Clinical Outcomes With Furosemide Versus Torsemide in Patients With Heart Failure: An Updated Systematic Review and Meta-Analysis.

Despite potential advantages of torsemide over furosemide, <10% of the patients with heart failure (HF) are on torsemide in clinical practice. Prior studies comparing furosemide to torsemide in patients with HF have shown conflicting findings, regarding hospitalizations and mortality. We aimed to pool all the studies conducted to date and provide the most updated and comprehensive evidence, regarding the effect of furosemide vs torsemide in reducing mortality and hospitalizations in patients with HF. We conducted a comprehensive literature search of the PubMed/Medline, Cochrane Library and Scopus from inception till June 2023, for randomized and nonrandomized studies comparing furosemide to torsemide in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations and all-cause hospitalizations was extracted, pooled, and analyzed. Forest plots were created based on the random effects model. A total of 17 studies (n = 11,996 patients) were included in our analysis with a median follow-up time of 8 months. Our pooled analysis demonstrated no difference in all-cause mortality between furosemide and torsemide groups in HF patients (OR = 0.98, 95% CI: 0.75-1.29, P = 0.89). However, torsemide was associated with a significantly lesser incidence of HF-related hospitalizations (OR = 0.73, 95% CI: 0.54-0.99, P = 0.04), and all-cause hospitalizations (OR = 0.84, 95% CI: 0.73-0.98, P = 0.03), as compared to furosemide. Torsemide significantly reduces HF-related and all-cause hospitalizations as compared to furosemide, with no difference in mortality. We recommend transitioning from furosemide to torsemide in HF patients who are not attaining symptomatic control.

Cardiovascular Diseases in the Patients With Psoriatic Arthritis.

There are limited data regarding the burden and trend of cardiovascular diseases (CVD) in psoriatic arthritis (PsA). We analyzed the National Inpatient Sample database from January 2005 to December 2018 to examine the hospitalization trends amongst adults with PsA primarily for heart failure (HF), acute myocardial infarction (AMI), and stroke. The primary outcomes of interest included in-hospital mortality, length of stay (LOS), and inflation-adjusted cost. The age-adjusted percentage of HF hospitalizations among PsA patients decreased from 2.5% (2005/06) to 1.4% (2011/12; P-trend 0.013) and subsequently increased to 2.0% (2017/18; P-trend 0.044). The age-adjusted percentage of AMI hospitalizations among PsA patients showed a non-statistically significant decreasing trend from 2.1% (2005/06) to 1.7% (2011/12; P-trend 0.248) and showed a non-statistically significant increase to 2.3% (2017/18; P-trend 0.056). The age-adjusted stroke hospitalizations increased from 1.1% (2005/06) to 1.3% (2017/18; P-trend 0.036). Apart from a decrease in adjusted inflation-adjusted cost among heart failure hospitalizations, there was no significant change in inpatient mortality, length of stay or hospital cost, during the study period. We found an increasing trend of cardiovascular hospitalizations in patients with PsA. These findings will raise awareness and inform further research and clinical practice for PSA patients with CVD.

Digoxin Use in Atrial Fibrillation; Insights From National Ambulatory Medical Care Survey.

The study evaluates the characteristics and trends of digoxin use during outpatient visits with atrial fibrillation in the US from 2006 to 2015.We conducted a retrospective analysis of adult (age >/= 18) patient visits to office-based physicians from National Ambulatory Medical Care Survey (NAMCS) database between 2006-2015. The International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients with Atrial fibrillation. Visits in which digoxin was listed as medication were analyzed with descriptive statistics. Multivariable logistic regression analysis was used to identify the predictors of usage of digoxin. Of a weighted sample of 108,113,894 patient visits, 17,617,853 (16.3%) visits included use of digoxin. Patients who used digoxin had a mean age of 75 ± 0.7 years and were predominantly Caucasian (92.56%). Among the patients who used digoxin, 24% had a diagnosis of heart failure. Multivariate analysis showed that the increased likelihood of digoxin utilization was associated with female sex (adjusted odds ratio (AOR) 1.34, 95% CI 1.05-1.71, p = .019), heart failure (aOR 1.51, 95% CI 1.05-1.17, p = .025), and usage of ³5 medications (aOR 5.32, 95% CI 3.67-7.71, p = <0.001). Among the visits with Atrial fibrillation, the percentage of visits with digoxin usage decreased from 23% in 2006 to 9% in 2013 and then again increased to 14% in 2015(P-trend <0.001). This is the first study to examine the use of digoxin in atrial fibrillation patients in a big outpatient setting. During 2006-2015, the percentage of digoxin prescriptions in atrial fibrillation patients has declined. Predictors of digoxin use in atrial fibrillation patients are female sex, congestive heart failure and higher number of concurrent medications.

Demographics, clinical characteristics, and recurrence rate of patients with primary spontaneous pneumothorax at a tertiary care center in Qatar.

