Canaloplasty and Trabeculotomy Combined With Phacoemulsification for Primary Angle-Closure Glaucoma: A Single-Surgeon Case Series.

PURPOSE: To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG). METHODS: In this retrospective, consecutive, single-surgeon case series, we analyzed the pre- and postoperative measurements of PACG patients who had the procedure. Adverse events were recorded. The main outcomes were mean intraocular pressure (IOP) in each quartile of the follow-up year and the number of IOP-lowering medications the patients were on by the end of each quartile compared to their baseline values. RESULTS:  A total of 46 eyes from 39 PACG patients were included. The preoperative IOP and glaucoma medications taken were 19.33±6.03 mm Hg and 1.80±1.39, respectively (N=46). Postoperative IOP means (mm Hg) in the subsequent four quartiles were 14.00±3.33 (N=44), 13.44±2.83 (N=32), 14.38±2.39 (N=16), and 14.92±2.90 (N=13) (p<0.0001). The mean number of meds was 0.32±0.80, 0.22±0.42, 0.59±0.80, and 0.08±0.28 in each respective quartile (p<0.0001), while the median was 0 across all quartiles. CONCLUSIONS: Combining the OMNI surgical system with phacoemulsification led to substantial reductions in mean IOP and the number of IOP-lowering medications when compared to baseline measurements.

Cardiac Rehabilitation Increases Plasma Klotho Levels.

Background: Mineral metabolism (MM), mainly fibroblast growth factor-23 (FGF-23) and klotho, has been linked to cardiovascular (CV) diseases. Cardiac rehabilitation (CR) has been demonstrated to reduce CV events, although its potential relationship with changes in MM is unknown. Methods: We performed a prospective, observational, case-control study, with acute coronary syndrome (ACS) patients who underwent CR and control patients (matched by age, gender, left ventricular ejection fraction, diabetes, and coronary artery bypass grafting), who did not. The inclusion dates were from August 2013 to November 2017 in CR group and from July 2006 to June 2014 in control group. Clinical, biochemical, and MM biomarkers were collected at discharge and six months later. Our objective was to evaluate differences in the modification pattern of MM in both groups. Results: We included 58 CR patients and 116 controls. The control group showed a higher prevalence of hypertension (50.9% vs. 34.5%), ST-elevated myocardial infarction (59.5% vs. 29.3%), and treatment with angiotensin-converting enzyme inhibitors (100% vs. 69%). P2Y12 inhibitors and beta-blockers were more frequently prescribed in the CR group (83.6% vs. 96.6% and 82.8% vs. 94.8%, respectively). After six months, klotho levels increased in CR patients whereas they were reduced in controls (+63 vs. -49 pg/mL; p < 0.001). FGF-23 was unchanged in the CR group and reduced in controls (+0.2 vs. -17.3 RU/dL; p < 0.003). After multivariate analysis, only the change in klotho levels was significantly different between groups (+124 pg/mL favoring CR group; IC 95% [+44 to +205]; p = 0.003). Conclusions: In our study, CR after ACS increases plasma klotho levels without significant changes in other components of MM. Further studies are needed to clarify whether this effect has a causal role in the clinical benefit of CR.

Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery.

Introduction: The presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG). Materials and methods: This is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery. Results: One-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27-2.69], age (HR = 1.35, 95% CI 1.09-1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80-0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001). Conclusions: Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.

Gender Differences in Hospital Outcomes among COVID-19 Hospitalizations.

OBJECTIVES: Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database. METHODS: We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission. RESULTS: There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38-1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31-1.39), vasopressor use (OR 1.59, 95% CI 1.51-1.66), mechanical ventilation (OR 1.62, 95% CI 1.47-1.78), and ICU admission rates (OR 1.58, 95% CI 1.51-1.66) were significantly higher among male hospitalizations. CONCLUSION: Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity.

Racial difference in mortality among COVID-19 hospitalizations in California.

