OBJECTIVE: To examine the association between GLP-1RAs and age-related macular degeneration. METHODS: This is a retrospective cohort study including two cohorts of adults aged ≥50 years free of macular degeneration at ba...OBJECTIVE: To examine the association between GLP-1RAs and age-related macular degeneration. METHODS: This is a retrospective cohort study including two cohorts of adults aged ≥50 years free of macular degeneration at baseline, including (i) the diabetes cohort comparing age-related macular degeneration risk between GLP-1RAs and metformin users, and (ii) the obesity cohort, consisting of individuals with a body mass index ≥30 kg/m without type 2 diabetes, comparing the risk of age-related macular degeneration between GLP-1RAs and other weight-loss medications. A 1:1 propensity score matching was performed to balance covariates. Cox proportional hazards models and Kaplan-Meier analysis were used to assess the risk of age-related macular degeneration across 5 years of follow-up. RESULTS: A total of 147,800 participants with diabetes and 49,518 participants with obesity were included. In the diabetes cohort, GLP-1RAs were associated with lower total age-related macular degeneration (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.75-0.91) and dry age-related macular degeneration (HR, 0.84; 95% CI, 0.73-0.98) risks compared to metformin. In the obesity cohort, GLP-1RAs were associated with a lower risk of total age-related macular degeneration (HR, 0.77; 95% CI, 0.61-0.98) and dry age-related macular degeneration (HR, 0.65; 95% CI, 0.46-0.94) compared to other weight-loss medications. CONCLUSIONS: GLP-1RAs were associated with a lower risk of age-related macular degeneration, particularly dry form, compared with metformin or other weight-loss medications.
Marijuana, or cannabis, is the most commonly used illicit substance in the United States, with prevalence nearly doubling over the past decade. Accumulating evidence implicates cannabis use as a potentially modifiable ri...Marijuana, or cannabis, is the most commonly used illicit substance in the United States, with prevalence nearly doubling over the past decade. Accumulating evidence implicates cannabis use as a potentially modifiable risk factor for acute myocardial infarction, particularly among younger adults without traditional cardiovascular risk factors. Marijuana precipitates acute myocardial infarction through multiple converging mechanisms: increased myocardial oxygen demand via sympathetic activation, impaired oxygen delivery through carboxyhemoglobin elevation, coronary vasospasm, endothelial dysfunction, and a prothrombotic state characterized by enhanced platelet activation. Genetic variability in cannabinoid receptor expression and CYP2C9-mediated tetrahydrocannabinol metabolism further modulates individual susceptibility. Among patients with established coronary artery disease, population-based data suggest elevated cardiovascular risk with frequent use, though prospective cohort data remain conflicting. In post-percutaneous coronary intervention patients on dual antiplatelet therapy, cannabidiol inhibition of CYP2C19 may impair clopidogrel bioactivation, warranting consideration of alternative P2Y12 inhibitors. These findings highlight the importance of cannabis use screening in clinical practice and the need for prospective studies to guide evidence-based management.
BACKGROUND: Hospital-at-Home programs deliver acute inpatient-level care in patients' homes and have demonstrated favorable outcomes compared with traditional, brick and mortar hospital hospitalization. Pyelonephritis is...BACKGROUND: Hospital-at-Home programs deliver acute inpatient-level care in patients' homes and have demonstrated favorable outcomes compared with traditional, brick and mortar hospital hospitalization. Pyelonephritis is a common inpatient condition; however, 30-day hospital readmission rates in Hospital-at-Home populations are unknown. METHODS: We performed a retrospective cohort study of adults treated for acute pyelonephritis in Mayo Clinic's Hospital at Home program across all three U.S. sites between July 2020 and January 2025. The primary outcome was 30-day all-cause unplanned readmission to a brick-and-mortar hospital or re-enrollment in Hospital-at-Home. RESULTS: Among 165 patients, 28 (17.0%) experienced a 30-day unplanned readmission. Hospital readmission was not associated with severity of illness, risk of mortality, Charlson Comorbidity Index, sepsis or bacteremia at presentation, Hospital-at-Home admission pathway, or length of stay. In adjusted analyses, the presence of an ileal conduit (p=0.02) and an indwelling or suprapubic urinary catheter (p=0.04) were independently associated with higher odds of 30-day hospital readmission. CONCLUSIONS: In this multi-site Hospital-at-Home cohort, 30-day hospital readmission after treatment for acute pyelonephritis was associated with genitourinary complexity rather than illness severity or treatment factors.
