Double Trouble: COVID-19 Infection Exacerbates Sickle Cell Crisis Outcomes in Hospitalized Patients-Insights from National Inpatient Sample 2020.

Background: This study investigated the impact of COVID-19 on patients with sickle cell crisis (SCC) using National Inpatient Sample (NIS) data for the year 2020. Methods: A retrospective cohort analysis was conducted utilizing International Classification of Diseases (ICD-10) codes to identify adults who were admitted with a principal diagnosis of sickle cell crisis. The primary outcomes examined were inpatient mortality, while the secondary outcomes assessed included morbidity, hospital length of stay, and resource utilization. Analyses were conducted with STATA. Multivariate logistic and linear regression analyses were used to adjust for confounding variables. Results: Of 66,415 adult patients with a primary SCC diagnosis, 875 were identified with a secondary diagnosis of COVID-19 infection. Unadjusted mortality rate was higher for SCC patients with COVID-19 (2.28%) compared to those without (0.33%), with an adjusted odds ratio (aOR) of 8.49 (p = 0.001). They also showed increased odds of developing acute respiratory failure (aOR = 2.37, p = 0.003) and acute kidney injury requiring dialysis (aOR = 8.66, p = 0.034). Additionally, these patients had longer hospital stays by an adjusted mean of 3.30 days (p < 0.001) and incurred higher hospitalization charges by an adjusted mean of USD 35,578 (p = 0.005). Conclusions: The SCC patients with COVID-19 presented higher mortality rates, increased morbidity indicators, longer hospital stays, and substantial economic burdens.

Hypertension in Patients With Peripheral Artery Disease: An Updated Literature Review.

Peripheral artery disease (PAD), a condition where there is reduced blood flow due to narrowing or blockage of the arteries of the peripheral vasculature, is an epidemic that currently affects eight million people in the United States alone and is a major risk equivalent to having active coronary artery disease (CAD). However, it is commonly underdiagnosed in the general population. Hypertension is a common cardiovascular condition characterized by elevated blood pressure levels. There are several mitigating risk factors that can reduce the risk of complications of PAD, with hypertension playing a major role. This literature review aims to explore the relationship between hypertension and PAD, including their shared risk factors, pathophysiological mechanisms, and management strategies. In addition, we will analyze how this impacts major cardiovascular outcomes, such as critical limb ischemia, vascular amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular-related death by examining relevant studies, current guidelines, and evidence. This literature review is intended to guide practitioners on ideal blood pressure parameters and evidence-based anti-hypertensives that provide overall cardiovascular benefit in both the primary care and hospital-based setting. By understanding the association between hypertension and PAD and the underlying pathophysiological mechanisms, healthcare professionals can improve diagnosis, treatment, and management strategies for affected individuals.

Independent predictors of mortality and 5-year trends in mortality and resource utilization in hospitalized patients with diffuse large B cell lymphoma.

Background: This retrospective study analyzed factors influencing all-cause inpatient mortality in 80,930 adult patients (2016-2020) with diffuse large B cell lymphoma using the National Inpatient Sample database. Methods: Utilizing ICD-10 codes, patients were identified, and statistical analysis was conducted using STATA. Fisher's exact and Student's t tests compared proportions and variables, multivariate logistic regression examined mortality predictors, and a 5-year longitudinal analysis identified mortality and resource utilization trends. Results: The inpatient mortality rate was found to be 6.56% with a mean age of 67.99 years. Several hospital- and patient-level factors including specific comorbidities such as congestive heart failure, atrial fibrillation, acute kidney injury, chronic obstructive pulmonary disease, liver failure, pancytopenia, tumor lysis syndrome, and severe protein-calorie malnutrition were independently associated with inpatient mortality. Hospitalization costs showed an increasing trend, impacting the overall population and survivors. Conclusion: These insights may refine risk assessment, treatment selection, and interventions.

Aeromonas caviae-Associated Severe Bloody Diarrhea.

Aeromonas species are capable of inducing severe infections in both immunocompetent and immunocompromised individuals. Gastroenteritis is the most common infection associated with Aeromonas species in humans. We report a rare case of Aeromonas caviae severe gastroenteritis and bloody diarrhea that led to the development of sepsis in a 45-year-old female with no history of immunocompromising conditions. This patient required extensive medical support which included blood transfusions and antibiotics. Fortunately, with appropriate diagnostic measures and targeted antibiotic therapy, her symptoms resolved. Aeromonas species are becoming increasingly frequent among the pathogens isolated from patients suffering from gastroenteritis. As such, it is becoming increasingly important for clinicians to consider this pathogen when working up their patients for diarrhea.

