West Virginia University

Infection enteritis is associated with the development of irritable bowel syndrome (IBS) and functional dyspepsia. This study aimed to examine the long-term risk of IBS and functional dyspepsia, and associated health care utilisation following infection enteritis. We conducted a retrospective cohort study using TriNetX U.S. Network. Adults with infection enteritis were identified and matched to controls, balancing demographics and comorbidities. Primary outcomes were the risk of incident IBS and functional dyspepsia diagnoses at 1, 5, and 10 years. Secondary outcomes were rates of IBS- and functional dyspepsia-related medications, endoscopy, abdominal imaging, and hospitalizations. Pathogen-specific and multivariate analyses were performed to assess variations in IBS risk. After matching, 202,244 patients were identified in each study cohort. At 1year of follow-up, the infection enteritis cohort had higher rates of IBS (RR = 2.35; 95% CI: 2.14-2.59), functional dyspepsia (RR = 2.02; 95% CI: 1.84-2.22), use of IBS-related medications (RR = 1.29; 95% CI: 1.26-1.31), functional dyspepsia-related medications (RR = 1.56; 95% CI: 1.55-1.59), abdominal imaging (RR = 2.42; 95% CI: 2.29-2.54), and Oesophagogastroduodenoscopy/colonoscopy (RR = 1.57; 95% CI: 1.50-1.65). These risks remained significantly higher in the IE cohort at 5 and 10 years. Salmonella/Shigella (RR = 6.48), and Giardia lamblia (RR = 5.05) had the highest risk of developing incident IBS. Infection enteritis was associated with increased risk of IBS and functional dyspepsia, rates of related medication use, and greater healthcare utilisation.

Left ventricular (LV) dysfunction is a potential cardioembolic source of ischemic stroke, but its role in recurrent stroke risk and treatment response remains unclear. We explore whether LV injury associates with the risk of recurrent stroke and modifies the association between anticoagulation and stroke recurrence using real-world data. We performed a multicenter, retrospective study of Cardiac Abnormalities in Stroke Prevention and Recurrence cohort across 27 US sites. Patients with LV ejection fraction ≥20% were included. LV injury, defined as LV ejection fraction 20% to 40% and wall motion abnormality, was the primary exposure and treatment effect modifier. The treatment of interest was anticoagulant versus antiplatelet therapy. The composite outcome included recurrent stroke, major bleeding, or death. Outcomes were evaluated using unadjusted and inverse probability weighting adjusted Cox proportional hazards models, with treatment effect modification tested by LV injury status. Among 2685 patients enrolled, 2328 with complete data were analyzed (median age, 65 years; 49.8% female; median follow-up, 1.6 years). LV injury was present in 310 patients (13.3%). Overall, 535 events occurred: 258 recurrent ischemic strokes, 28 hemorrhagic strokes, 67 major hemorrhages, and 256 deaths. LV injury was associated with a higher unadjusted risk of the primary outcome (hazard ratio [HR], 1.51 [95% CI, 1.21-1.87]), though nonsignificant after inverse probability weighting adjustment (adjusted HR, 1.29 [95% CI, 0.97-1.70]). In the LV injury subgroup, anticoagulation versus antiplatelet therapy was associated with a lower risk of the primary outcome (adjusted HR, 0.24 [95% CI, 0.10-0.59]), relative to the non-LV injury subgroup (adjusted HR, 1.28 [95% CI, 0.83-1.95]; p[LV-interaction], 0.001). Similar interactions were seen for EF 20% to 40% (versus >40%; adjusted HR, 0.19 [95% CI, 0.04-0.86]; p[LV-interaction], 0.001) and wall motion abnormality (versus no wall motion abnormality; adjusted HR, 0.33 [95% CI, 0.15-0.73]). After cryptogenic stroke, anticoagulation in those with LV injury was associated with lower rates of recurrent stroke, major bleeding, and death. These findings warrant confirmation in a dedicated randomized controlled trial. URL: https://www.clinicaltrials.gov; Unique identifier: NCT06398366.

Air pollution has long been recognized as a threat to human health. There is growing evidence that exposure to air pollution increases the risk of upper airway inflammatory disease including allergic and non-allergic rhinitis, and chronic rhinosinusitis. Recent improvement in air pollution measurement, including wearable pollution monitors, may improve our understanding of patient exposures. In this piece, we summarize salient literature and interventions.

This study characterized computed tomography (CT)-derived body composition and tissue morphology in females with non-metastatic breast cancer (BC), both cross-sectionally (n = 56) and longitudinally (n = 38), including comparisons with healthy women and cachexia-prone females with lung cancer. Morphologic changes occurred in the absence of pronounced muscle loss resultant of lean tissue reductions masked by concurrent increases in intra-muscular adipose. Longitudinal analyses suggest divergent phenotypes: non-cachectic patients (63% of BC cohort) demonstrated compositional shifts amid stable muscle quantity, whereas cachectic patients (37%) exhibited wasting of both muscle and adipose quantities alongside remodeling of externally-deposited adipose. Independent of weight, 32 of 38 patients with BC (84%) demonstrated clinically-relevant declines in muscle quantity and/or quality. Findings highlight the discordance between weight loss and underlying tissue dynamics, suggesting that conventional cachexia definitions may under-detect clinically relevant remodeling in early-stage BC. CT-based phenotyping may therefore refine risk stratification to better inform supportive interventions across cancer populations.