Gemfibrozil-Induced Polyuria.

Gemfibrozil is a lipid-regulating agent used mainly to treat patients with hypertriglyceridaemia, especially those at risk for acute pancreatitis. Like any other pharmacological agent, gemfibrozil has known adverse effects, mainly gastrointestinal, such as cholelithiasis, gallstones, elevated transaminase, and other non-specific symptoms including dyspepsia, nausea and vomiting. Other reported adverse reactions are dizziness and vertigo, myopathy and rhabdomyolysis, angioedema, urticaria and rash. As far as we knew, gemfibrozil does not have urinary tract adverse reactions. In this report, we present a case of polyuria secondary to gemfibrozil with a score of 9 on the Naranjo scale, and a literature review. LEARNING POINTS: Gemfibrozil has known, mainly gastrointestinal, adverse effects.We aim to increase awareness of the urinary side effects of gemfibrozil so unnecessary investigations can be avoided.

Cardiovascular and Hematological Risk Factors and Mortality Risk in Pediatric Arterial Ischemic Stroke: Analysis Report From Hospitals in the United States.

Objective We aimed to analyze the differences in demographics, comorbidities, and the risk of in-hospital mortality in pediatric arterial ischemic stroke (PAIS) inpatient population by hematological (HEM) and cardiovascular (CV) risk factors. Methods A total of 4,036 inpatients (1-18 years of age) from the Nationwide Inpatient Sample (NIS) with a primary diagnosis of PAIS were included. Descriptive statistics, linear-by-linear association test, and logistic regression models were utilized to analyze differences in demographics, comorbidities, and their impact on mortality in PAIS inpatients by CV and HEM risk factors. Results The cumulative in-hospital mortality rate in the entire PAIS inpatient cohort was 3.6%. The mortality rate was higher in the CV cohort (57.4%) as compared to the HEM cohort (29.7%). When compared with the cohort with no risk factors, HEM and CV were associated with four times (95% CI: 2.36-8.03) and seven (95% CI: 4.03-12.61) times higher odds for in-hospital mortality respectively. CV risk factors like cardiomyopathy and diabetes, and HEM risk factors like blood disorders, coagulation disorders, and deficiency anemias were associated with a significantly increased risk of in-hospital mortality. Conclusion The in-hospital mortality risk in PAIS patients was increased by 613% by CV risk factors and by 336% by HEM risk factors. Early identification and effective management of associated CV and HEM risk factors in the PAIS patient population can pave the way for increased survival and improved clinical outcomes.

Aortic Stenosis Patients With Transcatheter Aortic Valve Replacement: Caution Recommended With Renal Failure During Hospitalization.

Objective Our study aimed to assess the risk of in-patient mortality due to renal failure and other comorbidities in aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a cross-sectional study using a Nationwide Inpatient Sample (NIS, January 2010 to December 2014) from the United States and included 33,325 patients with a primary diagnosis of AS. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in AS by comorbidities including renal failure. Results The prevalence of renal failure in AS patients is 29.2%, and a higher proportion were males (60.1%) and non-white (14.1%). Major loss of function (96.6%) and in-hospital mortality (5.1%) were also proportionally higher in prevalence. Female patients (OR 1.35, 95% CI 1.20-1.51) had higher odds of in-patient mortality in AS patients. Race was a non-significant predictor for mortality risk. Patients with comorbid coagulopathy (OR 2.02, 95% CI 1.79-2.27) and heart failure (OR 1.62, 95% CI 1.39-1.89) have increased mortality in AS inpatients. After controlling confounders, renal failure was significantly associated with increased in-hospital mortality (OR 1.43, 95% CI 1.28-1.61) in AS patients. Conclusion Renal failure was prevalent in AS patients and was an independent factor that increases the risk of in-hospital mortality by 43%. Due to worse outcomes, more studies are required to evaluate risk-benefit ratio and strategies to improve health-related quality of life in post-TAVR patients with renal failure, and optimally decrease inpatient mortality.