Tripler Army Medical Center (TAMC) is a major United States Department of Defense medical facility administered by the United States Army in the state of Hawaii. It is the tertiary care hospital in the Pacific Rim, serving local active and retired military personnel along with residents of nine U.S. jurisdictions and forces deployed in more than 40 other countries in the region. Located on the slopes of Moanalua Ridge overlooking the Honolulu neighborhoods of Moanalua and Salt Lake, Tripler Army Medical Center's massive coral pink structure can be seen from any point in the Honolulu District. It also serves as headquarters of the Regional Health Command - Pacific.The main hospital facility is within the Honolulu census-designated place.
Introduction:Whole genome sequencing (WGS) was performed on 10 extensively drug-resistant (XDR) Pseudomonas aeruginosa ST235 isolates to investigate potential healthcare-associated transmission of XDR P. aeruginosa ST235 within a U.S. military treatment facility (MTF), assess its environmental persistence, and determine its genomic relatedness to global strains. Methods:Patient samples were collected and processed using standard clinical protocols. To assess potential environmental contamination, ICU sink drains from rooms previously occupied by study patients were swabbed, cultured in BHI and BAP media, and screened by PCR targeting 16S rRNA and P. aeruginosa ecfX. Isolates included 2 from the index patient with prior hospitalization in the Philippines, 4 from a secondary patient in the same ICU, and 4 from the index patient's room sink collected 9 months later. Genetic relatedness was evaluated using core genome multilocus sequence typing (cgMLST) and single nucleotide polymorphism (SNP) analysis. Antimicrobial resistance genes were identified with AMRFinderPlus, and global phylogenetic comparisons were performed using publicly available genomes from NCBI and the MRSN database. Results:The 6 clinical isolates differed by only 0-4 SNPs, indicating high genetic relatedness. The 4 environmental isolates differed from the clinical isolates by just 1 allele in cgMLST and 0-4 SNPs. Global phylogenetic analysis showed close clustering with ST235 strains from the Philippines, with the closest match being a 2018 Manila isolate (1-12 allele differences). The isolates carried the blaVIM-2 carbapenemase gene and exhibited resistance to all tested antibiotics. Discussion:WGS surveillance revealed an undetected intra-hospital transmission of XDR P. aeruginosa ST235 and its persistence in the environment for at least nine months. The findings underscore the importance of genomic surveillance in identifying AMR outbreaks, especially among patients returning from high-risk regions, and proactive infection control measures to prevent the spread of high-risk AMR clones in healthcare settings.
OBJECTIVE:To evaluate the efficacy of laparoscopic-assisted transversus abdominus plane (LA-TAP) block for minimally invasive gynecological surgeries (MIGS). DESIGN:Randomized controlled trial. SETTING:Two hospital sites within a tertiary academic healthcare system. PARTICIPANTS:Eighty participants undergoing MIGS for benign conditions. INTERVENTIONS:Participants were randomized to either a control group that received no block (n = 40) or a LA-TAP group (n = 40) which received a standardized mixture of liposomal and plain bupivacaine. No participants received trocar site local infiltration. Primary outcomes were patient-reported average and worst pain at rest and with activity assessed 24 hours after surgery. Secondary outcomes included: (1) average and worst pain with activity assessed at 48 and 72 hours after surgery, (2) opioids used in the post-anesthesia care unit (PACU) and cumulative use after PACU discharge assessed at each 24-hour block (oral morphine milligram equivalents [OME]), (3) time to PACU discharge (4) nausea or vomiting within the first 24 hours (yes/no), and (5) satisfaction with pain regimen. Pain and satisfaction were scored on a scale of 0 to 10 (10 = highest). Outcome assessor and participants were blinded to group assignment. RESULTS:Final analyses included 34 LA-TAP participants and 30 controls. Worst pain (mean ± SD) at rest within the first 24 hours was lower in the LA-TAP group (4.8 ± 2.7) versus control (6.2 ± 2.3) (p = .031). Opioid use in the PACU (mean ± SD) was reduced in the LA-TAP group (13.3 ± 14.1 OME) versus control (22.5 ± 20.1 OME) (p = .040). There was no difference in all other pain scores, cumulative opioid use, time to PACU discharge, incidence of nausea or vomiting, or overall satisfaction. CONCLUSION:LA-TAP blocks may reduce early postoperative pain and decrease PACU use of opioids after MIGS.
