Metropolitan Hospital Center (MHC, also referred to as Metropolitan Hospital) is a hospital in East Harlem, New York City. It has been affiliated with New York Medical College since it was founded in 1875, representing the oldest partnership between a hospital and a private medical school in the United States.MHC is part of the New York City Health and Hospitals Corporation (HHC), the largest municipal hospital and healthcare system in the country.
Hyperuricemia is a metabolic disorder associated with an increased risk of gout, chronic kidney disease (CKD), and cardiovascular disease (CVD). The management of hyperuricemia in conditions where urate deposition has already occurred primarily relies on xanthine oxidase inhibitors (XOIs), such as allopurinol and Febuxostat. Febuxostat, a non-purine selective XOI, has demonstrated superior urate-lowering efficacy, particularly in patients with renal impairment. This review provides an in-depth analysis of Febuxostat's pharmacological properties, clinical efficacy, and safety profile, with a focus on cardiovascular and nephroprotective effects.
INTRODUCTION/OBJECTIVE:Both fasting and postprandial hypertriglyceridemia are associated with atherosclerotic cardiovascular disease (ASCVD). The Hellenic Postprandial Lipemia Study (HPLS, NCT02163044) is the largest prospective cohort trial assessing the effects of statin therapy on postprandial lipemia. METHODS:Individuals at high or very high risk for ASCVD were evaluated, and their characteristics were recorded at baseline (Visit 1). At Visit 2 (2-4 weeks after Visit 1) and Visit 3 (3-4 months after Visit 2), serum triglyceride (TG) levels were measured after a 12-hour fast (fTG) as well as 4 hours after the ingestion of a commercially available oral fat tolerance test meal (pTG). After Visit 2, all individuals were treated with a statin. RESULTS AND DISCUSSION:Among 900 participants, 699 completed all 3 visits, and of these, 209 (29.9%) had an abnormal pTG response. The mean (standard deviation, SD) total- and low-density lipoprotein cholesterol concentrations were 225 (50) and 148 (46) mg/dL at Visit 1, 231 (42) and 156 (40) mg/dL at Visit 2, and 171 (28) and 101 (27) mg/dL at Visit 3. At Visit 2, the mean fTG level was 127 (45) mg/dL and pTG was 188 (73) mg/dL with a mean difference of 58 mg/dL (P<0.001). At Visit 3, the mean fTG concentration was 110 (40) mg/dL, while pTG was 140 (54) mg/dL (mean difference: 29 mg/dL; P<0.001). Fasting glucose levels had no impact on pTG response in statin-treated individuals with abnormal postprandial lipemia. CONCLUSION:Nearly 30% of individuals at high-/very high-risk for ASCVD had postprandial hypertriglyceridemia. Statin treatment normalized abnormal postprandial lipemia in 75.6% of participants, and decreased pTG concentration even in those with normal fTG levels.
This policy statement updates a previous statement to reflect advances in our understanding of both prenatal and postnatal environmental influences on early brain development, including the effects of alcohol and substance exposures prior to birth and the effects of severe or chronic stress on child development secondary to neglect, physical and sexual abuse, family disruption, poverty, and racism. The accompanying clinical report provides a detailed examination of the developmental challenges faced by children in foster care younger than 5 years.
OBJECTIVES:Intracerebral hemorrhage (ICH) is associated with adverse functional outcomes and elevated mortality, driven by hematoma size and expansion. Timely blood pressure (BP) management may help mitigate hematoma growth. We aimed to assess the effects of clevidipine, an intravenously administered calcium-channel blocker, on hematoma volume and functional outcomes compared with standard antihypertensive therapy in hypertensive ICH patients. METHODS:We performed a prospective cohort study with a historical control group assessing serial hematoma volume measurements and clinical outcomes in acute hypertensive ICH patients treated with intravenous clevidipine (2023-2025) compared with standard antihypertensive therapy using labetalol, clonidine and/or diuretics (2020-2022; prior to clevidipine availability). RESULTS:Sixty-four patients (cases:25; controls:39) were included. There was no difference in demographic characteristics and admission National Institutes of Health Stroke Scale (NIHSS) scores between cases and controls. Clevidipine administration resulted in effective BP control (< 140/90 mmHg) within 3.5 ± 3.2 h from treatment onset, with no hematoma expansion (0.0 vs. 7.7% in controls; p = 0.172) and significant ICH volume reduction on 24-h follow-up brain-CT (14.7% vs. 4.5% in controls; p = 0.023). A trend toward greater improvement in NIHSS scores during hospitalization and numerically lower 3-month mortality rates were observed in clevidipine group. No serious adverse events were reported in the clevidipine-treated patients. In multivariable linear regression models adjusting for potential confounders, clevidipine-use was independently associated with greater ICH-volume reduction (β = -0.16, 95% CI: -0.30, -0.02, p = 0.024). CONCLUSIONS:The present study highlights that clevidipine represents a safe and effective option in terms of acute BP management among patients with hypertensive ICH and may limit hematoma expansion.
ObjectivesCancer incidence and mortality have been increasing both globally and in Greece. The aim of this study was to quantify the health benefits and budget impact of including anti-PD-(L)1’s in three early-stage cancer indications, adjuvant melanoma stage IIB/C and III, adjuvant renal cell carcinoma, and perioperative triple-negative breast cancer.MethodsA Markov model approach was used to predict clinical outcomes and costs throughout the average patient pathway over a 10-year time horizon. The model includes two scenarios: (1) using anti-PD-(L)1’s for patients with early-stage and metastatic disease (ESD scenario) versus (2) treatment with the previous standard of care in the early-stage and anti-PD-(L)1’s only in the metastatic disease setting (reference scenario). Estimated outcomes include life-years (LYs), quality-adjusted life-years (QALYs), events or recurrences, productive LYs lost for patients and caregivers, active treatments administered for metastatic disease, deaths, and costs. The model inputs included efficacy data from clinical trials, Greek data on market shares, projected eligible patients, and the respective costs.ResultsResults indicate the following in the ESD scenario: a reduction of 1,722 (25%) recurrences, 881 (24%) deaths, an increase of 5,555 (11%) LYs without recurrence, an increase of productive LYs by 901 (16%) and 2,363 QALYs gained (4%), and a decrease of 1,782 (27%) in active treatments for the metastatic disease setting. The average incremental budget impact per patient per annum was €31,853 throughout the 10-year time horizon of the model from 2023 to 2032.ConclusionResults indicate that adjuvant/perioperative treatments could provide a significant benefit to patients with cancer, with a manageable additional cost for the healthcare system. The estimations of the model demonstrate a strong call to action for policymakers to enhance access to innovative treatments, since benefits arise for patients, their caregivers, and society as a whole through increased productivity gains.
