Avneet Kaur

Background/Objectives: Nonselective beta blockers (NSBBs) are widely used in cirrhosis for portal hypertension, but their safety in older adults with decompensated cirrhosis remains uncertain. Methods: We conducted a retrospective multicenter cohort study using the TriNetX Research Network. Adults aged 30–90 years with decompensated cirrhosis were stratified into three groups: 30–60 years, 61–90 years, and a prespecified subgroup of 81–90 years. NSBB exposure (propranolol, nadolol, or carvedilol) within 30 days of decompensation was assessed, and 1:1 propensity score matching was performed within each age group. The primary outcome was 12-month all-cause mortality. Secondary outcomes included acute kidney injury (AKI), electrolyte abnormalities, and acute care utilization. Results: After matching, 40,074 pairs (30–60 years), 96,084 pairs (61–90 years), and 19,024 pairs (81–90 years) were analyzed. NSBB use was associated with lower 12-month mortality in ages 30–60 (4.0% vs. 4.6%; RR 0.86, 95% confidence interval [CI] 0.81–0.92). 61–90-year cohort, mortality was similar between groups (7.4% vs. 7.4%; RR 0.99, 95% CI 0.96–1.02). Patients aged 81–90 years, NSBB use was associated with higher mortality (10.9% vs. 10.0%; RR 1.08, 95% CI 1.02–1.16). Across age strata, NSBB was associated with increased AKI, hyperkalemia, and acute care visits. Conclusions: NSBB therapy was associated with reduced mortality in younger adults (30–60 years) but not in older patients (61–90 years) and was associated with increased mortality among those aged 81–90 years. These findings support individualized NSBB use and suggest that patient age should be considered when weighing potential benefits and risks.

Importance: Data on advanced therapy (AT) in patients with HIV and inflammatory bowel disease (HIV-IBD) are limited. We evaluated the safety and outcomes of AT in this population using real-world data. Design, Setting, and Participants: We conducted a retrospective cohort study in the TriNetX database (2015–2020). Adult patients with HIV-IBD on anti-retroviral therapy were identified using ICD-10 codes. Propensity score matching (PSM) adjusted for baseline clinical and demographic differences. Intervention(s) or Exposure(s) AT exposure identified via prescription codes of biologics or small molecules. Primary outcomes were serious infections, opportunistic infections, and incident cancers; secondary outcomes included IBD-related surgery and all-cause mortality. Results: Among 3422 patients with HIV-IBD, 173 (5.05%) received AT. The most commonly used agents were infliximab (41.6%), adalimumab (36.4%), and ustekinumab (11.6%). Mean follow-up was 4.86 years (9861 patient-years). In the unmatched ­cohort, rates of serious infections (34.1% vs 36.9%, OR 0.86, P = .14) and opportunistic infections (26.6% vs 26.9%, OR 0.99, P = .94) were similar between patients receiving AT and those not receiving AT. After PSM (163 matched pairs), no significant differences were observed in serious infections (34.3% vs 35.6%, OR 0.85, P = .26), opportunistic infections (24.5% vs 28.2%, OR 0.83, P = .45), malignancy rate, IBD-related surgery, or mortality. Kaplan–Meier analyses showed no statistically significant differences in the cumulative incidence of infections or mortality between groups. Conclusions and Relevance: In this large multicenter cohort, AT use in HIV-IBD was rare but not associated with higher risks of infection, cancer, surgery, or death. These findings support the safety of AT in this population.

Surgical clip migration is a rare but important cause of delayed postcholecystectomy complications. An 83-year-old man presented 8 years after laparoscopic cholecystectomy with abdominal pain and jaundice. Imaging showed biliary dilation with a 20-mm common bile duct stone. Endoscopic retrograde cholangiopancreatography with cholangioscopy identified a migrated surgical clip serving as the nidus. Electrohydraulic lithotripsy achieved fragmentation, followed by balloon extraction and placement of a fully covered metal stent. The patient recovered uneventfully. This case highlights the need to consider clip migration in patients with late-onset biliary obstruction after cholecystectomy and supports cholangioscopy-guided lithotripsy as a definitive therapy.