Formulation, Evaluation and Optimization of Antimicrobial Potential of Herbal Cream Containing Allium sativum, Moringa oleifera Extracts and Thymus vulgaris Oil.

BACKGROUND: Herbal preparations can be formed by combining several plant classes. One possible explanation for the effectiveness of combined medications is that the various mixtures with different mechanisms may add up to produce a more comprehensive therapeutic effect. OBJECTIVE: This study aims to investigate the synergistic antibiotic potential of a cream containing three natural herbal extracts: Allium sativum, Moringa oleifera, and Thymus vulgaris. The efficacy of combining these plant extracts was compared to that of a standard antibiotic formulation (Polyfax). METHODS: The herbal cream was formulated by using aqueous extracts of garlic (Allium sativum), moringa (Moringa oleifera) and essential oil of thyme (Thymus vulgaris). The study aimed to explore the therapeutic potential of these extracts against bacteria. P. aeruginosa, B. subtilis, E. coli, S. aureus, and S. pneumonia are commonly found in fresh wounds. RESULTS: The results showed that garlic extract (5%) had the highest zone of inhibition, 14.26 ± 0.05 mm, and a combination of garlic (5%) and thyme (2%) exhibited a significant synergistic effect, with a 23.5 ± 0.05 mm zone of inhibition. High-performance liquid chromatography analysis revealed the presence of allicin, quercetin and thymol as potential therapeutic phytoconstituents. The formulated herbal cream had a soft texture, was easily spreadable, and had better stability and absorption than the standard polyfax. The topical application of the cream did not cause any skin reaction or allergy in mice. The in vivo wound healing effect of the herbal cream was investigated on an abrasion model of albino mice, and the results showed that the treatment group (46 ± 16.31%) had significant wound healing potential compared to the standard (64 ± 17.49%) and control groups (18 ± 3.74%). CONCLUSION: The formulated herbal cream was a better alternative to standard therapy, exhibiting promising healing and antimicrobial effects with significant compatibility and safety profile.

Remote Monitoring in Heart Failure patients: A Systemic Review and Meta-analysis.

Heart failure (HF) approximately affects about 1%-2% of the adult population in developed countries and is a leading cause of morbidity and mortality worldwide. Inadequate HF management occurs because of poor adherence to prescribed medications. This meta-analysis compares and contrasts standard care with remote medication monitoring in HF patients. Six randomized control trials were selected using the PubMed database from inception until October 25, 2022, incorporating a total of 2390 patients with HF, out of which 1260 were subjected to remote monitoring while the remaining were in the control group. An odds ratio (OR) with a confidence interval (CI) of 95% was calculated. Remote monitoring in HF patients did not significantly reduce the risks of Cardiovascular (CV) hospitalization <6 months (RR = 0.32, P = 0.27), emergency department (ED) visits (RR = 0.95, P = 0.56) and all-cause mortality (RR = 1.08, P = 0.36). However, a significant reduction in CV hospitalization >6 months was associated with remote monitoring (RR = 0.83, P = 0.002). The meta-analysis revealed that remote monitoring does not significantly reduce the risks of CV hospitalizations, ED visits, or mortality in patients with HF. Therefore, standard care methods must continue to be utilized in HF management.

Molecular characterization of recombinant premembrane protein of dengue virus serotype-2 for development of diagnostic assay.

Dengue is an acute arboviral infection common in tropical and subtropical countries. Dengue has been highlighted as a public health concern in the last five decades, affecting almost 50% of the population in developing nations. Dengue infection results in a complex symptomatic disease that ranges from headache, fever, and skin rash to extreme hemorrhage fever and liver dysfunction. The diagnosis of the disease is essential for effective treatment. The early onset of the infection can be detected through viral structural peptides that act as markers for detection, including Pre-Membrane (Pre-M) protein. In the currently proposed research, the structural gene obtained from local isolates was targeted for studies. For this purpose, recombinant structural protein Pre-M was amplified, cloned, and expressed in the bacterial expression system. The expression of the structural protein (Pre-M) was scrutinized by Sodium Dodecyl Sulphate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) and validated by western blot and dot blot, and afterwards, the antigen was purified. The purified Pre-M protein carries the potential for the development of in-house diagnostic assay as well as for vaccine production. This study aimed to develop a highly specific, sensitive, and cost-effective in-house enzyme-linked immunoassay (ELISA) for the detection of antibodies of Pakistani most prevalent dengue virus serotype 2 (DENV-2). The success of this research would also pave the way toward developing novel vaccines for the future prevention of dengue infection.

