Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis.

Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non-ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (aOR 1.11, CI 0.93 to 1.32, p = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, p = 0.22) were similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.

Burden of firearm-related injuries as associated secondary diagnosis in the United States from National Inpatient Sample Dataset.

There is little known about the differences, from the point of view of healthcare resource utilization, between non-fatal versus fatal firearm-related injuries. We undertook this research project utilizing the National Inpatient Sample (NIS) database to address this critical knowledge gap. Our aims for this study were to describe the patterns of FRI in the United States during the period of 2016-2019 and to evaluate the patient-centered outcomes in the survivor (non-fatal injuries) versus the non-survivor (fatal injuries) groups. We used the National Inpatient Sample (NIS) Database, 2016-2019 (5) (~ 20% of United States hospitalizations) to identify patients with an associated diagnosis of firearm-related injuries (FRI) [Gibson T et al (2016) in Agency for Healthcare Research and Quality 2016-02]. We found that the individuals from the lowest quartile of annual household income, males, young Americans, and racial minorities were disproportionally affected The non-survivor (fatal injuries) group had a shorter length of stay in the hospital by 5.1 days (95% CI - 5.64 to - 4.58, p value = < 0.01), the higher median cost of hospitalization by $8903 (95% confidence interval $311.9 to $17,494.2, p value = 0.04), and a higher median cost of hospitalization per day by $41,576.74 (95% confidence interval $ 40,333.1 to $42,820.3, p value = < 0.01). In conclusion, the individuals from the lowest quartile of annual household income, males, young Americans and racial minorities were disproportionally affected. Firearm-related injuries pose a persistent healthcare cost burden with the cumulative and per day cost of hospitalization for fatal injuries being significantly higher than the non-fatal injuries despite a shorter hospital LOS.

Takotsubo syndrome and respiratory diseases: a systematic review.

Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown the association of respiratory diseases with TTS. Here, we comprehensively reviewed the literature and examined the available evidence for this association. After searching PubMed, EMBASE, and Cochrane Library databases, two investigators independently reviewed 3117 studies published through May 2021. Of these studies, 99 met the inclusion criteria (n = 108 patients). In patients with coexisting respiratory disease and TTS, the most common TTS symptom was dyspnoea (70.48%), followed by chest pain (24.76%) and syncope (2.86%). The most common type of TTS was apical, accounting for 81.13% of cases, followed by the midventricular (8.49%), basal (8.49%), and biventricular (1.89%) types. Among the TTS cases, 39.82% were associated with obstructive lung disease and 38.89% were associated with pneumonia. Coronavirus disease 2019 (COVID-19), which has been increasingly reported in patients with TTS, was identified in 29 of 42 (69.05%) patients with pneumonia. The overall mortality rate for patients admitted for respiratory disease complicated by TTS was 12.50%. Obstructive lung disease and pneumonia are the most frequently identified respiratory triggers of TTS. Medications and invasive procedures utilized in managing respiratory diseases may also contribute to the development of TTS. Furthermore, the diagnosis of TTS triggered by these conditions can be challenging due to its atypical presentation. Future prospective studies are needed to establish appropriate guidelines for managing respiratory disease with concurrent TTS.

Impact of malnutrition on in-hospital outcomes in takotsubo cardiomyopathy.

OBJECTIVE: This study assesses the effect of malnutrition on the in-hospital outcomes of patients with takotsubo cardiomyopathy (TCM). METHODS: We performed a retrospective cohort analysis using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for a primary diagnosis of TCM from the National Inpatient Sample database (2016-2018). A concurrent diagnosis of malnutrition was then identified, and these patients were divided into the malnutrition group and non-malnutrition group. To adjust for underlying risk factors, a multivariable logistic regression model was employed followed by a propensity score matching analysis for the malnutrition and the non-malnutrition group. We then compared the in-hospital outcomes between these two groups. RESULTS: Among 4733 patients with a primary diagnosis of TCM, 221 (4.7%) patients with TCM were found to be malnourished. After propensity score matching, patients with TCM with malnutrition were found to have a higher mortality rate (8.3% versus 2.0%, P < 0.001), a higher rate of complications including cardiogenic shock (16.1% versus 7.0%, P < 0.001), ventricular arrhythmia (8.8% versus 3.9%, P = 0.01), acute kidney injury (24.9% versus 10.6%, P < 0.001), and acute respiratory failure (32.7% versus 17.8%, P < 0.001). There was no statistically significant difference in the incidence of cardiac arrest between the two groups. Malnutrition of severe degree was associated with a sevenfold (odds ratio 6.8, 95% confidence interval, 3.2-13.4) increased risk of in-hospital mortality compared with those without malnutrition. CONCLUSION: Patients with malnutrition who were admitted with TCM were associated with higher rates of in-hospital mortality and complications compared with those without malnutrition.

A Rare Cause of Cellulitis: Photobacterium damselae.

Photobacterium damselae, a marine bacterium from Vibrionaceae family, is a well-known primary pathogen for fish, mollusks, crustaceans, etc. Humans may also get infected accidentally during exposure to marine animals or seawater. In addition to economic concern for aquaculture and fish industry, it is also a microbe of concern for human beings, as it has potential to cause lethal infections. Necrotic fasciitis is the most fulminant form.

Testicular Myeloid Sarcoma: A Systematic Review of the Literature.

Myeloid sarcoma usually involves lymph nodes, and head and neck regions. Uncommon sites like testis and ovary are rarely involved and pose a diagnostic challenge. Nonspecific findings, difficulty in retrieving biopsy specimens, and associated infertility are few of the hurdles faced during diagnosis and treatment of testicular myeloid sarcoma. Our review is an attempt to study myeloid sarcoma involving testis.