In the US, racial disparities in hospital outcomes are well documented. We explored whether race was associated with all-cause in-hospital mortality and intensive care unit (ICU) admission among COVID-19 patients in California. This was a retrospective analysis of California State Inpatient Database during 2020. Hospitalizations ≥ 18 years of age for COVID-19 were included. Cox proportional hazards with mixed effects were used for associations between race and in-hospital mortality. Logistic regression was used for the association between race and ICU admission. Among 87,934 COVID-19 hospitalizations, majority were Hispanics (56.5%), followed by White (27.3%), Asian, Pacific Islander, Native American (9.9%), and Black (6.3%). Cox regression showed higher mortality risk among Hispanics, compared to Whites (hazard ratio, 0.91; 95% CI 0.87-0.96), Blacks (hazard ratio, 0.87; 95% CI 0.79-0.94), and Asian, Pacific Islander, Native American (hazard ratio, 0.89; 95% CI 0.83-0.95). Logistic regression showed that the odds of ICU admission were significantly higher among Hispanics, compared to Whites (OR, 1.70; 95% CI 1.67-1.74), Blacks (OR, 1.70; 95% CI 1.64-1.78), and Asian, Pacific Islander, Native American (OR, 1.82; 95% CI 1.76-1.89). We found significant disparities in mortality among COVID-19 hospitalizations in California. Hispanics were the worst affected with the highest mortality and ICU admission rates.

Adverse Outcomes in Hospitalizations for Amyloid-Related Heart Failure.

Transthyretin amyloid cardiomyopathy is being increasingly recognized as an important cause of heart failure (HF). In this study, we looked at adverse outcomes in hospitalizations with amyloid-related HF. This study was a retrospective analysis of the National Inpatient Sample data, collected from 2016 to 2019. Patients ≥41 years of age and admitted for HF were included in the study. In these hospitalizations, amyloid-related HF was identified through the International Classification of Diseases, Tenth Revision, Clinical Modification codes for amyloidosis. The primary outcome of the study was in-hospital mortality, whereas secondary outcomes were prolonged length of stay, mechanical ventilation, mechanical circulatory support, vasopressors use, and dispositions other than home. From 2016 to 2019, there were 4,705,274 HF hospitalizations, of which 16,955 (0.4%) had amyloid cardiomyopathy. In all HF hospitalizations, amyloid-related increased from 0.26% in 2016 to 0.46% in 2019 (relative increase, 76.9%, P for trend <0.001). Amyloid-related HF hospitalizations were more common in older, male, and Black patients. The odds of in-hospital mortality (odds ratio [OR], 1.29; 95% confidence interval [CI]: 1.11 to 1.38), prolonged hospital length (OR, 1.61; 95% CI: 1.49 to 1.73) and vasopressors use (OR, 1.59; 95% CI: 1.23 to 2.05) were significantly higher for amyloid-related hospitalizations. Amyloid-related HF hospitalizations are increasing substantially and are associated with adverse hospital outcomes. These hospitalizations were disproportionately higher for older, male, and Black patients. Amyloid-related HF is rare and underdiagnosed yet has several adverse outcomes. Hence, healthcare providers should be watchful of this condition for early identification and prompt management.

Reconstrucción mamaria con TRAM bipediculado. Variantes utilizadas y resultados obtenidos / Breast reconstruction with bipedicled TRAM. Variants used and results obtained

La reconstrucción mamaria utilizando el colgajo TRAM (transverse rectus abdominis muscle) bipediculado es un procedimiento poco frecuente aunque en ciertas ocasiones es de gran utilidad. Las indicaciones principales están descriptas para los casos que se requieren volúmenes de tejidos de mayor cantidad que la reconstrucción mamaria convencional, antecedentes de irradiación de grandes zonas de la pared del tórax y, en ciertas ocasiones, en reconstrucciones mamarias autólogas bilaterales. La presente publicación revisa el uso de 12 colgajos TRAM bipediculados en nuestra institución, las variantes que hemos usado y los resultados obtenidos. También se detallan elementos anatómicos de interés técnico con el objeto de reducir las complicaciones.

Breast reconstruction using the bipedicle TRAM (transverse rectus abdominis muscle) flap is a rare procedure, although it is sometimes very useful. The main indications are described for cases that require larger tissue volumes than conventional breast reconstruction, a history of irradiation of large areas of the chest wall, and on certain occasions, in bilateral autologous breast reconstructions. This publication reviews the use of 12 bipedicle TRAM flaps in our institution, the variants that we have used, and the results obtained. Anatomical elements of technical interest are also detailed to reduce complications.

The impact of the Coronavirus disease 2019 on hospitalizations for coronary artery revascularization: results from California State Inpatient Database.

