Journal of the National Medical Association最新文献

{"title":"COVID-19 Impact on Adverse Event Reports of Cardiovascular Drugs","authors":"Xiaodong Feng, Alicia Feng, David Tran, Uyen Le PhD","doi":"10.1016/j.jnma.2025.08.014","DOIUrl":"10.1016/j.jnma.2025.08.014","url":null,"abstract":"<div><h3>Introduction</h3><div>During the COVID-19 pandemic, adverse event (AE) reports were significantly affected. Since Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) interact with the ACE pathway, the entry target for SARS-CoV-2, we hypothesized they might show distinct AE trends compared to other cardiovascular drugs. This study examines COVID-19 cases and AE reporting for these drugs from 2016 to 2023.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using publicly available data from the CDC COVID Data Tracker and the FDA Adverse Event Reporting System (FAERS). AE trends for most common 29 cardiovascular drugs across seven major classes were analyzed, including ACEIs, ARBs, renin inhibitors, loop diuretics, beta-blockers, and calcium channel blockers (CCB). The study compared AE reporting trends for ACEIs and ARBs during and after the COVID-19 pandemic against other cardiovascular drugs to determine whether their observed AE decline was linked to COVID-19 treatment interactions, altered prescribing behaviors, or reporting shifts.</div></div><div><h3>Results</h3><div>The analysis revealed a steady increase in AE reports across cardiovascular drug classes from 2016 to 2019, with ACEIs peaking at 9.5K AEs and ARBs at 8.1K AEs in 2019. However, unlike other cardiovascular drugs, ACEIs and ARBs sharply declined from 2019 to 2023, with ACEIs decreasing by 3.5K AEs (-36.8%) and ARBs by 2.7K AEs (-30.9%). This suggests a potential shift in reduction in the severity of adverse reactions reported. In contrast, CCBs and Diuretics/Loop maintained stable or increasing trends, with CCBs rising by 10.6% from 6.6K to 7.3K AEs and Diuretics/Loop showing minimal fluctuation (+1.6%). Beta-blockers exhibited a moderate decrease (-21.6%), while Renin Inhibitors and Aldosterone Antagonists remained low and stable throughout this period. In addition, the top three drugs Ramipril, Lisinopril, and Valsartan experienced significant declines in reported AEs. Ramipril AEs dropped from 4.4K in 2019 to 2.5K in 2023 (-43.2%), Lisinopril decreased by 52% (4.2K to 2K), and Valsartan fell by 54.8% (3.1K to 1.4K). The steepest declines occurred between 2019 and 2021, during the COVID-19 pandemic, suggesting changes in AE reporting behavior.</div><div>In addition, the Davies test on ACEI data yielded a statistically significant change in slope (p = 0.01732) with an optimal breakpoint near 2019. Before 2019, AEs increased at about 1,221 reports per year, while after the breakpoint, the slope reversed by –2,306.9, resulting in a post-break trend of roughly –1,085.9 reports per year. These findings demonstrate a significant reversal from a strong upward trend to a marked decline.</div></div><div><h3>Conclusion</h3><div>The findings show that ACEIs and ARBs experienced significant declines in AE reports from 2019 to 2023, especially between 2019 and 2021, while other cardiovascular drugs like CCBs remained sta","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 4"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Diabetic Distress in African Americans with Type 2 Diabetes","authors":"Aaron Hemphill BS,&nbsp;Kelechi C. Fluitt PhD,&nbsp;Kanwal K. Gambhir PhD,&nbsp;Gail Nunlee-Bland MD,&nbsp;Maurice B. Fluitt PhD","doi":"10.1016/j.jnma.2025.08.035","DOIUrl":"10.1016/j.jnma.2025.08.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetic distress—a specific emotional burden stemming from the daily challenges of managing type 2 diabetes—has emerged as a critical factor affecting patient outcomes. African Americans, who experience disproportionate rates of type 2 diabetes and related complications, often encounter unique socio-economic and systemic barriers that exacerbate this distress. This abstract synthesizes a systematic review of studies published over the past five years to assess the prevalence, clinical impact, and intervention strategies for diabetic distress among African American patients, emphasizing practical applications for healthcare professionals.