A wealth of new literature is published annually in the growing field of perioperative medicine. The most noteworthy publications are often hard to find as they are spread over a variety of journals. We have undertaken a...A wealth of new literature is published annually in the growing field of perioperative medicine. The most noteworthy publications are often hard to find as they are spread over a variety of journals. We have undertaken a multi-database literature search from January to December of 2025 to identify the most impactful perioperative articles from the past year. We included original research articles, systematic reviews, meta-analyses, and guidelines. We excluded abstracts, case reports, letters, or literature pertaining to cardiovascular surgery, pediatrics, and obstetrics. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ontario, Canada). A modified Delphi technique was used to narrow down to seven of the most impactful publications and another eight tabular summaries. The purpose of this review is to highlight new literature to improve perioperative outcomes for patients.
BACKGROUND: Cushing's syndrome is associated with immune dysfunction and increased susceptibility to infection, yet risk of infection-related hospitalization remains unclear. We evaluated infection-related hospitalizatio...BACKGROUND: Cushing's syndrome is associated with immune dysfunction and increased susceptibility to infection, yet risk of infection-related hospitalization remains unclear. We evaluated infection-related hospitalization in Cushing's syndrome versus controls. METHODS: Using the Clalit Health Services database, 609 patients with Cushing's syndrome were identified and matched to 3,018 controls by age, sex, socioeconomic status, and body mass index. The primary outcome was infection-related hospitalization. Competing-risk models were used with death as a competing event. Analyses were performed according to etiology, remission, and infection subtype. RESULTS: During mean follow-up of 13.4 years in patients with Cushing's syndrome and 13.9 years in controls, infection-related hospitalization occurred in 14.1% vs 5.9% (86/609 vs 178/3,018), with incidence rates of 10.5 vs 4.2 per 1,000 person-years. Patients with Cushing's syndrome had a higher risk of infection-related hospitalization (HR 2.5, 95% CI 1.9-3.2), observed in both Cushing's disease (HR 3.8, 95% CI 2.5-5.7) and adrenal disease (HR 2.3, 95% CI 1.5-3.6). Respiratory and genitourinary infections were the most common causes, and opportunistic infections were more frequent in Cushing's syndrome (12.5% vs 5.6%, p=0.04). Patients in remission remained at increased risk (HR 2.5, 95% CI 1.6-3.8), while older age and higher body mass index independently predicted hospitalization, with most infections occurring in patients aged ≥55 years and body mass index ≥25 kg/m². CONCLUSION: Patients with Cushing's syndrome have an excess risk of infection-related hospitalization affecting both common and opportunistic infections and risk persists after remission. These findings support ongoing infection surveillance and preventive measures.
BACKGROUND: Systemic inflammation promotes the initiation and progression of pancreatic cancer, but the association between chronic inflammatory diseases and survival is less understood. This study aimed to investigate t...BACKGROUND: Systemic inflammation promotes the initiation and progression of pancreatic cancer, but the association between chronic inflammatory diseases and survival is less understood. This study aimed to investigate the relationship between chronic inflammatory diseases and survival among patients with pancreatic cancer in the U.S. Military Health System (MHS), a healthcare system with universal access. METHODS: The study utilized the Military Cancer Epidemiology database (MilCanEpi), a linked database comprising data from the Department of War's Central Cancer Registry (CCR) and the Military Health System (MHS) Data Repository (MDR). The diagnosis of chronic inflammatory diseases was queried in the MilCanEpi database. All-cause death was the study outcome. Multivariable time-dependent Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence interval (95% CI) of death associated with chronic inflammatory diseases. RESULTS: Four hundred patients had chronic inflammatory diseases concurrent with or following their pancreatic cancer diagnosis, compared to 477 without such a diagnosis. There was a nearly two-fold increased risk of death associated with chronic inflammatory diseases after adjustment for confounders (adjusted HR=1.77, 95% CI=1.51-2.06). The association was observed in most subgroups defined by age, comorbidity, tumor stage, tumor grade, and time at diagnosis of chronic inflammatory diseases relative to pancreatic cancer diagnosis. CONCLUSION: Chronic inflammation, characterized by chronic inflammatory diseases, was independently associated with risk of increased all-cause death among patients with pancreatic cancer in the MHS.
