Virtua Health

Background Patellar instability is commonly associated with disruption of the medial patellofemoral ligament (MPFL). Although MPFL reconstruction (MPFLR) is the current standard of care, complication rates remain notable, particularly in young and high-risk patients. Reinforced bioinductive implants (RBI) have recently emerged as a biologically supportive alternative. Augmented MPFL repair (AMPFLr) using an RBI aims to combine anatomic reconstruction principles with biologic repair augmentation. The purpose of this study is to retrospectively evaluate patient reported outcomes and re-dislocation rates after undergoing AMPFLr using an RBI for patella instability. It is hypothesized that patients who underwent this procedure demonstrate clinical improvement over baseline in patient reported outcomes metrics (PROMs) and range of motion. A secondary hypothesis is AMPFLr would be non-inferior compared to historical data at early time points. Methods A retrospective review was performed for all patients undergoing AMPFLr between May 2021 and September 2024 at a single institution. Inclusion criteria were primary MPFL surgery, age ≥14 years, preoperative MRI confirming MPFL tear, RBI augmentation, and ≥1-year follow-up. Exclusion criteria included allograft/autograft use, inadequate imaging, derotational osteotomies, and concomitant ACL reconstruction. Outcomes included range of motion (ROM), visual analog scale (VAS) pain scores, and BANFF Patella Instability Instrument (BPII2.0) scores collected preoperatively and at 6 and 12 months. Complications and reoperations were recorded. Paired t-tests compared postoperative values to baseline (α = 0.05). Results Forty-seven patients met inclusion criteria (mean age, 23.9 ± 8.5 years; 61.7% female) with a mean clinical follow-up of 12.7 ± 2.6 months. Three patients (6.4%) underwent reoperation: two for arthrofibrosis requiring manipulation under anesthesia and one for tibial tubercle osteotomy hardware failure after trauma. 1 patient suffered complete re-dislocation, 3 patients (6%) reported subjective instability during pivoting. Significant improvement was observed across all outcome measures. VAS pain decreased from 4.4 ± 1.4 to 0.5 ± 0.8 at 12 months (p < 0.001). BPII2.0 scores improved from 36.7 ± 7.8 to 73.9 ± 5.3 at 12 months (p < 0.001). Flexion increased from 106.8° ± 17.2° to 128.6° ± 5.0° (p < 0.001), and extension normalized by 12 months (p = 0.004). Conclusion AMPFLr with RBI augmentation resulted in significant improvements in pain, function, and knee ROM within 12 months, with no cases of recurrent dislocation and a low reoperation rate. PROM improvements were comparable to historically reported MPFL reconstruction outcomes, supporting the non-inferiority of AMPFLr at early follow-up. These findings suggest that AMPFLr is a safe and effective option for treating patellar instability, though longer-term and comparative studies are needed to determine durability and optimize indications. Level of Evidence Level IV, retrospective case series.

Abstract Background Clostridioides difficile infection (CDI) is a major healthcare burden, particularly in severe cases with high recurrence and mortality rates. Probiotics are often used alongside antibiotics to restore gut microbiota, but their efficacy and safety remain controversial. This study compares outcomes in patients with severe CDI treated with antibiotics alone versus antibiotics plus probiotics. Methods A retrospective cohort analysis was conducted using the TriNetX Research Network. Adult patients (≥18 years) diagnosed with severe CDI between 2010 and 2023 were included. Patients were divided into two cohorts: (1) Antibiotics + Probiotics Group, receiving fidaxomicin, vancomycin, or metronidazole with probiotics (Lactobacillus spp. or Saccharomyces boulardii), and (2) Antibiotics-Only Group, with propensity score matching (1:1) balanced baseline characteristics. Results After matching, 1,146 patients were included in each group, the mean age was (66.3 ± 15.8 vs 66.4 ± 15.1) retrospectively, and female was 47.644% vs 48.429%. At three months, the Antibiotics + Probiotics group had higher risks of CDI recurrence (57.8% vs 44.6%, HR: 1.334, p < 0.0001), diarrhea (23% vs 16%, HR: 1.376, p < 0.0001), MACEs (41.7% vs 33.4%, HR: 1.240, p = 0.0002), and IBD flare-ups (5.1% vs 2.9%, HR: 1.629, p = 0.0072). However, all-cause mortality was lower (11.5% vs 15.3%, HR: 0.685, p = 0.0191). These trends persisted at one year. Conclusion Probiotics were associated with increased recurrent CDI, diarrhea, MACEs, and IBD flare-ups, despite lower mortality. These findings challenge routine probiotic use in severe CDI and highlight the need for targeted, strain-specific trials. Conflict of interest: Hussein, Abdullah: No conflict of interest Rajab, Islam: No conflict of interest Mabrouk, Mohamed: No conflict of interest Nazir, Abubakar: No conflict of interest S. Elgendy, Mohamed: No conflict of interest Altobaishat, Obieda: No conflict of interest ElSafty, Mahmoud: No conflict of interest Bathobakae, Lefika: No conflict of interest Khatib, Elaf: No conflict of interest Patel, Dhruv: No conflict of interest Baddoura, Walid: No conflict of interest

