The role of Sodium-Glucose Transporter-2 Inhibitors (SGLT-2i) in preventing chronic obstructive disease exacerbation in patients with diabetes and COPD: An electronic health database analysis.

BACKGROUND: Sodium Glucose Transporter 2 inhibitor (SGLT-2i) medications reduce inflammation, improve glycemic control, and impart weight loss, all of which may play a role in chronic obstructive pulmonary disease (COPD) pathophysiology. OBJECTIVES: The primary objective of our study was to explore the incidence of COPD exacerbation in patients with diabetes and COPD on SGLT-2i medications. The secondary objective was to assess the impact of SGLT-2i medications on COPD exacerbations needing hospitalization, ICU admission, and mechanical ventilation. METHODS: This was a retrospective cohort analysis of COPD patients with diabetes enrolled in the COPD registry at a Mid-west Tertiary care teaching hospital from January 1, 2022, to December 31, 2022. We used Slicer-Dicer, a self-service cohort exploration tool embedded in EPIC for data extraction. RESULTS: We had 31,411 patients registered with the COPD registry during the study period. Of these, 18,713 had diabetes, and 1295 patients were on SGLT-2i medication. The incidence of COPD exacerbation, including severe COPD exacerbation needing hospitalization, was significantly lower in the SGLT-2i medication group (3.16% vs 18.3%, p < 0.05; 1.2% vs 5.04%, p < 0.05). Also, there was a non-significant trend suggesting that the incidence of COPD exacerbation needing intensive care unit admission and intubation was lower in the SGLT-2i medication group (0.07% vs 3.4%; 0 vs 0.04%). SGLT-2i medication use was associated with reduced incidence of COPD exacerbation irrespective of underlying control of diabetes. CONCLUSIONS: Our study suggests possible role of SGLT-2i in preventing COPD exacerbation. Randomized trials are needed in the future to confirm or refute these findings.

Tracheopathia osteochondroplastica: a case report illustrating the importance of imaging in this rare disorder.

Background: Tracheopathia osteochondroplastica (TPO) is an uncommon and benign abnormality of the cartilaginous tracheal wall. It is characterized by multiple calcified nodules in the submucosa of the trachea and main bronchi. This disorder can present as a wide range of nonspecific symptoms; therefore, TPO is usually found as an incidental finding during bronchoscopy. However, it does pose a risk for complicated intubations and recurrent respiratory infection. The etiology of the disease is unknown, and treatments are often only for symptomatic relief, if necessary. Case Description: In this report, we present a case of a 71-year-old woman who presents with chest pain and dyspnea on exertion. She has a history of takotsubo cardiomyopathy, and the symptoms have been persistent since the diagnosis over 6 months ago. A chest computed tomography (CT) demonstrated possible endobronchial lesions and minimal fibrosis. A bronchoscopy was completed following this observation, and it revealed nodular lesions on the cartilaginous rings of the trachea. She was diagnosed with TPO. The patient also has a history of gastroesophageal reflux disease (GERD) and reports relief from chest pain and dyspnea post-esophageal dilation for dysphagia. Conclusions: This case illustrates the relationship between esophageal, cardiac, and pulmonary symptoms, and highlights the role of imaging in the diagnosis of TPO. It also demonstrates a possible treatment option for symptomatic TPO that hasn't previously been discussed.

Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review.

ABSTRACT: This review investigated the ability of dual-task tests to predict falls in people with neurological disorders. Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with neurological disorders. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. Eighteen studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances were predictive of future falls in people with Huntington's disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, 37% of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer's or Parkinson's disease. Complex dual tasks seemed to be more predictive of fall risk than simpler dual tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in neurological disorders. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions.

Prediction Models for Successful External Cephalic Version: An Updated Systematic Review.