A highly compact Fabry Perot cavity-based MIMO antenna with decorrelated fields.

This work presents the design of a low profile Fabry-Perot cavity-based multiple-input-multiple-output antenna with low correlation coefficient. The fields of closely placed antenna elements are tilted by using a phase-gradient partially reflective surface (PRS), thereby decreasing the correlation coefficient. The PRS is designed in such a way that its reflection phase is complementary to that of the ground plane. The PRS decorrelates the fields of the two radiating elements when placed at a height of λ/10 above them resulting in a reduction of the correlation coefficient by almost 95% for an isotropic environment. This height is considerably less than λ/4, which has been reported previously.

In-hospital outcomes of TAVR patients with a bundle branch block: Insights from the National Inpatient Sample 2011-2018.

INTRODUCTION: Data on the outcomes following transcatheter aortic valve replacement (TAVR) in patients with a bundle branch block (BBB) remains limited. METHODS: We studied the outcomes of TAVR patients with a BBB from the National Inpatient Sample (NIS) database between 2011 and 2018 using ICD-9-CM and ICD-10-CM codes. RESULTS: Between 2011 and 2018, 194,237 patients underwent TAVR, where 1.7% (n = 3,232) had a right BBB (RBBB) and 13.7% (n = 26,689) had a left BBB (LBBB). Patients with a RBBB and LBBB had a higher rate of new permanent pacemaker (PPM) implantation (31.5% - RBBB, 15.7% LBBB vs. 10.2% - no BBB). RBBB was associated with a significantly longer median length of stay (5 days) and total hospitalization cost ($53,669) compared with LBBB (3 days and $47,552) and no BBB (3 days and $47,171). Trend analysis revealed lower rates of PPM implantation and reduced lengths of stay and costs across all comparison groups. CONCLUSION: In conclusion, patients undergoing TAVR with a BBB are associated with higher new rates of PPM implantation. RBBB is the strongest independent predictor for new PPM implantation following TAVR. Rates of new PPM implantation in TAVR patients with and without a BBB have improved over time including reductions in length of stay and hospital costs. Further study is needed to reduce the risks of PPM implantation in TAVR patients.

Sudden cardiac arrest in patients with chronic obstructive pulmonary disease: trends and outcomes from the national inpatient sample.

BACKGROUND: The outcomes of patients with sudden cardiac arrest (SCA) and chronic obstructive pulmonary disease (COPD) are largely unknown. The purpose of this study was to assess mortality, trends, predictors, and outcomes in patients of SCA and COPD from a large inpatient administrative database. METHODS: Data from the National Inpatient Sample (NIS) was used from January 2002 to December 2014. Patients were identified by applying relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes. Propensity score matching was applied for adjustment of cofounders. Binomial multiple logistic regression analysis was used to assess for predictors of mortality. RESULTS: In total 59,610 were identified with sudden cardiac arrest in which 13,195 (22.1%) patients had COPD. The mean age was 65.6 years. 37.8% were females. In the propensity match cohort, Mortality was 44.4% in patients with SCA without COPD when compared to 47.6% in SCA patients with COPD (p < 0.01). COPD was independently associated with higher mortality (OR, 1.121 [95% CI; 1.070-1.175] p < 0.01). Comorbidities like, diabetes mellitus and liver disease were associated with higher mortality. Female sex, racial and ethnic minorities were independent predictors for higher mortality. CONCLUSIONS: SCA in settings of COPD may have high mortality when compared to patients with SCA and no concomitant COPD. Further research delving into potential mechanisms for SCA in COPD patients is warranted.

Gender, Racial, Ethnic, and Socioeconomic Disparities in Palliative Care Encounters in Ischemic Stroke Admissions.

