Trends of Cardiac Complications in Patients With Rheumatoid Arthritis: Analysis of the United States National Inpatient Sample; 2005-2014.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory condition. Chronic inflammation is associated with atherosclerosis, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease. But sparse data are available regarding the trends of cardiovascular diseases and complications in RA. We conducted a National Inpatient Sample database analysis to demonstrate the trends of cardiac complications in patients with RA. METHODS: We used National Inpatient Sample data from 2005 to 2014 to identify admissions with the diagnosis of RA and identified who had associated cardiovascular complications also. The International Classification of Diseases-9th Revision-Clinical Modification codes were used for the diagnoses of RA; congestive heart failure (CHF), acute myocardial infarction (AMI), and atrial fibrillation (AF). RESULTS: A statistically significant increasing trend of AMI, CHF, and AF was found. Independent predictors of mortality in RA patients with AMI were age (OR 1.03, CI 1.02-1.04; P < 0.001), COPD (OR 1.67, CI 1.40-2.00; P < 0.001), cerebrovascular disease (OR 2.207, CI 1.71-2.86; P < 0.001), renal disease (OR 1.42, CI 1.16-1.75; P = 0.001), and alcohol abuse (OR 2.73, CI 1.73-4.32; P < 0.001). Independent predictors of mortality in RA patients with CHF were age (odds ratio [OR] 1.02, confidence interval [CI] 1.017-1.024; P < 0.001]), COPD (OR 1.09, CI 1.01-1.18; P = 0.023), cerebrovascular disease (OR 1.67, CI 1.44-1.95; P < 0.001), renal disease (OR 1.16, CI 1.07-1.27; P = 0.001). Independent predictors of mortality in RA patients with AF were age (OR 1.02, CI 1.02-1.03; P < 0.001), race (OR 1.16, CI 1.02-1.31; P = 0.022), COPD (OR 1.56, CI 1.42-1.71; P < 0.001), peripheral arterial disease (OR 1.34, CI 1.16-1.53; P < 0.001), cerebrovascular disease (OR 2.27, CI 1.0-2.58; P < 0.001), renal disease (OR 1.60, CI 1.44-1.80; P < 0.001). The mortality trend has increased significantly in the CHF (P = 0.025) and AF (P = 0.042) groups during this study period. CONCLUSIONS: We have found a significant increase in trend of cardiovascular complications in RA patients. The proportion of patients, with cardiovascular comorbidities, have also been increased significantly.

Renal cell carcinoma in ectopic pelvic kidney: A rare case report with relevant surgical anatomy.

Renal Ectopia is a rare developmental anomaly, leading to failure of mature kidney to reach its normal location within the renal fossa. Most ectopic kidneys are asymphtomatic and gets diagnosed as incidental finding on radiography or at surgery. The incidence of RCC in ectopic kidney are very uncommon, presenting with atypical symptoms causes a diagnostic as well as therapeutic dilemma in front of urologists. We present a case of 65 years old gentleman, having complaints of hematuria having heterogeneously enhancing SOL in left pelvic ectopic kidney.

An optimal spatial configuration of sample sites for air pollution monitoring.

A novel sampling design is proposed that optimizes the spatial configuration of sampling sites and captures maximum intraurban variability in ambient air pollution with a minimum sample size. Unlike the classical sampling design, a deterministic approach is adopted and the redundancy in the site selection is minimized by controlling for spatial autocorrelation. The proposed design was tested and implemented in a medium-sized midwestern city. The analysis suggested that 32 sites were adequate to capture more than 95% of the total variance in airborne particulate 10 microm or less in aerodynamic diameter (PM10). A list of 20 households was prepared around each of the 32 sites. Households were approached in order of their distance from these sites until one was recruited for intensive indoor and outdoor air pollution monitoring from spring through fall of 2008. Finally, 30 households located around the optimal sites participated in the study. One set of four photometric and gravimetric samplers was deployed for each indoor and outdoor environment. The average ambient PM10 concentration (monitored from April to September 2008) at the selected locations was lower but statistically insignificant as compared with the PM10 (computed using the data from mobile sampling in 2006) at the optimal sites.