Spartan Health Sciences University

Abstract Rationale Patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) experience significant cardiopulmonary morbidity. Emerging evidence suggests sodium-glucose cotransporter-2 inhibitors (SGLT2i) may confer cardiovascular and survival benefits through pleiotropic mechanisms, yet their role in RA-ILD remains unclear. Methods We performed a retrospective, multicenter cohort study using the TriNetX U.S. Collaborative Network, which aggregates de-identified electronic health records from 109 healthcare organizations. Adults with RA-ILD and type 2 diabetes were categorized by SGLT2i exposure (dapagliflozin or empagliflozin) versus no exposure. Propensity-score matching (1:1) was applied to balance demographics, comorbidities, and cardiometabolic factors, yielding 452 patients in each group. Outcomes were assessed ≥180 days after index diagnosis and included all-cause mortality and major adverse cardiovascular events (MACE: myocardial infarction, stroke, cardiac arrest, or death). Measures of association and Kaplan-Meier analyses were conducted within the TriNetX analytic environment. Results After matching, cohorts were well balanced for age (70.4 ± 9.7 vs 70.6 ± 12.3 years), sex (61% female), and comorbid burden. SGLT2i use was associated with a numerically lower risk of all-cause mortality compared with non-users (11.7% vs 13.1%; odds ratio 0.89, 95% CI 0.60-1.32; p = 0.55). Kaplan-Meier analysis demonstrated improved survival among SGLT2i users (five-year survival 72.2% vs 19.4%; log-rank p = 0.032; hazard ratio 0.67, 95% CI 0.46-0.97). Rates of MACE were similar between groups (22.8% vs 18.8%; OR 1.27, 95% CI 0.92-1.76; p = 0.14), with a neutral effect on event-free survival (HR 0.95, 95% CI 0.71-1.26). No significant differences were observed in hospitalization frequency or event recurrence. Conclusions In this national real-world cohort of patients with RA-ILD and diabetes, SGLT2 inhibitor therapy was associated with improved long-term survival but did not significantly alter cardiovascular event rates. These findings support a potential mortality benefit independent of cardiovascular endpoints and warrant prospective validation to clarify mechanistic pathways in RA-ILD. This abstract is funded by: None

Multidrug-resistant (MDR) infections in ICUs are a growing global health challenge associated with increased morbidity, mortality, prolonged hospitalization, and rising healthcare costs. Critically ill patients are particularly vulnerable because of immune dysfunction, invasive procedures, prolonged ICU stays, and frequent exposure to broad-spectrum antibiotics, all of which increase susceptibility to MDR infections and antimicrobial selection pressure. Common MDR pathogens in ICU settings include Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacterales. Major resistance mechanisms include β-lactamase and carbapenemase production, efflux pump overexpression, reduced membrane permeability, target modification, biofilm formation, and horizontal gene transfer. Effective management of MDR infections in ICUs requires an integrated, evidence-based approach combining early recognition, microbiological diagnosis, optimized antimicrobial therapy, and strict infection-prevention strategies. Pharmacological management relies on appropriate empiric therapy, antimicrobial stewardship, therapeutic drug monitoring, and pharmacokinetic/pharmacodynamic optimization to improve treatment efficacy while minimizing toxicity and resistance development. Newer antimicrobial agents, including β-lactam/β-lactamase inhibitor combinations and cefiderocol, have expanded treatment options for resistant resistant Gram-negative infections. Non-pharmacological interventions such as hand hygiene, environmental disinfection, surveillance cultures where indicated, contact precautions, and multidisciplinary infection-control programs remain essential in reducing transmission. Emerging innovations, including artificial intelligence-guided antimicrobial selection, rapid diagnostic technologies, microbiome-based therapies, and bacteriophage therapy, show promise for future management. A multidisciplinary strategy integrating prevention, stewardship, and ongoing research is essential to reduce the MDR burden in ICUs and preserve antimicrobial effectiveness.

Introduction: Acute ischemic stroke is the second leading cause of death worldwide. Levels of LDL-C were correlated with the risk of recurrent stroke or transient ischemic attack (TIA). However, there are controversial data regarding the effect of statins on recurrent stroke across different baseline LDL levels. We aimed to assess the effect of statins across different LDL levels to prevent recurrent stroke in patients with acute ischemic stroke. Methods: PubMed, Scopus, Web of Science, and the Cochrane Library were searched for Randomized Controlled Trials (RCTs) assessing the impact of statins across levels of baseline LDL from inception until April 2024. The primary outcome was the incidence of recurrent stroke which was categorized according to baseline LDL levels, absolute decrease in LDL levels, and percentage decrease in LDL levels. The odds ratio (OR) with its 95% confidence interval (CI) was used in a random-effect model. Results: Eighteen RCTs comprising 175,225 patients (mean follow-up of 3 years) were included in the final analysis. Statins were associated with a reduced incidence of recurrent stroke in patients with baseline LDL <100 mg/dl, or >100 mg/dl, with the following values, respectively (OR: 0.85, 95% CI: 0.72 to 0.98, p= 0.04, and 0.88, 95% CI: 0.78 to 0.98, p= 0.03). Additional analysis in patients with an absolute decrease in LDL levels >3 mg/dl showed a lower incidence of recurrent stroke (OR: 0.85, 95% CI: 0.77 to 0.94, p <0.001). Regarding percentage decrease in LDL levels (30-49% and >50%), statins showed a lower risk of recurrent stroke, respectively as follows (OR: 0.65, 95% CI: 0.44 to 0.97, p =0.03, and 0.83, 95% CI: 0.7 to 0.98, p =0.03). Conclusion: This study suggests that statins-based therapies were associated with recurrent stroke risk reduction across baseline LDL levels, absolute and percentage decrease in LDL levels. Additional data on the evidence of atherosclerosis might be warranted to study the impact of statins on high LDL levels in the presence of atherosclerosis.

Background: Traumatic acute subdural hematoma (tSDH) is a life-threatening condition and frequently requires surgical evacuation via craniotomy (bone flap) or decompressive craniectomy (no bone flap). However, there are controversial data regarding this setting. We aimed to give a comprehensive assessment of craniotomy versus decompressive craniectomy in patients with tSDH. Methods: We systematically searched PubMed, OVID, Cochrane Library, Scopus, and Web of Science for eligible comparative studies from inception until April 2024. The primary outcome of interest was the rating of the Glasgow Coma Scale (GCS). Other studied outcomes are all-cause mortality, and rate of residual SDH. STATA 18MP was used to analyze the data using the Der-Simonian Leir random effect model. Results: A total of 16 studies comprising 6405 patients (3963 in the craniotomy, and 2442 in the craniectomy), with a mean age ranging from 34.4 to 68.9 years, and a mean follow-up of 9 months. Craniotomy was associated with a lower risk of all-cause mortality (OR: 0.74, 95% CI: 0.56 to 0.99, p= 0.004; I2= 80.66, p <0.001). Moreover, for patients with GCS scores of 13-15, there were significantly higher rates in the craniotomy group compared to the craniectomy group (OR: 1.64, 95% CI: 1.13 to 2.36, p= 0.001; I2= 0.00, p= 0.75); however, there was no significant difference in patients with the most severe GCS scores of 3-8 or those with GCS scores of 9-12. Conclusion: Craniotomy was associated with better clinical presentation and postoperative outcomes compared to craniectomy for patients with acute SDH. However, the results are powered by the observational data, and further large-volume RCTs are warranted.