The association between completion of supervised exercise therapy and long-term outcomes in patients with intermittent claudication, concomitant sarcopenia and cardiometabolic multimorbidity.

INTRODUCTION: The combination of intermittent claudication (IC), cardiometabolic multimorbidity (CMM) and sarcopenia is associated with worse outcomes than IC alone. This study aimed to identify whether the completion of Supervised exercise therapy(SET) attenuates these adverse outcomes in patients with combined IC, sarcopenia and CMM. METHODS: This registry review included consecutive IC patients with concomitant CMM and sarcopenia, who were referred for SET from 2014 to 2017. CMM was defined as two or more comorbidities (diabetes, heart disease, stroke, or chronic kidney disease). Sarcopenia was assessed using the L3-skeletal muscle index (L3SMI) from CT scans in the preceding 18 months. Outcomes of interest were progression to chronic limb-threatening ischemia (CLTI), major adverse cardiovascular events (MACE), and major adverse limb events (MALE). Survival and Cox regression analyses were performed. RESULTS: Eighty-two patients with a combination of IC, CMM and sarcopenia were included. Of these, 56 declined or prematurely discontinued SET and 26 completed SET. Baseline characteristics and L3SMI did not significantly differ between groups. Completion of SET was associated with slower progression to CLTI (HR: 0.23; 95% CI: 0.07-0.69; p = 0.02) and a reduced risk of MALE (HR: 0.21; 95%CI: 0.057-0.775;p=0.02). However, there was no reduction in the risk of MACE (HR: 0.88; 95%CI: 0.423-1.629; p=0.73). Models demonstrated good predictive accuracy (Harrell's C-index>0.6). CONCLUSION: Completion of SET was associated with significant improvements in adverse limb outcomes in patients with IC, concomitant sarcopenia and CMM.

Pediatric Cardiac Emergencies: When to Worry and When to Reassure.

Cardiac symptoms are a frequent reason for pediatric patients to present to the emergency department. As stressful as these visits can be for both parents and inexperienced providers, many of these symptoms may have a benign explanation, and recognition of red flags are of the utmost importance to provide optimal care. In this article, we present four clinical scenarios that have a cardiac etiology and are common to the pediatric emergency department. In addition to highlighting differential diagnoses, we discuss important red flags, key signs, and findings on physical examination that should not be missed. A brief review of important workup and management is also discussed. Lastly, we review common electrocardiogram pearls and pitfalls important for the ordering provider to recognize. In this article, we hope to provide guidance on when to provide reassurance and when to refer to a pediatric cardiologist for evaluation. [Pediatr Ann. 2023;52(4):e128-e134.].

Gallstone extraction from a back abscess resulting from spilled gallstones during laparoscopic cholecystectomy: a case report.

Laparoscopic cholecystectomy is a routinely performed surgery nowadays. However, it is associated with certain complications. Gall bladder perforation during the procedure can result in spilled and lost gallstones. Lost gallstones most commonly cause intra-abdominal infection. However, very rarely, they can be associated with troublesome retroperitoneal abscess formation. We present a case where a lost gallstone caused a retroperitoneal abscess formation and was retrieved from a back abscess in the right paraspinal region.