BACKGROUND: There is a scarcity of data on disparities in palliative care encounters in ischemic stroke patients. We have sought to answer these questions using the national inpatient database (NIS) data between 2002 and 2017. We aim to study gender, racial, regional, and socioeconomic disparities in palliative care encounters in ischemic stroke patients. METHODS: We have analyzed the NIS data from January 2002 to December 2017 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and ICD-10-CM codes. Linear regression was used for trend analysis and multiple logistic regression was used for adjusted analysis. RESULTS: A total of 9,542,169 discharge encounters with a diagnosis of ischemic stroke were recorded from 2002 to 2017. Out of these 412,394 (4.3%) had a palliative care (PC) encounter. The median age for patients with a PC encounter was 81 (Interquartile range [IQR 79-88]). PC encounters have shown a rapid increase over the years (from 0.5% in 2002 to 8.3% in 2017, p < 0.01). Adjusted multivariate analysis showed that African Americans (OR, 0.726 [95%CI, 0.716-0.736], p < 0.01), and Hispanics (OR, 0.738 [95%CI, 0.725-0.751]) were less likely to have a PC encounters. Females (OR, 1.18 7 [95% CI, 1.177-1.197], p < 0.01) were more likely to have PC encounters. Patients with better socio-economic status (OR, 1.034 [95%CI, 1.011-1.034], p < 0.01), having private insurance (OR, 1.562 [95%CI, 1.542-1.583], p < 0.01) and being in urban centers (OR, 1.815 [95%CI, 1.788-1.843], p < 0.01) were more likely to receive a PC encounter. CONCLUSIONS: Significant racial, ethnic and socioeconomic disparities exist in PC encounters in ischemic stroke patients. The underlying reasons for this need to be explored further.

Trends in Location of Death in Patients With Aortic Aneurysm and Dissection.

Aortic dissections and aneurysms (ADA) are associated with significant morbidity and mortality, and location of death for these patients is important in determining impact on end of life care. We analyzed the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. Black and Hispanic backgrounds had decreased odds of dying at home from ADA. Married or educated individuals tended to die at home at a higher rate than unmarried individuals. Overall, we have shown place of death in individuals with ADA is different among individuals of different demographics.

Baseline characteristics and outcomes of end-stage renal disease patients after in-hospital sudden cardiac arrest: a national perspective.

PURPOSE: End-stage renal disease (ESRD) is a well-recognized risk factor for the development of sudden cardiac arrest (SCA). There is limited data on baseline characteristics and outcomes after an in-hospital SCA event in ESRD patients. METHODS: For the purpose of this study, data were obtained from the National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using the International Classification of Disease, 9th Revision, Clinical Modification and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63, and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Baseline characteristics and outcomes were compared among ESRD and non-ESRD patients in crude and propensity score (PS)-matched cohorts. Predictors of mortality in ESRD patients after an in-hospital SCA event were analyzed using a multivariate logistic regression model. RESULTS: A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS-matched cohort (70.4% vs. 70.7%, p = 0.45) with an overall downward trend over our study years. Advanced age, Black race, and key co-morbidities independently predicted increased mortality while prior implantable defibrillator was associated with decreased mortality in ESRD patients after an in-hospital SCA event. CONCLUSIONS: In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients.

Efficacy and safety for the achievement of guideline-recommended lower low-density lipoprotein cholesterol levels: a systematic review and meta-analysis.

AIM: The 2018 American Heart Association/American College of Cardiology/Multi-Society Cholesterol Guidelines recommended the addition of non-statins to statin therapy for high-risk secondary prevention patients above a low-density lipoprotein cholesterol (LDL-C) threshold of ≥70 mg/dL (1.8 mmol/L). We compared effectiveness and safety of treatment to achieve lower (<70) vs. higher (≥70 mg/dL) LDL-C among patients receiving intensive lipid-lowering therapy (statins alone or plus ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors). METHODS AND RESULTS: Eleven randomized controlled trials (130 070 patients), comparing intensive vs. less-intensive lipid-lowering therapy, with follow-up ≥6 months and sample size ≥1000 patients were selected. Meta-analysis was reported as random effects risk ratios (RRs) [95% confidence intervals] and absolute risk differences (ARDs) as incident cases per 1000 person-years. The median LDL-C levels achieved in lower LDL-C vs. higher LDL-C groups were 62 and 103 mg/dL, respectively. At median follow-up of 2 years, the lower LDL-C vs. higher LDL-C group was associated with significant reduction in all-cause mortality [ARD -1.56; RR 0.94 (0.89-1.00)], cardiovascular mortality [ARD -1.49; RR 0.90 (0.81-1.00)], and reduced risk of myocardial infarction, cerebrovascular events, revascularization, and major adverse cardiovascular events (MACE). These benefits were achieved without increasing the risk of incident cancer, diabetes mellitus, or haemorrhagic stroke. All-cause mortality benefit in lower LDL-C group was limited to statin therapy and those with higher baseline LDL-C (≥100 mg/dL). However, the RR reduction in ischaemic and safety endpoints was independent of baseline LDL-C or drug therapy. CONCLUSION: This meta-analysis showed that treatment to achieve LDL-C levels below 70 mg/dL using intensive lipid-lowering therapy can safely reduce the risk of mortality and MACE.

