a similar ICU LOS to the high-dose group (3.5 vs 2.9 days; p = 0.126). There was no difference between hospital LOS (p = 0.546) and the incidence of mechanical ventilation (p = 0.381). BZD use was lower in the high-dose group (97.5% vs 82.2%; p < 0.05). Use of other adjunctive medications and discharge disposition did not differ. Conclusions: Higher PHB loading doses did not significantly reduce ICU LOS compared to lower doses, suggesting unclear benefit in escalating dosing beyond 5 mg/kg in the first 24 hours of treatment for AWS.

The abstract has been submitted for presentation to the AANS 2026 meeting being held in San Antonio, TX, USA. Introduction: Oligodendrogliomas are an uncommon subset of gliomas that are molecularly defined by 1p/19q codeletion in the setting of an isocitrate dehydrogenase (IDH) 1/2 mutation. Standard-of-care management involves maximal safe resection followed by adjuvant chemoradiation with procarbazine, lomustine, and vincristine (PCV). Although PCV confers a durable survival advantage, treatment-limiting toxicity is common and often necessitates discontinuation. IDH inhibitors such as vorasidenib have demonstrated promising efficacy and more favorable tolerability profiles, but a paucity of comparative data across therapeutic classes limits optimal treatment decision-making. Methods: A systematic search was conducted through to 7 March 2025 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Eligible studies included adult patients (≥18 years) with IDH-mutant, 1p/19q-codeleted oligodendrogliomas treated with PCV chemotherapy or IDH inhibitors and with a minimum follow-up of 12 months. Outcomes of interest included overall survival (OS), progression-free survival (PFS), and grade ≥ 3 adverse events (AEs) that led to treatment discontinuation. Results: Twenty-eight studies met the inclusion criteria, with a total of 406 patients. All 406 patients carried a confirmed diagnosis of oligodendroglioma. For mixed-histology cohorts, only oligodendroglioma-specific data were extracted and analyzed. Among PCV cohorts, median PFS ranged from 24.3 months to 8.4 years and median OS was reported up to 14.7 years in long-term follow-up from RTOG 9402 and EORTC 26951. Grade ≥ 3 AEs resulted in treatment discontinuation in 65-70% of patients, primarily due to hematologic or neurologic events. In comparison, vorasidenib achieved a median PFS of 27.7 months in the phase III INDIGO trial (HR 0.39; 95% CI 0.27-0.56; p < 0.001), with median OS not yet reached at 14.2 months of follow-up. Grade ≥ 3 AEs occurred in 22.8% of patients and led to treatment discontinuation in only 1-3%, primarily due to asymptomatic transaminitis. Early real-world data from expanded-access programs similarly support these tolerability findings. Conclusions: While PCV chemotherapy remains the standard-of-care systemic therapy for oligodendroglioma supported by mature survival data, IDH inhibitors represent a mechanistically targeted alternative with encouraging early-phase outcomes and a significantly improved safety profile. Direct comparison across these regimens is constrained by differences in study design and limited long-term OS data for IDH inhibitors. Prospective head-to-head trials are essential for defining the optimal therapeutic sequence in this evolving treatment landscape. In the interim, we provide a recommend approach for current use.

Left renal vein (LRV) compression, also known as nutcracker syndrome, is a vascular compression disorder characterized by narrowing of the LRV between the aorta and superior mesenteric artery. This may result in venous hypertension and enlarged collateral formation. Clinically, nutcracker syndrome presents with a range of symptoms including hematuria, pelvic pain, and flank discomfort. Currently, there is no universally accepted duplex ultrasound protocol to evaluate for LRV compression, leading to variability in diagnostic accuracy and delay in treatment. We propose a standardized imaging protocol for duplex assessment of LRV compression that integrates patient positioning, grayscale, color, and spectral Doppler measurements. Implementation of this structured approach at our institution has enhanced diagnostic consistency, improved patient selection for further imaging or intervention, and facilitated earlier diagnosis.

Splenic cysts are an uncommon entity, usually diagnosed incidentally due to their asymptomatic nature in clinical practice. Surgical treatment is essential in symptomatic cysts, those larger than 5 cm, or when malignancy cannot be excluded. Histopathological analysis is necessary to identify the splenic subtype and to rule out potential malignant transformation of the pluripotent epithelium. This report presents the case of a patient with a true giant splenic cyst that mimicked a pancreatic cystic neoplasm, diagnosed in the General Surgery Department of the High Specialty Medical Unit No. 25 of the Mexican Institute of Social Security. A 41-year-old woman presented with left upper quadrant abdominal pain, accompanied by postprandial fullness and weight loss, due to an 18 cm tumor causing a mass effect. CT imaging revealed a pancreatic cystic lesion, displacement of other intra-abdominal organs, and the presence of an accessory spleen. The patient was scheduled for surgical treatment due to the tumor size, with planned laparotomy, distal pancreatectomy, and splenectomy. However, based on intraoperative findings, total and accessory splenectomy and resection of the splenic cyst were performed. Histopathological examination confirmed an epithelial splenic cyst, negative for malignancy. Objective: To document the presentation of a splenic cyst as an intraoperative finding and describe the subsequent definitive surgical treatment. Materials And Methods: Descriptive observational study. A literature review was conducted on the PubMed platform, including reported cases from 2020 to 2025.