Evaluating safe time to discharge after closed reduction and percutaneous pinning of uncomplicated type III supracondylar humerus fractures: a single-center retrospective review.

The purpose of this retrospective study was to review complications following closed reduction, percutaneous pinning of isolated, type III supracondylar fractures without associated injuries to evaluate if patients may be discharged safely on the day of surgery. We performed a retrospective chart and radiographic review of patients with isolated Gartland type III supracondylar humerus fractures who underwent closed reduction and percutaneous pinning over a 4-year period. We reviewed admission time to the emergency department, time and length of surgery, time to discharge, postoperative complications, readmission rate and office visits. Of the 110 patients included, 19 patients were discharged in less than 6 h, 45 patients between 6 and 12 h and 46 patients greater than 12 h. A total of 61 patients were discharged on the same day as surgery and 49 were discharged the next day. There were 11 postoperative complications. No postoperative complications were found in patients discharged less than 6 hours from surgery. For patients discharged between 6 and 12 hours postoperatively, one patient returned to the office earlier than scheduled. The result of our review suggests that patients can be safely discharged within the 12-h postoperative period with no increased risk of complications. This is contingent upon the patient having a stable neurovascular examination, pain control and caregiver's comfort level. This can decrease medical cost, family stress and burden to the hospital system. Time to discharge should still be evaluated on a case-by-case basis after evaluating medical and social barriers.

Observation versus Cast Treatment of Toddler's Fracture: A Prospective Pilot Study.

"Toddler's fractures" are common in the pediatric population. Traditional treatment recommends casting these fractures, although with their inherent stability, may be unnecessary. This study evaluated if toddler's fractures can be treated with observation alone as opposed to casts. A prospective pilot study was performed with randomization and observational arms. Children were placed in short casts or observed without immobilization. A 21-day log was given to families to record walking. Follow up with radiographs occurred at 3 and 12 weeks. Twenty-one patients enrolled, three randomized and 18 chose their treatment. Thirteen patients were casted, and eight went without immobilization. Ambulation time was similar between groups (p = 0.260). Three without immobilization returned early but none converted to cast. All fractures healed uneventfully. There were no cast complications. Toddler's fractures treated with or without cast immobilization appears to be safe and effective but should be a shared decision between physician and parents. (Journal of Surgical Orthopaedic Advances 32(3):207-211, 2023).

Diagnosis of the Primary Tumor Site in the Case of Liver Metastatic Carcinoma.

Immunohistochemical markers have been frequently utilized as a diagnostic tool in pathology to help in diagnosing malignancy of unknown primary sites. In previous cases, the immunohistological expression of cytokeratin 7 (CK7), Napsin A, and thyroid transcription factor-1 (TTF-1) has helped identify and diagnose primary malignancy as originating from the lung. This case report describes an elderly woman with a liver metastasis consistent with a lung primary and illustrates the utility and importance of tissue-specific markers as a diagnostic tool in the evaluation of unknown primary tumors.

Case for Thought: Meckel's Diverticulum in the Adult Population.

Meckel's diverticulum (MD) is a well-known gastrointestinal (GI) congenital anomaly that is generally considered a disorder in neonates or a "clinically silent" disorder in adults. While prevalent in children, MD is not often considered as a differential in the etiology of GI bleeding in the adult population. We describe a case of MD presenting as a copious GI bleed in a 65-year-old male, which was found after numerous diagnostic studies. Our case report aims to challenge the idea that Meckel's diverticulum is solely a neonatal disorder, identify this vitelline duct remnant as a potential cause of GI pathology in the adult population, and discuss the detection and management of this congenital abnormality when found in the older population.

Development of a Global Pediatric Orthopedic Outreach Program in Ecuador Through Project Perfect World: Past, Present, and Future Directions.

Global health delivery is a complex initiative requiring dedicated personnel to achieve a successful program. To be most beneficial, global health delivery should focus on cultural competence, bidirectional education, and capacity building through direct and purposeful means. The authors present the expansion of their global health delivery program in Ecuador focusing on the evolution of the program from a medical mission trip to a multilayered program that helps foster engagement, education, and learning while helping children who might not otherwise have access to care, along with future directions and potential methods to decrease the need for such initiatives in Ecuador.