Peroral endoscopic myotomy (POEM) is a standard achalasia treatment, matching surgery in efficacy. However, myotomy length varies. Shorter myotomies are gaining attention for potential benefits. This study compares short versus long myotomies to identify the optimal approach. We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) retrieved from PubMed (MEDLINE), Scopus, Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) until November 28, 2024. Pooled results were calculated using risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, with 95% CI (PROSPERO ID: CRD42024621638). Four RCTs with 419 patients were included. Clinical success (Eckardt score ≤3) showed no significant difference between short and long myotomy (97.4% vs. 95.9%, RR: 1.02 with 95% CI: 0.98-1.06, P =0.33), Reflux symptoms (RR: 0.93, 95% CI: 0.60-1.47, P =0.77), and reflux esophagitis (RR: 0.83, 95% CI: 0.55-1.27, P =0.39). However, short myotomy significantly reduced pathologic acid exposure (RR: 0.57, 95% CI: 0.36-0.91, P =0.02), procedural time (MD: -16.61min, 95% CI: -26.40 to -6.81, P <0.001), and hospital stay (MD: -2.37d, 95% CI: -4.67 to -0.06, P =0.04). Intraprocedural complications were similar ( P =0.73), as was integrated relaxation pressure ( P =0.95), indicating similar postoperative esophageal function. Short myotomy reduced acid exposure, procedure time, and hospital stay in POEM for achalasia without compromising clinical success or symptom improvement. It shows potential as an effective treatment, but large-scale RCTs are needed for definitive clinical endorsement.

Background: Recurrence of atrial fibrillation (AF) remains a concern even after catheter ablation. The impact of Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) on Atrial tachyarrythmia free event remains unclear. Hypothesis: This analysis aims to analyze outcomes in patients treated with SGLT2i after catheter ablation. Methods: A meta-analysis of available studies comparing SGLT2i to non- SGLT2i group following ablation was conducted using electronic databases; PubMed and Embase until May 2025. A random-effects meta-analysis using the DerSimonian–Laird model was performed. Primary outcomes: tachyarrhythmia-free survival and secondary outcomes: all-cause hospitalization and all-cause mortality, and Relative risks (RR) with 95% confidence intervals (CI) were calculated with p &lt;0.05 considered significant. Results: A total of 10 studies were included for meta-analysis with sample size of 10,985 (SGLT2i group: 5534 and non-SGLT2i group: 5451). Primary outcome: There was no significant difference in tachyarrhythmia-free survival (RR: 0.99, 95% CI: 0.76–1.29; p = 0.96), and high heterogeneity (I2 = 84.6%) was observed for this endpoint. Secondary outcome: SGLT2i therapy significantly reduced all-cause hospitalization (RR: 0.74, 95% CI: 0.59–0.94; p = 0.01; I2 = 36.4%) and all-cause mortality (RR: 0.64, 95% CI: 0.45–0.89; p = 0.01; I2 = 0%) Conclusion: SGLT2i therapy offers additive clinical benefits over non-SGLT2i group, notably in reducing hospitalizations and cardiovascular mortality. Its effect on arrhythmia prevention remains uncertain, highlighting the need for further investigation into patient selection and mechanistic interactions.

