RESUMO
Background: Every July, new residents begin training across the United States, but it is unclear whether this affects the mortality rate of critically ill patients such as those with diabetes ketoacidosis (DKA). Methods: This national retrospective cohort study included patients aged 18 years or older admitted to acute care with DKA between 2016 and 2020. Data were obtained from the National Inpatient Sample Database. We compared patients admitted in July and August with those admitted during the remaining months and assessed the primary endpoint of all-cause inpatient mortality. We also obtained an odds ratio adjusted for confounders using multivariate logistic regression analysis. Secondary endpoints included length of hospital stay, total hospital charges, the crude rate of mechanical ventilation, acute kidney injury requiring hemodialysis, and vasopressor requirement. Hypothesis testing was conducted using the chi-square test for categorical variables and Student's t test for continuous variables. A two-tailed P value of < 0.05 was considered statistically significant. Results: Of the 269,095 hospitalizations identified over 5 years with a discharge diagnosis of DKA, 250,990 met the inclusion criteria. During July and August, 42,668 (17%) hospitalizations occurred, and 208,322 (83%) occurred during the remaining months. The mean age of the patients was 47 years, and there was no significant difference among the cohorts (P = 0.41). Female patients represented 54% of the total patients, and there was no difference between the cohorts (P = 0.68). Of the admitted patients, 61% were White, 21% were Black, and 11% were Hispanic, with no differences between the cohorts (P = 0.38). Medicare (35%) and Medicaid (30%) were the primary payers for most patients, and approximately 25% had private insurance. There were no differences between the cohorts in terms of primary payers (P = 0.49). The mean length of stay was 7 days, and the total hospitalization cost was $85,509. Admission in July or August did not increase the odds of inpatient mortality (adjusted odds ratio 0.96, P = 0.58). Conclusions: In this retrospective cohort study of patients admitted with DKA, inpatient care during July and August did not increase the odds of inpatient mortality.
RESUMO
This case report presents a 53-year-old male patient infected with COVID-19 who developed acute respiratory distress syndrome (ARDS) and septic shock due to meningococcemia, despite the absence of clinical signs of meningitis. This patient's condition was complicated by pneumonia in the setting of myocardial failure. In the curse of the disease, it is remarked that the importance of early recognition of sepsis symptoms is crucial in distinguishing patients with COVID-19 from those with other infections and preventing fatal outcomes. The case presented an excellent opportunity to review meningococcal disease's intrinsic and extrinsic risk factors. With the identified risk factors, we propose different measures to be considered to diminish and recognize this fatal disease early.
RESUMO
Background Hypertension is one of the most common conditions affecting almost one in every five adults globally and hypertensive emergency is a life-threatening complication of uncontrolled hypertension leading to significant disability. Despite advances in treatment, gender disparities are yet to be addressed. Methods This retrospective cohort study used nationally representative data from the Healthcare Cost and Utilization Project (HCUP), specifically the National Inpatient Sample, to study two cohorts divided by sex (males and females). The primary outcome was all-cause inpatient mortality. Multivariate logistic regression analysis yielded adjusted odds ratios (aORs) for confounders. Secondary outcomes included length of stay (LOS) and total hospital charges. Multivariate linear regression identified independent predictors. We described crude rates of mechanical ventilation, acute kidney injury (AKI) requiring hemodialysis (HD), and vasopressor requirements. Patient demographics were also presented. We used the chi-squared (χ2) test for categorical variables and Student's t-test for continuous variables. Statistical significance was defined as a two-tailed p-value<0.05. Results A total of 229,025 patients met the inclusion criteria, where 52% were male and 48% were female. The mean patient age was 58 years (55 for men and 62 for women, p <0.001). White patients represented 40% of hospitalizations (males: 37%; females: 42%), black patients represented 42% (males: 43%; females: 41%), and Hispanics 11% (males: 12%; females: 10%). Medicare was the primary payer 47% of the time (males: 38%; females: 56%), Medicaid in 21% (males: 23%; females: 18%), private insurance in 20% (males: 23%; females: 17%), and no insurance in 10% (males: 14%; females: 7%). Female patients had higher rates of chronic obstructive pulmonary disease (COPD) (21% for females vs. 15% for males), connective tissue disease (4.6% for females vs. 0.98% for males; p<0.001), and dementia (6% for females vs. 3% for males). Conversely, males had a higher rate of chronic kidney disease (CKD) (51% vs. 42% for females). Male sex was a predictor of mortality (aOR 1.39, p=0.036), along with age (aOR 1.02, p<0.001) and Charlson Comorbidity Index (http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?printer=Y&conceptID=1098) (aOR 1.20, p<0.001). Sex was not a predictor of length of stay (LOS) (p=0.496) or total hospital charges (p=0.192). Conclusions In an attempt to achieve better outcomes in patients affected by hypertensive emergency, our retrospective cohort study found that male patients who experienced hypertensive emergency had 39% higher odds of mortality than female patients. Age and Charlson Comorbidity Index were additionally found to be independent predictors of mortality.