Outcomes of transcatheter aortic valve replacement in patients with and without atrial fibrillation: Insight from national inpatient sample.

BACKGROUND: Atrial fibrillation (AF) is one of the most frequent rhythm disturbance encountered in the population in general. Our study aims to evaluate the in-hospital outcomes of TAVR with AF. METHODS: We used National Inpatient Sample database from 2011 to 2018. Baseline characteristics and in-hospital outcomes were evaluated in TAVR based on AF status or not in both unmatched and propensity-matched cohorts. RESULTS: A total of 215,938 patients underwent TAVR during our study period and out of these AF was encountered in 89,587 (41.5%) patients. AF patients undergoing TAVR had a higher mean age and had an increased burden of key co-morbidities in the unmatched cohort. With propensity matched 1:1 analysis, AF had higher mortality as compared to no-AF group (2.4% vs. 2.1%, p < 0.01). The rate of cardiogenic shock (2.9% vs 2.1%), respiratory complications (9.9% vs 8.2%), acute kidney injury (15.6% vs 12.0%), vascular complications (5.0% vs 4.7%), and blood transfusion (10.4% vs 8.6%) was higher in TAVR patients with AF. A lower proportion of patients had routine discharge to home for TAVR with AF (80.8% vs 74.4%). Cost of hospitalization (23,0171[SD, 20,5242] vs 210,608[28,4203]) and length of stay (5.7[SD, 11.8] vs 4.29[7.2] days) were considerably higher in patients undergoing TAVR with AF. CONCLUSION: Patients undergoing TAVR with concomitant AF tended to have increased mortality, complications, length, and cost of stay compared to non-AF patients.

Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample.

Background Redo mitral valve surgery is required in up to one-third of patients and is associated with significant mortality and morbidity. Valve-in-valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real-world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P<0.01) and acute kidney injury (36.7% versus 13.9%, P<0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P<0.01), length of stay was longer (10 versus 3 days, P<0.01), and discharge to home was lower (20.3% versus 64.6%, P<0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long-term outcomes and durability of ViV TMVR are needed. A patient-centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision-making about the choice of intervention for the individual patient.

Comparison of In-Hospital Outcomes of Transcatheter Mitral Valve Repair in Patients With vs Without Pulmonary Hypertension (From the National Inpatient Sample).

Pulmonary hypertension (PH) is common in patients with left heart disease and is present in varying degrees in patients with severe mitral valve disease. There is paucity of data regarding outcomes following transcatheter mitral valve repair (TMVr) in patients with PH. For this study, we analyzed NIS data from 2014 to 2018 using the ICD-9-CM and 10-CM codes. Baseline characteristics were compared using a Pearson chi-squared test for categorical variables and independent samples t-test for continuous variables. To account for selection bias, a 1:1 propensity match cohort was derived using logistic regression. Trend analysis was- done using linear regression. Of 21,505 encounters, 6780 encounters had PH. 6610 PH encounters were matched with 6610 encounters without PH. In-hospital mortality (3.3% versus 1.9%, p <0.01) was higher in PH population. Complications such as blood transfusion (3.6% versus 1.7%, p <0.01), GI bleed (1.4% versus 1%, p = 0.04), vascular complications (5.3% versus 3.3%, p <0.01), vasopressors use (2.9% versus 1.7%, p <0.01) and pacemaker placement (1.3% versus 0.8%, p = 0.01) remained significantly higher for encounters with PH. Multiple Logistic regression showed PH was associated with higher mortality (adjusted odds ratio [AOR], 1.68 [95% confidence interval [CI], 1.39-2.05], p <0.01). The mean length of stay (6.2 versus 5.3 days, p <0.01) and cost per hospitalization ($53,780 versus $50,801, p <0.01) remained significantly higher in the PH group when compared to group without PH. In conclusion, TMVr in PH as compared to without PH is associated with higher mortality, post-procedure complication rates, length of stay, and cost of stay.

Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study.

BACKGROUND: Outcomes data on the use of cerebral embolic protection devices (CPDs) with transcatheter aortic valve replacement (TAVR) remain limited. Previous randomized trials were underpowered for primary outcomes of stroke prevention and mortality. METHODS: The National Inpatient Sample and Nationwide Readmissions Database were queried from 2017 to 2018 to study utilization and inpatient mortality, neurological complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack), procedural complications, resource utilization, and 30-day readmissions with and without use of CPD. A 1:3 ratio propensity score matched model was created. RESULTS: Among 108,315 weighted encounters, CPD was used in 4380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs. 0.5%, p < 0.01). Neurological complications (2.5% vs. 1.7%, p < 0.01), hemorrhagic stroke (0.2% vs. 0%, p < 0.01) and ischemic stroke (2.2% vs. 1.4%, p < 0.01) were also lower in TAVR with CPD. Multiple logistic regression showed CPD use was associated with lower adjusted mortality (odds ratio (OR], 0.34 [95% confidence interval [CI], 0.22-0.52), p < 0.01) and lower adjusted neurological complications (OR, 0.68 (95% CI, 0.54-0.85], p < 0.01). On adjusted analysis, 30-day all-cause readmissions (Hazard ratio, HR 0.839, [95% CI, 0.773-0.911], p < 0.01) and stroke (HR, 0.727 [95% CI, 0.554-0.955), p = 0.02) were less likely in TAVR with CPD. CONCLUSION: We report real-world data on utilization and in-hospital outcomes of CPD use in TAVR. CPD use is associated with lower inpatient mortality, neurological, and clinical complications as compared to TAVR without CPD.

Contemporary Trends and Outcomes of Prosthetic Valve Infective Endocarditis in the United States: Insights from the Nationwide Inpatient Sample.

BACKGROUND: Prosthetic valve endocarditis (PVE) carries high mortality and morbidity as compared to native valve endocarditis (NVE). Contemporary data on PVE are lacking, we aimed to study contemporary trends, outcomes, and burden of PVE using nationally representative data. METHODS: We used the National Inpatient Sample from 2000 to 2017 to identify patients admitted with PVE using ICD-9-CM and ICD-10 codes. Risk-adjusted rates were calculated using an Analysis of Covariance (ANCOVA) with the Generalized Linear Model (GLM). Trends were assessed with linear regression and Pearson's Chi-square when appropriate. Binomial logistic regression was used to assess predictors of in-hospital mortality. RESULTS: We identified 43,602 hospitalizations for PVE. PVE hospitalizations increased from 1803 in 2000 to 3450 in 2017. Risk-adjusted mortality decreased from 10.7% in 2002 to 7.3% in 2017 (P<0.01). Logistic regression analysis on mortality showed increase association with age (OR, 1.021, 95%CI [1.017-1.024], p<0.01), Hispanics (OR, 1.493, 95%CI [1.296-1.719], p<0.01) and patients with drug abuse (OR, 1.233, 95%CI [1.05-1.449], p=0.01). Co-morbid conditions like congestive heart failure (OR, 1.511, 95%CI [1.366-1.673], p<0.01), renal failure (OR, 1.572, 95%CI [1.427-1.732], p<0.01) and weight loss (OR, 1.425, 95%CI [1.093-1.419], p<0.01) were also associated with higher mortality. CONCLUSIONS: Over the years the adjusted in-hospital mortality in PVE has trended down but the average cost of stay has increased despite decrease in length of stay.

Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017.

