Vassar Brothers Medical Center

Nocturia, defined as waking at night to void during the main sleep period is among the most common and bothersome of lower urinary tract symptoms (LUTS). While widely viewed as an inevitable consequence of chronological aging, there is a considerable inter-individual variability as middle-aged adults may experience severe nocturia and older age individuals might not. Therefore, nocturia may be related to accelerated biological aging rather than simply “getting older”. Accordingly, we sought to compare associations of chronological and biological age with relation to nocturnal voiding frequency. In this pilot study, we prospectively studied 68 patients who were evaluated for cardiovascular disease - a condition in which chronological and biological age often differ considerably. Biological age was estimated using PhenoAge, a validated composite biomarker derived from 9 clinical and laboratory parameters reflecting systemic aging processes. Mean chronological age was significantly younger than mean biological age (70.5 ± 10.2 years vs. 78.8 ± 17.8 years, p < 0.001) and the two measures of age were significantly correlated (r=0.67, p<0.001). Median number of nighttime voids was 2. On univariate and mutlivariate analyses, ANV was significantly correlated with PhenoAge (r = 0.33, p=0.006), but not chronological age (r = 0.084, p = 0.49). In conclusion, this pilot study suggests that PhenoAge may better capture the physiological processes associated with nocturia than chronological age alone.

Follicular lymphoma (FL) is an incurable, indolent non-Hodgkin lymphoma with a high relapse rate despite effective chemoimmunotherapy. Lenalidomide, an immunomodulatory agent, in combination with rituximab (R²), has been evaluated as an alternative to chemoimmunotherapy and to other standard regimens in FL. We conducted a systematic review and meta-analysis to assess the efficacy and safety of R² compared with standard regimens in FL. A PRISMA-guided search of PubMed, Embase, and Cochrane Library through May 2025 identified randomized controlled trials (RCTs) comparing R² to rituximab monotherapy, chemoimmunotherapy, or lenalidomide alone. Four RCTs (n = 1315 patients) were included. Primary endpoints were overall response rate (ORR), complete response (CR) and partial response (PR). Secondary outcomes were 2-year progression-free survival (PFS), 3-year overall survival (OS) and adverse events. R² did not differ significantly from comparators in 2-year PFS in the primary analysis (RR = 1.53, 95

Hypothyroidism affects a large subset of the population, with many undiagnosed. In iodine-sufficient regions, chronic autoimmune thyroiditis (Hashimoto's) is the leading cause. Chronic, untreated hypothyroidism can result in multisystem complications, including cardiovascular disease, infertility, and respiratory failure. The most severe presentation, myxedema, is a medical emergency marked by altered mentation, ranging from lethargy to coma, hypothermia, and hypoventilation. Prompt recognition and treatment with thyroid hormone replacement are essential to improve outcomes. We present a case of hypercapnic respiratory failure secondary to myxedema coma. A 51-year-old female with morbid obesity (BMI 39.9 kg/m²) presented unresponsive, hypoxemic, and cyanotic, requiring emergent intubation. Labs revealed severe anemia (Hb 6.5 g/dL) and respiratory acidosis. The urinalysis was positive for infection, and the urine culture grew Escherichia (E.) coli. Imaging showed small pericardial and pleural effusions, and echocardiography revealed preserved ejection fraction (55%). Thyroid studies confirmed severe hypothyroidism with thyroid-stimulating hormone (TSH) 38.2 mIU/L and free thyroxine (T₄) < 0.07 ng/dL, consistent with myxedema coma. She was managed with IV levothyroxine, IV hydrocortisone, antibiotics, ventilatory support, diuresis, and electrolyte repletion. Following thyroid hormone therapy, her respiratory status and mentation improved, allowing extubation and discharge after 14 days on 2 L home oxygen. Myxedema coma-induced hypercapnic respiratory failure occurs through reduced central respiratory drive, respiratory muscle weakness, and impaired gas exchange from pleural effusions or pneumonia. Studies have shown diminished maximal inspiratory and expiratory pressures in hypothyroid patients, reversible with hormone replacement. Pericardial effusion, observed in up to one-third of severe hypothyroid cases, results from increased capillary permeability and typically resolves with levothyroxine therapy without invasive intervention. Hypercapnic respiratory failure secondary to myxedema coma is rare but life-threatening. Early diagnosis and thyroid hormone replacement are essential to prevent morbidity and mortality. Clinical vigilance is required for patients with unexplained respiratory failure, particularly women with nonspecific hypothyroid symptoms. Ensuring medication adherence, thyroid function monitoring, and adequate respiratory support is vital for preventing recurrence and improving outcomes.