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across major databases including PubMed, ClinicalKey, and PsycInfo. The review focused on studies that explicitly evaluated diabetic distress in African American populations with type 2 diabetes. Keywords such as “diabetes,” “type 2 diabetes mellitus,” “diabetic distress,” “African Americans,” and “health outcomes” were used to identify relevant articles. Fifteen studies meeting the inclusion criteria were analyzed for assessment tools (e.g., the Diabetes Distress Scale-17 and Problem Areas in Diabetes scale), intervention modalities, and their association with clinical outcomes such as glycemic control and self-management behaviors.</div></div><div><h3>Results</h3><div>The review revealed that diabetic distress is highly prevalent among African American patients with type 2 diabetes, with elevated distress levels correlating with poorer glycemic control, reduced self-efficacy, and lower adherence to treatment regimens. Interventions—including diabetes self-management education (DSME), cognitive-behavioral therapy (CBT), and culturally tailored peer support programs—demonstrated significant improvements. Patients participating in these interventions showed reductions in distress scores alongside meaningful decreases in HbA1c levels and other key health metrics. Notably, studies underscored interventions addressing cultural and socio-economic challenges yielded the most robust improvements in patient engagement and clinical outcomes, thereby highlighting their immediate practical application in clinical settings.</div></div><div><h3>Conclusion</h3><div>Addressing diabetic distress in African American patients is essential for optimizing diabetes management and mitigating health disparities. This review advocates for the integration of culturally sensitive, patient-centered interventions into routine diabetes care to enhance self-management and reduce adverse clinical outcomes. Future research with larger and more diverse cohorts is needed to standardize distress assessment tools and refine intervention strategies. Such efforts are vital to ensure safe patient care and promote health equity.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 17"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Access and Treatment Challenges in Multiple Myeloma","authors":"C. Iwuagwu ,&nbsp;B. Dhakal ,&nbsp;J. Thompson ,&nbsp;J. Cook","doi":"10.1016/j.jnma.2025.08.090","DOIUrl":"10.1016/j.jnma.2025.08.090","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Multiple myeloma patients face complex barriers to diagnosis, care access, support, and navigation. This study analyzes patient-reported experiences to identify structural gaps and cluster patients into meaningful segments based on their needs and perceptions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We administered a 48-item anonymous survey to adult myeloma patients at the Medical College of Wisconsin and through national platforms, including the International Myeloma Foundation, Leukemia &amp; Lymphoma Society, and Facebook groups. The survey assessed demographics, treatment experiences, delays, perceived personalization, and barriers to care. We used JMP 17 for analysis and Julius.AI for visualization. Rule based segmentation of structured responses was used to identify distinct patient personas. Chi-square tests assessed associations, with p &lt; 0.05 considered significant. The study was IRB-approved.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 320 participants responded between April 25 and June 5, 2025; 289 (90.3%) completed the survey in full. The cohort was predominantly older (55.7%, n=170/305 between 60-75), White (79.3%, n=241/304), female (58.9%, n=179/304), highly educated (89.5%, n=272/304), and suburban (52.5%, n=159/303). Modal insurance types were Medicare (37.8%) or private insurance (30.9%); 11.2% both. Most (69.7%) reported a smooth treatment start; delays were primarily due to insurance/cost (4%).&lt;/div&gt;&lt;div&gt;Using rule-based segmentation of structured responses, we identified three distinct patient personas: (1) &lt;em&gt;Empowered but Unsupported&lt;/em&gt; (n=56; 17.5%) who indicated no emotional support barriers, less interest in navigators, but frequent reports of unmet needs such as poor communication. (2) &lt;em&gt;Engaged and Informed&lt;/em&gt; (n=105; 32.8%): Highly motivated patients who requested personalized care, clinical trial transparency, or insurance navigation and (3) &lt;em&gt;Delayed and Discouraged&lt;/em&gt; (n=35; 10.9%) who reported lower support, diagnostic delays, and a strong perception of race-related disparities. Unclassifiable personas (n=124) were due to missing or neutral responses. There was no difference in self-identified race across the personas (p = 0.08), but 100% of