Rochester General Hospital, an affiliate hospital of Rochester Regional Health, is a 528-bed tertiary care hospital, located in Rochester, New York. Rochester General Hospital has been serving the residents of the Rochester Region and beyond since 1847. Rochester General Hospital offers primary medical care and a broad range of specialties. Rochester General Hospital's medical staff includes over 1,000 primary care physicians and specialists, many of whom have offices at the hospital and throughout the community.
BACKGROUND:Respiratory syncytial virus (RSV) infection has been associated with an increased risk of cardiac events. This systematic review aims to synthesise the evidence on the absolute and relative risks of cardiac events in adults with RSV disease. METHODS:We searched Embase, PubMed and grey literature sources for studies published between 1 January 2000 and 6 March 2024, reporting on cardiac events in adults with RSV disease. Study quality was assessed using a validated checklist. Absolute and relative risks of cardiac events following RSV disease were summarised and pooled estimates using random effects meta-analysis were calculated. RESULTS:Of 3887 publications, 28 met the inclusion criteria. Among hospitalised patients with RSV disease (25 studies), the pooled estimates showed that 19.2% (95% CI 15.1-24.2) experienced any cardiac event (including specific and unspecific events and combinations of cardiac events), 15.7% (95% CI 14.8-16.5%) heart failure (HF) and 5.4% (95% CI 3.1-9.5%) acute coronary syndrome (ACS). Cardiac event-related mortality ranged from 1.1 to 9.8%. Compared to influenza patients, those with RSV disease had a risk ratio of 1.2 (95% CI 1.1-1.4) for any cardiac event, 1.3 (95% CI 1.1-1.6) for HF and 1.2 (95% CI 0.9-1.5) for ACS. CONCLUSION:RSV disease poses significant risks beyond respiratory illness, including cardiac events, among older adult patients. RSV was associated with a higher risk of HF compared to influenza. Further research is needed to more precisely define the risk period of cardiac events following RSV disease.
GLP1 receptor agonists (GLP-1 RAs) improve cardiorenal outcomes in chronic kidney disease (CKD) patients with obesity or type 2 diabetes. Whether GLP-1 RAs reduce risk of atrial fibrillation (AF) in CKD patients, especially in absence of diabetes or obesity, is unclear. Investigate association between GLP-1 RA use and AF in patients with CKD. Using the TriNetX US Collaborative Network, we identified patients with CKD without prior AF or kidney failure. First use of GLP-1 RA (exposure) served as index event. For non-users, an outpatient visit after chronic kidney disease diagnosis served as pseudo-index event. After 1:1 propensity score matching of users to non-users for baseline risk factors, the cohort was followed up from index/pseudo-index event up to 3 years, death, or end of study period. Primary outcome was incident AF; secondary outcomes were AF-related interventions (a composite of ablation therapy, left atrial appendage occlusion, cardioversion, or pacemaker implantation), heart failure exacerbation, use of antiarrhythmic therapy, major adverse cardiovascular events, kidney failure, major adverse kidney events, and death. Survival analyses were performed. After propensity score matching, each cohort—GLP-1 RA and non-GLP-1 RA—had 37,768 patients with CKD without prior AF or kidney failure. Mean age was 67 ± 11 years; 55
Mediastinal radiation potentiates aortic stenosis and complicates its treatment. We compared the short and midterm-outcomes with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior mediastinal radiation. Electronic databases were searched from inception through December 2024. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as mean differences (MDs) with respective 95% confidence intervals (CIs). Six observational studies were identified, including 2458 TAVR patients and 1873 SAVR patients. In the short-term, TAVR was associated with lower rate of mortality (RR: 0.54; 95% CI: 0.34-0.88), atrial fibrillation (RR: 0.31; 95% CI: 0.15-0.65), acute kidney injury (RR: 0.75; 95% CI: 0.59-0.95), bleeding (RR: 0.37, 95% CI: 0.33-0.42), and shorter length of hospital stay (MD: -4.30; 95% CI: -5.45 to -3.15). One-year mortality was comparable between the 2 groups (RR: 1.04; 95% CI: 0.50-2.13). This meta-analysis of observational studies of patients with prior mediastinal radiation demonstrated that TAVR was associated with better short-term outcomes compared to SAVR. While 1-year mortality appeared similar between the 2 interventions, this finding should be interpreted with caution. However, randomized controlled trials are needed to validate these findings.
We report a case of severe hypercalcaemia after a single cycle of a combination therapy of ipilimumab and nivolumab. Initial evaluation ruled out common causes, including bone metastases, parathyroid hormone/parathyroid hormone-related protein elevation and paraproteinaemia. Her serum 1,25-dihydroxyvitamin D (calcitriol) levels were significantly elevated following the first immunotherapy cycle. Hypercalcaemia responded only to glucocorticoid therapy, with normalisation of serum calcium and calcitriol levels. Recurrence of hypercalcaemia after glucocorticoid discontinuation and subsequent resolution with glucocorticoid re-initiation strongly supported a calcitriol-mediated mechanism, most likely as an immune-related effect of ipilimumab and nivolumab.
Immune-checkpoint inhibitors (ICIs) such as nivolumab and ipilimumab have improved outcomes in metastatic renal cell carcinoma (RCC) but can cause immune-related adverse events (irAEs), including potentially irreversible endocrine toxicities with long-term treatment implications. We present a 62-year-old man with metastatic clear-cell RCC who developed 3 distinct endocrine irAEs during ICI therapy: thyroiditis evolving into hypothyroidism, insulin-dependent diabetes mellitus with diabetic ketoacidosis, and secondary adrenal insufficiency (AI), necessitating ICI discontinuation. Additionally, he experienced immune-mediated inflammatory arthritis. His course required thyroid hormone replacement, insulin therapy, and hydrocortisone for AI. This case underscores the potential for sequential, multiglandular endocrine toxicities from ICIs, a phenomenon infrequently reported in the literature. Clinicians should remain vigilant for delayed or evolving presentations, even in the absence of autoantibodies or radiographic abnormalities. Early recognition, multidisciplinary management, and long-term follow-up are critical for ICI-associated endocrinopathies.
