Maria Parham Health, formerly known as Maria Parham Hospital and the Maria Parham Medical Center, is a private, full-service regional hospital in Henderson, North Carolina that is part of Duke LifePoint.The historic 1925 building was listed on the National Register of Historic Places in 1994.The current hospital is accredited.
ABSTRACT:Snakebite envenoming affects an estimated 10,000 people annually in the United States. Two FDA-approved antivenoms, ANAVIP® (equine F(ab') 2 ) and CroFab® (ovine Fab), are standard treatments. However, higher-than-expected adverse reactions to ANAVIP have been reported in the southeastern United States, paralleling the regional prevalence of alpha-gal syndrome (AGS), an IgE-mediated allergy induced by lone star tick ( Amblyomma americanum ) bites. Although AGS typically manifests after ingestion of mammalian meat, parenteral exposure to alpha-gal-containing biologics may trigger immediate hypersensitivity. We describe a patient in central North Carolina who developed severe hypotensive anaphylaxis shortly after ANAVIP initiation for copperhead ( Agkistrodon contortrix ) envenomation. Despite elevated alpha-gal-specific IgE, he reported tolerating mammalian meat and subsequently received ovine Fab antivenom without complication. This case underscores the need for clinicians in alpha-gal-endemic regions to anticipate antivenom-associated hypersensitivity and be prepared for rapid recognition and management.
The management of biliary stones in patients with postsurgical anatomical variations can be particularly challenging. Percutaneous cholangioscopy (PC) with electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) has been proposed as a treatment approach. However, the requirement for a stable and wide biliary tract, combined with the limitations of standard cholangioscopes—such as restricted bilateral movements and limited operative angles—can reduce success rates and increase the risk of adverse events. This study aimed to evaluate the feasibility, efficacy, and safety of PC with EHL using a single-operator, small-caliber cholangioscope (SpyGlass™ DS System, Boston Scientific, Natick, MA, USA). Data from patients with postsurgical altered anatomy who underwent PC with EHL at two Italian referral centers were retrospectively reviewed. Demographic data, type of anatomical alteration, technical success, complications, and recurrence rates were collected and analyzed. Technical success was achieved in 37 out of 38 patients (97.3
397 Background: ARTO (NCT03449719) was a multicenter randomized phase II trial exploring the benefit of concomitant Abiraterone acetate and stereotactic body radiotherapy (SBRT) administration in oligometastatic castrate resistant prostate cancer patients (omCRPC). Both biochemical response and biochemical progression free survival (bPFS) were improved by the addition of SBRT in the experimental arm if compared to abiraterone alone. Here is presented a secondary analysis focusing on prognostic impact of BRCA alterations in enrolled patients. Methods: Patients affected by omCRPC (< 3 non-visceral metastatic lesions) were randomized 1:1 to receive either Abiraterone alone (ARM A) or associated with concomitant SBRT on all sites of disease (ARM B). Subgroup analysis focusing on BRCA positive, negative or BRCA untested patients were conducted. Results: Overall population consisted of 157 patients, 89 patients were tested for BRCA 1 and BRCA 2 alterations, of whom 80 and 9 patients resulted negative and positive, respectively. Sixty eight patients were untested. In the BRCA negative population, bPFS events were registered in 43 patients (72.1 and 32.4% of population included in ARM A and B, respectively). Six bPFS events were registered in BRCA positive population (80 and 50% of patients included in ARM A and B, respectively). In the BRCA untested population, 26 bPFS events were detected (52.9 and 23.5% of patients included in ARM A and B, respectively). No significant difference in terms of bPFS was detected between BRCA positive and negative patients (HR 0.93, p=0.86). Conversely, BRCA untested patients had a significant lower risk of biochemical progression (HR 0.58, p=0.02). Benefit of SBRT in the experimental arm was confirmed both in the BRCA negative and BRCA untested populations in terms of bPFS, with HR of 0.37 (95% CI 0.19-0.73) and 0.50 (95% CI 0.14-0.76), respectively. In BRCA positive patients, results were inconclusive due to limited sample size (HR 0.5, 95% CI 0.09-2.89). Conclusions: In a well selected cohort of omCRPC included in a prospective trial, benefit of SBRT was confirmed in BRCA negative and untested patients. Larger cohorts of BRCA positive omCRPC patients undergoing SBRT are needed to confirm these results in this scenario. Clinical trial information: NCT03449719 . Biochemical progression free survival (BPFS) results in the two trial arms according to BRCA status. BRCA negative BRCA positive(vs negative) BRCA untested(vs negative) N Events N Events HR (95%CI), p N Events HR (95%CI), p BPFS 80 43 9 6 0,93(0,39-2,19)p=0,863 68 26 0,58(0,35-0,94)p=0,028 arm A 43 31 5 4 0,86(0,30-2,44)p=0,773 34 18 1,07(0,24-4,85)p=0,926 arm B 37 12 4 2 0,64(0,36-1,15)p=0,135 34 8 0,56(0,23-1,38)p=0,207
