The use of transcatheter aortic valve implantation (TAVI) in patients with aortic valve disease excluded from clinical trials has increased with no large-scale data on its safety. The purpose of this study was to assess the trend of utilization and adjusted outcomes of TAVI in clinical trials excluded (CTE) vs clinical trials included TAVI (CTI-TAVI) patients. We used the National Readmission Database (2015-2019) to identify 15 CTE-TAVI conditions. A propensity score-matched analysis was used to calculate the adjusted odds ratio (aOR) of net adverse clinical events (composite of mortality, stroke, and major bleeding) in patients undergoing CTE-TAVI vs CTI-TAVI. Among the 223,238 patients undergoing TAVI, CTE-TAVI was used in 41,408 patients (18.5%). The yearly trend showed a steep increase in CTE-TAVI utilization (P = 0.026). At index admission, the adjusted odds of net adverse clinical events (aOR: 1.83, 95% CI: 1.73-1.95) and its components, including mortality (aOR: 2.94, 95% CI: 2.66-3.24), stroke (aOR: 1.20, 95% CI: 1.07-1.34), and major bleeding (aOR: 1.49, 95% CI: 1.36-1.63) were significantly higher in CTE-TAVI compared with CTI-TAVI. Among the individual contraindications to clinical trial enrollment in the CTE-TAVI, patients with bicuspid aortic valve, leukopenia, and peptic ulcer disease appeared to have similar outcomes compared with CTI-TAVI, while patients with end-stage renal disease, bioprosthetic aortic valves, and coagulopathy had a higher readmission rate at 30 and 180 days. CTE-TAVI utilization has increased significantly over the 4-year study period. Patients undergoing CTE-TAVI have a higher likelihood of mortality, stroke, and bleeding than those undergoing CTI-TAVI.
Introduction: Reports have shown socioeconomic healthcare disparities among patients with cardiovascular diseases. We studied the trends in AMI hospitalization burden and outcomes over a decade with a focus on disparities in outcomes. This would provide epidemiologic data to assess the impact of current guidelines and recommendations on the general population. Methods: This was a trend study of the National Inpatient database from 2010 to 2019. We searched for AMI as the reason for hospitalization using the ICD codes. We estimated trends, inpatient mortality, mean length of hospital stay (LOS) and mean total hospital charges (THC) over the period. We performed a stratified analysis in categories: sex (male and female), race (Caucasians, Blacks, Hispanics), and median household income for patient's zip code (low-income quartile [LIQ] vs high-income quartile [HIQ]) to assess disparities in outcomes. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes. Results: There were about 6,158,738 hospitalizations for AMI over the study period with females making up 38.2%. Yearly hospitalizations increased from 1,851 - 1,983 per 100,000 adult hospitalizations from 2010 to 2019 (p<0.001). There was a significant increase in hospitalizations among men from 60.4% in 2010 to 63.4% in 2019 (p<0.001). The proportion of AMI increased by 37% in Hispanics, 15% in Blacks, and 8% in Caucasians. The LIQ patients had a 6.2% increase while the HIQ had a 7.0% decrease in AMI hospitalizations. The mortality rate over the decade was 4.9%. Females had a mortality rate of 5.6% compared to 4.5% in Males. The LIQ average mortality was 5.0% compared to 4.9 in the HIQ. There was a significant decrease in the overall mortality from 5.3% in 2010 to 4.5% in 2019 (p<0.001). The mortality in females decreased by 20.3% (p<0.001) compared to 11.5% in males (p<0.001). Adjusted for inflation, there was a 41.8% increase in the THC over the study period. Conclusion: Hospitalization incidence for AMI appears to be rising among males, Hispanics, and LIQ patients. Information from this study brings awareness to ongoing disparities in AMI hospitalizations. We recommend multidisciplinary and sustained efforts to eliminate socioeconomic disparities in healthcare
Pentalogy of Cantrell (POC) is a collection of five congenital midline birth anomalies that present a distinctive challenge for providers and surgeons. Those five defects are of the heart, pericardium, diaphragm, sternum, and abdominal wall. This condition has been divided into two categories, complete or partial. Complete, as the name indicates, refers to the presence of all five defects, while others may present with only partial defects. It is also referred to as thoracoabdominal ectopia cordis, a condition where the heart is covered by an omphalocele-like membrane. Ectopia cordis (EC) is often found in fetuses with POC. Infants usually have multiple cardiac malformations with ventricular septal defect, and tetralogy of Fallot being the most common. POC may also carry genetic associations with trisomy 13, 18, 21, and Turner syndrome. The initial management addresses the lack of skin overlying the heart and abdominal cavity.Following initial management, additional surgery involve covering the midline defects, separating the abdominal and pericardial compartment, and repairing the diaphragm. Advanced reconstructive techniques are utilized for additional closure, including the use of flaps, skin closure only, and bioprosthetic agents. The intracardiac defects are often repaired at a later date. Survival depends on the associated cardiac anomalies and degree of thoracoabdominal defect.
