Carotid Body Tumors
Because CBTs may become malignant and metastasize, it is important for NPs to be knowledgeable about presenting symptoms and appropriate diagnostic studies to be able to refer patients to vascular surgeons early to prevent complications.
KEY FINDINGS: This case series showed that patients with CBTs should be assessed with a combination of history and physical exams along with imaging studies to confirm the diagnosis. Because CBTs may become malignant and metastasize, it is important for NPs to be knowledgeable about presenting symptoms and appropriate diagnostic studies to be able to refer patients to vascular surgeons early to prevent complications.
BACKGROUND: Carotid body tumors (CBTs) are uncommon neuroendocrine tumors located near the carotid bifurcation within the carotid body. CBTs are slow-growing; affected individuals may remain asymptomatic for years and are often diagnosed incidentally following imaging studies. When present, symptoms are nonspecific. Because incidence is low, retrospective review of CBT case series is an ideal study design for investigating common symptomology, identifying successful diagnostic tools, and evaluating treatment outcomes.
DETAILS: This article describes a case series of 11 patients treated for CBTs at an academic medical center in the Southeastern US. A retrospective chart review of 11 patients who had been discharged from the hospital following treatment for CBTs between 2017 and 2021 was conducted. Descriptive statistics were used to delineate the case series. There were four males (36%) and seven females (64%) included in the retrospective case series. The age range was 34 to 79 with a mean of 56.73 (standard deviation 16.038). Three patients were found to have a neck mass on physical exam. Additional symptoms included vocal cord paralysis, facial paralysis, ischemic stroke, Bell palsy, dysphonia, and dizziness. Two patients had familial CBTs. Ten patients underwent surgical excision.
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Copyright © Wolters Kluwer Health, Inc. All rights reserved.
Source: Ratliff, C. R. and Strider, D. V. (2023). Carotid Body Tumors: A Retrospective Case Series Of 11 Patients. The Nurse Practitioner. 2023; 48(2): 35-40. Published: February, 2023. DOI: 10.1097/01.NPR.0000000000000004.
Association of Family History and Polygenic Risk Score With Longitudinal Prognosis in Parkinson Disease
Having a family history of PD predicts slower progression of cognitive decline and caudate dopaminergic degeneration, and less FOG compared with those without a family history independent of PRS. Taken together, information on family history could be used as a proxy for the clinical heterogeneity of PD.
KEY FINDINGS: Having a family history of PD predicts slower progression of cognitive decline and caudate dopaminergic degeneration, and less FOG compared with those without a family history independent of PRS. Taken together, information on family history could be used as a proxy for the clinical heterogeneity of PD.
BACKGROUND: Evidence suggests that either family history or polygenic risk score (PRS) is associated with developing Parkinson disease (PD). However, little is known about the longitudinal prognosis of PD according to family history and higher PRS.
DETAILS: From the Parkinson's Progression Markers Initiative database, 395 patients with PD who followed up for more than 2 years were grouped into those with family history within first-degree, second-degree, and third-degree relatives (N = 127 [32.2%]) vs those without (N = 268 [67.8%]). The PRS of 386 patients was computed using whole-genome sequencing data. Longitudinal assessment of motor, cognition, and imaging based on dopaminergic degeneration was conducted during the regular follow-up period. Effects of family history, PRS, or both on longitudinal changes of cognition, motor severity, and nigrostriatal degeneration were tested using a linear mixed model. The risk of freezing of gait (FOG) according to family history was assessed using the Kaplan-Meier analysis and Cox regression models. During a median follow-up of 9.1 years, PD with positive family history showed a slower decline of caudate dopamine transporter uptake (ß estimate of family history x time = 0.02, 95% CI = 0.002-0.036, p = 0.027). Family history of PD and higher PRS were independently associated with a slower decline of Montreal Cognitive Assessment (ß estimate of family history x time = 0.12, 95% CI = 0.02-0.22, p = 0.017; ß estimate of PRS x time = 0.09, 95% CI = 0.03-0.16, p = 0.006). In those 364 patients without FOG at baseline, PD with positive family history had a lower risk of FOG (hazard ratio of family history = 0.57, 95% CI = 0.38-0.84, p = 0.005).
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Copyright © American Academy of Neurology. All Rights Reserved.
Source: Park, M. and Lee, Y. (2025). Association of Family History and Polygenic Risk Score With Longitudinal Prognosis in Parkinson Disease. Neurology Genetics. 2025; Published: October, 2025. DOI: 10.1212/NXG.0000000000200115.
Renal Outcomes and Safety of Dipeptidyl Peptidase-4 Inhibitors versus Meglitinides in Advanced CKD with Type 2 Diabetes
Curettage remains optimal for thick, hyperkeratotic SKs, enabling histopathological confirmation. The 532-nm laser, preferred subjectively for convenience, may suit small, non-hyperkeratotic lesions but warrants further validation. Propane-butane cryotherapy offers a cost-effective alternative.