BACKGROUND: Coronavirus disease 2019 (COVID-19) outbreak has negatively impacted routine cardiovascular care. In this study, we assessed the impact of COVID-19 pandemic on percutaneous coronary artery intervention (PCI) and coronary artery bypass grafting (CABG) hospitalizations and outcomes using a large database. METHODS: The current study was a retrospective analysis of California State Inpatient Database (SID) during March-December of 2019 and 2020. All adult hospitalizations for coronary artery revascularization were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. The primary outcome was inhospital mortality, and secondary outcomes were hospital length of stay, stroke, acute kidney injury, and mechanical ventilation. Propensity score match analysis was done to compare adverse clinical outcomes. RESULTS: PCI hospitalizations (relative decrease, 15.0%, P for trend <0.001) and CABG hospitalizations (relative decrease, 16.4%, P for trend <0.001) decreased from 2019 to 2020, while viral pneumonia hospitalizations increased (relative increase, 1751.6%, P for trend <0.001). Monthly PCI and CABG hospitalization showed decreasing trends from January 2019 to December 2020. Propensity score match analysis showed that the odds of inhospital mortality (OR, 1.12; 95% CI, 1.01-1.24), acute kidney injury (OR, 1.12; 95% CI, 1.06-1.17), and ARDS (OR, 1.89; 95% CI, 1.18-3.01) were higher among patients who received PCI in 2020. CONCLUSION: Results of our study indicate that initiatives such as encouraging patients to receive treatments and controlling the spread of COVID-19 should be instituted to improve PCI and CABG hospitalizations.

Association Between Frailty, 30-day Unplanned Readmission and Mortality After Hospitalization for Heart Failure: Results From the Nationwide Readmissions Database.

Objectives: This study examined how frailty in traditional risk-adjusted models could improve the predictability of unplanned 30-day readmission and mortality among heart failure patients. Methods: This study was a retrospective analysis of Nationwide Readmissions Database data collected during the years 2010-2018. All patients ≥65 years who had a principal diagnosis of heart failure were included in the analysis. The Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator was used to identify frail patients. Results: There was a total of 819,854 patients admitted for heart failure during the study period. Among them, 63,302 (7.7%) were frail. In the regression analysis, the risk of all-cause 30-day readmission (OR, 1.18; 95% CI, 1.14-1.22) and in-hospital mortality (OR, 1.52; 95% CI, 1.40-1.66) were higher in patients with frailty. Discussion: Inclusion of frailty in comorbidity-based risk-prediction models significantly improved the predictability of unplanned 30-day readmission and in-hospital mortality.

Revascularización miocárdica completa con injertos arteriales en un paciente con dextrocardia / Complete coronary artery bypass grafting in a patient with dextrocardia

Introducción: la dextrocardia es una rara anomalía cardiaca congénita. Aunque la incidencia de enfermedad coronaria es similar a la población en general, son pocos los casos documentados en la literatura. La disposición anatómica en esta anomalía constituye un desafío a la hora de planificar la técnica quirúrgica y los injertos a utilizar. Presentación del caso: paciente de 59 años con enfermedad coronaria de 2 vasos que fue sometido a una cirugía de revascularización arterial completa.

Introduction: dextrocardia is a rare congenital heart abnormality. Although the incidence of coronary heart disease is similar to that in the general population, few cases have been documented in the literature. Anatomic variants in this anomaly are a challenge when planning the surgical technique and the choice of graft configuration to be used. Case presentation: a 59 -year- old patient with 2-vessel coronary artery disease who underwent coronary artery bypass grafting

De un centro de trauma a un sistema de trauma en el suroccidente colombiano / From a Trauma Center to a Trauma System in Southwest Colombia

Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma. Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad. Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad. Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad

Introduction. This study aims to evaluate the impact on mortality by admission profile to a trauma center in Southwest Colombia between direct and referred patients, as a method to understand the dynamics of trauma care.Methods. A sub-analysis of the Panamerican Trauma Society registry associated with a trauma center in Southwest Colombia was performed. Patients attended between 2012-2021 were analyzed. Patients with direct admission and referred condition were compared. Analyses of populations of interest such as patients with severe trauma (ISS > 15) and patients with/without brain trauma were made. The impact of referred patients and their admission status on mortality was evaluated. Results. A total of 10,814 patients were included. The proportion of referred patients was 54.7%. Patients admitted referred vs. with direct admission have differences regarding trauma severity and physiological compromise on admission. The referred patient has a higher risk of mortality (RR: 2.81; 95% CI 2.44-3.22). There is a high proportion of penetrating trauma by gunshot wounds. However, it is the physiological state at admission that impacts mortality. Conclusion. Patients referred from other institutions have a higher mortality risk, being a health inequity that invites the articulation of institutional actors in trauma care. A trauma center should relate to partner institutions to create a trauma system that optimizes care and timeliness