Age - a significant independent factor of A1C levels. Evidence from the National Health and Nutrition Examination Survey 1999-2014.

AIM: The aim of our study is to examine the association between age and A1C levels in nondiabetic subjects and develop the age-adjusted A1C levels for screening and diagnosis of prediabetes and diabetes. METHODS: Participants from National Health and Nutrition Examination Survey (NHANES) -1999-2014 with age over 12 years were examined. Individuals with previous diagnosed diabetes, baseline anemia, established hemoglobinopathies, known liver or chronic kidney disease, and abnormal liver function tests or creatinine levels were excluded. Total 16949 subjects consisting of 8651 female subjects and 8298 male subjects were included in the analyses. Linear regression and multivariate regression analyses were performed to assess the relationship between A1C levels and age. Age adjusted A1C levels were determined. RESULTS: Significant positive correlation between A1C and age was found in both female and male subjects in the fasting plasma glucose (FPG) interval between 4.4-7mmol/L (80-126mg/dL) (P<0.0001). There was a linear correlation between A1C levels and age. Linear regression analysis suggested A1C levels rose by 0.009% (about 0.09mmol/mol) in female and by 0.008% (about 0.08mmol/mol) in male per year in subjects without abnormality in glucose homeostasis (p<0.0001). CONCLUSIONS: Our study concluded that age is a significant independent factor of A1C levels.

Multi-site reproducibility of a human immunophenotyping assay in whole blood and peripheral blood mononuclear cells preparations using CyTOF technology coupled with Maxpar Pathsetter, an automated data analysis system.

High-dimensional mass cytometry data potentially enable a comprehensive characterization of immune cells. In order to positively affect clinical trials and translational clinical research, this advanced technology needs to demonstrate a high reproducibility of results across multiple sites for both peripheral blood mononuclear cells (PBMC) and whole blood preparations. A dry 30-marker broad immunophenotyping panel and customized automated analysis software were recently engineered and are commercially available as the Fluidigm® Maxpar® Direct™ Immune Profiling Assay™. In this study, seven sites received whole blood and six sites received PBMC samples from single donors over a 2-week interval. Each site labeled replicate samples and acquired data on Helios™ instruments using an assay-specific acquisition template. All acquired sample files were then automatically analyzed by Maxpar Pathsetter™ software. A cleanup step eliminated debris, dead cells, aggregates, and normalization beads. The second step automatically enumerated 37 immune cell populations and performed label intensity assessments on all 30 markers. The inter-site reproducibility of the 37 quantified cell populations had consistent population frequencies, with an average %CV of 14.4% for whole blood and 17.7% for PBMC. The dry reagent coupled with automated data analysis is not only convenient but also provides a high degree of reproducibility within and among multiple test sites resulting in a comprehensive yet practical solution for deep immune phenotyping.

Automated Data Cleanup for Mass Cytometry.

Mass cytometry is an emerging technology capable of 40 or more correlated measurements on a single cell. The complexity and volume of data generated by this platform have accelerated the creation of novel methods for high-dimensional data analysis and visualization. A key step in any high-level data analysis is the removal of unwanted events, a process often referred to as data cleanup. Data cleanup as applied to mass cytometry typically focuses on elimination of dead cells, debris, normalization beads, true aggregates, and coincident ion clouds from raw data. We describe a probability state modeling (PSM) method that automatically identifies and removes these elements, resulting in FCS files that contain mostly live and intact events. This approach not only leverages QC measurements such as DNA, live/dead, and event length but also four additional pulse-processing parameters that are available on Fluidigm Helios™ and CyTOF® (Fluidigm, Markham, Canada) 2 instruments with software versions of 6.3 or higher. These extra Gaussian-derived parameters are valuable for detecting well-formed pulses and eliminating coincident positive ion clouds. The automated nature of this new routine avoids the subjectivity of other gating methods and results in unbiased elimination of unwanted events. © 2019 International Society for Advancement of Cytometry.

Sinoatrial Arrest Caused by Ticagrelor after Angioplasty in a 62-Year-Old Woman with Acute Coronary Syndrome.