OBJECTIVE: To assess trends of stroke hospitalization rates, inpatient mortality, and health care resource use in young (aged ≤44 years), midlife (aged 45-64 years), and older (aged ≥65 years) adults. PATIENTS AND METHODS: We studied the National Inpatient Sample database (January 1, 2002 to December 31, 2017) to analyze stroke-related hospitalizations. We identified data using the International Classification of Diseases, Ninth/Tenth Revision codes. RESULTS: Of 11,381,390 strokes, 79% (n=9,009,007) were ischemic and 21% (n=2,372,383) were hemorrhagic. Chronic diseases were more frequent in older adults; smoking, alcoholism, and migraine were more prevalent in midlife adults; and coagulopathy and intravenous drug abuse were more common in young patients with stroke. The hospitalization rates of stroke per 10,000 increased overall (31.6 to 33.3) in young and midlife adults while decreasing in older adults. Although mortality decreased overall and in all age groups, the decline was slower in young and midlife adults than older adults. The mean length of stay significantly decreased in midlife and older adults and increased in young adults. The inflation-adjusted mean cost of stay increased consistently, with an average annual growth rate of 2.44% in young, 1.72% in midlife, and 1.45% in older adults owing to the higher use of health care resources. These trends were consistent in both ischemic and hemorrhagic stroke. CONCLUSION: Stroke-related hospitalization and health care expenditure are increasing in the United States, particularly among young and midlife adults. A higher cost of stay counterbalances the benefits of reducing stroke and mortality in older patients.

Burden of Infective Endocarditis in Homeless Patients in the United States: A National Perspective.

BACKGROUND: Earlier studies have shown disparate cardiovascular care in homeless patients. Limited data exist on burden of infective endocarditis (IE) in homeless patients and in this study, we aimed to analyze it using a nationally representative United States population sample. METHODS: Data were extracted from National Inpatient Sample database from January 2000 to December 2017. Patients with endocarditis were sampled using International Classification of Diseases, 9th Revision, Clinical Modification codes of 421.0, 421.1 or 421.9 and International Classification of Diseases, 10th Revision, Clinical Modification codes of I33.0 or I33.9. Homeless patients were identified using codes of V60 and Z59. Linear regression was used for trend analysis and logistic regression was utilized to identify predictors of mortality. 1:1 propensity score (PS) matching was also done to balance confounders and outcomes were assessed in both unmatched and matched cohorts. RESULTS: We found an increase in proportion of homeless patients admitted with endocarditis from 0.2% in year 2000 to 2.4% in year 2017. Mortality was not statistically significant in PS matched homeless and non-homeless cohorts (4.7% vs 6.6%, p = 0.072). There was a trend towards increased mortality in homeless endocarditis patients over our study years with lower utilization of valvular surgeries. Advanced age, alcohol abuse and admission to large hospitals were independently associated with mortality in homeless endocarditis patients. CONCLUSION: Homeless patients have rising trend of IE and IE related mortality and also found to have low utilization of life saving valvular surgeries when compared to general population.

In-hospital outcomes of transcatheter mitral valve repair in patients with and without end stage renal disease: A national propensity match study.

OBJECTIVES: To study trends of utilization, outcomes, and cost of care in patients undergoing undergoing transcatheter mitral valve repair (TMVr) with end-stage renal disease (ESRD). BACKGROUND: Renal disease has been known to be a predictor of poor outcome in patients with mitral valve disease. Outcome data for patients with ESRD undergoing TMVr remains limited. Therefore, our study aims to investigate trends of utilization, outcomes, and cost of care among patients with ESRD undergoing TMVr. METHODS: We analyzed NIS data from January 2010 to December 2017 using the ICD-9-CM codes ICD-10-CM to identify patients who underwent TMVr. Baseline characteristics were compared using a Pearson 𝜒2 test for categorical variables and independent samples t-test for continuous variables. Propensity matched analysis was done for adjusted analysis to compare outcomes between TMVr with and without ESRD. Markov chain Monte Carlo was used to account for missing values. RESULTS: A total of 15,260 patients (weighted sample) undergoing TMVr were identified between 2010 and 2017. Of these, 638 patients had ESRD compared to 14,631 patients who did not have ESRD. Adjusted in-hospital mortality was lower in non-ESRD group (3.9 vs. <1.8%). Similarly, ESRD patients were more likely to have non-home discharges (85.6 vs. 74.9%). ESRD patients also had a longer mean length of stay (7.9 vs. 13.5 days) and higher mean cost of stay ($306,300 vs. $271,503). CONCLUSION: ESRD is associated with higher mortality, complications, and resource utilization compared to non-ESRD patients. It is important to include this data in shared decision-making process and patient selection.