Background: Traditional TEER studies have prioritized anatomical and technical success, often underreporting the outcomes that matter most to patients—functional status and health-related quality of life (HRQoL). The PASCAL system, with its anatomic versatility, offers a unique opportunity to assess meaningful patient improvement beyond procedural endpoints. Objective: To quantify improvement in New York Heart Association (NYHA) class and Kansas City Cardiomyopathy Questionnaire (KCCQ) score following PASCAL transcatheter edge-to-edge repair (TEER) in patients with symptomatic mitral regurgitation. Methods: A systematic review and meta-analysis were conducted using prospective trials and large registries of patients undergoing PASCAL TEER. Studies were eligible if they reported either NYHA class improvement or change in KCCQ scores. Outcomes were extracted from CLASP, CLASP IID/F, Geis et al., Iberian study, Bartkowiak, and the Srinivasan review. For NYHA class, we calculated the proportion of patients in NYHA I/II at 30 days or 1 year. For KCCQ, mean score changes from baseline were pooled using inverse variance weighting. All analyses were performed using RStudio (v2024.03) with the meta and metafor packages. Random-effects models were applied, and 95% confidence intervals (CIs) were estimated using the Wilson and normal approximation methods, respectively. Results: Across six studies including 600+ patients, 83–91% achieved NYHA Class I/II post-procedure, with a pooled proportion of 86.4% (95% CI: 83.3–89.2%). Among the three studies reporting KCCQ scores (CLASP, CLASP IID/F, and Srinivasan), mean improvements ranged from +15.0 to +17.1, exceeding the clinically meaningful threshold of 10 points. No study showed regression in functional or QoL status. Heterogeneity was low (I 2 &lt; 15%), and results were consistent across FMR and DMR populations. Conclusions: This is the first meta-analysis to comprehensively synthesize patient-reported functional and quality-of-life outcomes following PASCAL TEER. The device delivers robust and durable improvements in NYHA class and KCCQ scores—outcomes directly relevant to patients’ daily lives. These findings underscore the importance of integrating HRQoL metrics in future mitral valve device trials and shared decision-making.

Background: Zilebesiran, a novel small interfering RNA (siRNA) therapeutic targeting hepatic angiotensinogen (AGT), has demonstrated promising antihypertensive effects in recent phase 2 trials. This meta-analysis aimed to quantify the pooled reduction in systolic blood pressure (SBP) following zilebesiran treatment, assess dose-response effects, and explore the association between AGT suppression and SBP reduction. Methods: A random-effects meta-analysis was conducted using data from six treatment arms across the KARDIA-1 and KARDIA-2 trials, evaluating zilebesiran monotherapy and add-on therapy in adults with mild to moderate hypertension. Pooled mean SBP reduction and 95% confidence intervals (CIs) were estimated. Meta-regression was performed using dose (mg) as a continuous moderator. Additionally, a linear regression model was used to examine the relationship between percentage AGT suppression and SBP reduction. All analyses were performed in R (version 4.3.2) using the metafor package. Results: The pooled analysis demonstrated a significant SBP reduction of –11.80 mmHg (95% CI: –15.70 to –7.89; p &lt; 0.0001), with high heterogeneity (I 2 = 81.6%). Meta-regression did not reveal a significant dose-dependent trend (β = 0.0127 mmHg per mg, p = 0.231; R 2 = 13.2%), indicating that SBP reductions were not linearly associated with zilebesiran dose across the 150–600 mg range. Furthermore, no significant correlation was found between AGT suppression and SBP change (β = –0.23, p = 0.491), despite a moderate R 2 of 0.51, limited by small sample size (n = 3). Conclusions: Zilebesiran significantly reduces 24-hour systolic blood pressure across dosing regimens. However, no clear dose-response relationship or direct link between AGT suppression and SBP reduction was observed. These findings highlight the need for further trials with harmonized dosing and biomarker reporting to clarify predictors of response.