KEY FINDINGS:
- DPP-4 inhibitors offer a safer alternative to meglitinides in T2D patients with Stage 5 CKD with lower severe renal outcomes and hypoglycemia risk.
- Hypoglycemia risk is lower with DPP-4i due to glucose-dependent insulinotropic action.
- DPP-4i are weight neutral, helpful in normal or lower BMI patients.
- Renoprotection mechanisms of DPP-4i may involve GLP-1 dependent pathways and antifibrotic effects but need further study.
- Observational data with residual confounding; randomized trials needed for conclusive evidence.
- Cost and access issues may influence DPP-4i use in some settings.
BACKGROUND: Managing hyperglycemia in type 2 diabetes (T2D) patients with advanced chronic kidney disease (CKD) is complex due to altered drug metabolism and risk of adverse events. Conventional treatments like metformin pose risks due to renal excretion; sulphonylureas and pioglitazone involve metabolites renally cleared raising hypoglycemia and fluid retention risks. Meglitinide repaglinide is preferred in this setting due to hepatic metabolism and flexible dosing. DPP-4 inhibitors (DPP-4i) offer a safer profile with low hypoglycemia risk and weight neutrality, but data on their safety and efficacy in Stage 5 CKD remain scarce.
DETAILS: Hung et al. conducted a nationwide Taiwanese cohort study (2012-2020) comparing renal outcomes in Stage 5 CKD patients with T2D starting either DPP-4i (n=5028) or meglitinides (n=2243). Stage 5 CKD was defined using erythropoiesis-stimulating agent (ESA) use as a surrogate for eGFR <15 mL/min/1.73 m2. Propensity score matching adjusted for confounders. The primary composite outcome included renal replacement therapy (RRT), renal death, and kidney-related hospitalization. DPP-4i use was associated with a 14% lower risk of the primary composite renal outcome vs. meglitinides (HR 0.86; 95% CI 0.81-0.92), mainly through reduced need for RRT. Severe hypoglycemia risk was 41% lower in the DPP-4i group. The findings support the renal safety and possible benefits of DPP-4i over meglitinides in severe CKD. Limitations include observational design, ESA use as CKD surrogate, lack of clinical measurements, and limited generalizability due to homogeneous Taiwanese cohort.
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Copyright © John Wiley & Sons, Inc. All rights reserved
Source: Ryden, M. (2025). Choosing Oral Antihyperglycaemic Drugs in People Living With Type 2 Diabetes and Severe Chronic Kidney Disease. Journal of Internal Medicine. 2025; 298(3): 149-151. Published: September, 2025. DOI: 10.1111/joim.70002.
Effects of Emergency Nurses' Life-Sustaining Treatment Withdrawal Knowledge, Role Perception, and Job Stress on Providing End-of-Life Care
Despite the challenging environment of the emergency department, nurses who recognize their important role in the process of life-sustaining treatment withdrawal are more likely to provide high-quality EOL care. The perception of nurses' roles is especially influential on psychological care performance, and alternative approaches may be necessary for spiritual care.
KEY FINDINGS: Despite the challenging environment of the emergency department, nurses who recognize their important role in the process of life-sustaining treatment withdrawal are more likely to provide high-quality EOL care. The perception of nurses' roles is especially influential on psychological care performance, and alternative approaches may be necessary for spiritual care.
BACKGROUND: This study aimed to identify predictors of end-of-life (EOL) care provided by emergency nurses in South Korea.
DETAILS: A cross-sectional survey was conducted using a structured questionnaire. Data were collected using Google Forms between June 21 and 30, 2022. A total of 154 emergency nurses from 10 tertiary hospitals in a metropolitan area were recruited using convenience sampling, and 139 completed surveys were analyzed. Multiple linear regression was employed to examine the effects of nurses' knowledge of life-sustaining treatment withdrawal (knowledge), their perceptions of their role in the withdrawal process (role perception), and job stress on EOL care. The mean scores for knowledge, role perception, job stress, and EOL care were 13.09±1.75 (max 6), 4.18±0.44 (max 5), 3.55±0.32 (max 4), and 2.48±0.40 (max 4), respectively. Among the EOL care subdomains, psychological domain scores were the highest. Multiple linear regression analysis indicated that nurses' role perception significantly predicted EOL care performance, particularly in the psychological (F=3.924, P=0.001) and spiritual (F=2.171, P=0.020) domains.
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Copyright © Journal of Hospice and Palliative Care. All rights reserved.
Source: Park, H. J., Hong, E. A., Min, S. H., et al. (2024). Effects of Emergency Nurses' Life-Sustaining Treatment Withdrawal Knowledge, Role Perception, and Job Stress on Providing End-of-Life Care. J Hosp Palliat Care. 2025; 28(3): 89-98. Published: September 1, 2025. DOI: 10.14475/jhpc.2025.28.3.89.