Clinical Implications of the "Broken Line" Angiographic Pattern in Patients With Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute myocardial infarction. Coronary angiography remains the best diagnostic tool; however, clinical suspicion and experience is required to interpret angiographic findings. This study sought to assess the clinical implications of the "broken line" (BKL) angiographic pattern in a large, nationwide, cohort of patients with SCAD. The Spanish SCAD registry (NCT03607981) prospectively enrolled consecutive patients with SCAD. All angiograms were centrally analyzed and the BKL pattern was systematically assessed. The BKL angiographic pattern was found in 64 of 389 patients (16%). Patients with the BKL appearance were more frequently female (97 vs 87%, p <0.05), presented more often as intramural hematoma (83 vs 58%, p <0.001), had longer lesions (47 ± 29 vs 36 ± 22 mm, p <0.01), and had severe tortuosity (25 vs 10%, p <0.01) but showed better initial coronary flow (thrombolysis in myocardial infarction flow 2.6 ± 0.8 vs 2.1 ± 1.2, p <0.01). Patients with BKL received more frequently conservative medical management (91 vs 76%, p <0.01). At late clinical follow-up (median 29 months, interquartile range 17 to 38) predefined adverse events (death, myocardial infarction, revascularization, recurrent SCAD, or stroke) occurred less frequently (3.5 vs 15%, p <0.05) in patients with the BKL appearance. The better clinical outcomes of patients in the BKL group persisted after adjusting for potential confounders (adjusted hazard ratio 0.2, 95% confidence interval 0.1 to 0.9, p <0.05). In conclusion, patients with SCAD presenting the BKL angiographic pattern are more frequently female and present more often as intramural hematoma with longer lesions and severe vessel tortuosity but have better coronary flow. Patients with the BKL morphology have a favorable prognosis (NCT03607981).

Factors Associated With Control of Diabetes and Hypertension Among Patients Seen as Part of a Longitudinal Medical School Service-Learning Program From 2018-2019: An Exploratory Analysis.

Introduction The Florida International University (FIU) Green Family Neighborhood Health Education Learning Program (NeighborhoodHELP) in Miami-Dade County serves communities impacted by adverse social determinants of health. This study identified sociodemographic factors affecting control of diabetes and hypertension among NeighborhoodHELP patients. Methods This non-concurrent cohort study evaluated NeighborhoodHELP patients who received care at mobile health centers (MHCs) utilizing de-identified data extracted from the MHCs' clinical quality metrics data set for the 2018-2019 fiscal year. A total of 143 eligible adults with diabetes and 222 adults with hypertension were identified. Condition control was defined as blood pressure ≤ 130 mmHg (systolic) and ≤ 80 mmHg (diastolic) or hemoglobin A1c (HbA1c) ≤ 7% (diabetes). Association with age, gender, ethnicity, marital status, language, service area, income per-capita, and medical student assignment was explored using logistic regression. Results The model showed decreased diabetes control likelihood among Haitian-Creole speakers (OR: 0.13; 95% CI: 0.02-0.75). Odds of diabetes control were greater in two discrete areas serviced by the program, one known as Hippocrates (OR: 4.9; 95% CI: 1.23-19.37) and the other Semmelweis (OR: 3.71; 95% CI: 1.07-12.83). Income greater than $10,000 increased hypertension control likelihood (OR: 2.22; 95% CI: 1.03-4.8). Conclusions Among NeighborhoodHELP patients, geographic region and language impact diabetes control, while income affects hypertension control. Further research is warranted to identify the role of other factors.

Hospital Outcomes Among COVID-19 Hospitalizations With Myocarditis from the California State Inpatient Database.

Many case reports have indicated that myocarditis could be a prognostic factor for predicting morbidity and mortality among patients with COVID-19. In this study, using a large database we examined the association between myocarditis among COVID-19 hospitalizations and in-hospital mortality and other adverse hospital outcomes. The present study was a retrospective analysis of data collected in the California State Inpatient Database during 2020. All hospitalizations for COVID-19 were included in the analysis and grouped into those with and without myocarditis. The outcomes were in-hospital mortality, cardiac arrest, cardiogenic shock, mechanical ventilation, and acute respiratory distress syndrome. Propensity score matching, followed by conditional logistic regression, was performed to find the association between myocarditis and outcomes. Among 164,417 COVID-19 hospitalizations, 578 (0.4%) were with myocarditis. After propensity score matching, the rate of in-hospital mortality was significantly higher among COVID-19 hospitalizations with myocarditis (30.0% vs 17.5%, p <0.001). Survival analysis with log-rank test showed that 30-day survival rates were significantly lower among those with myocarditis (39.5% vs 46.3%, p <0.001). Conditional logistic regression analysis showed that the odds of cardiac arrest (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.16 to 3.14), cardiogenic shock (OR 4.13, 95% CI 2.14 to 7.99), mechanical ventilation (OR 3.30, 95% CI 2.47 to 4.41), and acute respiratory distress syndrome (OR 2.49, 95% CI 1.70 to 3.66) were significantly higher among those with myocarditis. Myocarditis was associated with greater rates of in-hospital mortality and adverse hospital outcomes among patients with COVID-19, and early suspicion is important for prompt diagnosis and management.