INTRODUCTION: Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation, needle thoracentesis, pleural catheter, video-assisted thoracoscopy (VATS), and open surgery. We aimed to establish the demographic, clinical characteristics, and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation, Qatar. MATERIALS AND METHODS: We conducted a retrospective analysis of patients >14 years old who were admitted with PSP from January 1, 2017 to December 31, 2019. The patients were followed up for 12 months for the recurrence of PSP. RESULTS: Out of 246 patients enrolled in this study, 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/m2. Of these, 123 (51.2%) patients were smokers. Chest pain was the most common presenting complaint (82.5%). A total of 59 (23.98%) patients had a small pneumothorax, whereas 187 (76.01%) patients had a large pneumothorax. Among the patients with small pneumothorax, 16 (28.33%) were managed through observation alone, 2 (3.33%) required needle aspiration, 15 (25%) required pleural catheter insertion, and 26 (44.06%) underwent surgical intervention for management. Out of 187 patients with large pneumothorax, 16 (8.6%) were managed through observation, 7 (3.76%) required needle aspiration, 73 (38.1%) required pleural catheter insertion, and 91 (48.6%) underwent surgery. During the 12-month follow-up, 58 patients were lost to follow-up and 5 patients (5/188; 2.66%) presented with a recurrence of PSP. Out of 108 patients who underwent VATS, 2 (1.85%) had a recurrence of PSP. CONCLUSION: PSP is more common in males than in females, with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore, the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.

Changes in the Tibial Strain After Proximal Fibular Osteotomy: A Biomechanical Cadaveric Study.

Total knee arthroplasty surgery is an increasingly common procedure for the treatment of uni- and tricompartmental knee osteoarthritis, particularly in advanced stages and in the older population. Its usage is being extended to younger patients, where implant longevity is of concern. In the younger age group, especially with early disease, other options merit consideration. On the other hand, it may not be possible for elderly patients with medical comorbidities to undergo joint replacement surgery. Proximal fibular osteotomy (PFO) has recently been advocated to treat medial knee osteoarthritis. Although there have been clinical reports showing promising outcomes, the biomechanical basis of this procedure is still unclear. We performed a cadaveric study to investigate the effect of PFO on proximal tibial strain. Eight unpaired cadaveric lower limb specimens were loaded in compression at 2 times body weight. Strain gauges were mounted on various sites on the proximal tibia and fibula. After PFO, there was a significant increase in the lateral tibial strain adjacent to the proximal tibiofibular joint (P<.05). There was moderate effect size reduction in the anteromedial tibial strain as well as moderate effect size increase in the posterior tibial strain. The strain reduction seen at the anteromedial tibia can offer a possible explanation for symptomatic relief after PFO. However, the increase in the lateral and posterior tibial strain raises concern about long-term accelerated wear in these regions. [Orthopedics. 2022;45(5):314-319.].

Hydatid cyst involving Right Pectoralis Major Muscle: A case report.

BACKGROUND AND AIM: Hydatid disease is caused by Echinococcus granulosus; a tapeworm. They rarely affect the musculoskeletal system of the body (<5% of cases). The objective of this case report is to discuss about hydatid cyst disease involving the right pectoralis major muscle. CASE PRESENTATION: Herein, we report a case of a 35 years old lady who came to the outpatient department with a gradually increasing soft swelling at the right upper chest below the clavicle. The final diagnosis was made with the help of a CT scan. The cyst was excised and the area was washed with a scolicidal agent. There was no recurrence after six months of follow up and the patient was doing well. CONCLUSION: Hydatid cyst of the Pectoralis Major is rare and must be considered in the differential of any muscular swelling in the body in endemic areas. These cysts should be treated with enucleation/excicion followed by irrigation of the area with a scolicidal agent.

Vanek's tumor as an unusual cause of ileo-ileal intessuception - A unique case report.

BACKGROUND AND AIM: Vanek's tumor is a rare solitary lesion that is non-neoplastic, and arises from the submucosa of the gut. The most commonly affected sites are the stomach and the ileum [1]. IFP causing intestinal obstruction is uncommon and that ileo-ileal intussusception has been reported in the literature rarely. We present a case of an ileo-ileal intessuception in a patient who presented with acute on chronic pain abdomen and anorexia. CT abdomen & pelvis revealed a 46 × 36 mm intraluminal mass in the left iliac fossa causing ileo-ileal intussusception. CASE PRESENTATION: A 60 years old gentleman was brought to the A&E with a history of intestinal obstruction. He was examined and admitted to the surgical unit. CBC revealed unique feature of reactive thrombocytosis apart from a low hemoglobin and a raised TLC. His CT scan demonstrated findings of ileo-ileal intussusception. After an informed written consent, patient underwent an exploratory laparotomy and had resection and anastomosis of the bowel. Histopathology of the specimen revealed findings compatible with IFP. Patient made an uneventful recovery post-operatively and was sent home in the next few days. On follow-up, the patient was doing well and had no complaints of abdominal pain or anorexia. CONCLUSION: Vanek's tumor although a rare entity, should be considered in each case of acute abdomen and physicians and surgeons need to have a high degree of suspicion in such cases. Moreover, IFP can cause reactive thrombocytosis that gets resolved after a post-operative period of 6-8 weeks.

Tube thorocostomy: management and outcome in patients with penetrating chest trauma.

BACKGROUND: Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. METHODS: One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. RESULTS: There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lung expansion or pneumothorax was present in three (60%) in group I and 10 (20%) in group II. One patient in group I and three (6%) patients in group II had no response. The mean time to removal of chest drains were 8.2 +/- 3.14 days in group I and 12.6 +/- 4.20 days in group II. The length of hospital stay was 7.2 +/- 2.07 days and 12.4 +/- 3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed in three (6%) patients in group I and 8 (16%) patients in group II. CONCLUSION: Placing chest tubes on continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema.