Saint Peter's University Hospital (SPUH) is a Roman Catholic hospital on Easton Avenue in New Brunswick, New Jersey. The hospital is a member of the Saint Peter's Healthcare System, Inc., a New Jersey nonprofit corporation sponsored by the Roman Catholic Diocese of Metuchen.
BACKGROUND:Many patients remain functionally limited after transcatheter aortic valve replacement (TAVR) despite successful correction of aortic stenosis. Exercise-based cardiac rehabilitation (EBCR) is effective in other cardiac populations, but its benefits after TAVR remain uncertain. This study evaluated the impact of EBCR on functional capacity, cardiac function, quality of life, and safety outcomes in post-TAVR patients. METHODS:A systematic review and meta-analysis of randomized controlled trials (RCTs) published through February 2025 was conducted using major databases. Outcomes were pooled using mean differences or risk ratios with 95% confidence intervals. RESULTS:Six RCTs with 272 patients were included. No significant difference was found between EBCR and usual care for peak VO2 change (MD: 1.46, 95% CI: [-0.16 to 3.08], p = 0.076) and six-minute walk distance (6MWD) change (MD: 18.72, 95% CI: [-2.24 to 39.68], p = 0.08). Similarly, no significant difference was observed between EBCR and usual care for left ventricular ejection fraction (LVEF) change (MD: 1.31, 95% CI: [-2.06 to 4.69], p = 0.45), and aortic valve orifice area change (AVOA) (MD: -0.03, 95% CI: [-0.24 to 0.18], p = 0.78). CONCLUSION:EBCR did not significantly improve outcomes after TAVR; however, near-significant trends in functional capacity warrant further large-scale investigation. PROTOCOL REGISTRATION:PROSPERO ID CRD420250652719.
EUS-guided radiofrequency ablation (EUS-RFA) has gained recognition in the last decade as a preferred alternative method for pancreatic neuroendocrine tumors (PNETS) where surgical resection is contraindicated. However, clinical outcomes of EUS-RFA for PNETS have not been well studied due to variability in procedure techniques and lack of data from good-quality studies. In this meta-analysis, we aim to study the pooled clinical outcomes of EUS-RFA in patients with PNETS. We searched multiple electronic databases and conference proceedings from inception through Jan 2024. The clinical outcomes studied were pooled technical success, clinical success, and adverse events. We also performed a subgroup analysis based on the sample size of the studies. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I 2 statistics. We analyzed 11 studies, which included 7 prospective and 4 retrospective studies involving 345 patients (55.3% females with a mean age of 58.73 ± 3.01 years) having a mean tumor size of 13.87 ± 0.82 cm and a mean duration follow-up of 13.36 months. Technical was assessed on per session basis, defined by EUS-guided access to PNETs along with the completion of the planned ablation procedure. Clinical success was defined as symptom resolution in functional lesions or complete ablation/disappearance or absence of imaging (cross-sectional or EUS) enhancement in nonfunctional lesions upon follow-up. The pooled technical success rate of EUS-RFA for PNETS was 97.6% (confidence interval 93.3%-99.2%; I 2 = 0%), and the pooled clinical success rate was 88.2% (76.3%-94.6%; I 2 = 74%). The pooled overall adverse event rate associated with EUS-RFA for PNETS was 19.6% (15.3%-24.9%; I 2 = 0%). The pooled rates of pancreatitis, bleeding, perforation, infection, and abdominal pain associated per procedure were as follows: 9.1% (6.2%-13.2%; I 2 = 0%); 4.0% (1.9%-8.2%; I 2 = 0%); 2.3% (1.0%-5.4%; I 2 = 0%); 2.3% (1.0%-5.4%; I 2 = 0%) and 8.8% (5.4%-14.1%; I 2 = 0%), respectively. There were no reported deaths with EUS-RFA. Due to the presence of small sample-size studies, subgroup analysis based on patient sample size of number (N) >20 and (N) <20 was performed. The pooled clinical success rate for studies with N >20 was 90.6% (68.1%-97.7%), whereas for studies with N <20 was 83.0% (69.3%-91.4%). On meta-analysis of EUS-RFA for PNETS, the overall technical success was 97.6%, the clinical success rate was 88.2%, and the overall adverse events was 19.6%. A key finding of this study was the pooled pancreatitis rate of 9.1%. Future studies are warranted to study methods aimed at pretreatment prophylactic measures to prevent this significant adverse event.
Background:Drug-induced liver injury (DILI) refers to hepatotoxicity caused by conventional chemical drugs or xenobiotics, whereas herb-induced liver injury (HILI) is attributed to herbal and dietary supplements. Both these conditions pose diagnostic challenges, particularly when concurrent etiologies such as acute viral hepatitis are present. Hurler syndrome (mucopolysaccharidosis Type I) causes hepatocyte and Kupffer cell vacuolization and can predispose to DILI. Early diagnosis is critical given the high fatality rates associated with DILI. Case Report:We present a case of a 28-year-old male with Hurler syndrome who presented with acute onset of nausea, vomiting, and jaundice. Liver function tests (LFTs) revealed markedly elevated liver enzymes. Serological workup identified newly acquired acute hepatitis C virus (HCV) infection. The patient had recent amoxicillin use and was taking hibiscus tea daily. Causality assessment using the updated Roussel Uclaf Causality Assessment Method (RUCAM) of 2016 yielded a score of 6 (probable DILI). Liver biopsy confirmed DILI. The patient showed clinical improvement with N-acetylcysteine and corticosteroids, with progressive normalization of liver enzymes. Conclusions:This case highlights the importance of differentiating DILI from acute viral hepatitis: strong clinical suspicion, temporal relation with offending drug, liver biopsy, and treatment response assessment. Clinicians should have a high index of suspicion for DILI even in the presence of concurrent acute HCV infection, especially in patients with underlying hepatic dysfunction such as Hurler syndrome in our case.
Bouveret syndrome, or gallstone obstruction of the duodenum, is a rare cause of gastric outlet obstruction, where gallstones migrate through a bilioenteric fistula and obstruct the pylorus or duodenum. Here, we present a case of a 61-year-old man who presented with intractable nausea and vomiting. Initial imaging, such as computed tomography of the abdomen and pelvis, showed gastric distention without an obvious obstructing lesion, and a subsequent upper endoscopy revealed a cholecystoduodenal fistula filled with gallstones, posterior to a stenotic region in the duodenal bulb. The calculi were spontaneously evacuated, the patient's symptoms resolved, and the patient was referred for surgical management. This case highlights the diagnostic challenges of Bouveret syndrome, particularly in the setting of atypical imaging, and emphasizes the importance of timely endoscopic assessment in uncovering rare etiologies of gastric outlet obstruction.
