Palm Springs General Hospital (currently Larkin Community Hospital Palm Springs Campus) is a 247-bed acute care hospital located on a 15-acre campus in Hialeah, Florida. Services include orthopedic surgery (hips, knees, shoulders), cardiac implants, pacemakers, interventional radiological procedures such as endovascular aneurysm repair of abdominal aortic aneuryisms (AAA).
Rural and underserved communities continue to face barriers to timely and accurate healthcare due to shortages of specialists, limited diagnostic infrastructure, and geographic isolation. Artificial intelligence (AI)-driven diagnostic tools, including machine learning (ML) algorithms, telehealth platforms, and clinical decision support systems, have the potential to address these challenges. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and Embase were searched for studies published between January 2010 and April 2025 that evaluated AI-based diagnostic interventions in rural or low-resource settings. Findings were synthesized thematically to assess diagnostic performance, healthcare access, efficiency, and implementation factors. Twenty-six studies met the inclusion criteria, including observational studies, implementation case reports, and systematic reviews. Overall, AI tools were associated with improved diagnostic accuracy, reduced turnaround times, and enhanced access to services through mobile and telehealth applications. Commonly reported barriers included limited digital infrastructure, gaps in provider training, data privacy concerns, and regulatory uncertainty, while enabling factors included community trust, integration with existing health systems, and supportive policy environments. AI-driven diagnostics therefore show considerable promise for reducing inequities in rural healthcare, although successful implementation will require context-specific strategies, sustained infrastructure investment, and strong ethical and regulatory oversight.
Post-inflammatory hyperpigmentation (PIH) is a common pigmentary disorder that is especially prevalent among individuals with skin of color. Lesions can persist for months to years and may contribute to psychosocial distress. Given its chronicity and significant impact, it is important to optimize treatment approaches tailored to diverse skin types. This review evaluated emerging therapies and treatment algorithms for PIH across adult and pediatric populations, with a focus on evidence specific to skin of color. A comprehensive literature search covering 2015 to 2025 identified clinical studies including randomized controlled trials (RCTs), cohort studies, case series, and case reports that reported on topical, systemic, or procedural interventions for PIH. Emphasis was placed on therapies that were evaluated in skin-of-color cohorts. Topical agents such as hydroquinone (HQ), retinoids, azelaic acid (AA), cysteamine, and tranexamic acid (TXA) remain first-line therapies alongside photoprotection. Recent clinical trials have demonstrated their efficacy: cysteamine 5% cream reduced hyperpigmentation indices within 16 weeks, while topical TXA combinations yielded a 30-40% improvement in pigmentation with favorable safety. Oral TXA and emerging nutraceuticals have also shown promise as systemic options. Procedural interventions, including chemical peels and laser therapies, must be used cautiously in individuals with darker skin. In pediatric PIH, first-line management includes gentle skincare, sun protection, and treatment of the underlying inflammatory condition before considering more aggressive interventions. Emerging therapies such as cysteamine and TXA expand the range of treatment options for PIH, providing effective and safe alternatives to HQ in skin of color. Stepwise, individualized regimens that integrate topical therapy, photoprotection, and adjunctive interventions can optimize outcomes while minimizing risks. Further research in pediatric and skin-of-color populations is needed to refine treatment algorithms.
Background and aim Obesity is strongly linked to elevated blood pressure and increased cardiovascular risk. Glucagon-like peptide-1 (GLP-1) receptor agonists have gained attention for their role in weight management and potential cardiovascular benefits. Evidence in nondiabetic populations remains limited. The aim of this study was to descriptively evaluate the association between GLP-1 receptor agonist use and systolic and diastolic blood pressure levels among nondiabetic adults with obesity. Methods This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 prepandemic cycle, selected to ensure use of the most recent complete data prior to disruptions related to the COVID-19 pandemic. Adults aged 18 years or older with obesity were included, and individuals with self-reported diabetes were excluded. GLP-1 receptor agonist use was identified from prescription medication data, with a very small number of exposed participants in the analytic sample. Blood pressure was assessed using standardized examination measures. A complete-case approach was applied, whereby participants with missing data on any variables included in the analysis were excluded to ensure a consistent analytic sample. Analyses incorporated NHANES examination sample weights to produce nationally representative estimates and accounted for the complex survey design by including stratification and primary sampling units to ensure correct variance estimation. Descriptive statistics were used to compare characteristics by exposure. Results Lower systolic blood pressure was observed among GLP-1 users compared with nonusers (107.2 vs 122.1 mmHg), and diastolic blood pressure was also lower (74.4 vs 76.9 mmHg). The proportion of hypertension was lower among GLP-1 users, 5,814 (14.1%), compared with nonusers, 25,207,405 (36.5%). The extremely small number of exposed participants (n = 2) limited further statistical analysis and inference. Conclusions Lower blood pressure levels were observed among GLP-1 receptor agonist users compared with nonusers in this population. These findings are descriptive and reflect observed differences in blood pressure within the analytic sample, without implying a causal relationship. Further studies using datasets with greater representation of GLP-1 receptor agonist use in nondiabetic populations are needed to better characterize this relationship.
BACKGROUND:Cesarean delivery is a common obstetric procedure in the United States, yet concerns remain regarding its association with maternal and neonatal outcomes at the population level. Understanding outcome patterns by mode of delivery is important for informing clinical practice and public health planning. OBJECTIVE:To examine population-level associations between mode of delivery and severe maternal morbidity (blood transfusion, uterine rupture, unplanned hysterectomy, or maternal intensive care unit admission) and adverse neonatal outcomes (neonatal intensive care unit admission, assisted ventilation, or infant transfer) among live births in the United States. METHODS:This retrospective cross-sectional study analyzed the Centers for Disease Control and Prevention (CDC) Natality public use microdata from 2017 to 2020, including all recorded live births during the study period. The mode of delivery was categorized as cesarean or vaginal. Severe maternal morbidity and adverse neonatal outcomes were defined using composite indicators derived from reported clinical variables. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) while controlling for maternal demographic characteristics, clinical comorbidities, obstetric factors, and year of delivery. Robust standard errors were applied. RESULTS:Among the 15,035,328 births included in the analysis, severe maternal morbidity occurred in 32,630 (0.32%) vaginal deliveries compared with 55,463 (1.16%) cesarean deliveries (p < 0.001). The composite adverse neonatal outcome was observed in 770,413 (7.52%) vaginal deliveries and 903,895 (18.88%) cesarean deliveries (p < 0.001). In multivariable analyses adjusting for maternal demographic characteristics, clinical comorbidities, obstetric factors, and year of delivery, cesarean delivery was associated with higher odds of severe maternal morbidity compared with vaginal delivery (aOR, 2.99; 95% CI, 2.94-3.04). Cesarean delivery was also associated with higher odds of adverse neonatal outcomes (aOR, 2.19; 95% CI, 2.19-2.20). Preterm birth demonstrated a strong association with adverse neonatal outcomes (aOR, 13.87; 95% CI, 13.81-13.93). CONCLUSION:Cesarean delivery was associated with higher maternal and neonatal morbidity in this national analysis. These associations likely reflect, in part, underlying obstetric complexity and high-risk clinical conditions that contribute both to the decision for cesarean delivery and to adverse outcomes. These findings emphasize the importance of careful clinical decision-making and continued efforts to improve maternal and neonatal care in high-risk pregnancies.