The platelet aggregation inhibitor ticagrelor, a P2Y12 receptor antagonist, is widely used after angioplasty in patients with acute coronary syndrome. Clinical trial data have shown that it is well tolerated by most patients. We present the case of a 62-year-old woman whose ticagrelor-related asymptomatic and persistent sinus pauses after angioplasty resolved when ticagrelor was replaced with prasugrel.

A biomimetic approach towards phorone sesterterpenoids.

We report an investigation towards a unified total synthesis of the Korean sponge derived sesterterpenoids, phorones A (1) and B (2), via a biomimetic strategy. This work has established a new synthetic strategy to the parent ansellane sesterterpenoid skeleton with unanticipated diversion to a biogenetically related pathway.

Multivariate analysis of hypertension in general US adults based on the 2017 ACC/AHA guideline: data from the national health and nutrition examination survey 1999 to 2016.

PURPOSE: Since the publication of the 2017 ACC/AHA hypertension guideline, few studies have analyzed the epidemiology and management of hypertension across many heterogeneous subgroups in the US. MATERIALS AND METHODS: We analyzed the data collected by the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. Participants greater than 20 years of age, who had valid blood pressure measurements, were included in the study. A comprehensive analysis of 14 population subgroups was done to systematically examine how hypertension awareness, treatment, and control varied by subpopulations. RESULTS: Our study included 45,557 participants with a mean age of 47.1 years, 48.3% were male and 51.7% were female. 47.8% participants had hypertension, of which 59.9% were aware of their diagnosis. Among the participants who were aware of their hypertension, 90.3% were prescribed medication(s) to lower blood pressure, of which 39.2% had achieved control. Multivariate analysis showed age, gender, Race/ethnicity, annual family income, education level, BMI, waist to height ratio, diabetes, and previous cardiovascular events to be independent risk factors for hypertension. Lower likelihoods of awareness and treatment were associated with male sex, younger age, Mexican ethnicity, participants without health insurance, absence of previous cardiovascular events, diabetes, obesity, or smoking. Overall, hypertension control rate was suboptimal across most of subgroups (<40%). CONCLUSION: Based on the 2017 ACC/AHA guideline, almost half of the US adult population has hypertension. The suboptimal number of people with controlled blood pressure is pervasive in all subgroups and warrants greater efforts in prevention, as well as more effective treatment.

Total hemoglobin count has significant impact on A1C - Data from National Health and Nutrition Examination Survey 1999-2014.

BACKGROUND: Previous study showed A1C was affected by hemoglobin and gender in non-anemic Koreans. However, there was no other data to support those important findings. METHODS: Participants from National Health and Nutrition Examination Survey (NHANES) - 1999 to 2014 with age over 12 years were examined. After excluding participants with hypoglycemia and moderate to severe anemia, 22,974 participants were included in analysis. Both female and male were divided into three groups based on their hemoglobin level. Linear regression and multivariate regression analyses were conducted to assess the relationship between A1C and hemoglobin in three fasting plasma glucose (FPG) intervals. RESULTS: For both female and male, A1C was significantly negatively correlated with hemoglobin in the FPG interval range between 80 to 126mg/dl, p<0.0001. A1C was not significantly associated with hemoglobin over the other two intervals (70≤FPG<80mg/dl and FPG≥126mg/dl, p>0.05). In addition, over FPG interval between 80 to 126mg/dl, after adjusting age and fasting glucose level, A1C still significantly negatively correlated with hemoglobin (regression coefficient=-0.052, p<0.0001 in females, regression coefficient=-0.050, p<0.0001 in males). CONCLUSIONS: A1C would decrease by 0.05% (about 0.5mmol/mol) as a result of each 1g/dl increase in total hemoglobin count when plasma glucose level in normal or prediabetes range. The mechanism behind this finding is unclear. Further study should be conducted and hemoglobin count may need be taken into consideration when applying A1C for the diagnosis of diabetes or to screen for prediabetes.

Association Between Hepatitis B Infection and Pancreatic Cancer: A Population-Based Analysis in the United States.

