United States

Background :
Herpes simplex virus (HSV) esophagitis is an uncommon condition, typically occurring in immunocompromised individuals. It presents with inflammation and ulceration of esophageal mucosa. Both HSV-1 and HSV-2 can be implicated. Prompt diagnosis and treatment are essential to prevent complications. 

Case Presentation :
We report a case of a 57-year-old female with a history of mixed connective tissue disorder and Raynaud’s phenomenon, currently on corticosteroid therapy. She presented with a two-month history of progressive dysphagia to both solids and liquids, odynophagia, and significant weight loss. Physical examination revealed pallor. Laboratory investigations showed anemia (Hb: 8.5 g/dL), leukopenia (TLC: 2800/mm³), and thrombocytopenia (Platelets: 110,000/mm³). Upper gastrointestinal endoscopy revealed superficial ulcers with exudates throughout the esophagus. Histopathological examination of biopsy samples showed characteristic features of HSV infection, including multinucleated giant cells, ground-glass nuclei, nuclear molding, and intranuclear inclusions with perinuclear halo. A diagnosis of HSV esophagitis was confirmed. The patient was treated with oral acyclovir 800 mg QID for 21 days, resulting in clinical improvement and endoscopic healing of esophageal ulcers. 

Discussion:
HSV esophagitis should be considered in immunocompromised patients presenting with odynophagia, dysphagia, and weight loss. Diagnosis is established through endoscopy and histopathological confirmation. Early initiation of antiviral therapy is effective and leads to favorable outcomes. This case highlights the importance of maintaining a high index of suspicion for HSV esophagitis in at-risk populations.


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A Case of Herpes Simplex Esophagitis

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Background
Acinetobacter baumannii is an opportunistic nosocomial pathogen of concern due to its increasing pan-drug resistance and growing recognition in its involvement in necrotizing fasciitis (NF), a severe soft tissue infection with high morbidity if left untreated. Some NF associated strains of A. baumannii (NFAb) exhibit an ability to survive within human macrophages. However, the macrophage response to intracellular infection by these strains is not well understood. Understanding the macrophage transcriptional response to NFAb infection may help us uncover new immune evasion mechanisms and inform future therapies.

Methods
Human monocyte-derived THP-1 macrophages were infected with two NFAb strains (NFAb1 and NFAb2) or the reference strain ATCC 19606T at a MOI of 100. After 2 hours of infection and 2 hours of colistin protection assay, intracellular bacteria were quantified and total macrophage RNA was collected and subjected to RNA-sequencing (RNA-seq). Differential gene expression analysis was performed using the DESeq2 package in R and gene ontology analysis was used to evaluate enriched immune pathways.

Results
RNA-seq identified distinct transcriptional signatures in response to infection with NFAb strains compared to the reference strain. Pro-inflammatory genes like TNF, CCL4 and IL1B were upregulated in response to NFAb infection, indicating heightened immune activation. Genes related to immune regulation and signaling like CX3CR1 and GPRIN3 were downregulated across all strains. This may indicate disruption of communication pathways. Genes involved in microtubule associated proteins and intracellular trafficking were upregulated as well, suggesting a role for macrophage phagocytosis in intracellular bacterial infection.

Conclusion
This study sheds light on the transcriptional responses of human macrophages to A. baumannii infection, especially in the context of NF. Responses to NFAb strains were characterized by altered signaling regulation and increased inflammation, suggesting NFAb strains may survive intracellularly by triggering and modulating host immune pathways. Understanding of these mechanisms may provide us with novel targets for future therapeutic interventions against multidrug resistant A. baumannii infections.