BACKGROUND: Antithrombotic agents have been linked to a higher risk of gastrointestinal bleeding, but their impact on in-hospital mortality remains controversial, with observational studies variably reporting increased,...BACKGROUND: Antithrombotic agents have been linked to a higher risk of gastrointestinal bleeding, but their impact on in-hospital mortality remains controversial, with observational studies variably reporting increased, unchanged, or reduced mortality.. This systematic review and meta-analysis assessed the influence of antithrombotic on in-hospital mortality in patients with upper gastrointestinal bleeding. METHODS: Following Cochrane and PRISMA recommendations, we included observational studies of adult patients admitted for acute upper gastrointestinal bleeding comparing in-hospital all-cause mortality between those receiving antithrombotic therapy (antiplatelets, anticoagulants, or both) at admission and those not. Studies in which antithrombotic therapy was initiated de novo during admission were excluded. Seventeen studies published between 2004 and 2025 were included (18,712 patients; 6,558 on antithrombotic therapy at presentation, 12,154 not). The primary outcome was in-hospital all-cause mortality, extended to 30-day mortality where in-hospital data were not separately reported. RESULTS: Antithrombotic therapy at admission was not associated with increased in-hospital mortality, with a trend towards a protective association (OR 0.79; 95% CI 0.62-1.01). Subgroup analyses showed a significant protective effect for antiplatelet agents (OR 0.67; 95% CI 0.47-0.95), no significant influence for anticoagulants (OR 1.09; 95% CI 0.72-1.64), and significantly lower mortality in studies restricted to non-variceal bleeding (OR 0.60; 95% CI 0.41-0.87). CONCLUSION: Antithrombotic therapy at admission was not associated with increased in-hospital mortality in acute upper gastrointestinal bleeding, with a protective trend overall and significant protection in antiplatelet users and non-variceal bleeding. Given the observational design, findings should be interpreted as a prognostic association supporting standard management.
OBJECTIVE: Night-shift work has been associated with adverse cardiovascular outcomes. It remains unclear whether the cardiovascular association of night-shift exposure differs according to underlying baseline cardiovascu...OBJECTIVE: Night-shift work has been associated with adverse cardiovascular outcomes. It remains unclear whether the cardiovascular association of night-shift exposure differs according to underlying baseline cardiovascular susceptibility and whether short-term intensity and longer-term duration show similar patterns. METHODS: We analyzed 85,322 UK Biobank participants with occupational night-shift information. Baseline cardiovascular disease risk profile was classified as low, intermediate, or high using a composite score based on cardiovascular disease polygenic risk score tertiles, current smoking, obesity, low moderate-to-vigorous physical activity, and insomnia. Night-shift exposure was evaluated in two ways: monthly intensity and yearly duration, each categorized as none, low, or high. Incident cardiovascular disease was identified from inpatient records. Cox proportional hazards models were evaluated for the associations. RESULTS: Of 85,322 participants, 24,696 were classified as low cardiovascular disease risk, 49,332 as intermediate risk, and 11,294 as high risk. Across all strata, workers without night-shift exposure generally had the lowest incidence of cardiovascular disease . In the low-risk group, high monthly intensity and high yearly duration were each associated with similar increased risk and having more pronounced in high-risk group. For monthly intensity, the aHR were 1.35 (95% CI 1.19-1.52) and 1.22 (95% CI 1.08-1.37) for low- and high-intensity groups, respectively, whereas for yearly duration the corresponding aHR were 1.21 (95% CI 1.06-1.37) and 1.34 (95% CI 1.19-1.51). CONCLUSIONS: Among workers with occupational night-shift information, the association between night-shift exposure and incident cardiovascular disease was strongest in those with greater baseline cardiovascular susceptibility. Compared with monthly intensity, yearly duration showed a more consistent exposure-response pattern.
BACKGROUND: Alcohol-associated liver disease (ALD) is a major cause of liver-related morbidity and mortality, with alcohol abstinence remaining the cornerstone of management. Pharmacologic therapies for alcohol use disor...BACKGROUND: Alcohol-associated liver disease (ALD) is a major cause of liver-related morbidity and mortality, with alcohol abstinence remaining the cornerstone of management. Pharmacologic therapies for alcohol use disorder (AUD) can support abstinence but remain underutilized in patients with ALD. The impact of Gastroenterology (GI)/hepatology involvement on the use and outcomes of medications for alcohol use disorder (MAUD) remains understudied. METHODS: We conducted a retrospective chart review of patients with ALD and AUD identified by ICD-10 codes at a tertiary care liver transplant center between January 2022 and December 2023. Patients prescribed MAUD with ≥90 days of follow-up were included. Clinical characteristics, liver disease severity, and GI/hepatology involvement were assessed. Outcomes included MAUD adherence, alcohol abstinence, and negative alcohol biomarkers. Multivariable logistic regression evaluated associations with outcomes. RESULTS: Among 165 patients (mean age 46.3±10.8 years; 42% female; 87% White), 41% had cirrhosis, of whom 75% had Child-Pugh B/C. GI/hepatology was involved in 47% of cases. Acamprosate (52%) and naltrexone (40%) were most prescribed. At 90 days, mortality was 11%, adherence 46%, abstinence 38%, and negative biomarkers 39%. Higher MELD-Na scores were associated with adherence and abstinence. GI/hepatology-prescribed MAUD was independently associated with negative biomarkers (OR 5.37, 95% CI 1.58-18.32, p=0.007) and showed favorable associations with adherence and abstinence. CONCLUSION: MAUD are effective in patients with ALD, including cirrhosis. Outcomes were similar across prescribing providers, supporting broader GI/hepatology engagement in initiating AUD treatment.