Explore the vast range of titles available.

( ) antimicrobial resistance is a key driver of eradication failure in children and adults. Recognizing factors associated with antimicrobial resistance may help identify individuals at risk for treatment failure and tailor management. We conducted a retrospective cohort study of patients with -positive gastric biopsy culture and available antimicrobial susceptibility data at a large pediatric tertiary care center between 2020 and 2025. Descriptive statistics and logistic regression models were used to assess associations among demographic characteristics, prior treatment history, and antimicrobial resistance. Of 174 patients (56.1% male, median 14 years), 50.3% were resistant to at least one antimicrobial. Resistance rates included metronidazole (28.3%), clarithromycin (18.5%), rifampin (12.7%), fluoroquinolones (11.6%), amoxicillin (4%), and tetracycline (0.6%). The multidrug resistance rate was 17.3%. Prior treatment was the most consistent predictor of antimicrobial resistance on both bivariate and multivariable analyses. Race was independently associated with metronidazole resistance, with Black patients exhibiting the highest rates and significantly greater odds compared to White patients. Hispanic ethnicity was also independently associated with increased odds of metronidazole resistance. Careful consideration of prior treatment history, race, and ethnicity is warranted when managing pediatric infection, given their association with increased antimicrobial resistance.

Background: Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. Results: We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). Conclusions: Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.

Background Statin intolerance is a key barrier to the effective prevention of atherosclerotic cardiovascular disease (ASCVD). Experts do not agree on what it is and how to respond to this problem clinically. Objective To characterize the range of expert recommendations about the care of patients with statin intolerance. Methods Systematic review registered in PROSPERO that searched on April 1 2022 in PubMed, EMBASE, Scopus, Cochrane, online textbooks, and specialty textbooks for expert reviews (e.g., review articles and book chapters), systematic reviews, or clinical practice guidelines published in the past 5 years without language restriction. Authors working in duplicate extracted definitions, management recommendations, and supportive evidence cited. Results We identified 26 eligible articles, none of which described a systematic method to summarize the evidence or to develop and grade recommendations. Of these, 14 (54%) offered a definition of statin intolerance. A sequenced approach to management of statin intolerance was suggested in 24 (92%) articles describing 12 different approaches without supporting evidence of efficacy. Investigating for other causes was the most common first step. All authors suggested rechallenging after a washout period with either the same or other statin. Few considered nonlipid approaches to reducing ASCVD risk and none recommended involving patients in shared decision making. Conclusion We found substantial variability in the definition and management of statin intolerance among experts. Few focused on ASCVD risk reduction and none promoted the participation of patients in shared decision making about how to address the threat of ASCVD with or without statins.

Introduction: Radiation-induced soft tissue sarcomas (RISs) are rare secondary malignancies with a dire prognosis. The literature on the management of these tumors remains scarce due to their low incidence. Our systematic review sought to assess the treatment alternatives and outcomes of patients with RIS. Methods: A systematic review was conducted following the PRISMA guidelines. Our study was registered in PROSPERO (ID: CRD42023438415). Quality assessment was performed using the STROBE checklist. Weighted means for both continuous and categorical values were calculated. Results: Twenty-one studies comprising 1371 patients with RIS were included. The mean latency period from radiation to RIS diagnosis was 14 years, and the mean radiation dose delivered to the primary malignancy was 29.2 Gy. The most common histological type was undifferentiated pleomorphic sarcoma (42.2%), and 64% of all tumors were high-grade. The trunk was the most common location (59%), followed by extremities (21%) and pelvis (11%). Surgery was performed in 68% of patients and, among those with an appendicular tumor, the majority (74%) underwent limb-salvage surgery. Negative margins were attained in 58% of patients. Chemotherapy and radiotherapy were administered in 29% and 15% of patients, respectively. The mean 5-year overall survival was 45%, and the local recurrence and metastasis rates were 39% and 27%, respectively. Conclusions: In our study, the most common treatment was surgical resection, with RT and chemotherapy being administered in less than one third of patients. Patients with RIS exhibited poor oncologic outcomes. Future studies should compare RIS with de novo STS while controlling for confounders.