Evaluation of Innate Immune Transcriptional Responses in the Context of Intracellular Infection by Necrotizing Fasciitis-associated Acinetobacter baumannii

Background
Immunotherapy has revolutionized cancer treatment, with FDA approvals and NCCN guidelines
incorporating immune checkpoint inhibitors across over 20 malignancies. Despite its growing
use and preference over chemotherapy, data on immunotherapy-related complications leading to
hospital readmissions remain limited. No large retrospective cohort study has yet addressed this
gap
Methods
We conducted a retrospective cohort study using the 2022 Nationwide Readmissions Database
(NRD). Index admissions involving inpatient immunotherapy were identified using ICD-10 code
Z51.12, and 90-day all-cause readmissions were tracked. Survey-weighted logistic, linear, and
Cox proportional hazards models were used to compare baseline characteristics and identify
predictors of 90-day readmission
Results
A total of 2,394 weighted admissions met criteria as index immunotherapy admissions, with a
90-day readmission rate of 41.06% (95% CI: 36.7–47.2%). There were 983 weighted 90-day
readmissions. Mean index LOS was 10.1 days, with a cumulative LOS of 24,222 days. The
average total hospital charge for index admissions was $692,011, and the mean cost was
$161,506, yielding a total cost burden of ~$379 million. Among readmitted patients (n ≈ 961
weighted), mean LOS was 8.7 days (8,510 total days), with a mean cost of $114,195 and
cumulative cost burden of ~$110 million.
© 2025 American Medical Association. All rights reserved.
Primary payer distribution differed between groups (p = 0.0002): Medicare was most common
among index admissions (51.7%), while Medicaid was more prevalent in readmissions (16.1%
vs. 7.1%). Most care occurred in urban teaching hospitals (95.3% vs. 98.0%). Discharge
disposition varied slightly (p = 0.047), with most patients discharged home; transfers and home
health use were more common in readmissions.Multivariable Cox regression identified the
following significant predictors of 90-day readmission: younger age (HR=0.983, p=0.000), self-
pay status (HR=2.82), Addison’s disease (HR=4.58), hyperthyroidism (HR=5.59), Crohn’s
disease (HR=7.13), COPD (HR=2.00), and others.Top non-cancer, non-chemotherapy
readmission diagnoses included neutropenia (79.1), sepsis (55.1), immune effector therapy
complications (32.5), COVID-19 (32.1), infusion complications (23.4), anemia of chronic
disease (21.8), ABO incompatibility (10.4), AKI (9.0), transplant complications (8.6), and
bacteremia (8.4)
Conclusion
Inpatient immunotherapy is associated with a high 90-day readmission rate and substantial
healthcare costs. Readmission risk is influenced by insurance type and specific comorbidities,
offering targets for intervention to reduce preventable hospitalizations in this expanding
population

Healthcare Utilization and Predictors of Readmission After Immunotherapy in a National Cohort


Background:
Pulsed-field ablation (PFA) for atrial fibrillation (AF) offers several advantages compared to thermal ablation, however direct comparisons of patient-reported outcomes after PFA and radiofrequency ablation (RFA) are limited. This study aimed to assess patient experience following PFA or RFA in AF ablation performed under general anesthesia.

Methods:
A retrospective study across a single integrated health system was conducted on consecutive patients who underwent PFA or RFA for AF under general anesthesia from March 2024-December 2024. Data were collected from electronic medical records. Primary endpoints included postprocedural pain complaints and scores, need for post-procedure analgesic medication, and frequency of emergency department (ED) visits for procedure-related concerns.

Results:
Two hundred patients (100 PFA and 100 RFA) were analyzed (age 73.2 ±9.2y, 38% female). Patients undergoing RFA had a significantly higher rate of ED visits compared to those who underwent PFA (17% vs. 6%, p <.05). The most common complaints prompting RFA ED visits were shortness of breath (29% of RFA ED visits), palpitations (23% of RFA ED visits), dizziness (18% of RFA ED visits), and other (30% of RFA ED visits). There were no statistically significant differences in postprocedural pain scores (RFA 1.70 vs. PFA 1.57, p = 0.61), requests for analgesic medications in the recovery area (RFA 36% vs. PFA 27%, p = 0.26), nor encounters made to the care team within 4 weeks following the procedure (RFA 57% vs. PFA 44%, p = 0.20).

Conclusion:
In this retrospective study, patients undergoing PFA for AF under general anesthesia experienced fewer ED visits for procedure-related issues compared to those undergoing RFA. While these clinical endpoints potentially suggest improved procedural recovery with PFA compared to RFA, larger prospective studies using patient-reported outcome measures are warranted.