The etiopathogenesis of endometriosis, a chronic debilitating disease affecting nearly 10% of women, has evaded elucidation until the recent epigenetic discoveries. Although still deemed multifactorial, endometriosis is likely predisposed in women with genetic and epigenetic alterations, which are activated by environmental factors. There are many epigenetic changes that have recently been associated with endometriosis: DNA methylation and phosphorylation, modifications to histones and non-coding RNA, and chromatin remodeling and organization. Gene markers, such as HOXA10, SF-1, and GATA transcription factors, are also debatably correlated to endometriosis. An improved understanding of the etiopathogenesis of endometriosis may propel our field toward our objectives: sooner and more efficient detection as well as targeted therapy. In this comprehensive review, we will identify and discuss the current literature on epigenetic changes seen in endometriosis. A primary computerized search was performed on PubMed and Google scholar of publications from 1990 to 2022. We searched for keyword terms such as "endometriosis" and "endometriosis epigenetics." We also looked through the references of prior articles to find other relevant articles to this topic. Articles were categorized by type of epigenetic change found such as DNA hypo- or hyper- methylation, histone hyper- or hypo-acetylation, chromatin remodeling, and non-coding RNA-mediated down-regulation and the research was elaborated in sections based on the type of epigenetic change. There are many articles on TET, DNMTs, EZH2, HDACs, HATs, let-7 family, miRNAs, Hox proteins, GATA family, sirtuins (e.g. SIRT1, SIRT3), ARID1A, SF-1, USF1, USF2, STRA6, ESR1, ESR2, PGR, ALDHIA2, and CTCF; however, the studies analyzed in this review were heterogeneous in comparison populations, analysis methods, tissues types (e.g. endometriomas, ectopic endometriotic tissue, eutopic endometrial tissue). Due to this, it is difficult to synthesize over-arching conclusions based on the current literature; however, there are many epigenetic changes and genes linked to endometriosis as noted in the literature.

BackgroundCoordinated specialty care (CSC) programs for first episodes of psychosis are increasingly offered in the United States. A component of CSC programs is active family engagement in treatment, though research on the impact of this engagement is limited. This study examined the characteristics of families engaged compared to families not engaged in treatment, and the impact of family engagement on client participation and medication adherence over the first 6 months of treatment.MethodsUsing data from the Early Psychosis Intervention Network (EPINET) research hub in Minnesota (EPI-MINN), we compared two groups of individuals: clients who had a family member(s) engaged in their treatment vs. clients who did not. Family engagement was defined as any treatment services provided to a family member(s) by CSC clinical staff. The groups were compared on intake demographic variables, duration of untreated psychosis (DUP), hospitalizations, symptom severity, and functioning. A comparison of the total number of treatment visits during the first 6 months of treatment was tested using both nonparametric (Mann Whitney U) and parametric (ANCOVA) tests. Group comparisons on self ratings of “intent to attend visits,” “intent to complete the program,” and medication adherence were tested with ANCOVA and Chi-Square.ResultsFamily-engaged clients were younger, with less years of education, and more often White; clients without family engagement were more often Black. Family engagement was positively associated with increased total number of visits for all interventions with the exceptions of client peer support and case management visits. Family engagement increased clients’ self-reported intent to attend visits, though not intention to complete the program, which was moderately to markedly high in both groups. No differences were noted with medication adherence, with high rates of adherence across the entire study sample.ConclusionsOverall, results of the study support the benefits of family engagement in CSC on client participation, though future research is needed to understand why Black families are less engaged and what treatment adaptations are needed to reduce these racial differences. The results also support the value of CSC programs for medication adherence, a critical factor in symptom reduction and mental health recovery.

Introduction: Novel glucagon-like peptide-1 (GLP-1) agonists, most notably Semaglutide and Tirzepatide, have surged in utilization as weight loss medications. Semaglutide now accounts for 65% of all GLP-1 prescriptions, and latecomer Tirzepatide (approved in 2022) has added to the 300% increase in prescription volumes for GLP-1s since 2020. Previous studies have demonstrated conflicting association between GLP-1 therapies and pancreatitis, biliary disease, or acute kidney failure. Given the increased incidence of these diseases in people with diabetes and obesity, it’s crucial to weigh the relative risks of these drugs. This retrospective study aims to provide valuable insights into the clinician's decision-making process by comparing the incidence rates of the above between matched patients prescribed Semaglutide and Tirzepatide. Methods: Utilizing the TriNetX platform, we analyzed patients initially prescribed a GLP-1 agonist who obtained a refill 3 months later. Exclusions and matching criteria were applied to enhance the study's internal validity. Patients were matched by gender, ethnicity, and diagnosis of Type 2 diabetes and obesity. Outcomes of acute pancreatitis (ICD-10 K85), cholelithiasis (ICD-10 K80), cholecystitis (ICD-10 K81), and acute renal failure (ICD-10 N17) were collected for comparison. Descriptive statistics were used to calculate frequencies and percentages within TriNetX. Results: In comparing 20,168 patients on Semaglutide to an equal number on Tirzepatide, there was no statistically significant difference in the incidence rates of acute pancreatitis (OR 1.10, CI 0.68 – 1.79, P 0.61) or gallbladder diseases (OR 1.16, CI 0.92 – 1.46, P 0.92). However, there was an increased risk of AKI in those on Semaglutide vs Tirzepatide (OR 1.96, CI 1.56 – 2.45, P < 0.0001). Conclusion: These findings suggest comparable safety profiles for Semaglutide and Tirzepatide in terms of acute pancreatitis and gallbladder diseases, but an increased risk of AKI for Semaglutide users; underscoring the importance of monitoring kidney function in patients on Semaglutide. Study limitations include data extraction from multiple different software systems, data processing into standardized formats, proper identification of eligible medical record for accurate inclusion/exclusion criteria, and generalizability due to sampling bias of patients who are part of the EMR used. This comparative analysis not only expands the knowledge base but also offers practical guidance for clinicians managing weight loss medications.