Background Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism; however, 10–15% of patients have persistent hypothyroid symptoms despite normalizing thyroid hormone levels with LT4. This study aims to summarize the best available evidence on interventions to improve symptomatology in patients with hypothyroidism and persistent symptoms. Methods A systematic search was conducted in March 2022 for randomized controlled trials and observational studies on interventions for adult patients with persistent hypothyroid symptoms despite biochemical euthyroidism on thyroid hormone replacement. Results A total of 277 articles were reviewed and seven fulfilled the inclusion criteria. 455 participants were included. Most intervention participants were female (78.6%) with a mean age of 47.5 (±2.8) years. Five clinical trials evaluating ginger (vs. starch), L-carnitine (vs. placebo), combination LT4 and liothyronine (LT3) (vs. LT4 or placebo), and surgery for patients with serum antithyroid peroxidase (TPO Ab) titers greater than 1000 IU/ml (vs. LT4) found inconsistent improvement in hypothyroidism related symptoms and general health. The two clinical trials with the largest improvement in fatigue scores were the use of ginger and surgery. One observational study comparing thyroidectomy vs observation found no significant difference on general health. Lastly, another observational study evaluating combination LT4/LT3 (vs. LT4 monotherapy) found improvement in fatigue and quality of life. There were 31 (12%) adverse events in the intervention group and 18 (10.8%) in the comparator group. Conclusions There is no high-quality evidence supporting any intervention for persistent symptoms in hypothyroidism. Available evidence, limited by the risk of bias, inconsistency, and heterogeneity, suggests that some persistent symptoms, particularly fatigue, could improve with ginger and thyroidectomy.

Objectives The 2023 joint North American Society for Pediatric Gastroenterology, Hepatology & Nutrition/European Society for Pediatric Gastroenterology, Hepatology & Nutrition guidelines for Helicobacter pylori infection management continue recommending initial diagnosis via endoscopy with biopsies, and obtaining a gastric biopsy culture. We previously reported on a quality improvement (QI) initiative to improve the rate of successful gastric biopsy culture at our hospital. We present 5‐year follow‐up data and describe implementation strategies that may guide similar efforts at other centers. Methods Interventions were conducted using the plan‐do‐study‐act (PDSA) framework to: (1) consolidate specialty laboratory processing to a single outside laboratory, and (2) educate and provide reminders to gastroenterologists, endoscopy suite personnel, and laboratory staff. Descriptive statistics were performed on all collected variables. Differences in culture positivity by year, and before and after consolidation to a single specialty laboratory, were assessed using logistic regression, and a p‐chart was constructed to determine variation. All analyses were conducted using R (version 2025.05). Results Between November 1, 2019, and March 31, 2025, we observed a consistent increase in the number of gastric biopsy cultures obtained by gastroenterologists each year. Among patients with positive histology, a logistic regression model demonstrated a significant association between calendar year and the odds of a positive culture (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.7–2.9, p < 0.001). A marked improvement in culture positivity was observed following the intervention to consolidate specialty laboratory processing. Conclusion The implemented interventions, such as staff education, standardized checklists, and processing consolidation, may have led to sustained improvements in the success of primary gastric biopsy cultures. What is Known Standardized checklists for endoscopy suite staff and educational activities directed at healthcare providers increase the use of gastric biopsy culture in patients with suspected Helicobacter pylori infection. Proper specimen handling by endoscopy and laboratory staff increases culture yield in patients with positive H. pylori histology. What is New Embedding educational reminders into existing scheduled activities (e.g., grand rounds, administrative conferences) for healthcare providers, along with procedural prompts for endoscopy nursing and laboratory staff, promotes sustained use of primary gastric biopsy culture in patients with suspected H. pylori infection. Consolidation of specimen processing to a single specialty laboratory led to marked improvement in culture yield in patients with positive H. pylori histology.