BACKGROUND:Given excellent prostate cancer outcomes, comorbidity management is critical to survivorship. While hormone therapy or androgen deprivation therapy (ADT) is a mainstay of treatment, they can negatively impact quality of life and survivorship through cardiovascular, sexual, and metabolic effects. ADT-induced metabolic syndrome causes impaired glucose tolerance, muscle mass loss, and weight gain. This systematic review examined recent randomized clinical trials (RCTs) investigating the impact of diet and weight management strategies on mitigating ADT-related adverse effects. METHODS:A systematic review of RCTs (2015-2025) was performed using PubMed/Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To identify how diet and weight management impacts ADT symptoms, search terms included: "prostate cancer," "diet," "nutrition," "glucagon-like peptide-1 receptor agonists" (GLP-1RA), and "ADT." Risk of Bias 2 (ROB2) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools evaluated RCT quality. RESULTS:Of 2799 publications, 16 met inclusion/exclusion criteria (range, 23-96 patients/RCT). No RCTs had a high risk of bias or evaluated GLP-1RA. Outcomes included metabolic labs, body composition, and quality of life. Mediterranean and low-carbohydrate diets with exercise reduced cardiovascular and metabolic risk factors, with variable durability. Creatine trended toward increasing lean muscle mass. Multidisciplinary care and community involvement improved accountability and outcome durability. CONCLUSIONS:This comprehensive review of diet and ADT in prostate cancer identified nutritional interventions that were safe, feasible, and may be recommended as part of prostate cancer treatment and survivorship. Future RCTs should evaluate optimal diet duration, longer follow-up, multidisciplinary patient support, and novel anti-metabolic therapies like GLP-1RA.
IntroductionRecurrent urinary tract infections (rUTIs) in postmenopausal (PM) women pose a significant clinical challenge, complicated by rising antibiotic resistance among uropathogens. The vaginal microbiota in this population remains underexplored. We aim to characterize vaginal flora of PM women with and without a history of rUTIs, and to evaluate relationships to demographic variables, clinical characteristics, and rectal pathogen colonization.MethodsWe conducted a cross-sectional study of 62 PM women (n = 31 rUTI, (n = 31 control). Vaginal swabs were analyzed using 16S rRNA and a next-generation sequencing tool designed to identify UTI pathogens and antibiotic resistance (AMR) markers. Rectal swabs were cultured to identify uropathogens and their phenotypic resistance. These were integrated with subject demographic and historical clinical data.ResultsCompared to controls, rUTI vaginal microbiota exhibited a marked depletion in Lactobacillus crispatus and L. iners, species commonly associated with vaginal health, alongside an enrichment of L. gasseri and L. jensenii. The rUTI cohort also had a greater burden of AMR markers (p = 0.0003). Notably, Gram-negative uropathogens in the rUTI group frequently carried multidrug resistance genes, at rates nearly three times higher than controls. The rUTI cohort was further characterized by enrichment of Gram-negative uropathogens in the vagina. These alterations were more pronounced with increasing years in menopause.DiscussionThe rectum emerged as a key reservoir, with notable concordance of organisms across rectal and urogenital sites. Our findings indicate that rUTIs in postmenopausal women are associated with a dysbiotic vaginal microbiome that is closely linked to a rectal reservoir of multidrug-resistant uropathogens.
Artificial intelligence (AI) continues to rapidly transform the practice of medicine, with clinicians increasingly adopting data-driven decision-making aids and diagnostic support tools. Orthopaedic physicians are well poised to harness the capabilities of AI, with an abundance of quantifiable imaging, biomechanical data, and structured clinical parameters lending themselves to algorithmic interpretation and automation. Namely, AI-augmented vision systems may increase the breadth of information readily available to clinicians, whereas smart exam rooms and automated clinical summaries may soon streamline clinical workflows to decrease administrative burden and allow more time for direct patient care. Personalised education materials and visual aids may improve patient understanding and compliance, with the aim of optimising patient outcomes. Generative medical and orthopaedic event models may soon alter decision-making heuristics and improve patient counselling. While the widespread adaptation of AI into clinical practices is not without limitations, physicians will likely come to share an increasingly symbiotic relationship with these platforms throughout their continued evolution. Accordingly, it is imperative that current and future orthopaedic practitioners become well-versed in harnessing the capabilities of AI and continue to identify new avenues for such technologies to benefit clinicians and patients alike. As such, the current manuscript provides a narrative review of the potential future applications of AI within orthopaedic practices by exploring current and developing technologies and detailing how the continued integration of AI-powered systems may serve to revolutionise the delivery of orthopaedic care. LEVEL OF EVIDENCE: Level V.