After an acid attack, also known as vitriolage, many patients suffer from changes in life perspective, behavior, feelings, social withdrawal, social isolation, and depression. Formal and informal social support is vital for the proper and complete rehabilitation of acid burn victims. The government should form separate public help centers for such patients. The need of the hour, however, is the invention of proper legislation for the prevention of this heinous crime.
The rapid international spread of severe acute respiratory syndrome coronavirus 2 responsible for coronavirus disease 2019 (COVID-19) has posed a global health emergency in 2020. It has affected over 52 million people and led to over 1.29 million deaths worldwide, as of November 13th, 2020. Patients diagnosed with COVID-19 present with symptoms ranging from none to severe and include fever, shortness of breath, dry cough, anosmia, and gastrointestinal abnormalities. Severe complications are largely due to overdrive of the host immune system leading to "cytokine storm". This results in disseminated intravascular coagulation, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and death. Due to its highly infectious nature and concerning mortality rate, every effort has been focused on prevention and creating new medications or repurposing old treatment options to ameliorate the suffering of COVID-19 patients including the immune dysregulation. Omega-3 fatty acids are known to be incorporated throughout the body into the bi-phospholipid layer of the cell membrane leading to the production of less pro-inflammatory mediators compared to other fatty acids that are more prevalent in the Western diet. In this article, the benefits of omega-3 fatty acids, especially eicosapentaenoic acid and docosahexaenoic acid, including their anti-inflammatory, immunomodulating, and possible antiviral effects have been discussed.
BackgroundUltrafiltration (UF) is frequently used in patients with decompensated heart failure with reduced ejection fraction (HFrEF) refractory to diuretics. However, data on its relative merits are limited.MethodsOnline databases were queried to identify clinical trials on the comparison of UF and diuretics. The major adverse cardiovascular (MACE) and its components (mortality and re-hospitalizations) were compared using the random-effects model to calculate unadjusted odds ratio (OR).ResultsA total of 10 clinical trials comprising 760 (374 UF, 386 diuretics) patients were included in the analysis. At a median follow-up of 30 days, there was no significant difference in the odds of MACE (OR 0.87, 95% CI 0.56-1.34) and all-cause mortality (OR 1.10, 95% CI 0.74-1.65) between patients undergoing UF compared with those receiving diuretics therapy. The need for emergency department visits (OR 1.05, 95% CI 0.38-2.90), all-cause admissions (OR 0.97, 95% CI 0.72-1.30) and heart failure-related re-hospitalization (OR 0.47, 95% CI 0.21-1.02) was also similar between the two groups. The in-hospital risk for hypotension (OR 0.49, 0.23-1.04) and post-therapy creatinine rise>0.3mg/dL (OR 1.18, 95% CI 0.74-1.89) was also non-significantly different between the UF and diuretics arms. A sensitivity analysis based on follow-up duration did not show any deviation from the pooled outcomes.ConclusionsDisclosuresM. K. Sana Nothing to disclose. W. Ullah Nothing to disclose. H. U. Mustafa Nothing to disclose. T. Mir Nothing to disclose. D. L. Fischman Nothing to disclose. BackgroundUltrafiltration (UF) is frequently used in patients with decompensated heart failure with reduced ejection fraction (HFrEF) refractory to diuretics. However, data on its relative merits are limited. Ultrafiltration (UF) is frequently used in patients with decompensated heart failure with reduced ejection fraction (HFrEF) refractory to diuretics. However, data on its relative merits are limited. MethodsOnline databases were queried to identify clinical trials on the comparison of UF and diuretics. The major adverse cardiovascular (MACE) and its components (mortality and re-hospitalizations) were compared using the random-effects model to calculate unadjusted odds ratio (OR). Online databases were queried to identify clinical trials on the comparison of UF and diuretics. The major adverse cardiovascular (MACE) and its components (mortality and re-hospitalizations) were compared using the random-effects model to calculate unadjusted odds ratio (OR). ResultsA total of 10 clinical trials comprising 760 (374 UF, 386 diuretics) patients were included in the analysis. At a median follow-up of 30 days, there was no significant difference in the odds of MACE (OR 0.87, 95% CI 0.56-1.34) and all-cause mortality (OR 1.10, 95% CI 0.74-1.65) between patients undergoing UF compared with those receiving diuretics therapy. The need for emergency department visits (OR 1.05, 95% CI 0.38-2.90), all-cause admissions (OR 0.97, 95% CI 0.72-1.30) and heart failure-related re-hospitalization (OR 0.47, 95% CI 0.21-1.02) was also similar between the two groups. The in-hospital risk for hypotension (OR 0.49, 0.23-1.04) and post-therapy creatinine rise>0.3mg/dL (OR 1.18, 95% CI 0.74-1.89) was also non-significantly different between the UF and diuretics arms. A sensitivity analysis based on follow-up duration did not show any deviation from the pooled outcomes. A total of 10 clinical trials comprising 760 (374 UF, 386 diuretics) patients were included in the analysis. At a median follow-up of 30 days, there was no significant difference in the odds of MACE (OR 0.87, 95% CI 0.56-1.34) and all-cause mortality (OR 1.10, 95% CI 0.74-1.65) between patients undergoing UF compared with those receiving diuretics therapy. The need for emergency department visits (OR 1.05, 95% CI 0.38-2.90), all-cause admissions (OR 0.97, 95% CI 0.72-1.30) and heart failure-related re-hospitalization (OR 0.47, 95% CI 0.21-1.02) was also similar between the two groups. The in-hospital risk for hypotension (OR 0.49, 0.23-1.04) and post-therapy creatinine rise>0.3mg/dL (OR 1.18, 95% CI 0.74-1.89) was also non-significantly different between the UF and diuretics arms. A sensitivity analysis based on follow-up duration did not show any deviation from the pooled outcomes. Conclusions DisclosuresM. K. Sana Nothing to disclose. W. Ullah Nothing to disclose. H. U. Mustafa Nothing to disclose. T. Mir Nothing to disclose. D. L. Fischman Nothing to disclose. M. K. Sana Nothing to disclose. W. Ullah Nothing to disclose. H. U. Mustafa Nothing to disclose. T. Mir Nothing to disclose. D. L. Fischman Nothing to disclose.
Pancreatic cancer is one of the most aggressive malignancies of the digestive tract and carries a poor prognosis. The majority of patients have advanced disease at the time of diagnosis. Surgical resection offers the only curative treatment, but only a small proportion of patients can undergo surgical resection. Radiofrequency ablation (RFA) is a well-known modality in the management of solid organ tumors, however, its utility in the management of pancreatic cancer is under investigation. Since the past decade, there is increasing use of RFA as it provides a feasible palliation treatment in the management of unresectable pancreatic cancer. RFA causes tumor cytoreduction through multiple mechanisms such as coagulative necrosis, protein denaturation, and activation of anticancer immunity. The safety profile of RFA is controversial because of the high risk for complications, however, small prospective and retrospective studies have shown promising results in its applicability for palliative management of unresectable pancreatic malignancies. In this review, we discuss different approaches of RFA, their indications, technical accessibility, safety, and major complications in the management of unresectable pancreatic cancer.
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