OBJECTIVES: The aim of this study was to assess the role of hepatitis B (HepB) infection in the causation of pancreatic cancer and the predictors of pancreatic cancer and mortality. METHODS: We identified pancreatic cancer patients 11 to 70 years of age from the 2013-2014 National Inpatient Sample. Pearson χ test and Student's t-test were used for categorical and continuous variables, respectively. We assessed the association of HepB and pancreatic cancer and the independent mortality predictors by multivariate analyses. RESULTS: Of 69,210 pancreatic cancer patients, 175 patients with a history of HepB and 69,035 patients without a history of HepB were identified. Compared with the pancreatic cancer-non-HepB group, the pancreatic cancer-HepB group consisted more of younger (mean, 60.4 [standard deviation, 7.4] years vs 68.2 [standard deviation, 12.1] years), male, black, and Asian patients with low household income and nonelective admissions. The odds of developing pancreatic cancer among the HepB patients were significantly higher (adjusted odds ratio, 1.24; 95% confidence interval, 1.056-1.449; P = 0.008). Black race, age ≥ 65 years, and male sex demonstrated greater odds of mortality. CONCLUSIONS: This study concluded up to a 24% increased likelihood of pancreatic cancer among the HepB patients. Blacks showed greater odds of pancreatic cancer and related mortality.

Effective and efficient characterization of Chinese hamster ovary production cell lines using automated intracellular staining and statistical modeling.

Mammalian cell line development is critical to bioproduct manufacturing. Success requires selecting a line with desirable performance characteristics, including consistent expression throughout the proposed manufacturing window. Given the genetic and phenotypic flux inherent to immortalized lines such as Chinese hamster ovary cells, clonally-derived cell line characterization is vital. We describe here the development and implementation of a novel addition to our characterization approach to ensure production cell line suitability: automated intracellular staining with statistical modeling. Case studies are presented which highlight this method's sensitivity to epigenetic expression effects, closing a gap left by our historically-leveraged genetic suitability characterization. Additionally, we demonstrate how an orthogonal, complimentary assay can help identify opportunities for improvement in even a well-established methodology such as our genetic suitability assessment. © 2018 American Institute of Chemical Engineers Biotechnol. Prog., 34:570-583, 2018.

Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership - the PRioRiTy (Prioritising Recruitment in Randomised Trials) study.

BACKGROUND: Despite the problem of inadequate recruitment to randomised trials, there is little evidence to guide researchers on decisions about how people are effectively recruited to take part in trials. The PRioRiTy study aimed to identify and prioritise important unanswered trial recruitment questions for research. The PRioRiTy study - Priority Setting Partnership (PSP) included members of the public approached to take part in a randomised trial or who have represented participants on randomised trial steering committees, health professionals and research staff with experience of recruiting to randomised trials, people who have designed, conducted, analysed or reported on randomised trials and people with experience of randomised trials methodology. METHODS: This partnership was aided by the James Lind Alliance and involved eight stages: (i) identifying a unique, relevant prioritisation area within trial methodology; (ii) establishing a steering group (iii) identifying and engaging with partners and stakeholders; (iv) formulating an initial list of uncertainties; (v) collating the uncertainties into research questions; (vi) confirming that the questions for research are a current recruitment challenge; (vii) shortlisting questions and (viii) final prioritisation through a face-to-face workshop. RESULTS: A total of 790 survey respondents yielded 1693 open-text answers to 6 questions, from which 1880 potential questions for research were identified. After merging duplicates, the number of questions was reduced to 496. Questions were combined further, and those that were submitted by fewer than 15 people and/or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation resulting in 31 unique questions for research. All 31 questions were confirmed as being unanswered after checking relevant, up-to-date research evidence. The 10 highest priority questions were ranked at a face-to-face workshop. The number 1 ranked question was "How can randomised trials become part of routine care and best utilise current clinical care pathways?" The top 10 research questions can be viewed at www.priorityresearch.ie . CONCLUSION: The prioritised questions call for a collective focus on normalising trials as part of clinical care, enhancing communication, addressing barriers, enablers and motivators around participation and exploring greater public involvement in the research process.

Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview.

A 56-year-old healthy male with no obvious risk factors or significant past medical history was admitted to the emergency room with acute ischemic stroke. On his transthoracic echocardiography (TTE), an extremely large thrombus was detected at the apex involving the distal anterior wall. The thrombus was predominantly adherent but with a mobile tip. The patient was subsequently managed with dual antiplatelet therapy. In this report, we present an interesting case of an acute ischemic stroke secondary to a giant left ventricular thrombus in a patient with no past significant cardiac or neurologic medical history.