Patient Experience Following Pulsed Field Ablation Compared to Radiofrequency Ablation for Atrial Fibrillation

Background 
The CDC reports that 15% of Americans live in rural areas (population <50,000). Rural residents are generally older, have higher rates of chronic illnesses like osteoarthritis, and experience more musculoskeletal injuries than urban populations. Unfortunately, local access to both urgent and elective orthopaedic care in these areas remains limited. 

Despite residency program expansion, the shortage of rural orthopaedic surgeons persists. From 2013 to 2018, the total number of orthopaedic surgeons grew by 1.9%, but the proportion practicing in rural areas declined by 0.9%. Little data exists on why orthopaedic residents aren’t choosing rural practice despite the clear need. 

This study aims to explore orthopaedic surgery residents’ views on rural practice and the key factors influencing their decisions, providing insights for educators and healthcare leaders addressing rural orthopaedic care gaps. 


Methods 
A 22-question survey was created in REDCap. Questions captured basic individual demographic information, information about the participant’s training program, future practice plans, interest in rural practice, and reasons for or against practice in rural areas. Interested orthopaedic surgery residency Program Directors (PD) at various institutions were identified through the Collaborative Orthopaedic Education Research Group’s (COERG) database. A letter of invitation to participate was sent to the program directors at interested institutions. 

Of the 29 program directors expressing interest in the study, 16 (55.17%) confirmed they had forwarded the survey to their trainees. Demographics were compared by responses to interest in future rural practice: yes, no, and maybe (have or haven't considered rural practice). 


Results 
107 orthopaedic surgery residents (25 women, 82 men) of a total of 404 (response rate 26.7%) completed the survey. Results are shown in Table 1. Only 6 respondents (5.6%) plan to practice in rural areas, with 3 planning full-time rural practice. Thirty-two (30%) reported no interest in rural practice. 
There were no significant differences in rural practice interest based on gender or parental status. However, residents from hometowns with populations under 50,000 were more likely to consider rural practice. 
The main reasons for choosing rural practice were growing up in rural areas, proximity to family, and recreational opportunities. Reasons against it included limited recreation, family preferences, and personal wellbeing (Table 2). 


Conclusion 
Given the prevalence of orthopaedic conditions among those living in rural America, there is a need for more orthopaedic surgeons to practice in these areas. Addressing this issue is complex and will require collaboration at all levels- including medical schools, local community leaders, orthopaedic surgeons, and professional associations.

The Future of Rural Orthopaedic Practice: A COERG Resident Survey

Introduction:
Residency salaries are typically standardized within institutional programs, yet the cost of living (COL) varies widely across the United States. These regional disparities can affect the surplus income that residents have available for personal use, a factor that students may consider. This study aims to analyze the relationship between PGY-2 salaries and the COL across physical medicine and rehabilitation (PM&R) programs in the United States. 
Methods:
PGY-2 salary data were primarily obtained from the 2024-2025 academic year (n=107), with a small proportion from 2023-2024 and 2025-2026 (n=3 for both), from program websites (n = 113). The annual COL for 2025 was obtained using the Massachusetts Institute of Technology (MIT) Living Wage calculator based on the program county. The surplus income and percentages were calculated using the salary and COL. Correlation and regression analyses were conducted to assess the relationship between salary, COL, and surplus income. The programs were grouped by the U.S. Census geographic regions for subgroup analyses. ANOVA and effect sizes were calculated for regional effects. 
Results:
The average PGY-2 salaries, COL, surplus income, and surplus percentages were $70,766, $50,113, $20,653, and 29% respectively. Correlation analysis revealed a moderate positive association between salary and COL (r=0.58), moderately negative association between surplus percentage and COL (r= -0.64), and a weak positive association between surplus percentage and salary (r=0.25). Regression found that COL was a significant predictor of surplus income (adjusted R2 = 0.54, p<0.0001), with the West showing a significantly lower adjusted surplus compared to the Southeast (p<0.0001). Surplus percentage across U.S. regions was significantly different (F(4,108) = 6.65, p<0.0001, n2 = 0.2), with geographic region having a large effect on cost-adjusted surplus income. 
Conclusion:
PM&R PGY-2 salaries, COL, surplus income, and surplus percentages varied significantly geographically across the U.S. Although salaries moderately correlate with COL, they do not provide equitable surplus income for residents.

