Long Island Jewish Medical Center (LIJMC or LIJ) is a clinical and academic hospital within the Northwell Health system. It is a 583-bed, non-profit tertiary care teaching hospital serving the greater New York metropolitan area. The 48-acre (19 ha) campus is 15 miles (24 km) east of Manhattan, on the border of Queens and Nassau Counties, in Glen Oaks, Queens and Lake Success, New York, respectively.LIJMC has three components: Long Island Jewish Hospital, Steven & Alexandra Cohen Children's Medical Center of New York, and The Zucker Hillside Hospital. Long Island Jewish Hospital is a 452-bed tertiary adult care hospital with advanced diagnostic and treatment technology, and modern facilities for medical, surgical, dental and obstetrical care. As a primary teaching hospital for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (along with North Shore University Hospital) and the Hofstra Northwell School of Nursing and Physician Assistant Studies Island Campus for the Albert Einstein College of Medicine, LIJMC's graduate medical education program is one of the largest in New York State, and programs are in divisions headed by full-time faculty.LIJ's full-time staff includes more than 500 physicians, who supervise care in all major specialties and participate in the medical center's teaching and research programs.The medical center is located on the southeast side of North Shore Towers.The center was founded in 1954 by a group of nine philanthropists, including Jacob H. Horwitz.
BACKGROUND Lifestyle modification remains the cornerstone of obesity management, serving as an essential component of all treatment plans, even in an era of effective pharmacotherapy. SOURCES OF MATERIAL This review examines the key elements of lifestyle interventions, their mechanisms of action, implementation strategies, and challenges in clinical practice. It additionally discusses the evolving role of lifestyle modification when integrated alongside new pharmaceutical advances, particularly glucagon-like peptide-1 receptor agonists, and how these combined approaches may optimize outcomes in obesity treatment. ABSTRACT OF FINDINGS Effective implementation of lifestyle modification requires a multidisciplinary approach, incorporating exercise counseling, medical nutrition therapy, and behavioral change strategies to address the complex nature of obesity. Nutritional approaches, including various evidence-based dietary patterns, function by creating energy deficits and altering metabolic pathways that influence weight regulation. Physical activity complements dietary interventions by increasing energy expenditure, improving body composition, and enhancing metabolic health. Studies have demonstrated benefits of physical activity for both weight loss and maintenance. Behavioral change techniques are critical for developing sustainable habits, overcoming psychological barriers, and facilitating long-term adherence to lifestyle modifications. CONCLUSION Despite evidence supporting lifestyle modification, challenges limit its use within obesity care, including poor long-term adherence, limited access to specialized facilities and professionals, and inadequate reimbursement for these clinical services.
INTRODUCTION:Nephrotic syndrome (NS), a common glomerular disease in children, is classified based on response to corticosteroid therapy as either steroid-sensitive nephrotic syndrome (SSNS), or steroid-resistant nephrotic syndrome (SRNS). However, there are no current reliable predictors of therapy response at initial clinical presentation. METHODS:To evaluate predictors, we conducted genome-wide association studies, developed polygenic risk scores (PRS) for therapy response and analyzed classical HLA alleles in 1,997 children (994 discovery and 1,003 replication/validation cohorts) previously unstudied children with NS and 3,558 ancestry-matched control individuals. RESULTS:A significant association with HLA loci defined by variants in HLA-DQB1, HLA-DRB1, and HLA-DQA1 were found for SSNS (but not SRNS), along with a second immune-related SSNS locus: CLEC16A. A PRS that discriminates between SSNS and SRNS was validated in two independent cohorts. The HLA haplotype HLA- DRB1∗07:01∼DQA1∗02:01∼DQB1∗02:02 was associated with about four times the risk of developing SSNS. A model incorporating HLA haplotype, PRS score, and age at disease onset was the best predictor of steroid responsiveness with an area under the curve of 0.68-0.70 and an overall classification accuracy of SSNS versus SRNS of 67-71%. CONCLUSIONS:Our findings confirm that SSNS, unlike SRNS, is an immune-mediated HLA-associated disorder. The PRS for therapy response and HLA haplotype can serve as biomarkers, provide a foundation for more accurate diagnoses and tailored individualized treatment.
