Ella Huszti

Objective: Persistent post traumatic headache (PTH) is a common sequalae of concussion. There is a lack of research on real world pharmacological treatment. This study aims to evaluate the effectiveness of prophylactic medication for PTH in a clinical environment. Methods: This study is a retrospective chart review of patients referred to a tertiary care center. We compared effectiveness of standard headache prophylactic therapies in PTH. Results: Headache improvement was 64 % after first medication and 79% after all medications. For first line therapy, the most improvement was treatment with Gabapentin (73.3%). The odds of headache improvement from MVC were 3.8 times higher for Gabapentin compared to Amitriptyline/Nortriptyline. Conclusion: PTH may be improved by prophylactic migraine medication. Targeted therapies particularly gabapentin in concussions following motor vehicle accidents support the broader concept that PTH is responsive to preventive treatment strategies. However, the small sample size and retrospective design limit the ability to draw definite treatment-specific conclusions.

Key Points: DSA ⁺ kidney grafts with antibody-mediated rejection had higher glomerular and tubulointerstitial complement protein levels than those with donor-specific antibodies but no rejection. DSA ⁺ patients without rejection lacked accommodation but showed preserved podocyte and tubular protein expression compared with antibody-mediated rejection. Elevated complement and decreased mitochondrial proteins were associated with death-censored allograft loss in DSA ⁺ patients with antibody-mediated rejection. Background: Antibody-mediated rejection (AMR) is the main driver of late kidney allograft loss. Anti-HLA donor-specific antibodies (DSAs) are strongly associated with AMR. However, 30%–60% of DSA ⁺ patients do not develop AMR, raising the possibility of local tissue adaptations to DSAs. Methods: We performed unbiased proteomic analysis on glomeruli and tubulointerstitium isolated using laser-capture microdissection from the kidney biopsies of 116 DSA ⁺ kidney transplant recipients with Banff-classified active AMR, chronic active AMR, mixed AMR, or no rejection. The Significant Latent factor Interaction Discovery and Exploration (SLIDE) machine learning algorithm was used to identify latent factors linked to graft loss among patients with AMR. Results: We quantified 1917 glomerular and 2758 tubulointerstitial proteins by mass spectrometry, with 127 glomerular and 389 tubulointerstitial proteins significantly differentially expressed between all 4 patient groups (one-way ANOVA P < 0.05, Tukey false discovery rate + biopsies without rejection were characterized by preservation of podocyte and tubular proteins in glomeruli and tubulointerstitium, respectively, but did not show conventional markers of accommodation. SLIDE identified 3 latent factors from the glomerular proteome and 4 from the tubulointerstitial proteome that significantly distinguished AMR patients with and without graft loss, correlated significantly with allograft injury, and improved prediction of graft loss beyond standard clinical variables in a multivariable risk model. Top proteins within the glomerular SLIDE model included complement components, while top proteins for the tubulointerstitial SLIDE model included tubular and mitochondrial proteins. Conclusions: AMR and graft loss after kidney transplantation were defined by compartment-specific disruptions in complement and mitochondrial proteins.

Introduction: In vitro fertilization (IVF) cycles typically require multiple in-person visits for blood tests and ultrasonography to monitor the response to gonadotropins and predict treatment outcomes. The aim of the quality improvement project was to reduce the number of in-person visits for patients undergoing IVF while maintaining high-quality patient care. Methods: A multimodal quality improvement (QI) initiative was implemented for patients undergoing IVF through changes to the default settings in the electronic medical record and staff education. Data were collected prospectively for all patients undergoing IVF from June to August 2020 and retrospectively from June to August 2019. Results: A total of 178 and 202 IVF cycles were included in the preintervention and postintervention periods, respectively. The median number of visits per IVF cycle was reduced by 50% in the postintervention period compared with baseline (4.00 [3.00, 5.00] vs. 8.00 [7.00, 8.00], p < .001). There were no statistically significant differences in the odds of having more than 20 oocytes retrieved (OR 1.568; 95% CI 0.91–2.703), moderate or severe ovarian hyperstimulation syndrome (OHSS) symptoms (OR 1.08, 95% CI 0.17–6.73), or pregnancy rate per embryo transfer (OR 0.82, 95% CI 0.45–1.50). A high level of patient satisfaction was observed. Conclusions: In-person visits during an IVF cycle were rapidly reduced, with good patient satisfaction and no statistically significant differences in outcomes.

Background/Objectives: Shift work is a form of circadian dysregulation, which has been associated with adverse reproductive health outcomes. However, the association between circadian dysregulation and ovarian reserve remains uncertain. The present study examines whether shift work is associated with lower AMH levels in women seeking fertility treatment. Methods: This retrospective cohort study includes female patients aged 20–39 years presenting between February 2023 and June 2024. Patients were excluded if they had only one ovary, a current cancer diagnosis, or past chemotherapy use. Demographic and medical data were obtained from the electronic medical record. AMH levels were compared between daytime workers and shift workers. Results: A total of 1135 patients met inclusion criteria. The median age was 35 years (IQR 32–37). Of these, 89% (n = 1014) reported daytime work, and 11% (n = 121) reported shift work, comprising 102 working rotating shifts, seven working night shifts, and 12 working evening shifts. Daytime-only workers had a median AMH of 17.20 pmol/L (9.1–30.0). Combined shift workers had a median AMH of 17.10 pmol/L (8.1–31.0). There was no statistically significant difference in AMH levels between daytime workers and shift workers (p = 0.935). Although not significant, the odds of having low AMH levels (p = 0.345). Conclusions: In this cohort, AMH levels did not significantly differ between daytime and shift workers, offering reassurance to individuals required to engage in shift work. Future research should include larger cohorts and incorporate more comprehensive measures of circadian disruption.

