Jackson Memorial Hospital (also known as "Jackson" or abbreviated "MJMH") is a non-profit, tertiary care hospital, the primary teaching hospital of the University of Miami's School of Medicine, and the largest hospital in the United States with 1,547 beds.The hospital is located in Miami's Health District at 1611 NW 12th Avenue at the Northwest quadrant of Interstate 95 and the Dolphin East-West Expressway, two of metropolitan Miami's most heavily trafficked highways. The hospital is accessible by Miami Metrorail's rapid transit system at the Civic Center Station stop at 1501 Northwest 12th Avenue in Miami.Jackson Memorial Hospital is the center of a thriving medical campus in Miami's Health District that includes Miami's Veterans Administration Medical Center, the University of Miami Hospital (formerly Cedars of Lebanon Medical Center), and the University of Miami's Leonard M. Miller School of Medicine with its vast research affiliates, laboratories, and institutes, including the University of Miami Sylvester Comprehensive Cancer Center, the University of Miami's Bascom Palmer Eye Institute (the nation's top-rated ophthalmology hospital), the Anne Bates Leach Eye Hospital, the Diabetes Research Foundation, the National Parkinson's Foundation, and the University of Miami's Project to Cure Paralysis. Jackson Memorial Hospital's Miami Transplant Institute is the largest transplant center in the U.S., performing more transplants in 2019 than any US center has ever performed in a single year. It is the only hospital in Florida to perform every kind of organ transplant for both adult and pediatric patients,It is among the world's largest hospitals, currently the third largest public hospital and third largest teaching hospital in the United States. With more than 1,550 beds, it is a referral center, a magnet for research and home to the Ryder Trauma Center, the only Level 1 Adult and Pediatric trauma center in Miami-Dade County, the most populous county in Florida and the seventh most populous county in the nation. Jackson Memorial is the centerpiece of the Jackson Health System, owned and operated by Miami-Dade County through the Public Health Trust. The hospital is supported by Miami-Dade County residents through a half-cent sales tax. In fiscal 2014 the Public Health Trust received $364 million in unrestricted funds from Miami-Dade County. In 2013 Miami-Dade voters approved a separate $830 million bond program for major upgrades to the facility.S.S.
Background ACC/AHA/HSFA Heart Failure (HF) Stages emphasize the progressive nature of HF from clinical risk factors (Stage A) to subclinical cardiac dysfunction (Stage B) to clinical HF (Stage C). However, little is known regarding the rate and predictors of progression of HF stages in late life when HF burden is greatest. Methods Among 2,894 participants in the longitudinal ARIC cohort study who attended both study Visits 5 (V5; 2011-13) and 7 (V7; 2017-18), we determined HF Stage at each visit based on prevalent cardiovascular risk factors to define Stage A, protocoled echocardiography and cardiac biomarkers (NT-proBNP, high sensitivity troponin T, c-reactive protein) for Stage B, and active surveillance and physician adjudication of HF hospitalization for Stage C. Progression was defined as an increase in HF stage from V5 to V7. Variables associated with progression were assessed using multivariable linear and logistic regression. Results Mean age was 74±4 years at V5 and 80±4 at V7, 57% were women, and 23% reported Black race. The prevalences of no HF stage (‘Stage 0’) and Stages A, B and C changed from 3%, 17%, 78% and 3% respectively at V5 to 1%, 6%, 86%, and 8% respectively at V7 (Figure). Overall, 21% of participants progressed to a higher HF Stage over the 6 years between V5 and V7. Progression occurred in 88% of V5 Stage 0, 82% of V5 Stage A, and 6% of V5 Stage B participants. Progression from stage A and stage B was associated with older age, lower eGFR, and higher NT-proBNP at V5 (all p<0.05). Progression from stage B to stage C was also associated with higher BMI, higher hs-Troponin T, and lower LVEF (all p<0.05). Conclusion Among older adults in the community, progression in HF stage is observed in over one-fifth of older adults over six years, with a three-fold increase in Stage C prevalence. These findings highlight the opportunity to prevent HF progression in late life.
Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) characterized by distinctive chronic cutaneous manifestations. Although immune-mediated and microvascular mechanisms are well established, the role of metabolic dysfunction, particularly hyperglycemia, is underexplored in dermatological conditions. This review synthesizes mechanistic, clinical, and translational evidence to explore the relationship between dysglycemia and cutaneous disease severity in DM. Hyperglycemia is associated with oxidative stress, advanced glycation end-product formation, endothelial injury, and proinflammatory cytokine signaling. These processes may plausibly amplify DM-associated vasculopathy, impair wound healing, and worsen cutaneous inflammation. Limited DM-specific studies demonstrate increased insulin resistance and a higher prevalence of diabetes compared with healthy controls. Meanwhile, case reports suggest that poor glycemic control can exacerbate cutaneous disease. Evidence from other inflammatory dermatoses supports a biologically plausible role for dysglycemia in increasing flare frequency, infection risk, and delayed tissue repair. Dietary patterns characterized by high glycemic index and coexisting metabolic syndrome may further intensify systemic and cutaneous inflammation. Collectively, these findings suggest hyperglycemia as a biologically plausible contributor to cutaneous disease severity in DM that warrants further investigation. These observations highlight the need for future studies to evaluate whether metabolic screening, dietary patterns, and interdisciplinary care influence cutaneous disease activity and wound healing in DM. Prospective clinical investigation is needed to determine whether targeted glycemic optimization is associated with changes in cutaneous and systemic outcomes in DM.
Hyponatremia remains the most common electrolyte disorder in clinical practice, with a wide range of causes ranging from endocrine dysregulation to iatrogenic causes. Recent developments in point-of-care ultrasonography, vasopressin physiology, and osmoregulation have transformed diagnostics by emphasizing accuracy above purely clinical judgment. Although traditional management based on fluid restriction and hypertonic solutions remain the cornerstone of treatment, a careful and cautious monitoring is required to avoid osmotic demyelination and overcorrection. The Furst equation, a validated predictor of response to fluid restriction, should be integrated into routine practice, together with objective tools such as point-of-care ultrasonography, to improve the accuracy of volume assessment and guide more precise therapeutic decisions. Likewise, different therapeutic options have been studied for non-responders to fluid restriction, including urea, desmopressin, and selective vasopressin receptor antagonists (vaptans), showing promising results. Ongoing developments in artificial intelligence and laboratory-based decision support tools are expected to improve personalized management and predictive accuracy, potentially reconciling the disparity between evidence and clinical practice.
Kidney transplantation is the gold standard for end-stage renal disease, and robotic kidney transplant is becoming increasingly common globally. There have not been large-scale studies, however, assessing national outcomes of robotic kidney transplant compared to open kidney transplant. This was a retrospective cohort analysis of adults undergoing kidney-only transplant from the National Inpatient Sample, 2016–2022. Comparative analysis was performed using log-transformed linear regression for continuous variables and Rao-Scott chi-square testing for categorical variables. Rates of delayed graft function, length of stay, and costs were regressed on age, sex, race, primary payer, median household income, diabetes, obesity, hospital size, region, and calendar year. Of an estimated 140,495 kidney-only transplants, 670 (0.48
Gingival squamous cell carcinoma (GSCC) is an uncommon oral malignancy that may mimic benign periodontal disease, often leading to delayed diagnosis and advanced stage presentation. We present a 68-year-old man with primary GSCC demonstrating extensive secondary invasion into the maxillary sinus, orbit, and skull base. He presented with progressive weakness, poor oral intake, cachexia, right facial numbness, and visual disturbances. His history was notable for a prolonged absence of medical and dental care due to financial barriers. Imaging revealed a large, destructive mass with orbital apex, cavernous sinus, and skull base involvement, consistent with aggressive perineural and intracranial spread, with regional metastasis to a level II cervical lymph node and distant osseous metastasis to the occipital bone. Given the extent of disease, the tumor was deemed unresectable and managed with systemic therapy, radiation, and corticosteroids for compressive optic neuropathy. This case highlights the aggressive potential of GSCC when diagnosis is delayed and emphasizes the critical role of early recognition and access to preventive care in improving outcomes.