The Association Between Electronic Cigarette Use During Pregnancy and Unfavorable Birth Outcomes.

Introduction and objective While the use of electronic cigarettes (e-cigarettes) continues to gain popularity amongst consumers, literature focusing on the safety and risks of e-cigarette usage remains scarce. Literature focused on the potential effects of e-cigarette use on fetal development is particularly limited. The objective of this study is to investigate the association between the use of e-cigarettes during pregnancy and unfavorable birth outcomes. Methods A retrospective cohort using secondary data analysis was conducted from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2017 Phase 8 survey. This database contains both state-specific and population-based information on maternal attitudes and experiences before, during, and shortly after pregnancy. Female participants in the study were initially found through each state's birth certificate file. Eligible women included those who have had a recent live birth. Data collection procedures and instruments were standardized to allow comparisons between states. The independent variable was self-reported use of any e-cigarette products during pregnancy. The dependent variable was dichotomized into the presence of at least one unfavorable birth outcome (preterm birth, low birth weight, or extended postnatal hospital stay for the newborn) or the absence of all. Binary logistic regression analysis was used to calculate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI). Results A total of 71,940 women were included in our study. After adjusting for age, race, ethnicity, insurance, maternal education, prenatal care, physical abuse during pregnancy, and complications during pregnancy, the odds of unfavorable birth outcomes increase by 62% among women who reported e-cigarette use during pregnancy versus women who did not (aOR 1.62, 95%CI 1.16-2.26, p-value 0.005). Conclusions/implications Moving forward, it is imperative for consumers to understand the implications of using e-cigarettes, such as the increased risk of unfavorable birth outcomes associated with use during pregnancy. Moreover, healthcare providers, particularly obstetricians, should be encouraged to communicate this novel information to at-risk patients. Overall, researchers must continue to study the long-term effects of e-cigarettes, including those on fetal development, as there is still much to be uncovered.

Management and Outcomes of ST-Segment Elevation Myocardial Infarction in Hospitalized Frail Patients in the United States.

Cardiovascular diseases and frailty are common conditions of aging populations and often coexist. In this study, we examined the in-hospital management, outcomes, and resource use of frail patients hospitalized for ST-segment elevation myocardial infarction (STEMI). This was a retrospective analysis of the 2005-2014 data from the Nationwide Inpatient Sample. Patients were classified into to versus 'nonfrail' using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. The primary outcome was STEMI management, whereas secondary outcomes were in-hospital mortality, length of stay, and cost. Outcomes were compared between frail and nonfrail patients using propensity score-matched analysis. There were 1,360,597 STEMI hospitalizations, of which 36,316 (2.7%) were frail. Propensity score-matched analysis showed that in in-hospital management options for STEMI, the odds of overall revascularization (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.55 to 0.65), percutaneous coronary intervention (OR, 0.53; 95% CI, 0.49 to 0.57), and coronary angiography (OR, 0.59; 95% CI, 0.55 to 0.64) were significantly lower for frail patients. The odds of receiving coronary artery bypass grafting (OR, 1.66; 95% CI, 1.48 to 1.86) and overall hemodynamic support (OR, 1.26; 95% CI, 1.15 to 1.39) were significantly higher for frail patients. In-hospital mortality (18.7% vs 8.2%, p <0.001), length of stay (7.7 vs 3.7 days, p <0.001) and costs ($90,060 vs $63,507, p <0.001) were significantly higher in frail patients. Our findings suggest that collaborative efforts by cardiologists and cardiovascular surgeons for identifying frailty in patients with STEMI and incorporating frailty in risk estimation measures may improve management strategies, resource use and optimize patient outcomes.

Postoperative outcomes of total knee arthroplasty across varying levels of multimodal pain management protocol adherence.

