Incidence and implications of acute kidney injury in patients hospitalized with acute decompensated heart failure.

Acute kidney injury (AKI) is a common complication in patients hospitalized with heart failure (HF). There is a paucity of research on the incidence and consequences of AKI among patients hospitalized with HF who do not have evidence of chronic kidney disease (CKD). The National Inpatient Sample database was used to identify index hospitalizations for acute HF from January 2012 through September 2015. The incidence of new-onset AKI was determined, and the study population was divided into two groups: HF with AKI (HFwAKI) and HF without AKI (HFwoAKI). These groups were further divided into the subgroups HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A total of 2,010,095 index hospitalizations for HF were identified. The incidence of new-onset AKI was found to be ~ 20% for this population. In a fully adjusted model, in-hospital mortality was higher in the HFwAKI group (adjusted OR 3.63, P ≤ 0.001) and higher among patients with HFrEF (adjusted OR 3.85), as opposed to patients with HFpEF (adjusted OR 3.21). Similarly, length of stay and cost of care for the HFwAKI group were significantly higher as well. New-onset AKI among hospitalizations for HF poses a significant health problem, especially considering the increasing prevalence of HF. Further research into the causes of AKI among HF hospitalizations is, therefore, important as it will enable the development of treatment strategies to prevent AKI in HF hospitalizations and, consequently, benefit both the patients and health care system of the United States.

'Acute leukemia in congenital methehemoglobinemia - an enigma to explore'.

Congenital methemoglobinemia is a rare disease, resulting in increased oxygen affinity and impaired oxygen delivery to the tissues. While there have been studies that have linked acquired methemoglobinemia in almost 79% of leukemia patients, to the best of our knowledge, this is the first case of leukemia development in a patient with congenital methemoglobinemia. Chronic deprivation of oxygen to metabolically active bone marrow can theoretically lead to hematopoietic disorders. It would be interesting to further investigate if presence of congenital methemoglobinemia is a risk factor for developing acute leukemia.

Comparison of Baseline Characteristics and In-hospital Outcomes in Medicaid Versus Private Insurance Hospitalizations for Atrial Fibrillation.

The prevalence of atrial fibrillation (Afib) has been increasing over the past few decades. There are very few comparisons of health insurance plans available that incorporate measurement of co-morbidities and in-hospital outcomes. We sought to compare an impact of Medicaid versus private insurance (PI) on outcomes in hospitalizations with Afib. The US National Inpatient Sample database from years January 2010 to September 2015 was used to identify adult (≥18 years) Afib hospitalizations, whose payment source was either Medicaid or PI. We included propensity score-matched analysis for comparison of outcomes between the groups. In a total of 3,264,258 Afib hospitalizations, 22.9% hospitalizations were insured with Medicaid, while 77.1% had PI. Compared with PI, Medicaid beneficiaries (MB) were younger (59 vs 64 years), fewer were men (55.15% vs 63.16%), and fewer were Caucasians (52.66% vs 81.67%; all p<0.0001). As suggested by Charlson co-morbidity index ≥3, more MB (40.86%) had the significantly higher burden of co-morbidities compared with PI (29.87%; p<0.0001). About 83% of Afib hospitalizations had a CHA2DVASC2 score ≥2 in both the groups. After adjusting for confounders, in-hospital mortality was significantly higher (4.8% vs 4.3%, p = 0.02) in MB compared with PI. In MB, 55.3% hospitalizations were discharged to home and their median length of hospital stay was 5 days, whereas 61.3% hospitalizations with PI were discharged to home and their median length of stay was 4 days (p<0.0001). In conclusion, this extensive study of Afib hospitalizations, Medicaid group had greater co-morbidities, marginally higher in-hospital mortality, longer length of stay, and lesser disposition to home as compared with PI group.

Recurrent Unilateral Transudative Pleural Effusion Due to Low Flow, Low Gradient Severe Aortic Stenosis.

BACKGROUND In symptomatic severe aortic stenosis (AS), the majority of patients have high gradient AS. However, some patients have an AS gradient less than 40 with a valve area under 1.0 cm². For patients with a low gradient, severe AS is difficult to detect and requires a high index of suspicion. Transcatheter aortic valve replacement (TAVR) is currently recommended for patients with moderate to high risk AS according to the Society of Thoracic Surgery (STS) risk score. CASE REPORT Here we present the case of an 86-year-old female with recurrent pleural effusion over the course of 2-year; she had multiple thoracentesis procedures and was being considered for a pleurodesis. Later the patient was found to have severe AS; an echocardiogram showed an aortic valve (AV) area of 0.67 cm², AV mean gradient of 34 mmHg, and ejection fraction of 75%. The patient underwent a diagnostic cardiac catheterization and was treated with TAVR. CONCLUSIONS The diagnosis was made after exclusion of all other causes of unilateral pleural effusion and was confirmed by improvement of effusion following the TAVR procedure.