Abstract Background Infective endocarditis (IE) is an infection of the endocardial surface of the heart, most commonly affecting cardiac valves. Right-sided IE, particularly of the tricuspid valve, is notably prevalent among individuals with a history of intravenous drug use (IVDU). The standard of care consists of prolonged antibiotics and surgical intervention, including valve replacement. However, patients with active IVDU often have prohibitive operative risk or are not considered surgical candidates due to anticipated reinfection. Aspiration systems such as the AngioVac device have emerged as a bridge to surgical intervention and a debulking method appropriate for high-risk populations. Case Presentation A 48-year-old male with a history of IVDU on Suboxone and IE post-tricuspid valve excision (2016) and bioprosthetic tricuspid valve replacement (2023), presented to the hospital with complaints of persistent fever and altered mental status. Blood cultures grew MRSA. Transthoracic echocardiogram revealed a large vegetation on the bioprosthetic tricuspid valve. On day 3, the patient underwent AngioVac removal of the vegetation. Postoperatively, he developed acute hypoxic respiratory failure requiring intubation and bronchoscopy, which revealed MRSA, Enterobacter cloacae, and Prevotella species. His course was further complicated by persistent MRSA bacteremia, candidemia, septic emboli (pulmonary & intracranial), and ceftaroline-induced neutropenia. Despite targeted antimicrobial therapy to blood culture findings (daptomycin, ceftaroline, metronidazole, micafungin), repeat imaging demonstrated persistent and evolving tricuspid vegetations. Considering the patient was not an appropriate candidate for surgical intervention, the patient underwent a second AngioVac procedure on day 31 of hospitalization following extensive multi-disciplinary team meetings. Cultures were negative post-procedure. He gradually improved, was successfully decannulated following earlier tracheostomy, completed a course of 8 weeks of IV Vancomycin and 6 weeks of Micafungin. Patient was discharged on Doxycycline and Rifampin for long-term antibiotic suppression. Discussion This case demonstrates unique aspects of patient care, including the repeated use of AngioVac in managing persistent prosthetic tricuspid valve IE, and addresses a potential gap in current IE management strategies. While AngioVac is increasingly reported as an alternative to open surgery in high-risk IE patients, the literature is limited in describing its repeated utilization and benefit. Given this patient’s history, this case may highlight the benefit of AngioVac when surgical options are limited and palliative/debulking measures are desired to medically optimize the patient and their prognosis. Repeat AngioVac procedures may reduce the risk of further septic embolization and enable enough stabilization for appropriate multi-disciplinary medicine interventions and potentially further surgical evaluation. This abstract is funded by: None

Abstract Rationale The Pulmonary Embolism Response Team (PERT) is a multidisciplinary model to optimize the care for patients with acute pulmonary embolism (PE). PERT primarily guides the treatment of patients with intermediate or high-risk PE - weighing up the risks and benefits of catheter-directed therapy (CDT) versus medical management. Existing guidelines provide general frameworks for follow-up; published data on post-PE surveillance remains limited, particularly in community-based tertiary care centers. Our retrospective study aims to address this gap by quantifying post-CDT and systemic thrombolysis follow-up rates at one and three months. Methods Adult patients (≥18 years) admitted for acute PE who underwent CDT and/or received systemic thrombolysis between 3/01/2021 - 3/31/2025 were identified from our PERT registry. Demographics, presenting features, interventions, and follow-up at one and three months were descriptively analyzed. Results A study population of 129 patients was identified (mean age = 62 years, 50.4% female, 48.8% male, 0.8% other). Dyspnea was the predominant presenting symptom (95.4%), with tachycardia (74.4%) and tachypnea (69.8%) being the most frequent clinical signs. Most patients were classified as intermediate-high risk (57.4%), followed by high risk (35.7%) and intermediate-low risk (7.0%). CDT was the most common intervention (aspiration thrombectomy n = 65 and catheter-directed thrombolysis n = 39); 25 patients underwent systemic thrombolysis. At one and three months, 58.1% (n = 75) and 48.1% (n = 48) of patients presented for follow-up, respectively. Of the 75 (58.1%) patients seen at one month, 53 (70.7%) continued to three-month follow-up, while 22 (29.3%) were lost. Among the 54 (41.9%) patients who did not follow up at one month, only 9 returned at three months (16.7%), leaving 45 (34.9%) with no documented follow-up. Conclusions Follow-up of patients with acute PE treated with CDT and/or systemic thrombolysis was suboptimal. Although 65% of patients had at least one outpatient follow-up within three months of discharge, over one-third of patients had no documented surveillance despite receiving advanced therapies. Our data suggests that patients seen at one month are more likely to remain engaged in care, supporting the utility of short-interval follow-up. Our descriptive analysis addresses a gap in post-PE care, particularly in smaller, tertiary community hospitals. Challenges present in this area include fragmentation of care, limited understanding of post-PE syndromes, and the logistics/resources required to facilitate follow-up. Next steps include PERT-led quality improvement projects, clinical trials such as PE-TRACT investigating the long-term outcomes of CDT, and advocacy for stepwise follow-up structures to investigate persistent dyspnea and post-PE syndromes. This abstract is funded by: None