Risdiplam in Presymptomatic Spinal Muscular Atrophy
Infants up to 6 weeks of age with genetically diagnosed SMA who were treated with risdiplam before the development of clinical signs or symptoms appeared to have better functional and survival outcomes at 12 and 24 months than untreated infants in natural history studies. Larger, controlled studies with longer follow-up are needed to further understand the relative efficacy and safety of presymptomatic treatment of SMA with risdiplam.
KEY FINDINGS: Infants up to 6 weeks of age with genetically diagnosed SMA who were treated with risdiplam before the development of clinical signs or symptoms appeared to have better functional and survival outcomes at 12 and 24 months than untreated infants in natural history studies. Larger, controlled studies with longer follow-up are needed to further understand the relative efficacy and safety of presymptomatic treatment of SMA with risdiplam.
BACKGROUND: Risdiplam, an oral pre–messenger RNA splicing modifier, is an efficacious treatment for persons with symptomatic spinal muscular atrophy (SMA). The safety and efficacy of risdiplam in presymptomatic disease are unclear.
DETAILS: Authors conducted an open-label study of daily oral risdiplam (with the dose adjusted to 0.2 mg per kilogram of body weight) in infants 1 day (birth) to 42 days of age with genetically diagnosed SMA but without strongly suggestive clinical signs or symptoms. The primary outcome, assessed in infants with two SMN2 copies and a baseline ulnar compound muscle action potential (CMAP) amplitude of at least 1.5 mV, was the ability to sit without support at month 12. Natural history studies have shown that the majority of infants with two SMN2 copies who are untreated would have a severe SMA phenotype (type 1), would never sit independently, would receive permanent ventilation and feeding support, or would die by 13 months of age. Secondary outcomes that were assessed over a period of 24 months included survival, ventilatory support, motor milestones, the development of clinically manifested SMA, feeding, and growth. A total of 26 infants with two, three, or four or more copies of SMN2 were enrolled. After 12 months of treatment, 21 infants (81%) could sit unsupported for 30 seconds, 14 (54%) could stand alone, and 11 (42%) could walk alone. A total of 4 of 5 infants (80%; 95% confidence interval, 28 to 100) with two SMN2 copies and a baseline ulnar CMAP amplitude of at least 1.5 mV were able to sit without support for at least 5 seconds. Three infants were withdrawn from the study by a parent or caregiver after the month 12 visit. Of 23 infants who completed 24 months of treatment, all were alive without the use of permanent ventilation or feeding support. Over a period of 24 months, nine treatment-related adverse events were reported in 7 infants; none of these events were serious.
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Copyright © Massachusetts Medical Society. All rights reserved.
Source: Finkel, R. S., Servais, L., Vlodavets, D., et al. (2024). Risdiplam in Presymptomatic Spinal Muscular Atrophy. N Engl J Med. 2025; 393(7): 671-682. Published: August 13, 2025. DOI: 10.1056/NEJMoa2410120.
Experience of Carbon Monoxide Poisoning Treated With Hyperbaric Oxygen Therapy and Steroid Pulse Therapy
This case suggests that the combination of steroid pulse therapy (SPT) and hyperbaric oxygen therapy (HBOT) may be effective for treating severe CO poisoning. The combined therapy not only improved acute neurological recovery but also appeared to prevent the development of delayed neurological sequelae (DNS).
KEY FINDINGS: This case suggests that the combination of steroid pulse therapy (SPT) and hyperbaric oxygen therapy (HBOT) may be effective for treating severe CO poisoning. The combined therapy not only improved acute neurological recovery but also appeared to prevent the development of delayed neurological sequelae (DNS). This is a single case report, and further research is needed to validate these findings.
BACKGROUND: Carbon monoxide (CO) poisoning is a significant concern in emergency medicine, often leading to delayed neurological sequelae (DNS) such as memory impairment, disorientation, apraxia, agnosia, gait disturbances, and Parkinson-like symptoms. While hyperbaric oxygen therapy (HBOT) is a recognized treatment for preventing DNS, there is no established treatment for the acute neurological symptoms of severe CO poisoning. This case report explores a combined therapeutic approach.
DETAILS: This is a case report about a 50-year-old man who was admitted to the hospital with severe CO poisoning, presenting with a Glasgow Coma Scale score of 3. His carboxyhemoglobin level was 51.2%. The patient was treated in the intensive care unit with a combination of hyperbaric oxygen therapy (HBOT) and steroid pulse therapy (SPT). The patient's level of consciousness improved significantly within three days of starting the combined therapy. He was discharged from the hospital after 14 days and had no complications, including DNS, during a follow-up period of 49 days.
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Copyright © BioMed Central Ltd unless otherwise stated. All rights reserved.
Source: Kano, S., Miyake, T., Asano, H.,s et al. (2025). Experience of Carbon Monoxide Poisoning Treated With Hyperbaric Oxygen Therapy and Steroid Pulse Therapy: A Case Report. International Journal of Emergency Medicine. 2025; Published: August 18, 2025. DOI: 10.1186/s12245-025-00966-5.
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