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Practicalities of Obesity Management for the Cardiologist: A "Quick Start" Companion to the CKM Guidelines.

Pagidipati Neha J NJ

Shelter dogs and cats as a one health interface for phenotypic and genomic surveillance of antimicrobial-resistant Enterococcus Spp. in the United Arab Emirates.

Habib Ihab I, Mohteshamuddin Khaja K, Mohamed Mohamed-Yousif Ibrahim MI, Bhagya Lakshmi Glindya G et al.

Companion animal shelters represent underexplored settings for One Health antimicrobial resistance (AMR) surveillance. This study investigated the recovery, antimicrobial resistance, and genomic features of Enterococcus spp. from shelter dogs and cats in the United Arab Emirates (UAE). Rectal swabs were collected from 230 shelter animals, including 129 dogs and 101 cats, across five shelters in four UAE emirates/cities. Enterococcus isolates were recovered using selective culture and identified by MALDI-TOF MS. Confirmed Enterococcus faecalis and Enterococcus faecium isolates underwent antimicrobial susceptibility testing using Vitek-2. Multidrug-resistant (MDR) and linezolid-resistant isolates were subjected to whole-genome sequencing (WGS) for multilocus sequence typing, resistome analysis, single-nucleotide polymorphism-based phylogeny, phenotype-genotype concordance assessment, and virulence-associated gene profiling. Enterococcus spp. were recovered from 122/230 animals (53.0%; 95% confidence interval: 46.6-59.4), with higher recovery in dogs (71.3% (92/129)) than cats (29.7% (30/101)). Overall, E. faecalis accounted for 63/122 isolates (51.6%) and E. faecium for 59/122 isolates (48.4%). Phenotypic resistance was most frequent for tetracycline (51.6%), erythromycin (30.3%), ciprofloxacin (27.2%), high-level streptomycin (20.5%), and high-level gentamicin (9.8%). All isolates were susceptible to ampicillin, vancomycin, teicoplanin, and tigecycline. MDR was detected in 25/122 isolates (20.5%) and was more frequent among E. faecalis than E. faecium. Linezolid resistance was detected in two isolates recovered from two dogs, one male and one female, housed in the same shelter. WGS of 25 MDR or linezolid-resistant isolates revealed diverse sequence types, including dominant E. faecalis ST16, shelter-associated SNP clusters, and multiple resistance determinants, including erm(B), tet(L), tet(M), aminoglycoside resistance genes, quinolone resistance-associated mutations, and plasmid-predicted optrA in three E. faecalis isolates. Virulence-associated genes were more prominent in E. faecalis, particularly the endocarditis- and biofilm-associated pilus genes involved in adhesion and biofilm formation, together with a putative exoenzyme-associated factor potentially contributing to host interaction and bacterial fitness. Shelter dogs and cats in the UAE carried E. faecalis and E. faecium with phenotypic AMR, MDR profiles, and diverse genomic resistance determinants. The detection of linezolid resistance and plasmid-predicted optrA supports inclusion of shelter companion animals in regional One Health AMR surveillance.

Optimizing tissue acquisition to improve the diagnostic yield of endoscopic ultrasound-guided fine needle biopsy of solid masses: a quality improvement initiative.

Khan Samina S, Ashrafinia Narges N, Mathura Pamela P, Puttagunta Lakshmi L et al.

A chart audit (pre-intervention, PRE) of endoscopic ultrasound (EUS)-fine needle biopsy (FNB) of solid masses identified a diagnostic yield of 75%. To improve diagnostic yield, a quality improvement intervention targeting tissue procurement and processing was developed and trialed (post-intervention, POST). Increase needle passes to ≥3/mass, limit the personnel preparing cytology slides, and replace saline with formalin for cell block preparation. A POST chart audit was undertaken for solid mass EUS-FNB from January 2024-December 2024, with quarterly reviews. Only a definite diagnosis was used to calculate diagnostic yield. 241 patients underwent 262 EUS-FNBs. Diagnostic yield was 81% in POST vs. 75% in PRE (p = ns). Single passes decreased to 14% in POST vs. 20% in PRE (p = ns), with similar diagnostic yield (57% vs. 56%, respectively). Number of ≥3 passes increased significantly (47% POST vs. 12% PRE, P < .0001). In POST, 86% of single passes were performed in the first half vs. 14% in the second (P = .012). Only 25% of ≥3 passes were performed in the first half vs. 75% in the second (P = .06). Diagnostic yield improved significantly between the first and second halves (72% vs. 90%, P < .0001). Replacing saline with formalin for cell block improved diagnostic yield (57% vs. 75%, P = .062). Limiting the personnel making slides from 25 nurses (PRE) to 3 endoscopists (POST) had no impact on diagnostic yield. Critical practice assessment, regular audit, and continued reinforcement led to a significant improvement in EUS-FNB diagnostic yield to 90% by increasing the number of needle passes to ≥3/mass.

Clinical value of intraoperative frozen section in the surgical management of ovarian tumors: diagnostic accuracy and correlation with final histopathology.

Mlodziankowska Natalia N, Kampioni Malgorzata M MM, Tomczyk Katarzyna K, Kedzia Witold W WW et al.

Intraoperative frozen section (FS) analysis is widely used during surgery for ovarian tumors to guide the extent of the operative procedure. It plays a particularly significant role in young women, in whom fertility-sparing surgery is considered. Despite its high clinical utility, FS has technical limitations that may result in discrepancies compared with final histopathological diagnosis. To assess the concordance between intraoperative frozen section diagnosis and final histopathological examination of ovarian tumors, and to evaluate the diagnostic accuracy, sensitivity, specificity, and predictive values of FS. The analysis included finally 100 women aged 11-78 years from among 114 who were hospitalized and underwent surgery for ovarian tumors conducted at a tertiary Gynecology and Obstetrics Clinical Hospital from January to June 2025. Frozen section diagnoses were compared with final histopathological results. Concordance rates, patterns of diagnostic discrepancies, and diagnostic performance parameters (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were calculated using final histopathology as the reference standard. Overall concordance between frozen section and final histopathology was 85%. Diagnostic discrepancies were observed in 15% of cases, with only 2% considered clinically significant. Frozen section showed excellent diagnostic performance for benign tumors (sensitivity 100%, specificity 94.1%) and malignant tumors (specificity and PPV 100%). The lowest diagnostic accuracy was observed for borderline tumors, which accounted for most clinically relevant discrepancies. The most frequent source of discordance involved hemorrhagic cysts, which were ultimately diagnosed as endometriotic cysts on final histopathology. Intraoperative frozen section analysis is a reliable and safe diagnostic tool that effectively supports surgical decision-making in ovarian tumors. Its high diagnostic accuracy and predictive values confirm its clinical value, particularly in tailoring the extent of surgery. Special caution is warranted in the interpretation of borderline tumors, for which final histopathological examination remains essential.