RESUMO
Here, we present a case of dysphagia with a very unusual etiology. Dysphagia is a symptom of concern and can occur secondary to multiple etiologies. Therefore, prompt and appropriate evaluation is necessary, as treatment varies depending on the underlying cause. Our patient was a 73-year-old female admitted for dysphagia associated with recent significant weight loss and a history of long-term smoking. A CT scan of her neck revealed a mass that was compressing the esophagus, but the etiology of the mass was unexpected. This case highlights the importance of considering rare causes of dysphagia and underscores the need for physicians to be aware of them.
RESUMO
Vitamin B12 deficiency is known to cause a variety of symptoms, including megaloblastic anemia, glossitis, and neuropsychiatric disorders. This case report describes a patient who presented with cognitive decline, psychosis, and seizures due to a severe vitamin B12 deficiency. Following treatment with vitamin supplementation therapy, the patient's condition significantly improved. The literature has also documented similar neuropsychiatric manifestations of vitamin B12 deficiency, highlighting the potential for symptom reversal with prompt and appropriate treatment. Therefore, early diagnosis and treatment of vitamin B12 deficiency are critical to preventing potentially irreversible neurological damage.
RESUMO
Syncope is a common condition affecting many individuals, and it remains uncertain whether admission to academic medical centers (AMCs) leads to better outcomes than non-AMCs. This study is aimed to investigate whether there is a difference in mortality, length of stay (LoS), and total hospital charges between patients admitted with syncope to AMCs and non-AMCs. This retrospective cohort study used the National Inpatient Database (NIS) to examine patients aged 18 years and older admitted with a primary diagnosis of syncope to AMCs and non-AMCs from 2016 to 2020. Univariate and multivariate logistic regression analyses were conducted, adjusting for confounders, to assess the primary outcome of all-cause in-hospital mortality and secondary outcomes, including hospital LoS and total cost of admission. Patient characteristics were also described. Of the 451,820 patients who met the inclusion criteria, 69.6% were admitted to AMCs and 30.4% to non-AMCs. Patient age was similar between the two groups (68 years in AMC versus 70 years in non-AMC; p < 0.001), as was sex distribution (52% female in AMC versus 53% in non-AMC; 48% male in AMC versus 47% in non-AMC; p < 0.002). Most patients in both groups were white, while the percentages of black and Hispanic patients were slightly higher in non-AMCs. The study found no difference in all-cause mortality between patients admitted to AMCs and non-AMCs (p = 0.33). However, LoS was marginally longer in AMC patients (2.6 days in AMC versus 2.4 days in the non-AMC group; p < 0.001), and the total cost was higher for AMCs by $3,526 per admission. The estimated total economic burden related to syncope was over 3 billion USD per year. This study suggests that the teaching status of hospitals did not significantly affect the mortality of patients admitted with syncope. However, it may have contributed to marginally longer hospital LoS and higher total hospital charges.
