Does Insurance Effect the Outcome in Patients With Acute Coronary Syndrome?: An Insight from the Most Recent National Inpatient Sample.

Several studies have shown disparities in outcome in the patients with Acute coronary syndrome (ACS) based on several factors. Treatment might differ based on insurance type. Therefore, we retrospectively analyzed National Inpatient Sample (NIS 2016) data to identify the impact of different types of insurances on mortality outcome in patients admitted with ACS. ICD-CM-10 codes were used to identify hospital discharges with a principal diagnosis of ACS. Observations were stratified based on insurance (Medicare, Medicaid, Private, and No insurance). Primary and secondary outcomes were in-hospital mortality, length of stay and total cost. Any potential confounders were adjusted using multivariate logistic regression. STATA/IC 15.1 Stata Corp LLC was used for analysis. A total of 8,01,195 hospitalizations with the primary diagnosis of ACS were identified, of which 59.2% had Medicare, 9.72% had Medicaid, 26.8% had Private insurance, and 4.3% had no insurance. Higher odds of mortality were seen in the patients with Medicare, Medicaid, and Noninsured group. Adjusted Odds ratio for mortality in Medicare was 1.01 (confidence interval [CI]: 0.94-1.1; P = 0.65), in Medicaid was 1.16 (CI: 1.03-1.30; P = 0.01) and in uninsured group was 1.46 (CI: 1.26-1.69; P ≤ 0.01). However, the patients with private insurance adjusted odds ratio for mortality were 0.77 (CI: 0.70-0.84; P ≤ 0.01) compared to the patients with other insurance groups. Above results show that the disparity exists in the outcome of patients admitted with ACS based on their insurance types, particularly for Medicaid patients. We need further studies to understand the root cause of this disparity.

Triad of Diabetic Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis: Severity of Acute Pancreatitis May Correlate with the Level of Hypertriglyceridemia.

A 50-year-old African-American male with no known previous medical comorbidities presented to the emergency room with complaints of three days of worsening epigastric pain associated with nausea and vomiting. Laboratory parameters on admission revealed high lipase: 1796 U/L (normal range 0-160 U/L), high blood glucose level: 300 mg/dl, anion gap metabolic acidosis, ketonuria, significant hyperlipidemia (triglyceride: 1226 mg/dl (normal range <150 mg/dl), and LDL cholesterol: 307 mg/dl (normal range <100 mg/dl)). Treatment with intravascular volume and electrolytes replacement as well as administration of intravenous insulin successfully resolved diabetic ketoacidosis (DKA) and hypertriglyceridemia (HTG) with a drop in triglyceride (TG) level from 1226 mg/dl to 193 mg/dl. Radiologic imaging studies by ultrasonography (USG) and CT of the abdomen showed features suggestive of interstitial pancreatitis. Glycated hemoglobin (HbA1) was 10.7% suggesting uncontrolled diabetes mellitus. Here, we explain the possible pathophysiology and management of this uncommon triad-DKA, hypertriglyceridemia, and acute pancreatitis-followed by discussion and literature review, which highlight the diagnostic challenge and possible relation of the severity of pancreatitis with the degree of hypertriglyceridemia.

Breakdown of the fermi liquid description for strongly interacting fermions.

The nature of the normal state of an ultracold Fermi gas in the BCS-BEC crossover regime is an intriguing and controversial topic. While the many-body ground state remains a condensate of paired fermions, the normal state must evolve from a Fermi liquid to a Bose gas of molecules as a function of the interaction strength. How this occurs is still largely unknown. We explore this question with measurements of the distribution of single-particle energies and momenta in a nearly homogeneous gas above T(c). The data fit well to a function that includes a narrow, positively dispersing peak that corresponds to quasiparticles and an "incoherent background" that can accommodate broad, asymmetric line shapes. We find that the quasiparticle's spectral weight vanishes abruptly as the strength of interactions is modified, which signals the breakdown of a Fermi liquid description. Such a sharp feature is surprising in a crossover.

Measurement of the homogeneous contact of a unitary Fermi gas.

By selectively probing the center of a trapped gas, we measure the local, or homogeneous, contact of a unitary Fermi gas as a function of temperature. Tan's contact, C, is proportional to the derivative of the energy with respect to the interaction strength and is thus an essential thermodynamic quantity for a gas with short-range correlations. Theoretical predictions for the temperature dependence of C differ substantially, especially near the superfluid transition, T(c), where C is predicted to either sharply decrease, sharply increase, or change very little. For T/T(F)>0.4, our measurements of the homogeneous gas contact show a gradual decrease of C with increasing temperature, as predicted by theory. We observe a sharp decrease in C at T/T(F)=0.16, which may be due to the superfluid phase transition. While a sharp decrease in C below T(c) is predicted by some many-body theories, we find that none of the predictions fully account for the data.