Geographic Variations in ACGME PGY-2 PM&R Residency Program Salaries Compared to Cost of Living

Persistent Racial and Ethnic Disparities in Aortic Aneurysm and Dissection Mortality in the 
United States, 2018-2023: A Population-Level Analysis Using CDC WONDER 
Background: 
Aortic aneurysm and dissection (AAD) are life-threatening vascular conditions requiring rapid diagnosis and treatment to prevent mortality. While technological advancements in care have improved outcomes overall, access to these resources remains unequal. Prior studies have documented racial disparities in cardiovascular outcomes, but data specifically examining mortality trends in AAD remain limited. This study evaluates racial and ethnic disparities in AAD mortality in the United States from 2018 to 2023, reflecting broader structural barriers in healthcare access. 
Methods: 
We extracted mortality data for aortic aneurysm and dissection (ICD-10 I71) from the CDC WONDER Underlying Cause of Death database for 2018–2023. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated using the direct method, standardized to the 2000 U.S. standard population. Mortality rates were stratified by race/ethnicity using CDC defined categories: American Indian/Alaska Native, Asian, Black/African American, Native 
Hawaiian/Pacific Islander, White, and Multiracial. Trends were analyzed descriptively using CDC WONDER query tools. 
Results: 
From 2018 to 2023, there were 59,300 AAD-related deaths nationwide, with an overall AAMR of 2.5 per 100,000. Black or African American individuals experienced the highest AAMR at 2.8 per 100,000, increasing from 2.8 in 2018 to 2.9 in 2023. White individuals accounted for the largest absolute number of deaths (n=49,508) with a stable AAMR of 2.4 per 100,000. American Indian/Alaska Native populations showed a notable rise in AAMR from 1.1 to 1.4 per 100,000 over the study period. Asian individuals maintained a stable rate of 1.6 per 100,000. Native Hawaiian/Pacific Islander populations had limited data but demonstrated a high cumulative AAMR of 2.8 per 100,000. Multiracial individuals had the lowest AAMR at 1.5 per 100,000. 
Conclusion: 
Racial and ethnic disparities in AAD mortality persist in the United States, with Black and American Indian/Alaska Native populations bearing disproportionate mortality burdens. These findings highlight the urgent need for targeted interventions addressing systemic inequities in emergency vascular care, including access to timely diagnosis, specialized surgical care, and broader social determinants of health.

Persistent Racial and Ethnic Disparities in Aortic Aneurysm and Dissection Mortality in the United States, 2018-2023: A Population-Level Analysis Using CDC WONDER

Background
After undergoing major surgery, 7-15% of patients experience postoperative complications, with a mortality rate of up to 5%. Since the total number of major surgeries continues to increase, improving postoperative outcomes has become a priority for advancing patient health and reducing medical costs. One method to reduce complications and length of hospital stay is by increasing preoperative cardiovascular fitness (CVF). Increased CVF may allow an individual to better tolerate other physical stresses, such as major surgery. This study aims to explore how preoperative CVF, self-reported by patients as the Exercise Vital Sign (EVS), relates to postoperative outcomes in patients undergoing mixed-major abdominal surgeries (ventral hernia repair, cholecystectomy, appendectomy, and colonic resection). It is hypothesized that patients who report higher levels of preoperative cardiovascular exercise will experience fewer postoperative complications compared to lower levels of reported preoperative cardiovascular exercise.

Methods
Data was gathered from 14254 de-identified patients who underwent major abdominal surgeries using data from a major hospital system. Exercise Vital Sign was evaluated at three thresholds: 0, 75, and 150 minutes of cardiovascular exercise per week. Postoperative outcomes, including complications (hematoma, abscess, infection, and internal bleeding), emergency department visits, critical care admissions, infusion therapy, and general health management, were identified via CPT codes. A multinomial logistic regression was performed. Comorbidities (cancer, diabetes, obesity, and hypertension) and length of stay were controlled for. 