the &lt;em&gt;Delayed/ Discouraged&lt;/em&gt; group believed race played a role in care, compared with 44% of the &lt;em&gt;Engaged/Informed&lt;/em&gt; and 21.4% of the &lt;em&gt;Empowered/Unsupported&lt;/em&gt; (p &lt; 0.001). Minoritized patients (86.7% Black, 100% other minoritized) were more likely to perceive race as a factor (p = 0.0024). &lt;em&gt;Empowered/Unsupported&lt;/em&gt; patients were significantly more likely to request better communication (100%) and empathy (53.6%), while &lt;em&gt;Engaged and Informed&lt;/em&gt; patients prioritized clinical trial access (61%). None of the &lt;em&gt;Delayed and Discouraged&lt;/em&gt; patients made this request (p &lt; 0.0001). Black respondents most frequently expressed the need for greater empathy (53.7%; p = 0.0012). Those &lt;60 (40.2%, n=33) wer","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 49-50"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real World Clinical Outcomes Based on Race and Ethnicity for Patients with Relapsed Refractory Multiple Myeloma Undergoing Treatment with Bispecific T cell Engagers","authors":"Joshua E. Lewis ,&nbsp;Christen Dillard MD ,&nbsp;Oren Pasvolsky MD ,&nbsp;Mahoud Gaballa MD ,&nbsp;Lei Feng MS ,&nbsp;Krina Patel MD","doi":"10.1016/j.jnma.2025.08.092","DOIUrl":"10.1016/j.jnma.2025.08.092","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Bispecific T cell engagers (bsAbs) represent a novel therapeutic strategy in relapsed and refractory multiple myeloma (RRMM). This project analyzes clinical outcomes including safety and efficacy for patients with relapsed/refractory multiple myeloma treated with bispecific T cell engagers at the University of Texas MD Anderson Cancer Center, focusing on differences across racial and ethnic groups. However, data is limited regarding outcomes across racial and ethnic subgroups. Our study aims to identify disparities and inform equitable treatment strategies. Understanding these disparities is essential to guide equitable clinical decision-making.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective cohort analysis of 63 RRMM patients treated with bsAbs. Patients were categorized by self-reported race/ethnicity as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (H/L), or Other. Clinical characteristics, treatment responses, and toxicity profiles were compared using Fisher’s exact test and Kruskal-Wallis test. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier estimates and log-rank tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Significant differences emerged in baseline characteristics across racial/ethnic groups. H/L patients had the highest median number of prior treatment lines (9 vs. 5.5 in NHW; &lt;em&gt;p&lt;/em&gt;=0.0177), and all had received prior autologous stem cell transplant (AutoSCT; &lt;em&gt;p&lt;/em&gt;=0.0212). NHB patients had a higher proportion of female patients (71.4%) compared to NHW (30.0%; &lt;em&gt;p&lt;/em&gt;=0.0189). H/L patients experienced higher rates of thrombocytopenia (70%) than NHW (51.7%), NHB (19.0%), and Other (50%; &lt;em&gt;p&lt;/em&gt;=0.0166). The rate of any grade ICANS was significantly lower in H/L patients (0%) compared to NHW (41.4%) and NHB (26.3%; &lt;em&gt;p&lt;/em&gt;=0.0423). Platelet nadir differed significantly across groups (&lt;em&gt;p&lt;/em&gt;=0.0106), with the H/L and Other groups experiencing the most profound thrombocytopenia. G-CSF support was more frequently required in the H/L group (70%) and Other (100%) compared to NHW (34.5%) and NHB (25%; &lt;em&gt;p&lt;/em&gt;=0.0291). Despite these differences in treatment course and hematologic toxicity, no statistically significant differences in best overall response, 30-day or 90-day response, or minimal residual disease negativity were observed across racial/ethnic groups. Median OS was not reached, with 6- and 12-month OS rates of 79% and 73%, respectively, and no significant survival differences across race/ethnicity groups (&lt;em&gt;p&lt;/em&gt;=0.7713). Median PFS was 10.6 months (95% CI: 7.75–22.0), also with no significant racial/ethnic variation (&lt;em&gt;p&lt;/em&gt;=0.2115).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Significant racial and ethnic differences were observed in baseline disease characteristics, prior treatment exposure, and toxicity profiles, particularly related to hematologic complications. However, treatment response ","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 50-51"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Pre-operative COVID-19 Diagnoses on Post-operative Outcomes in Laparoscopic Cholecystectomy: A Matched Cohort Analysis","authors":"Victoria Zhao BS,&nbsp;Nair Meghana BS,&nbsp;Salaam Musa BA,&nbsp;Feinn Richard PhD","doi":"10.1016/j.jnma.2025.08.025","DOIUrl":"10.1016/j.jnma.2025.08.025","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Laparoscopic cholecystectomy is the standard treatment for gallbladder disease, but post-operative complications can vary based on patient comorbidities. Recent studies have highlighted the consequences of a COVID-19 diagnosis on procedures of multiple organ systems. The robust detrimental effects of COVID-19 continue to impact patient outcomes beyond respiratory-related procedures and extend to surgical procedures across various specialties. Findings have shown that a pre-operative COVID-19 diagnosis leads to an increase in surgical complications and post-operative recovery. However, the implications of a COVID-19 diagnosis for laparoscopic cholecystectomy complications and post-operative outcomes remain less understood. This study investigates the impact a COVID-19 diagnosis has on patients’ hospitalization duration, time to surgery, and post-operative outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The National Surgical Quality Improvement Program (NSQIP) database was used to analyze data from laparoscopic cholecystectomy procedures performed in participating hospitals between 2021 and 2022. A 1:2 propensity score matched group analysis was conducted to evaluate differences in post-operative complication rates, time to surgery, total operation time, and hospital length of stay between patients with and without a pre-operative COVID-19 diagnosis. Patients were categorized into two cohorts: those with a pre- operative COVID-19 diagnosis and those without. Patients with pre-existing severe comorbidities, severe pneumonia, hypercoagulability (or those on anticoagulant therapy), and those requiring an unplanned conversion from laparoscopic to open surgery were excluded from the analysis. Propensity scores were generated using logistic regression and modeled using demographic and pre- operative clinical features. Patient outcomes were assessed using GGE marginal models with matched groups as clusters and robust standard errors. GEE Link functions used were logit for binary outcomes and log for quantitative outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 2,583 patients who underwent laparoscopic cholecystectomy were analyzed, with 1,722 in the PreOp COVID-negative group and 861 in the PreOp COVID-positive group. Following propensity score matching, baseline characteristics were well-balanced between cohorts. Patients with pre-operative COVID-19 had a higher risk of post-operative complications (OR = 2.01, 95% CI: 1.45– 2.77, p &lt; 0.001), with 8% experiencing complications compared to 4% in the non-COVID group. Time from admission to surgery was found to be significantly prolonged among PreOp COVID patients (1.61 days, 95%CI: 1.46-1.78 vs. 0.76 days, 95%CI: 0.70-0.84, p &lt; 0.001). Additionally, they had a longer hospital stay (3.02 days, 95%CI: 2.77-3.28 vs. 1.53 days, 95%CI: 1.41-1.66, p &lt; 0.001). Surgical duration was also significantly affected, with PreOp COVID patients requiring longer operative time","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 11-12"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erythema Dyschromicum Perstans: Investigating Clinical, Demographic, and Biochemical Correlates","authors":"Mallory A. Von Lotten BS, MS,&nbsp;Blake F. Frey PhD,&nbsp;Kavita Kantamneni MPH,&nbsp;Tiffany T. Mayo MD, FAAD","doi":"10.1016/j.jnma.2025.08.022","DOIUrl":"10.1016/j.jnma.2025.08.022","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Erythema Dyschromicum Perstans (EDP) is an idiopathic, asymptomatic, chronic hypermelanotic disorder characterized by blue-gray macules that affect the face, trunk, and extremities. It disproportionately affects individuals with skin of color and remains poorly understood, with no established etiology or standardized treatment. Laboratory investigations, including complete blood counts, thyroid function tests, biochemical profiles, urinalysis, and autoantibody assays, have historically been unremarkable. EDP shares clinical features with other pigmentary disorders such as Lichen Planopilaris (LPP), making diagnosis challenging. Given the paucity of research, this study analyzes potential clinical and biochemical correlates, including age, sex, and medication use, to elucidate contributing factors and guide future management strategies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective chart review was conducted using electronic medical records from the University of Alabama at Birmingham (UAB). Institutional Review Board (IRB) approval was obtained, and 300 patient records were accessed. Data collected included demographics, laboratory values, medication history, and histopathologic findings. All data was stored in a HIPAA-compliant database (ShareFile). Statistical evaluation identified significant associations between EDP and clinical or biochemical parameters.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our analysis assessed treatment variations among patients with ICD-10 codes L53.8 (Other specified erythematous conditions, including Erythema Dyschromicum Perstans [EDP]), L81.9 (Disorder of pigmentation, unspecified), and L81.0 (Postinflammatory hyperpigmentation [PIH]). Hydroquinone use was significantly higher in patients with L81.9 compared to those with EDP (β = 1.13050, p = 0.0161), indicating an approximately threefold increase in odds. Age was a key predictor of treatment patterns, as older patients were significantly more likely to receive hydrochlorothiazide (β = 0.03735, p = 0.0433) but less likely to receive topical treatments, including corticosteroids and calcineurin inhibitors (β = –0.10893, p = 0.000677), or topical retinoids (β = –0.03125, p = 0.0305). Additionally, dermoscopy data were available for 37 patients, with 25 having corresponding ICD-10 codes, and histopathology data were available for 26 patients, all with matching diagnoses. These data are being explored to further characterize diagnostic patterns and treatment responses. Findings emphasize the role of diagnostic classification and age in treatment selection, particularly in hydroquinone use, and highlight the need for further research on how patient demographics influence dermatologic care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study provides insight into the etiology of EDP by identifying potential clinical and biochemical correlations. By investigating demographic and laboratory data, we aim to establish patterns that contribu","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 9"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulinoma in the Elderly: An Unusual Case in an 85-Year-Old Male","authors":"Saifaleslam Jamal Elsahli MD,&nbsp;Muataz Kashbour MD,&nbsp;Mohamed Muhsin Elkharraz MD","doi":"10.1016/j.jnma.2025.08.034","DOIUrl":"10.1016/j.jnma.2025.08.034","url":null,"abstract":"<div><h3>Introduction</h3><div>The median age at diagnosis for insulinoma, a rare neuroendocrine tumor, is between 47 and 56 years old. We report an unusual case of insulinoma in a male patient who was 85 years old, above the typical age range for this illness.</div></div><div><h3>Case description</h3><div>The patient has a history of epilepsy and heart failure and presented with bilateral lower limb edema, cough, dyspnea, and orthopnea; the patient additionally had a temperature of 38.5°C and a low oxygen saturation level of 92%. Leukocytosis (WBC: 28.9 × 10⁹/L) and an increased C-reactive protein (CRP) level of 44.4 mg/L were found in the laboratory. Chest X-ray revealed cardiomegaly, pleural effusion, and chest infiltration. The patient had many hypoglycemic episodes during the hospital stay, with glucose levels ranging from 32 to 70 mg/dL. Dextrose was a successful treatment for these episodes. During one of the hypoglycemic episodes, laboratory tests revealed elevated C-peptide levels (14.6 ng/mL) and insulin levels (61.64 μIU/mL), which raised the possibility of insulinoma. An insulinoma-like 3.5 cm well-defined, rounded, hypervascular pancreatic lesion with early arterial enhancement was discovered during a multiphasic CT scan of the abdomen and pelvis using IV contrast. Bilateral pleural effusion and right lower lobe pneumonia were among the other CT findings.</div></div><div><h3>Discussion</h3><div>This case highlights the challenges and treatment of hypoglycemia in older individuals with complicated medical issues and how crucial it is to take uncommon causes like insulinoma into account.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 16-17"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes for Radiographic Node-Positive Prostate Cancer Following Definitive Radiotherapy","authors":"Jade K. Dodge MS,&nbsp;Lily Boe PhD,&nbsp;Kevin Boehm MD, PhD,&nbsp;David Guttmann MD,&nbsp;Zachary Moore MD, PhD,&nbsp;Dhwani Parikh MD,&nbsp;Andrew Barsky MD,&nbsp;Marisa Kollmeier MD,&nbsp;Sean McBride MD, MPH,&nbsp;Victoria Brennan MBBch,&nbsp;Jeremy Setton MD,&nbsp;Daniel Gorovets MD,&nbsp;Himanshu Nagar MD,&nbsp;James Janopaul-Naylor MD","doi":"10.1016/j.jnma.2025.08.070","DOIUrl":"10.1016/j.jnma.2025.08.070","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of regional lymph node metastases at diagnosis is approximately 15%. Androgen deprivation therapy (ADT) with radiotherapy (RT) remains a standard treatment option, but long-term effects and outcomes are understudied.</div></div><div><h3>Methods</h3><div>Data was retrospectively collected from 304 subjects with radiographic node-positive prostate cancer treated with RT from 2014-2024. Covariates include use of androgen receptor signaling inhibitors (ARSI), use of brachytherapy boost to primary disease in prostate, pre- RT PSA, and Gleason Score (GS). Endpoints included biochemical progression (bPFS), distant metastases free survival (DMFS) and overall survival (OS). Kaplan-Meier method, log rank test, univariate (UVA) and multivariate regression analyses (MVA) were used for time to event endpoints.</div></div><div><h3>Results</h3><div>Patient features are summarized in table. 48% of patients had ECOG 0. On MVA, GS 9-10 was significantly associated with worse OS (HR 2.26, 95%CI 1.15 – 4.43, p=0.02), DMFS (HR 2.37, 95%CI 1.32 – 4.24, p&lt;0.01), and bPFS (HR 2.10, 95%CI 1.23 – 3.59, p&lt;0.01). Worse performance status was associated with significantly worse OS (HR 3.14, 95%CI 1.35 – 7.29, p&lt;0.01) and trend for worse DMFS (HR 2.03, 95%CI 0.95 – 4.35, p=0.07) and bPFS (HR 2.01, 95%CI 0.99 – 4.07, p=0.05). Radiation boost dose to involved lymph nodes was significantly associated with OS (p=0.03) and DMFS (p=0.03) but not bPFS. There were no other statistically significant associations on MVA. There was no significant association on UVA between pre-radiation maximum PSA and OS, DMFS, or bPFS.</div></div><div><h3>Conclusion</h3><div>In this cohort of patients treated with ADT and definitive RT, 5-year DMFS was 67%. Gleason score and age were the strongest prognostic features. There was no significant association, but numerically higher survival seen with use of ARSI or brachytherapy boost. Future work characterizing patterns of care and failure is needed to help optimize management.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 36-37"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Prenatal Counseling on Lead and Mercury Levels","authors":"Chantay L. Young MD,&nbsp;Maryanne A. Adekunle MD,&nbsp;Nkeiruka S. Nwobu MPH,&nbsp;Damali M. Campbell MD,&nbsp;Natalie E. Roche MD","doi":"10.1016/j.jnma.2025.08.053","DOIUrl":"10.1016/j.jnma.2025.08.053","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The Newark, NJ lead water crisis was publicized in 2016 when elevated levels were detected in Newark Public School buildings. Subsequently, the city of Newark removed and replaced over 23,000 lead service lines and provided free water testing and filters; thousands of lead lines remain. Elevated lead and mercury exposure is associated with both obstetrical and pediatric complications. An increased risk of stillbirth, spontaneous abortion, gestational hypertension, and preeclampsia have been observed. Impaired neonatal neurodevelopment, low birth weight, and increased infant mortality rates have been documented. Elevated lead levels can impact a patient’s ability to provide their infant with human milk exclusively. Given the negative maternal and fetal outcomes over a wide range of blood levels, the American College of Obstetrics and Gynecology has recommended that all pregnant patients undergo screening at the earliest prenatal encounter and that select pregnant patients with elevated risk undergo screening for lead. University Hospital, located in Newark, NJ, has been screening patients since 2019, and those with elevated levels of lead and mercury have been provided counseling to reduce exposure during pregnancy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;At University Hospital, lead (Pb) and mercury (Hg) screening are part of the standard prenatal labs performed at the initial prenatal visit. If the level of lead or mercury is elevated beyond the established reference range (Pb&gt;3.5; Hg&gt;5), the obstetrical team refers the patient for counseling with a nurse or nutritionist. A 23-question questionnaire developed by the NJ Department of Health is used to identify potential sources of lead and mercury exposure. Repeat lead and mercury levels were collected at admission for delivery for comparison.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over 22,000 samples (initial screenings and follow-ups) have been performed on University Hospital patients. One-quarter of patients tested had lead levels, and fifty percent had mercury levels in the range of potential health effects and above the desired cut-off limit. Initial results have shown that common sources of lead exposure included pipes and cookware, while consumption of fish and cosmetics and skin care products containing heavy metals were typical causes for elevated mercury. These patients subsequently underwent the recommended counseling. After the removal of toxic exposures during the pregnancy, reductions in lead and mercury levels were observed at the time of admission to labor and delivery. This reduction was also reflected in the newborn screening for lead and mercury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Preliminary results demonstrate how dietary interventions and lifestyle modifications reduced lead and mercury levels in this patient population. A larger study in Newark and other similar populations across the country is recommended to confirm our findings. We w","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 27-28"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Faricimab on Diabetic Macular Edema in Underrepresented Patients","authors":"Joseph M. Coney MD, FACS,&nbsp;Manuel Amador MD,&nbsp;Jeremiah Brown MS, MD,&nbsp;Matthew A. Cunningham MD,&nbsp;Andres Emanuelli MD,&nbsp;Adrienne W. Scott MD, FASRS,&nbsp;Sofia Milunovich,&nbsp;Ming Yang PhD,&nbsp;Xiao-Yu Lu,&nbsp;Ruby Ha","doi":"10.1016/j.jnma.2025.08.055","DOIUrl":"10.1016/j.jnma.2025.08.055","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetic macular edema (DME) is the leading cause of vision loss among patients with diabetes mellitus and disproportionately affects Black and Hispanic patients in the US. Despite this, these patients are underrepresented in clinical trials.(1) ELEVATUM (NCT05224102) is a phase 4, open-label, single-arm, multicenter study assessing the response to faricimab treatment among patients with DME traditionally underrepresented in ophthalmology trials. We report year 1 efficacy and safety results from ELEVATUM for patients in the US.</div></div><div><h3>Methods</h3><div>Treatment-naïve patients with DME (n=123), who self-identified as Black or African American, Hispanic or Latin American, or Native American/Alaska Native/Native Hawaiian/Pacific Islander, received faricimab 6.0 mg every 4 weeks (Q4W) to week 20, then Q8W to week 52. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) changes from baseline at week 56, and the proportion of patients with ≥2-step Diabetic Retinopathy Severity Scale (DRSS) improvement, were assessed for Black/African American patients, Hispanic/Latino American patients, and the overall US study population.</div></div><div><h3>Results</h3><div>At baseline, Hispanic/Latino American patients had numerically worse BCVA (mean [standard deviation]: 59.2 [11.4] letters) and CST (491.1 [157.2] μm) compared with Black/African American patients (62.2 [10.2] letters and 467.4 [126.0] μm) and the overall US study population (61.1 [11.1] letters and 476.9 [138.5] μm). At week 56, adjusted mean (95% confidence interval) BCVA changes from baseline were +14.1 (9.9, 18.2), +11.3 (9.0, 13.5), and +12.3 (10.2, 14.5) letters in Hispanic/Latino American patients, Black/African American patients, and the overall US study population, respectively. Corresponding CST changes from baseline at week 56 were -230.4 (-252.1, -208.6) μm, -193.9 (-215.2, -172.7) μm, and -206.3 (-217.0, -195.7) μm in Hispanic/Latino American patients, Black/African American patients, and the overall US study population, respectively. DRSS improvement of ≥2 steps was achieved by 41.5% of Hispanic/Latino American patients, 17.6% of Black/African American patients, and 32.1% of the overall US study population. Faricimab was well tolerated; no new safety concerns were identified.</div></div><div><h3>Conclusions</h3><div>Year 1 results from ELEVATUM demonstrated robust vision and CST improvements with faricimab in underrepresented patients with DME in the US. Hispanic/Latino American patients had the greatest improvements in BCVA, CST, and diabetic retinopathy disease severity. Faricimab was well tolerated, with a safety profile consistent with that established in the YOSEMITE/RHINE (NCT03622580/NCT03622593) trials.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 28-29"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}