OBJECTIVE: To review the decision aids currently available or being developed to predict a patient's odds that their external cephalic version (ECV) will be successful. STUDY DESIGN: We searched PubMed/MEDLINE, Cochrane Central, and ClinicalTrials.gov from 2015 to 2022. Articles from a pre-2015 systematic review were also included. We selected English-language articles describing or evaluating models (prediction rules) designed to predict an outcome of ECV for an individual patient. Acceptable model outcomes included cephalic presentation after the ECV attempt and whether the ECV ultimately resulted in a vaginal delivery. Two authors independently performed article selection following PRISMA 2020 guidelines. Since 2015, 380 unique records underwent title and abstract screening, and 49 reports underwent full-text review. Ultimately, 17 new articles and 8 from the prior review were included. Of the 25 articles, 22 proposed one to two models each for a total of 25 models, while the remaining 3 articles validated prior models without proposing new ones. RESULTS: Of the 17 new articles, 10 were low, 6 moderate, and 1 high risk of bias. Almost all articles were from Europe (11/25) or Asia (10/25); only one study in the last 20 years was from the United States. The models found had diverse presentations including score charts, decision trees (flowcharts), and equations. The majority (13/25) had no form of validation and only 5/25 reached external validation. Only the Newman-Peacock model (United States, 1993) was repeatedly externally validated (Pakistan, 2012 and Portugal, 2018). Most models (14/25) were published in the last 5 years. In general, newer models were designed more robustly, used larger sample sizes, and were more mathematically rigorous. Thus, although they await further validation, there is great potential for these models to be more predictive than the Newman-Peacock model. CONCLUSION: Only the Newman-Peacock model is ready for regular clinical use. Many newer models are promising but require further validation. KEY POINTS: · 25 ECV prediction models have been published; 14 were in the last 5 years.. · The Newman-Peacock model is currently the only one with sufficient validation for clinical use.. · Many newer models appear to perform better but await further validation..

The neurosurgeon workforce: a geographical gender-focused analysis of the trends in representation of neurosurgeons and choices in training over 70 years.

OBJECTIVE: Neurosurgeons frequently move throughout their careers, with moves driven by personal and professional factors. In this study, the authors analyzed these migration trends through a dynamic migratory map and statistical review, with a particular focus on differences in education and practice patterns between male and female neurosurgeons. METHODS: A list containing all board-certified and -affiliated US neurosurgeons practicing in 2019 was obtained from the American Association of Neurological Surgeons. The list was augmented to include demographic and location information for medical school, residency, fellowship(s), and current practice for all neurosurgeons with publicly available data. Migration heatmaps were generated, and migration patterns over 10-year intervals were plotted. A web tool was additionally created to allow for dynamic visualization of this database. RESULTS: The database included 5307 neurosurgeons with a mean age of 57.2 ± 11.3 years. The female population made up 8.93% of all neurosurgeons, and were found to be more likely to complete fellowships than their male counterparts, at 54.2% and 39.1%, respectively (p < 0.0001). A total of 39.5% of all neurosurgeons completed at least one fellowship. A large proportion of currently practicing US neurosurgeons completed medical school internationally in the 1990s. Recently, there has been a trend in neurosurgeons choosing to practice in the South, emigrating from the Northeast and the Western US Census regions. By population, the Western US region trained the fewest neurosurgeons at 1 per 115,000 residents, and the Northeastern US region trained the most at 1 per 49,000. The web tool provides a simple interface to visualize the database on a world map. CONCLUSIONS: Diversity, equity, and inclusion in neurosurgery have been a strong point of discussion in recent literature, with neurosurgeons comprising one of the most gender-disparate workforces in the US medical system. This study provides additional metrics to assess these disparities to help motivate further action toward a larger, more diverse neurosurgical community.

Hedgehog proteins create a dynamic cholesterol interface.

During formation of the Hedgehog (Hh) signaling proteins, cooperative activities of the Hedgehog INTein (Hint) fold and Sterol Recognition Region (SRR) couple autoproteolysis to cholesterol ligation. The cholesteroylated Hh morphogens play essential roles in embryogenesis, tissue regeneration, and tumorigenesis. Despite the centrality of cholesterol in Hh function, the full structure of the Hint-SRR ("Hog") domain that attaches cholesterol to the last residue of the active Hh morphogen remains enigmatic. In this work, we combine molecular dynamics simulations, photoaffinity crosslinking, and mutagenesis assays to model cholesterolysis intermediates in the human Sonic Hedgehog (hSHH) protein. Our results provide evidence for a hydrophobic Hint-SRR interface that forms a dynamic, non-covalent cholesterol-Hog complex. Using these models, we suggest a unified mechanism by which Hh proteins can recruit, sequester, and orient cholesterol, and offer a molecular basis for the effects of disease-causing hSHH mutations.