Results
The results show a significant association between increased exercise and lower predicted probabilities of life-threatening CPT categories, particularly as weekly exercise increased from 0 to 75 minutes in patients with one or less comorbidities. Higher risk patients, those with multiple comorbidities, showed the greatest benefit as weekly exercise increased from 75 to 150 minutes per week with the risk of complication dropping from 0.11 at 75 minutes to nearly 0 at 150 minutes. All patient profiles showed a shift away from life-threatening care towards preventive care.

Conclusion
Modest levels of exercise were significantly associated with a sharp reduction in life-threatening postoperative outcomes across all patient profiles. Most patients benefitted by achieving 75 minutes of cardiovascular exercise per week; moreover, higher risk patients had additional benefits of achieving 150 minutes of cardiovascular exercise per week. Thus, preoperative exercise counseling could be an effective, low-cost intervention to reduce postoperative complications. Future policies could incentivize physical activity promotion as part of surgical quality improvement initiatives and integration of collecting exercise data in routine healthcare visits.


Understanding the Association between Preoperative Exercise Level and Post-Operative Outcomes of Mixed-Major Abdominal Surgery


Abstract Title: Barriers to Breast Cancer Screening Adherence Among African American Women in Michigan 
Author’s: Miranda Goodson B.S., Whitney Bowyer B.S., Anna Lundh B.S., Dr. Laura Benjamins M.D. 

Background 
African American (AA) women have lower adherence to breast cancer screening guidelines, which may contribute to delayed diagnoses and reduced survival rates. The importance of examining studies focused on the experiences of Black women within urban healthcare networks is essential to understanding the links between demographics, socioeconomic status (SES), and breast cancer outcomes. 

Methods 
A systematic literature search was conducted using Ovid Medline. The search string included terms such as “Black or African American,” “Breast Neoplasms,” and “Treatment Outcomes.” Inclusion criteria for the articles focused on studies published from 2014 to 2024 and included cohort studies, case-control studies, and other observational studies. The search yielded 24 articles which were reviewed and assessed for racial disparities and treatment outcomes within this population. 

Results 
Six articles reviewed the prevalence of triple-negative breast cancer, finding that AA women are affected at higher rates. Five articles highlighted SES disadvantages leading to worse health outcomes by limiting access to preventative care services and delaying diagnosis. The historical discrimination of AA patients in healthcare has also fostered hesitation towards seeking these services. Differences in lived experiences contributed largely to lower-quality care. Five studies examined implicit bias and mistrust in the physician-patient relationship, contributing to a compounded delay in diagnosis. The studies reported that physicians with high implicit bias often conducted shorter visits and were less engaged with AA patients. This can extend to decisions regarding preventative care, leading to fewer referrals for genetic and critical screenings compared to other patients. 

Conclusion 
This initial review highlighted how health disparities impact breast cancer screening, treatment and survival rates among Black women. In the next research phase, the attitudes toward mammogram screening will be explored by directly surveying patients. 



Barriers to Breast Cancer Screening Adherence Among African American Women in Michigan

Asthma is a chronic respiratory condition characterized by difficulty breathing, wheezing, and coughing. According to the United States Centers for Disease Control and Prevention (CDC), around 6 million children in the US have asthma. The asthma hospitalization rate for pediatric patients has been shown to be significantly higher in certain racial/ethnic groups. Socio-environmental factors play a role in the perpetuation of healthcare disparities and inequities across racial groups. Despite global clinical advances in asthma management and exacerbation prevention, asthma disproportionately affects Black and Hispanic/Latino children as compared to their White peers. This study aimed to examine racial and ethnic disparities in pediatric asthma hospital admissions and readmissions

We conducted a retrospective analysis using electronic medical record data from Loma Linda University Children’s Hospital (LLUCH). Variables examined included admission and discharge dates, date of birth, sex, and race/ethnicity. The target population was pediatric patients admitted to LLUCH in 2023 with a diagnosis of moderate persistent or severe persistent asthma. Patients were assigned to one of three racial/ethnic groups: Black, White, or Latino. Outcome variables were (1) asthma hospital admissions and (2) asthma readmissions. We conducted statistical analysis by calculating summary statistics and examining differences across racial/ethnic groups using chi-square analysis.