Background: Bronchoalveolar lavage (BAL) is frequently employed for diagnostic purposes in immunocompromised patients with pneumonia, yet its role in immunocompetent individuals remains debated. The study investigates whether BAL is associated with reduced mortality in immunocompetent patients hospitalized with pneumonia. Methods: A retrospective cohort study was conducted at SMC, including 13,180 immunocompetent patients hospitalized with pneumonia from 2007 to 2024. Patients who underwent BAL (n = 96) were matched 1: 4 to a control group (n = 384) using Propensity score matching based on age, gender, severity scores and comorbidities. Mortality was assessed at 30, 60, and 90 days using logistic regression models, adjusting for length of stay, inflammatory markers, albumin levels, smoking status, and BMI. Results: In the matched cohort, 30-day mortality did not differ significantly between groups (20.8% in BAL vs. 19.5% in controls, p = 0.886), and no significant association was observed after adjustment (OR = 0.95 [0.51–1.73]. However, both 60-day and 90-day mortality were significantly higher in the BAL group (39.6% vs. 24.7% and 45.8% vs. 26.8%, respectively; p < 0.01 for both), and these differences persisted after adjustment (60 days: OR = 1.74 [1.03–2.94]; 90 days: OR = 2.12 [1.27–3.54]). Conclusions: In this cohort of immunocompetent patients hospitalized with pneumonia, BAL was not associated with short-term survival. Clinicians should carefully weigh the potential risks and benefits of BAL in this population. Further studies are needed to identify patient subgroups that might benefit from BAL through enhanced diagnostic or therapeutic approaches.

Background Serum beta-human chorionic gonadotropin (β-hCG) hormone is a well-established biomarker used for pregnancy monitoring and prognosis in in vitro fertilization (IVF) cycles. After embryo transfer, a high serum β-hCG level with a prompt doubling time is typically reassuring, while a low initial β-hCG often leads to counselling around likely impending pregnancy loss and/or ectopic pregnancy. However, the number of patients with low β-hCG who ultimately deliver a live birth is unclear. Methods This is a single-centre retrospective cohort study of IVF pregnancies between January 2019 and December 2022. Serum β-hCG was drawn 14 days post-fertilization. We considered an initial β-hCG ≤ 50 mIU/mL as low. A logistic mixed-effects regression model assessed the odds of live birth for every 10 mIU/mL increase in β-hCG, adjusting for patient and cycle characteristics (age, body mass index, embryo stage, number of embryos transferred, and preimplantation genetic testing for aneuploidy). Receiver operating characteristic curves were plotted to determine optimal cut-points. Results Among 2443 pregnancies, the prevalence of live birth was 12% for those with an initial β-hCG ≤ 50 mIU/mL. For each 10 mIU/mL difference in initial β-hCG, the odds of live birth increased significantly (aOR = 1.035, 95% CI: 1.027, 1.042). Receiver operating characteristic curve analysis showed that an initial β-hCG greater than 22.5 mIU/mL identified over 99% of patients who ultimately had a live birth (sensitivity 1, specificity 0.21, AUC 0.726). The rate of change from initial β-hCG demonstrated stronger discriminatory performance for live birth among patients with low initial β-hCG (AUC 0.876 [0.84, 0.91]) than among those with an initial β-hCG > 50 mIU/mL (AUC 0.584 [0.56, 0.61]). Conclusions While IVF pregnancies with a low initial β-hCG can result in live birth, the likelihood is low. The rate of β-hCG rise emerged as a stronger discriminator of pregnancy outcomes when the initial β-hCG is low. Live birth was extremely rare when the initial β-hCG was below 22.5 mIU/mL. These findings offer prognostic data to guide counselling and refine expectations after IVF.

Background: Neutrophils are key innate immune cells in peripheral blood. In recent years, sub-populations of neutrophils have been identified. In addition to the normal-density neutrophils (NDNs) in both healthy subjects and patients, low-density neutrophils (LDNs) were described in chronic inflammation and cancer. In lung transplants (LTx), neutrophils play crucial roles in reperfusion injury, acute rejection, and chronic lung allograft dysfunction. Our pilot study examines neutrophil subsets and function in LTx recipients during the first post-transplant year. Methods: We collected blood from 11 LTx recipients at various intervals. LDNs and normal-density neutrophils (NDNs) were isolated. The production of reactive oxygen species (ROS) by NDNs was measured after PMA activation using a Luminol-HRP assay. Neutrophil phenotypic markers were analyzed with flow cytometry. Results: The LDN-to-NDN ratio increased at 3 and 6 months post-transplant. Expression levels of CD62-L (aging marker), PDL-1 (immune checkpoint), CD15 (maturation), and CXCR4 (homeostasis regulator) showed modulation. Interestingly, ROS production by NDNs was mildly elevated at baseline, reduced at 6 months, and returned to baseline levels by 9 months post-transplant. Conclusions: Neutrophils exhibit dynamic changes in the first post-LTx year. Investigating neutrophil plasticity could reveal clinically relevant biomarkers and facilitate the development of diagnostic and therapeutic tools in LTx.