We examined the effect of varying multimodal pain management (MMPM) combinations on oral morphine milligram equivalents (OMME) and length of stay (LOS) after total knee arthroplasty (TKA). Five groups were compared based on the combination of multimodal analgesics ranging from no MMPM to full MMPM with acetaminophen, gabapentinoids, and celecoxib. After risk adjustment, MMPM was associated with decreased odds of LOS ≥2 days and OMME ≥75th percentile. MMPM protocols are effective at reducing LOS and postoperative narcotic requirements post-TKA. Patients appear to derive similar benefit from receiving all three medications, as well as various combinations of these drugs.

Incidencia, tratamientos y resolución quirúrgica en fístulas por implantes mamarios / Incidence, treatments and surgical resolve for fistula in breast implants

Las fístulas o dehiscencia de heridas asociadas a implantes mamarios representan una complicación relativamente poco frecuente en la práctica diaria. Se asocia a factores locales y representa un riesgo en cuanto a la posibilidad de extrusión y remoción del implante. El tratamiento de esta complicación se realiza esterilizando y provocando una capsulitis química con TCA 90% en la zona del lecho del implante y la confección del Colgajo en Doble Banderín para el cierre cutáneo. De esta forma, ha permitido resolver dicha complicación, al mismo tiempo que refuerza la herida ofreciendo sostén al área de decúbito generada. Desde el punto de vista anatómico se muestran disecciones cadavéricas para evidenciar detalles de la técnica de cierre.

Fistula or dehiscence of wounds associated with breast implants represent a relatively rare complication in daily practice. It is associated with local factors and represents a risk in terms of the possibility of extrusion and removal of the implant. The treatment of this complication is carried out by sterilizing and causing a chemical capsulitis with TCA 90% in the area of the implant and making a Double Flag Flap for cutaneous closure. In this way, it has made to resolve this complication, at the same time that it reinforces the wound by offering support to the decubitus area generated. From the anatomical point of view, cadaveric dissections show details of the closure technique.

Association Between Race/Ethnicity and Survival in Women With Advanced Ovarian Cancer.

Introduction Ovarian cancer is the fifth-leading cause of cancer-related mortality in US women. There are survival disparities between non-Hispanic black (NHB) and non-Hispanic white (NHW) women. We assessed if insurance status or extent of disease modified the effect of race/ethnicity on survival for ovarian cancer. Methods A historical cohort was assembled using the 2007-2015 National Cancer Institute's Surveillance, Epidemiology, and End Result (SEER) dataset. Adult NHB and NHW (>18 years) diagnosed with regional and distant ovarian cancer were included. The outcome was five-year cause-specific mortality. Multivariable Cox regression models were fitted, including race by the extent of disease and race by insurance status interaction terms. Results For each significant interaction, separate Cox models were fitted. In total 8,043 women were included. The insurance status/race interaction was not statistically significant, but the extent of disease modified the effect of race on survival. NHB survival was lower in regional disease (adjusted hazard ratio (HR) =1.6; 95% confidence interval (CI) 1.1-2.4), while there was no difference in survival between women with distant disease (adjusted HR =1.0; 95%CI 0.9-1.2). Conclusions Ovarian cancer mortality is similar between NHB and NHW women with the distant disease but higher in NHB women with regional disease. Further research should clarify whether this difference is due to access to quality cancer treatment or other factors affecting treatment response.

Anti-Inflammatory Drugs in Patients with Ischemic Heart Disease.

Inflammation has long been known to play a role in atherogenesis and plaque complication, as well as in some drugs used in therapy for atherosclerotic disease, such as statins, acetylsalicylic acid, and modulators of the renin-angiotensin system, which also have anti-inflammatory effects. Furthermore, inflammatory biomarkers have been demonstrated to predict the incidence of cardiovascular events. In spite of this, and with the exception of acetylsalicylic acid, non-steroidal anti-inflammatory drugs are unable to decrease the incidence of cardiovascular events and may even be harmful to the cardiovascular system. In recent years, other anti-inflammatory drugs, such as canakinumab and colchicine, have shown an ability to reduce the incidence of cardiovascular events in secondary prevention. Colchicine could be a potential candidate for use in clinical practice given its safety and low price, although the results of temporary studies require confirmation in large randomized clinical trials. In this paper, we discuss the evidence linking inflammation with atherosclerosis and review the results from various clinical trials performed with anti-inflammatory drugs. We also discuss the potential use of these drugs in routine clinical settings.