Out of 140 total admissions, 40 were Black, 80 were Latino, and 20 were White. When comparing the proportion of admissions to the expected proportion based on regional demographics, pairwise chi-square analyses revealed significantly higher asthma admission rates among Black children compared to White and Latino children (p < 0.01), and among Latino children compared to White children (p < 0.01). There was also a significantly higher asthma readmission rate among Black children compared to White children (p = 0.03), and among Latino children compared to White children (p = 0.05), with no significant difference between Black and Latino children (p = 0.32)

This study demonstrated continued disparities in pediatric asthma care. Our findings demonstrate that Black and Latino children have significantly more asthma admissions and readmissions as compared to White children. Speculative reasoning for why these racial/ethnic inequities exist include provider biases and limited geographical access to providers for follow-up. Limitations of this study include the small sample size within a single hospital system and that chance of misclassification of race/ethnicity, both of which could introduce bias into the results. Future steps include a QI project to promote asthma follow-up of Black and Latino patients with primary care providers and/or specialists 


Breathless Disparities: Exploring Racial Differences in Pediatric Asthma Admissions

Title
Comparative Effects of Statins and Fibrates on the Onset of Diabetic Retinopathy in Type 2 Diabetes

Background
Diabetic retinopathy (DR) is a common complication of type 2 diabetes mellitus (T2DM) and a leading cause of vision loss in working-age adults. Management often requires invasive, costly procedures to preserve vision and while lipid-lowering drugs (LLDs), particularly statins and fibrates, have shown promise in slowing DR progression, their role in disease onset remains unclear. This study evaluated the association between statin or fibrate therapy and DR onset to assess their prophylactic potential. 
Methods
This retrospective cohort study used de-identified electronic health records from 152 healthcare organizations via the TriNetX Global Network. Patients with T2DM and no prior ocular complications, diagnosed at least 10 years prior, were assigned to fibrate-only (n = 7,004) or statin-only (n = 463,588) cohorts. Drug exposure required two records: one within 6 months and one at least 1 year after diagnosis. After propensity score matching on demographic characteristics, retinal vascular and non-diabetic retinopathy conditions, and serum HDL, LDL, triglycerides, and HbA1c, each cohort included 6,691 patients. Outcomes included diagnosis of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), or need for antiVEGF injections or retinal laser. Patients with outcomes prior to cohort entry were excluded.

Results
Fibrate therapy was associated with lower risk of DR across all stages: 55.1% reduction in mild NPDR (RR = 0.449; 95% CI: 0.359, 0.561; p < 0.001), 68.7% in moderate (RR = 0.313; 95% CI: 0.202, 0.486; p < 0.001), 65.3% in severe (RR = 0.357; 95% CI: 0.174, 0.735; p < 0.004), and 67.6% in PDR (RR = 0.324; 95% CI: 0.203, 0.517; p < 0.001). Onset was also delayed: mild (log-rank x2 = 25.238; p < 0.001), moderate (log-rank x2 = 17.419; p < 0.001), severe (log-rank x2 = 5.140; p < 0.024), and PDR (log-rank x2 = 15.125; p < 0.001).
Fibrate users had a 66.7% reduced risk of retinal laser (RR = 0.333; 95% CI: 0.212, 0.524; p < 0.001) and longer time-to-event (log-rank x2 = 14.372; p < 0.001). No difference was found in antiVEGF injection risk. 

Conclusion
Fibrate therapy was associated with reduced risk and delayed onset of DR in patients with T2DM compared to statin therapy. These findings support a potential role for fibrates in DR prophylaxis.


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Evaluation of Innate Immune Transcriptional Responses in the Context of Intracellular Infection by Necrotizing Fasciitis-associated Acinetobacter baumannii

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