New-onset arrhythmia associated with patients hospitalized for thyroid dysfunction.

BACKGROUND: Thyroid dysfunction has been associated with cardiovascular dysfunction in the literature. However, the frequency of new-onset arrhythmias associated with thyroid disease hospitalization is unknown. Hence, we analyzed frequency, in-hospital outcomes, and resource utilization of new-onset arrhythmias associated with thyroid dysfunction hospitalizations. METHODS: The patients who were admitted with the primary reason of thyroid dysfunction were included using appropriate international classification of disease, ninth revision, clinical modification (ICD-9-CM) codes. We then identified new-onset arrhythmias using appropriate ICD-9-CM codes. We utilized the "present on admission" variable to exclude arrhythmias that were present on admission. RESULTS: Among the eligible patients with thyroid dysfunction, only 3% (n=12,111) developed a new-onset arrhythmia. Atrioventricular block (1.49%) is the most frequent followed by atrial fibrillation (0.92%), ventricular tachycardia (0.47%), atrial flutter (0.23%), supraventricular tachycardia (0.1%) and ventricular fibrillation (0.07%). Patients with new-onset arrhythmias were older (mean age 76.7±12.5 years), more predominantly white (n=9008, 74.4%), higher females (n= 7632, 63%), and had a higher frequency of comorbidities. In-hospital mortality occurred in 827 (6.8%) patients with new-onset arrhythmias and 8632 (2.2%) patients without new-onset arrhythmias (P-value <0.001). The medical length of stay and cost of hospitalization was also higher in these patients. CONCLUSION: Thyroid dysfunction is not associated with significantly higher rates of new-onset arrhythmias while inpatient. However, when developed, these arrhythmias are associated with higher mortality and resource utilization. The patients admitted to the hospital should have thyroid function checked when found to have an arrhythmia.

HIV-associated vacuolar myelopathy: A rare initial presentation of HIV.

HIV-associated vacuolar myelopathy, or AIDS-associated myelopathy, is a rare initial presentation of HIV. One of the common HIV-associated neurocognitive disorders, HIV-associated vacuolar myelopathy presents with advanced immunosuppression in patients and is frequently associated with dementia. However, most cases are subclinical with characteristic findings identified through physical examination and/or imaging modalities. HIV-associated vacuolar myelopathy is characterized by progressive spastic paraparesis, gait disturbance and lower extremity sensory abnormalities including vibratory sensation. Magnetic resonance imaging findings in the spinal cord are abnormal in some patients with HIV-associated myelopathy, characteristically showing spinal cord atrophy at the level of the thoracic spine, but they may also be normal. Unfamiliarity with this as initial presentation of HIV infection may lead to failure to diagnose and intervene appropriately. We present a case of newly diagnosed HIV with myelopathy and dementia with minimal spinal cord involvement on magnetic resonance imaging.

Incidence and implications of acute kidney injury in patients hospitalized with acute decompensated heart failure.

Acute kidney injury (AKI) is a common complication in patients hospitalized with heart failure (HF). There is a paucity of research on the incidence and consequences of AKI among patients hospitalized with HF who do not have evidence of chronic kidney disease (CKD). The National Inpatient Sample database was used to identify index hospitalizations for acute HF from January 2012 through September 2015. The incidence of new-onset AKI was determined, and the study population was divided into two groups: HF with AKI (HFwAKI) and HF without AKI (HFwoAKI). These groups were further divided into the subgroups HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A total of 2,010,095 index hospitalizations for HF were identified. The incidence of new-onset AKI was found to be ~ 20% for this population. In a fully adjusted model, in-hospital mortality was higher in the HFwAKI group (adjusted OR 3.63, P ≤ 0.001) and higher among patients with HFrEF (adjusted OR 3.85), as opposed to patients with HFpEF (adjusted OR 3.21). Similarly, length of stay and cost of care for the HFwAKI group were significantly higher as well. New-onset AKI among hospitalizations for HF poses a significant health problem, especially considering the increasing prevalence of HF. Further research into the causes of AKI among HF hospitalizations is, therefore, important as it will enable the development of treatment strategies to prevent AKI in HF hospitalizations and, consequently, benefit both the patients and health care system of the United States.