Clostridioides difficile is a common cause of hospital-acquired diarrheal infections and immunocompromised patients, including heart transplant patients, are vulnerable to severe Clostridioides difficile infections (CDI). Primary prophylaxis of CDI with oral vancomycin can be utilized in these patients but data regarding efficacy is limited. This was an IRB-approved retrospective observational chart review conducted at North Shore University Hospital evaluating the efficacy of oral vancomycin for primary prophylaxis of CDI in heart transplant recipients admitted between January 2018 and December 2023. The study compared patients who received oral vancomycin prophylaxis (OVP) for CDI with those who did not, based on a protocol change in January 2022. Patients with a history of CDI were excluded. The primary objective was to compare the development of CDI within one-year post-transplant between patients who received OVP and those who did not. The secondary objective was the incidence of vancomycin-resistant Enterococcus infections within one-year post-transplant. Statistical analysis involved Fisher’s exact test for categorical data and Wilcoxon rank-sum test for continuous data. The study included 122 patients. Of these, 44 (36%) did not receive OVP, while 78 (64%) did. For the primary outcome, 2 patients developed CDI within one-year post-transplant, both of whom had not received prophylaxis, but this difference was not statistically significant. These patients developed CDI within 24 days and 39 days respectively. For the secondary outcome, 8 patients developed VRE within one-year post-transplant of which 63% (n=5) received prophylaxis. There was no significant difference in VRE development between those who did and did not receive OVP (6.4% vs. 6.8%, respectively). This study did not show a benefit for OVP in the prevention of CDI in heart transplant recipients without a history of CDI. However, these results have limitations, primarily due to the low incidence of CDI and the small sample size. Further research is needed to assess the efficacy of oral vancomycin primary prophylaxis in heart and other solid organ transplant recipients. All Authors: No reported disclosures
OBJECTIVES:We aimed to characterize the frequency of major complications of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C) and adolescents present at 6 months after initial presentation. METHODS:The Pediatric Research Immune Network on SARS-CoV-2 and MIS-C (PRISM) study was a prospective cohort at 20 US pediatric academic medical centers. Individuals aged younger than 21 years meeting any of the following were enrolled: SARS-CoV-2 detection within 7 days, Centers for Disease Control and Prevention (CDC) MIS-C criteria, or CDC MIS-C criteria except having involvement of 1 organ system. The study was designed to assess the proportion of children with major complications (cardiovascular, pulmonary, gastrointestinal/hepatic, renal, and/or neurologic) 6 months after presentation. RESULTS:Data were analyzed on 229 hospitalized participants: 59 with COVID-19 (mean age 10.4 years; SD, 5.5) and 170 with MIS-C (mean age 10.1 years; SD, 4.8). Overall, 42.8% were female, making up 55.9% and 38.2% of the COVID-19 and MIS-C groups, respectively. Overall, the frequencies of major complications at 6 months after initial presentation were: 16/195 (8.2%) cardiovascular, 11/154 (7.1%) pulmonary, 11/154 (7.1%) gastrointestinal/hepatic, 3/152 (2.0%) renal, and 3/189 (1.6%) neurologic. Organ system complications did not differ significantly between the COVID-19 and MIS-C groups. Six of 14 (42.9%) COVID-19 and 21/26 (80.7%) MIS-C participants with at least 1 six-month complication had no underlying medical condition that may have been associated with their complication(s). CONCLUSIONS:Major complications were infrequent but observed in children without underlying medical conditions, underscoring the importance of prospective follow-up to optimize management and elucidate the complications associated with severe SARS-CoV-2 infection in children.
