Guthrie Robert Packer Hospital is a rural teaching hospital in Sayre, Pennsylvania. It was founded as Robert Packer Hospital in 1885, making it the oldest hospital in the Twin Tiers of Pennsylvania and New York. The hospital is a primary stroke center and level II trauma center. It has received numerous awards, including being named one of the Truven Top 50 Cardiovascular Hospitals 10 times since 2001, "America’s 100 Best Hospitals for Coronary Intervention" by HealthGrades in 2017, 2018, and 2019 and receiving a Bariatric Surgery Excellence Award in 2019. It has also received a Center of Distinction Award for wound care and hyperbarics in 2018.
BackgroundAldosterone synthase inhibitors (ASIs) have emerged as a mechanistically targeted strategy for resistant and uncontrolled hypertension; however, no head-to-head trials exist, and comparative efficacy and safety remain uncertain. We compared their efficacy and safety using network and pairwise meta-analysis of randomized trials.MethodsThis systematic review and meta-analysis adhered to the PRISMA guidelines. PubMed/MEDLINE, Scopus, Embase, ClinicalTrials.gov, and Cochrane Library were searched from inception to January 14, 2026, for randomized trials evaluating ASIs versus placebo or standard care. A frequentist random-effects network meta-analysis assessed systolic (SBP) and diastolic blood pressure (DBP). Dichotomous safety outcomes were pooled using Hartung-Knapp random-effects models. Network consistency was evaluated using design-by-treatment interaction modeling. Prespecified subgroup analyses stratified outcomes by hypertension phenotype (resistant vs uncontrolled).ResultsAcross 7 RCTs (n = 2,828), all ASIs significantly reduced SBP versus placebo: baxdrostat -8.63 mmHg (95% CI -10.84 to -6.42), lorundrostat -7.47 mmHg (95% CI -9.54 to -5.40), and LCI699/osilodrostat -5.63 mmHg (95% CI -9.15 to -2.12), with no significant indirect differences between agents. In resistant hypertension, lorundrostat (-9.00 mmHg; 95% CI -13.19 to -4.81) and baxdrostat (-8.77 mmHg; 95% CI -10.50 to -7.05) demonstrated pronounced reductions. In uncontrolled hypertension, LCI699/osilodrostat showed the largest point estimate (-10.55 mmHg; 95% CI -16.49 to -4.61), though this derives from a single early-phase trial and requires cautious interpretation. DBP reductions were significant for baxdrostat (-3.23 mmHg; 95% CI -4.73 to -1.73) and lorundrostat (-3.60 mmHg; 95% CI -5.43 to -1.77). Hypotension (RR 2.67), hyperkalemia (RR 7.94), and hyponatremia (RR 2.07) were significantly increased; serious adverse events, discontinuation, and network inconsistency were not detected.ConclusionsASIs provide clinically meaningful BP reduction across both hypertension phenotypes; however, short-term use is associated with hypotension and electrolyte disturbances, necessitating careful monitoring. Phenotype-specific efficacy and long-term safety require validation in outcome-driven trials. Systematic Review Registration: PROSPERO CRD420251266257.
Tracheal stenosis is an uncommon but life-threatening complication of endotracheal intubation. The prevalence of tracheal stenosis after long-term intubation is 19%; however, only 1-2% of patients are symptomatic. Common risk factors include a history of previous intubation, duration of intubation, difficult airway, traumatic intubation, prior tracheostomy, advanced age, female sex, estrogen use, severe respiratory failure, and severe gastroesophageal reflux disease, among others. The typical presentation of tracheal stenosis is gradual dyspnea and wheezing that is unresponsive to bronchodilators and steroids. We describe a case of a 33-year-old female patient with atypical presentation who was diagnosed with tracheal stenosis on bronchoscopy nine years following initial short-term endotracheal intubation. Clinicians should maintain a high index of suspicion for tracheal stenosis and a low threshold to perform fiberoptic bronchoscopy in patients with persistent respiratory symptoms after a history of endotracheal intubation, to avoid delays in diagnosis and treatment.
ABSTRACT Epilepsy is a chronic neurological disorder marked by recurrent seizures and psychological consequences, affecting about 1% of the population. The etiology of epilepsy, according to the latest International League Against Epilepsy classification, includes structural, infectious, genetic, immune, metabolic, and unknown categories based on the underlying mechanisms. Standard treatments include anti‐seizure medications, surgery, and neuromodulation techniques such as vagus nerve stimulation and responsive neurostimulation, which reduce seizures but seldom provide a cure. Around one‐third of adolescents develop drug‐resistant epilepsy (DRE), which severely impairs mental health and quality of life, highlighting the need for alternative therapies. The ketogenic diet (KD), a high‐fat, low‐carbohydrate regimen, is a promising non‐pharmacological option. KD shifts metabolism from glucose to ketone bodies produced by the liver, stabilizing neuronal function, improving cognition, and reducing seizures. Clinical data show roughly 30% of DRE patients on KD achieve ≥ 50% seizure reduction, and some become seizure‐free. KD variants allow personalized treatment: the classic KD is most restrictive and effective for refractory cases; the medium‐chain triglyceride (MCT) diet is more flexible while boosting ketogenesis; the modified Atkins diet (MAD) is easier and popular with adolescents; and the low glycemic index treatment (LGIT) offers the fewest restrictions for lower‐risk patients. Despite its effectiveness, KD can pose social and nutritional challenges and carry potential side effects, so monitoring is essential. Nevertheless, KD remains a valuable, evidence‐based adjunct for managing DRE, can improve seizure control, and overall quality.
